Varicella and Dengue Co-Infection in a Child

A report describes a case of a five-year-old girl who presented with complaints of fever, rashes, and cold for the past week. She experienced continuous fever every day of the week. Her rashes began appearing from the day of the onset of fever, which first appeared on the trunk, later spread to extremities, and was papule-vesicular in nature.

Examination revealed the patient to be febrile (104°F), Respiratory rate of 32/min, Pulse 140/min, BP = 100/50 mm of Hg, CFT < 3 seconds, and oxygen saturation of 100% at room air. She displayed bilateral conjunctival congestion and non-erythematous black-crusted lesions all over the body. 

A respiratory examination revealed bilateral crepitations. Other systemic examinations were unremarkable. Her lab counts at admission were Hb = 10.8 g/dL, TLC = 8280/mm3, platelets = 2.3 lakh/mm3, PCV = 34, AST = 135 U/L, ALT = 79 U/L, and normal kidney functions. 

Chest x-ray revealed bilateral pneumonia, and peripheral smear for malarial parasite and the Widal test showed negative results. Her blood culture was sterile, and she was positive for dengue NS antigen by ELISA. 

The patient thus received moxclav injections and intra-venous Ringers lactate fluids according to the WHO protocol. She still experienced high spikes of fever for two days, along with a decreased platelet count to 31000/mm3; an increased PCV and hemoglobin to 37 and 12.4 gm/dL, respectively, on the third day of admission. She continued to show a decreased trend in platelets for another three days (24000/mm3, 29000/mm3, and 48000/mm3, respectively), which started increasing to reach 1.36 lakhs/mm3 on the sixth day. She received five days of moxclav injections and then a discharge.

Jagadishkumar K, Nataraj N, Dasappa U R. Varicella and Dengue Co-Infection in a Child: Case Report. J Compr Ped.11(1):e91300. doi: 10.5812/compreped.91300.