JOIN USCovid-19: Centre releases norms to manage co-infections
The Union Health Ministry on Tuesday released a set of guidelines for managing co-infections in Covid-19 patients in an effort to aid the doctors who would be seeing many such cases in post-monsoon India.
The next few months are tough times for the doctors given the seasonal pattern of epidemic-prone diseases like dengue, malaria, seasonal influenza, leptospirosis, chikungunya, enteric fever and scrub typhus that is routinely seen in some parts of the country or the other.
Such diseases pose challenges in clinical and laboratory diagnosis of Covid-19 and have a bearing on clinical management and patient outcomes.
Since the case definition of Covid-19 is not very specific, almost of the above mentioned diseases will appear as febrile illness, with symptoms that mimic Covid-19. As a result, in case of a co-infection, it may lead to difficulty and consequent delay in diagnosis.
“Symptoms do overlap and that’s where clinical experience and training comes in. There are tell-tale signs that doctors would use to identify the disease because a delay in management may be detrimental and that’s where the guideline will help,” Nitin Gupta, assistant professor of infectious diseases at the Kasturba Medical College, Manipal, told DH.
Treating co-infections like dengue in a Covid-19 patient is tricky as some of the treatment options are counter-productive.
For instance, patients with severe Covid-19 are at a risk of clotting for which treatment guidelines recommend low-molecular-weight heparin, a blood-thinning medication. But in dengue cases, use of heparin is a strict no-no as it increases the risk of platelet depletion and bleeding.
“In concomitant cases of dengue and Covid-19, it’s a call that the treating doctor takes on a case-by-case basis. If the platelet count is too low, we don’t give heparin,” Gupta.
Diseases like leptospirosis (caused by rodent urine and seen commonly after flood) and scrub typhus (caused by a mite) too are associated with platelet count drop; but it’s more serious in dengue. Detected in time, both leptospirosis and scrub typhus are curable with antibiotics.
Since Covid-19 and seasonal influenza present as Influenza Like Illness (ILI)/Severe Acute Respiratory Illness, all ILI/SARI cases in areas reporting Covid-19 cases must be evaluated and tested for both Covid-19 and Seasonal Influenza, if both viruses are circulating in population under consideration.
The Health Ministry guidelines recommend use of the anti-viral oseltamivir for patients co-infected with influenza. In case of an outbreak of seasonal influenza, oseltamivir “blanket therapy” should be considered for all patients with Covid-19.