A young nephrologist had to pay with her life after taking anticoagulants in order to prevent excessive clotting, thinking that it was due to COVID-19. She was later diagnosed with dengue, and it is believed that the anticoagulant had rapidly destroyed her already low platelets.
“Such patients have to be monitored closely in a hospital setting by an interdisciplinary team of doctors,” Dr. Manila Gaddh, Associate Professor of Haematology and Medical Oncology, Emory University School of Medicine, Atlanta, said when Dr. S.N.R. Naveen, a pulmonologist, brought the incident to her notice during a webinar on ‘Anticoagulation in acute COVID-10’, organised by Andhra Medical College (AMC) recently.
“It is here that we (doctors) have to use our clinical judgment. Anticoagulants are not without side-effects and they should be used judiciously. In our enthusiasm to correct only the parameters rather than treating the patient holistically, we sometimes end up harming the patient,” Dr. Gaddh said.
Doctors and health workers were busy treating COVID-19 and they had little time to even think of other diseases. A majority of the cases of COVID-19 and dengue are asymptomatic and some patients may be infected by both viruses at the same time. In such cases, one disease might enhance the severity of the other, feel doctors.
“It is difficult to distinguish symptoms and signs in ‘co-infections’ due to the overlapping clinical presentations and laboratory parameters. False positivity is also reported among patients with co-infection, which may create a diagnostic challenge,” says Dr. Naveen, who is also secretary of the Visakhapatnam chapter of Association of Physicians of India (API).
Meanwhile, the State government has launched intensive drives to check the spurt in dengue cases in the urban areas and increase in malaria cases in Visakhapatnam district. The officials have declared every Friday as a ‘dry day’ and citizens have been asked not to allow stagnation of freshwater, which is the breeding ground for the Aedes Aegypti mosquito that causes dengue.
“There is an acute shortage of platelets and patients need to be educated that not all dengue patients need to be given platelets,” says Dr. A. Sugandhi, Medical Director of A.S. Raja Voluntary Blood Bank.
A total of 462 cases of dengue, 708 cases of malaria and 24 cases of chikungunya were reported in the district till September 6 this year. “Though cases begin in July, the peak months are September and October for dengue and for malaria, the peak season begins in April and ends in August. Aedes Aegypti breeds in stagnant freshwater in and around homes, and people should understand this and cooperate with the authorities to prevent the breeding of mosquitoes,” says District Malaria Officer Y. Mani.
