Challenges of Dengue and Coronavirus Disease 2019 Coinfection

Two Case Reports

Olga Lucia Agudelo Rojas; Maria Elena Tello-Cajiao; Fernando Rosso


J Med Case Reports. 2021;15(439) 

In This Article

Case Report 1

A 24-year-old Hispanic female health worker with no significant medical history presented with symptoms of 6 days duration consisting of fever, odynophagia, adynamia, myalgia, arthralgia, vomiting, and diarrhea. She had no respiratory symptoms. On admission, her vital signs were a blood pressure of 101/62 mmHg, heart rate of 92 beats per minute, respiratory rate of 17 breaths per minute, O2 saturation of 92% (room air), and temperature of 37.4 °C. Physical examination showed dry oral and conjunctival mucosa, with no other findings.

On initial laboratory screening, the patient demonstrated thrombocytopenia (platelets 76 × 103/ml) and leukopenia [white blood cells (WBC) 1560 cells/ml, 57.8% neutrophils, 33.4% lymphocytes] without hemoconcentration. Transaminases [aspartate aminotransferase (AST) 666 IU and alanine aminotransferase (ALT) 516 IU], and D-dimer [0.648 μg/ml (normal value until 0.5 μg/ml)], were elevated, and dengue immunoglobulin M (IgM)/nonstructural protein 1 (NS1) and dengue reverse transcription polymerase chain reaction (RT-PCR) were positive. Because of this, dengue fever with warning signs was diagnosed, and she was admitted to the intensive care unit (ICU) for close monitoring. On the second day of stay, the patient presented a worsening of vomiting, in addition to dysgeusia. Considering her occupational exposure to COVID-19 cases, SARS CoV-2 the real-time RT-PCR (rRT-PCR) was conducted, which was positive. Chest X-ray did not show any abnormalities (Figure 1a). With these findings, coinfection was confirmed. Details of the coinfection clinical description are presented in Table 1. The patient was kept under continuous surveillance in the ICU, as her laboratory test results revealed worsening thrombocytopenia and leukopenia over the days and gradual atypical lymphocytosis (Figure 2). However, she did not exhibit signs of active bleeding. She was discharged after 6 days of hospitalization. She was followed up by telephone, and she reported adequate resolution of her symptoms. The last follow-up was done in July 2020.

Figure 1.

X-ray images of each case

Figure 2.

Behavior of leukocytes and platelets during coinfection