Govt issues SOPs to fight co-infections

NEW DELHI: With co-infection cases increasingly being reported by doctors, the Union health ministry has issued guidelines for the management of co-infection of the coronavirus disease (Covid-19) with other seasonal epidemic-prone diseases such as dengue, malaria, seasonal influenza (H1N1), etc.

“Given the seasonal pattern of epidemic-prone diseases observed every year in our country, diseases like dengue, malaria, seasonal influenza, leptospirosis, chikungunya, enteric fever, etc. cannot only present a diagnostic dilemma but may co-exist in Covid-19 cases. This poses challenges in the clinical and laboratory diagnosis of Covid-19, and may have a bearing on clinical management and patient outcomes,” a health ministry statement read. The document is based on the standards set by international health agencies such as the WHO, patients could present symptoms mimicking Covid-19 making the diagnosis difficult.

Diagnosis of co-infection

A high index of suspicion must be maintained for these epidemic-prone diseases prevalent in a particular geographic region during and after monsoon. Bacterial co-infections must also be suspected in moderate or severe cases of Covid-19 not responding to treatment.

Malaria/Dengue

Confirmation of malaria or dengue infection does not rule out the possibility of the patient not suffering from Covid-19.

Similarly, a high index of suspicion of malaria or dengue must be there when a fever is diagnosed as a symptom of Covid-19, particularly during the rainy and post-rainy season.

Seasonal influenza

Both Covid-19 and seasonal influenza present symptoms influenza like illness ((ILI/SARI), hence all ILI and SARI cases in areas reporting Covid-19 cases must be evaluated and tested for both Covid-19 and seasonal influenza.

Chikungunya

Chikungunya manifests itself with an acute onset of moderate to high-grade continuous fever and malaise followed by rash, myalgia (muscle pain) and arthralgia (joint pain). Respiratory failure may ensue in late stages. Co-infection with Covid-19 may be suspected in chikungunya-endemic areas during monsoon.

Bacterial infections

Few Covid patients experience a secondary bacterial infection.

In such cases, empiric antibiotic therapy needs to be considered. “Despite the possibility of above mentioned co-infections, in present times, the approach to diagnosis for Covid-19 remains the same. Testing protocol as per the ministry of health and ICMR guidelines will be followed. ,” the guidelines read.