Title : Case Report: COVID-19 pneumonia and Dengue Fever co-infection in an individual from Southeast Asia
Abstract:
COVID-19 infection is caused by the novel coronavirus, SARS-Co-V2 which was initially reported in Wuhan, China and declared a pandemic by the World Health Organization in 2020. Dengue fever is caused by the dengue virus from the Flaviviridae family and is transmitted via the bite of female Aedes Aegypti mosquito. COVID-19 pneumonia and dengue fever co-infection is a relatively difficult diagnosis to be established considering the similarities in the clinical manifestation of both diseases. This is a report on the co-infection in a tertiary hospital setting from a dengue endemic area in Southeast Asia.
A 62-year-old gentleman presented to the Emergency Department with fever for 6 days associated with chills, rigors, arthralgia, myalgia and a generalized pinpoint rash over chest and abdomen. He mentioned that he works in a café and that he might have had contact with one of the workers who was recently tested positive for COVID-19. Otherwise, he denies overseas travel and participation in mass gatherings. Vital signs were stable and peripheral capillary oxygen saturation (SPO2) of 99% under room air was recorded.
His full blood count revealed polycythemia with hemoglobin of 18.3 g/dl, increased hematocrit level of 0.54 L/L with
concomitant decrease in platelet count of 111 x 109/L. Both total white blood cell and lymphocyte counts were normal. However, the liver function test showed evidence of acute liver injury with increased total bilirubin level of 19 µmol/L, elevated transaminases with alanine transaminase (ALT) level of 110 U/L, aspartate transaminase (AST) level of 77 U/L and increased gamma-glutamyl transferase (GGT) level of 138 U/L. His coagulation profile, electrolytes and renal profile were normal. Viral screen for Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV) were negative. Posterior-anterior chest radiograph of the patient with ground glass opacity in both middle and lower zones of the lungs which is mostly peripheral with preservation of lung markings.
The diagnosis was confirmed by positive SARS-CoV-2 polymerase chain reaction (PCR) test with cycle threshold value of 19.97 and positive immunoglobulin M, immunoglobulin G titers on the Dengue Serology panel on the same day of testing. Predisposing risk factors were chronic medical illnesses (type 2 diabetes mellitus, hypertension and ischemic heart disease) and exposure to probable COVID-19 infected individual. The patient fully recovered after treatment with oral paracetamol 1 gram four times a day for five days and intravenous drip of 0.9% sodium chloride for 24 hours.
