1 in 25 children with COVID-19 has dengue, says study

A dengue coinfection is present for every 25 SARS-CoV-2 infections, a recent study involving Filipino children has found.

“Continued surveillance is needed to establish the interaction of SARS-CoV-2 and dengue virus, evaluate the impact of COVID-19 and/or dengue vaccination on coinfection, and monitor complications of coinfection,” the researchers said.

Overall, 3,341 SARS-CoV-2 infections in children had been documented, of which 145 (4.34 percent) had dengue coinfection. Of those with coinfections, 120 were matched to patients with monoinfection according to age, gender, and timing of infection. [Pediatr Infec Dis J 2023;42:787-791]

Many patients with coinfection had mild or moderate COVID-19, while those with monoinfection were more likely to be asymptomatic. The rates of severe and critical COVID-19 were similar between the two groups. Notably, coinfections typically presented with dengue symptoms rather than COVID-19 symptoms and laboratory parameters.

Common symptoms

“In our study, fever was the most common symptom for both the coinfection and monoinfection groups, although it presents more commonly in children with coinfection than in those with monoinfection,” the researchers said.

“Abdominal pain, vomiting, and bleeding, which are dengue warning signs, are significantly more common in the coinfection group,” they added.

Physicians should be suspicious of a coinfection with dengue if a child initially diagnosed with COVID-19 presented with fever and dengue warning signs. On the other hand, those with monoinfection were more likely to have cough, rhinorrhoea, and dypnoea, according to the researchers.

“These symptoms are also frequently reported as the most common symptoms of COVID-19 in children worldwide and in a local study based on the same paediatric COVID-19 registry used in this study,” they said. [J Med Virol 2021;93:1057-1069; EClinicalMedicine 2020;24:100433; PIDSP J 2022;23:31-42]

In terms of laboratory parameters, children with coinfection showed higher haematocrit, lower leukocyte count, and lower platelet count, suggesting the normal pathology seen in a dengue infection. Patients with coinfection also had significantly higher procalcitonin, ferritin, and lactate dehydrogenase. Such biomarkers significantly correlated with COVID-19 in children. [Arch Dis Child 2021;106:440-448]

Moreover, ferritin predicted a severe dengue infection, with high sensitivity on days 5‒7 of illness. [Southeast Asian J Trop Med Public Health 2008;39:832-836]

“Elevated levels of these biomarkers may suggest the presence of coinfection, although they are nonspecific and do not point to any particular aetiology,” the researchers said.

Fatality rate

No between-group differences were also observed in outcomes. In addition, the case fatality rates for coinfection and monoinfection were 6.7 percent and 5.0 percent, respectively.

“With COVID-19 predicted to become endemic, coinfections with other pathogens such as the endemic dengue virus will be frequently detected and will add to the infectious disease burden of the country,” the researchers said.

“Clinical symptomatology and specific laboratory parameters can guide clinicians treating children to diagnose a dengue and SARS-CoV-2 coinfection,” they said.

This retrospective matched cohort study included paediatric patients aged 0‒18 years diagnosed with SARS-CoV-2 and dengue coinfection or SARS-CoV-2 monoinfection in the Philippines. These cases had been reported to the Surveillance and Analysis of COVID-19 in Children Nationwide registry from 1 March 2020 to 30 June 2022.