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COVID-19 with dengue shock syndrome in a child: coinfection or cross-reactivity?
  1. Lokesh Tiwari,
  2. Shashank Shekhar,
  3. Anmol Bansal and
  4. Pradeep Kumar
  1. Department of Pediatrics, All India Institute of Medical Sciences Patna, Patna, Bihar, India
  1. Correspondence to Dr Lokesh Tiwari; lokeshdoc{at}


COVID-19, caused by SARS-CoV-2, has spread globally. Coinfection with other endemic viruses is likely to complicate the clinical presentation and outcome. Information on clinical manifestations and management strategies on COVID-19 coinfection with endemic diseases in children is yet to evolve. The risk of dengue infection exists in 129 countries and it is endemic in more than 100 countries. The SARS-CoV-2 pandemic might overlap with the dengue epidemics in tropical countries. We report the first paediatric case to the best of our knowledge of COVID-19 encephalitis with dengue shock syndrome. This clinical syndrome could be attributed to serological cross-reactivity, incidental coinfection or perhaps a warning for dengue-endemic regions to face the unique challenge of differentiating and managing two disease entities together. Enhanced understanding of potential COVID-19 and dengue coinfection warrants immediate attention of researchers and international health policy makers.

  • global health
  • influenza
  • tropical medicine (infectious disease)
  • paediatric intensive care
  • coma and raised intracranial pressure

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  • Contributors LT: concept and design, supervised initial draft, review of literature, analysis and final drafting of the manuscript and treatment decisions; SS, AB and PK: involved in patient management, literature search and initial draft writing. All the authors contributed to the final manuscript. The corresponding author had full access to all of the data and the final responsibility to submit for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Ethics approval Ethical clearance and written consent for publishing the case was granted by the institute ethics committee and the patient’s parents, respectively.

  • Provenance and peer review Not commissioned; externally peer reviewed.