key: cord-0907257-xt50zbi5
authors: Villamil-Gómez, Wilmer E.; Rojas-Torres, Indiana; Perea-Vásquez, Luis Enrique; Collazos-Torres, Luis Adolfo; Murillo-Moreno, Mauricio Andres; Morales-Rudas, Juan David; Pagani, Nina; Rodriguez-Morales, Alfonso J.; Paniz-Mondolfi., Alberto E.
title: SARS-CoV-2 and Dengue virus co-infection: a case from North Caribbean Colombia
date: 2021-06-03
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2021.102096
sha: 0dd2593676c706eac03ca8b81e56cf714284e7fb
doc_id: 907257
cord_uid: xt50zbi5

nan

Since its beginning, the evolving SARS-CoV-2/COVID-19 pandemic has shaded many other ongoing epidemics worldwide. Such is the case of many arboviruses, like Dengue virus (DENV). This has generated concern amongst travel medicine practitioners and public health authorities particularly after the pandemic started to hit and spread across DENV endemic regions worldwide. Now, concurrent overlapping infections have increasingly been reported from Brazil, Ecuador, Colombia and Peru [1, 2] . Furthermore, occurrence of co-infections in Mayotte, Argentina and other places [3, 4] have been reported, including many of them in returning travelers. Herein, we report a case of COVID-19 and Dengue co-infection in Colombia and discuss the potential clinical and epidemiological challenges of current syndemics.

A 52-year-old male, bus driver from Barranquilla, with no significant past-medical history (and no past history of dengue) presented on July 21 st , 2020, with flu-like symptoms and worsening fever, chills and pruritus. On admission, his temperature was 41.0°C accompanied by increasing arthralgia, myalgia, dorso-lumbar pain, asthenia and adynamia. He also referred dyspnea and dry cough days prior to admission. Physical examination revealed blood pressure of 110/70 mmHg, a heart rate of 100 beats/minute, respiratory frequency of 40 breaths/minute, and oxygen saturation of 90-92% -ambient air-, his BMI was 31.7 kg/m 2 (weight 95 kg, height 1.73 m). Pulmonary auscultation revealed bibasilar crackles extending to both mid pulmonary fields. Examination of the skin revealed a roseoliform maculopapular rash located to trunk and limbs, which rapidly evolved into a scarlatiniform-like rash. Lesions later progressed and coalesced to form rounded areas spared by unaffected skin (commonly referred to as "white islands in a red sea" in context DENV infection) ( Figure 1 ). There was neither mucosal nor hand and feet involvement. Initial pruritus quickly ceased.

During the hospital course, laboratory findings revealed leukocytosis 4,000 cells/mL (normal range 4,500-11,000 cells/mL), with 35% neutrophils, 18% lymphocytes, and a 120,000 cells/mL platelet count. Inflammatory markers included a C-reactive protein of 7 mg/l, LDH 700 IU/l, and ferritin 650 mcg/mL. The D-dimer was elevated 5175 ng/mL (with no clinical or pulmonary imaging signs of thromboembolism), with a troponin 0.8 ng/mL. AST and ALT were 55 IU/l and 40 IU/l respectively. Other laboratory findings, including arterial blood gases, are presented in the Table 1 [4] . Such findings may be explained in part by the opposed pro and anticoagulant states J o u r n a l P r e -p r o o f triggered by SARS-CoV-2 and DENV respectively, as well as to other potential causes such as viral interference [5] . Moreover, computational docking studies have shown that human DENV antibodies can bind to the receptor-binding (RBD) domain of SARS-CoV-2 spike protein conferring some degree of protection leading to reduced disease severity [6] . In addition, experimental evidence suggesting that blockage of AT1 and inhibition of ACE receptor may lead to decreased DENV cell internalization [4] [5] [6] provides further insights on how interaction between these two viruses may modulate disease outcome. Further studies aimed to provide a better understanding on how viral interaction and pathogenic mechanisms amongst these viruses modulate disease are urgently needed to better define disease prognosis in DENV and other arboviral endemic areas.

Finally, from a laboratory perspective, serological cross-reactivity has become an everincreasing challenge in DENV endemic regions, leading to a potential number of falsepositives [6] . This clearly underscores the need for implementing a more comprehensive testing strategy inclusive of other circulating and endemic viruses in order to better guide patient care as well as prevention and control measures.

Funding: This research received no external funding. 

Dengue and COVID-19, overlapping epidemics? An analysis from Colombia

Simultaneous occurrence of COVID-19 and dengue: what do the data show?

COVID-19 and dengue co-infection in a returning traveller

Characteristics of Patients Coinfected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus

Viral Interference Between Dengue Virus and Hepatitis C Virus Infections

Computational modelling supports that dengue virus envelope antibodies can bind to SARS-CoV-2 receptor binding sites: Is pre-exposure to dengue virus protective against COVID-19 severity?

Informed Consent Statement: Written consent inform was obtained from the patient.

All authors report no potential conflicts.

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