SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

Schulte, Heidi Luise; Brito-Sousa, José Diego; Lacerda, Marcus Vinicius Guimarães; Naves, Luciana Ansaneli; de Gois, Eliana Teles; Fernandes, Mariana Sirimarco; Lima, Valéria Paes; Rassi, Carlos Henrique Reis Esselin; de Siracusa, Clara Correia; Sasaki, Lizandra Moura Paravidine; Cerqueira, Selma Regina Penha Silva; de Albuquerque, Cleandro Pires; Reis, Ana Paula Monteiro Gomides; Gomes, Ciro Martins; Kurizky, Patricia Shu; da Mota, Licia Maria Henrique; Espindola, Laila Salmen

BACKGROUND: Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. METHODS: Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. RESULTS: Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. CONCLUSIONS: The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.