Clinical data from a unique case of SARS-CoV-2 and Dengue virus coinfection with heterozygous Beta Thalassemia
We report a 30-year-old man with hemoglobinopathies coinfected with SARS-CoV2 and Dengue virus from Bangladesh. Dengue virus was detected by ELISA. Covid-19 was confirmed by RT-PCR and Hemoglobin Electrophoresis revealed heterozygous beta-thalassemia. The patient was treated successfully at Dhaka Hospital in icddr,b during Covid-19 emergency response with symptomatic supportive treatment for Covid-19 and appropriate fluid therapy for dengue fever in response to daily hematocrit level. After 21 day, the patient’s RT-PCR for Covid-19 became negative. For thalassemia, the patient was advised to have genetic counseling and family screening on discharge. The data complies here were gathered from the patient management record file. The possibility of coinfection should be considered during the Dengue fever epidemic along with the confirmatory tests for Covid-19, when any alarming signs supporting possibility of dengue fever are found in an individual. Fluid therapy for dengue fever must be maintained with utmost care to avoid adverse effect from Covid-19-Dengue coinfection and careful monitoring of oxygen saturation during the sick period of this type of case should be performed with importance.
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Investigations: Before admission, the patient was tested positive for Covid-19 by RT-PCR. Upon admission to chest X-ray, Covid-19 radiological pneumonia was suggested by ill-defined ground-glass opacification (GGO) in the lower left and right lung areas (Figure 1). According to the X-ray score system for Covid-19 patients, suggested by Wong et al., the score was 1 (extent of involvement <25%) for each lung with a global score of 2. Considering the suspicious symptoms of vomiting with fresh blood and several days of high fever, the blood specimen for detecting Dengue virus was sent as the patient was presented during the year when Dengue fever is endemic here in Bangladesh. Detection of Dengue virus: The patient’s serum was tested by ELISA (InBios International, Inc., Seattle, USA) at icddr,b diagnostic laboratory according to the manufacturer's instructions for anti-dengue IgM and IgG. There were > 40 IgM antibodies in the sample and considered positive for recent dengue virus infection, whereas IgG was not. Detection of Hemoglobinopathies: Hemogram on admission showed no features of thrombocytopenia (platelet was 170,000/µL). All blood cell counts ranged within the reference values for adult male but red cell indices found abnormal pictures suggesting a further investigation of hemoglobin electrophoresis (Table 1). Electrophoresis of hemoglobin identified heterozygotic Beta-thalassemia variant of hemoglobinopathy (Figure 2). Later, B25 MY mutation was detected for this patient. Serum electrolytes and creatinine tested on admission revealed normal value, however, one inflammation marker, C-reactive protein (CRP) was 10.12 mg/dL. Blood for culture and sensitivity (CS) revealed no organism in aerobic and microaerophilic conditions at 35⁰C in 72 hours. Markers of coagulation were within normal limits for our case including D-Dimer, Fibrinogen, and Prothrombin time (Table 1). Other laboratory investigation's results can be found in Table 1.