An MCD worker fumigates the Laxmi Nagar Market area as a preventive measure against the spread of dengue, malaria and chikungunya, in New Delhi, India, on Wednesday, September 23, 2020.(Raj K Raj/HT PHOTO)
An MCD worker fumigates the Laxmi Nagar Market area as a preventive measure against the spread of dengue, malaria and chikungunya, in New Delhi, India, on Wednesday, September 23, 2020.(Raj K Raj/HT PHOTO)

Rise in Covid, dengue co-infections a concern

With cases of dengue and Covid-19 both on the rise, doctors at the All India Institute of Medical Sciences (AIIMS) in Delhi say they have recorded at least 20 cases of co-infection of the two diseases — a situation that presents a problem for diagnosis and treatment.
Hindustan Times, New Delhi | By Anonna Dutt
UPDATED ON OCT 08, 2020 11:21 AM IST

With cases of dengue and Covid-19 both on the rise, doctors at the All India Institute of Medical Sciences (AIIMS) in Delhi say they have recorded at least 20 cases of co-infection of the two diseases — a situation that presents a problem for diagnosis and treatment.

With fever and cough the predominant symptoms for both diseases, diagnosing both infections has become a challenge, doctors from the hospital said on Wednesday at the National Grand Rounds, which virtually connects physicians from across the country to discuss Covid-19 management.

It also presents a challenge in treatment — Covid-19 patients are often given anti-coagulants to prevent clotting, but the medicine increases the risk of bleeding, which can lead to a shock in dengue patients with low platelet counts.

Delhi has reported 266 cases of dengue till October 3, according to data shared by the city’s municipal corporations. Of these, 188 cases were reported in September alone.

Meanwhile, the Capital added 2,871 cases of Covid-19 on Wednesday, which took the city’s tally to 298,107.

“Cases of vector-borne diseases like dengue go up after the monsoon, and we are seeing many cases of Covd-19 with dengue. Co-infection with both the viruses becomes challenging to manage — in one disease we have to give anti-coagulants, because the body is in a hypercoagulable state (tendency of clot formation); and in the other you are worried about the fall in the platelets and shock syndrome that might happen. What is important is that if there is an atypical presentation of Covid-19, the clinicians should have a high degree of suspicion for other infections,” said Dr Randeep Guleria, director, AIIMS.

Of the 20 cases, nine were reported by the department of medicine from the main AIIMS campus, and the other were from their campus in Jhajjar. The analysis of the data of the first 4,200 Covid-19 patients from Jhajjar showed that the most common infection along with Covid-19 was tuberculosis, followed by HIV, and Hepatitis.

Data presented by Dr Pawan Tiwari, assistant professor of pulmonary medicine at AIIMS, showed that of the 4,200 patients with Covid-19, 32 had active tuberculosis (TB) and 35 had latent TB. There were 27 cases of HIV, 12 cases of Hepatitis B, and 11 cases of dengue.

“From what we have seen over the years, about 25% of dengue patients come in with some upper respiratory symptoms. On the other hand, Covid-19 does not predominantly present as a respiratory infection when the patients first come in. This complicates diagnosis. Another challenge is that if a person who tests positive for Covid-19 is put in home isolation, early diagnosis of dengue might be missed,” said Dr Tiwari.

Of the nine patients who came in with both the infections at the main campus, only three had moderate to severe dengue, and all but one had mild Covid-19. All of the patients recovered and were discharged, said Dr Ved Prakash Meena, assistant professor of the department of medicine.

At the Grand Rounds, Meena presented the case of a 22-year-old patient from Uttar Pradesh who tested positive for Covid-19 but not dengue initially. He was later diagnosed with the infection when his platelet count started dropping.

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