COVID-19 and Other Seasonal Co-Infections

Introductions:

COVID-19 and its variants have affected almost all countries in the world. With the symptoms of COVID-19 not being very specific and the prevalence of other seasonal infections every year, it is becoming a challenge to diagnose patients who present with influenza-like illnesses (ILI). Diseases like malaria, dengue, seasonal flu, chikungunya, leptospirosis, etc., can mimic COVID-19 or may coexist in patients affected by the coronavirus. This makes clinical and laboratory diagnosis of COVID-19 challenging and also affects the management and outcomes. This article will provide information on the signs and symptoms of various seasonal co-infections and ways to differentiate them from COVID-19.

Symptoms of COVID-19:

COVID-19 patients may present with:

• High fever.

• Cough.

• Tiredness.

The other symptoms include:

• Difficulty breathing (dyspnea).

• Chills.

• Sore throat.

• Runny nose.

• Body pain and muscle aches.

• Headache.

• Chest pain.

• Pink eye (conjunctivitis).

• Nausea.

• Vomiting.

• Diarrhea.

• Loss of taste and smell.

The symptoms are not very specific, and various other seasonal infections can mimic COVID-19. If a COVID-19 patient is co-infected with any other disease, he or she will still exhibit the same symptoms, which may lead to difficulty in diagnosis. Knowledge about the onset of disease, symptoms, complications, and warning signs can help differentiate COVID-19 from these infections.

What Are the Possible Seasonal Co-Infections?

The following co-infections should be suspected in moderate to severe COVID-19 cases if they are not responding to treatment:

1) Malaria - It is a life-threatening viral infection transmitted through the bite of an infected Anopheles mosquito. These mosquitoes carry the Plasmodium parasite. This parasite gets released into the bloodstream when they bite. Once inside the body, these parasites reach the liver and mature. The mature parasites enter the bloodstream again and infect red blood cells. In two to three days, the parasites inside the red blood cells multiply and destroy the cell. The parasites continuously infect other red blood cells and cause symptoms. It is common in tropical and subtropical climates.

Symptoms:

The symptoms develop within 10 to 14 days of the mosquito bite. The symptoms include -

• Chills and tremors.

• High fever.

• Headache.

• Vomiting and nausea.

• Profuse sweating.

• Stomach pain.

• Diarrhea.

• Anemia.

• Muscular pain.

• Convulsions.

• Bloody stools.

• Coma.

The warning signs of malaria include high-grade intermittent fever, tiredness, vomiting, and low urine output.

Complications:

• Altered sensorium - Alteration in the mental status.
• Acidosis hypoglycemia - Inborn errors of carbohydrate metabolism leading to fasting hypoglycemia.
• ARDS (acute respiratory distress syndrome) - Lung injury allowing fluid to leak into the lungs.

2) Dengue - It is also a mosquito-borne viral infection, commonly seen in tropical and subtropical areas of the world. These viruses are spread to humans through the bites of infected Aedes species mosquitoes. Dengue fever is common in Southeast Asia.

Symptoms:

Usually, children and teens might not experience any symptoms during mild dengue fever. In case symptoms occur, they begin four to seven days after getting bitten by the infected mosquito. The signs and symptoms are -

• High fever of 104 °F.

• Bone, muscle, and joint pain.

• Headache.

• Nausea and vomiting.

• Swollen lymph nodes.

• Skin rashes.

• Pain behind the eyes.

Sometimes, the blood vessels get damaged, and the platelet numbers fall, resulting in hemorrhage and is called dengue hemorrhagic fever or dengue shock syndrome or severe dengue. The warning symptoms include -

• Severe stomach pain.

• Severe vomiting.

• Nosebleeds and bleeding from gums.

• Blood in vomit, stools, and urine.

• Bruising.

• Rapid breathing.

Complications:

• Hypotensive shock - Condition that occurs due to sudden loss of fluids or blood from the body.
• Bleeding - Loss of blood either inside or outside the body.
• Metabolic derangement - It is a cluster of conditions that increase the risk of diabetes, heart disease, and stroke.

3) Chikungunya - Chikungunya is also a viral infection transmitted by the same mosquitoes that transmit the dengue virus, Aedes aegypti, and albopictus. They usually bite during the day and also at night. This infection should be suspected during monsoon in places where chikungunya endemics are common.

Symptoms:

The following symptoms of chikungunya generally begin in three to seven days after getting bitten by an infected mosquito -

• Fever as high as 104 °F.

• Joint and muscle pain.

• Headaches.

• Skin rashes.

• Joint swelling.

• Nausea and vomiting.

• Conjunctivitis (rarely).

The warning signs of chikungunya are high fever with increasing joint and muscle pain.

Complications:

• Cardiovascular decompensation - Inability to accommodate blood within the normal physiological pressure levels.
• Myocarditis - The middle layer of the heart wall becomes inflamed.
• Renal failure - Failure of one or both kidneys.
• Hemorrhage.
• Meningoencephalitis - Due to the infection, inflammation of the brain occurs.

4) Seasonal Influenza - Infection with the influenza virus, most commonly with types A and B, results in seasonal influenza or the flu. The transmission occurs through infected droplets spread and touching infected surfaces, similar to COVID-19. As both COVID-19 and seasonal influenza are Influenza-like Illness (ILI), patients with these symptoms should be evaluated for COVID-19 and seasonal influenza.

Symptoms:

The onset of symptoms takes one to four days. The infected person exhibits -

• Fever.

• Cough.

• Runny nose.

• Sore throat.

• Body pain.

• Tiredness.

• Headaches.

Complications:

• ARDS (acute respiratory distress syndrome).
• Myositis - Inflammation in muscles.
• Rhabdomyolysis - Direct or indirect muscle injury.
• Acute MI (myocardial infarction).
• Myocarditis.

5) Leptospirosis - It is a rare bacterial infection caused by the bacteria Leptospira. It is transmitted to humans when skin wounds are exposed to water or soil contaminated with infected animals' urine. It is commonly seen in tropical and subtropical countries and in both urban and rural settings, mostly during or after the monsoon.

Symptoms:

The following symptoms might take 2 to 26 days to be apparent -

• High fever.

• Chills or rigors.

• Muscle pain.

• Headaches.

• Yellowish skin and sclera.

• Red eyes.

• Stomach pain.

• Diarrhea.

• Skin rashes.

Complications:

• Acute respiratory distress syndrome (ARDS).
• Uveitis - Inflammation of the eye.
• Optic neuritis - Inflammation of the optic nerve.
• Peripheral neuropathy - Damage to the nerves, especially the hands and feet.
• Myocarditis.
• Rhabdomyolysis.

6) Scrub or Bush Typhus - It is a disease caused by the bacteria Orientia tsutsugamushi. The bacteria spread to humans through bites of infected larval mites (chiggers). This bacterial infection is prevalent in Southeast Asia, China, Indonesia, Japan, India, and northern Australia.

Symptoms:

People infected with this bacteria might show the following symptoms, approximately 10 days of being bitten -

• High fever.

• Chills.

• Muscle and body pain.

• Eschar - A dark lesion at the site of the bite.

• Confusion.

• Coma.

• Enlarged lymph nodes.

• Skin rashes.

If left untreated, organ failure and internal bleeding can result in death.

7) Bacterial Co-Infections - Apart from these infections, patients with COVID-19 pneumonia can experience any secondary bacterial infection. So it is essential to test and treat all possible infections along with COVID-19 to improve the prognosis.

8) Enteric Fever- (Also known as typhoid or paratyphoid fever). It is caused by infection due to bacteria, namely Salmonella typhi, and Salmonella paratyphi. The infections are transmitted through contaminated food and water.

Symptoms:

• Fever that starts low, increases daily, and reaches as high as 104.9 F.
• Fatigue and weakness.
• Headache.
• Weight loss and loss of appetite.
• Dry cough.
• Sweating.
• Rashes.
• Stomach ache and swollen belly.
• Constipation or diarrhea.

Complications:

• The patient may become delirious (disturbed state of mind).
• Typhoid state- The patient lies motionless and exhausted with the eyes half-closed.
• Life-threatening condition.

How to Differentiate COVID-19 From These Infections?

As the symptoms of the commonly occurring seasonal infections are so similar, the only certain way to differentiate them is by testing. The following signs might help differentiate the conditions to an extent.

What Are the Preventive Strategies for COVID-19 and Other Seasonal Co-infections?

Even though the preventive strategies of seasonal co-infections and COVID-19 are different, there is a synergy in the prevention of these diseases. Basic preventive measures for COVID-19 like getting vaccinated, maintaining physical distance, avoiding large gatherings, cough etiquette, and hand hygiene must be ensured at all times.

Vector control is needed to reduce mosquito breeding sites. The use of approved insect repellents is effective against vector-borne diseases, including scrub typhus. The preventive measure against leptospirosis includes wearing protective clothing for people at occupational risk, such as rice-paddy, sanitation workers, sugarcane workers, etc., and avoiding swimming in contaminated water. High-risk groups and all health care workers should be vaccinated for seasonal influenza. In addition, community support and awareness on COVID-19 and other seasonal diseases must be ensured.

Conclusion:

One or more infections can coexist in moderate to severely ill COVID-19 patients, which makes it crucial to differentiate and diagnose these conditions to prevent complications, including death. So, proper and reliable testing is needed.

For more information, consult a doctor online at iCliniq.com.