Dengue Adds To The Woes Of COVID Pandemic | Ruby General Hospital, Kolkata

Dr. Raktim Guha (Consultant Critical Care - Ruby General Hospital)

A gentleman of over 50 years had been presented in the Emergency Department of Ruby General Hospital with complaints of severe weakness for the last seven days along with fever and was admitted under the expert care of Dr. Raktim Guha (Consultant Critical Care). The gentleman was febrile initially and had dengue fever with uncomplicated course previously. On presentation he had severe body ache and rashes over the anterior part of the body and both upper limbs. Considering the pandemic scenario keeping in mind all the probabilities, a thorough evaluation had been done which revealed dengue fever and SARS-CoV-2 infection. The platelet count had been very low (22,000) with increased haemoglobin and P.C.V., so a close watch was kept on two parameters, hydration which was maintained properly with IV fluids, and coagulation profile as the liver function was deranged, which is very common in repeat dengue infection. The patient had a bleeding tendency as he tested positive for tourniquet test and it was due to dengue together with piles which could be a potential source of bleeding. Thus, it was hard for the treating consultant to decide whether to use heparin or not. It was decided to wait till the platelet count increased and then they started low molecular weight heparin (which is essential in SARS-CoV-2 infection due to increased blood clotting tendency), also keeping an eye on D dimer level along with taking care of stool consistency so that the piles do not bleed. Keeping in mind both the disease condition, the fluid balance was adjusted so that all the organs get perfused adequately and at the same time the lung should not get flooded. The other organ functions were also monitored closely. The patient got stable, oxygen was no longer required, D dimer had also decreased and the liver function was improving slowly.

The key steps were not to get indulged in the wave of SARS-CoV-2 only, but to keep in mind the endemic diseases like malaria or dengue. Secondly, a thorough workup for fever was required. Thirdly, a fine balance in treatment protocol should be maintained.

Location: Kolkata, West Bengal, India

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