COVID-۱۹ and influenza co-infection with new onset psychotic symptoms in a ۱۶-year-old

مقدمه : In December ۲۰۱۹ in Wuhan, China has been identified unusual group of coronaviruses that induced severe acute respiratory syndrome coronavirus ۲ (SARS-CoV-۲). On March , ۲۰۲۰ World Health Organization (WHO) promulgated the COVID-۱۹ diffuse cases worldwide as a pandemic (۱). Reports showed this disease distributed in ۱۸۸ countries and over ۱۰ million people affected until June, ۲۰۲۰ (۲). According to WHO, more than ۴۶۸ million recognized cases and over ۶ million deaths have been announced universally until ۲۰ March ۲۰۲۲. In Iran, until۱۶ May ۲۰۲۲, there have been announced ۷,۲۲۸,۰۵۱ cases of COVID-۱۹ with ۱۴۱,۲۲۴ deaths (۳). The manifestation of the beta, alpha, omicron and delta variant COVID-۱۹ were conjoined with new ripples of infections, the whole world as well as influenza A(H۳N۲), A(H۱N۱) has seasonal peak during autumn and winter (۴, ۵). Similar to influenza viruses, COVID-۱۹ is predominantly transfer through direct contact or respiratory droplets, also COVID-۱۹ has a resemble disorder disclosure to influenza, induce respiratory diseases that show as a wide-spectrum of disease from mild to severe illness or asymptomatic and, in some patients, death (۶). There are numerous and common clinical presentation of COVID-۱۹ including fever (۸۷.۹%), fatigue (۳۸.۱%), dry cough (۶۷.۷%), sore throat (۱۳.۹%), difficulty breathing (۱۸.۶%). Other manifestation like as loss of smell and taste, hypertension, ventricular arrhythmias, acute coronary syndrome, myocarditis, nausea or vomiting, diarrhea, diabetes, lymphopenia, thrombocytopenia, leukopenia and renal failure (۷). The prevalence of neurological characteristic rank from ۶ to ۳۶% in some of patients (۸). Neurological symptoms occur early in the disease (median ۱–۲ days) with most ordinary neurological property being confusion, headache, seizures, altered mental status, ataxia, and delirium. Other presentations involve meningitis, viral encephalitis, ischemic stroke and Guillain Barre Syndrome (GBS) (۹). Here we present a case of COVID-۱۹ and influenza co-infection with new onset psychotic symptoms in a ۱۶-year-old man.هدف : To investigation Covid-۱۹ and Influenza co-infection and survey psychotic symptoms. معرفی بیمار:The patient was a ۱۶-year-old Iranian boy had the primary symptoms fever, myalgia, sore throat, chills, weakness, dry cough, headache on ۲۲th of December ۲۰۲۱. On the ۵th days of illness consist with worsening psychotic symptoms such as hallucination, agitation, insomnia and delirium, so admitted to an isolation room in the Imam Hossein Hospital on ۲۷th of December ۲۰۲۱. In the past medical history, he had no prior head trauma, substance use and illegal drugs, special disorder or psychiatric disease and use any drugs. In his family history did not have psychotic disorder. His vaccination after birth completed, but he did not get vaccine for COVID-۱۹ and influenza. Initial diagnosis was COVID-۱۹ and influenza. In clinical examination he was ill, axillary temperature ۳۹ Celsius degree, a ۹۵% O۲ saturation in air room, blood pressure ۱۱۵/۷۰ mmHg , pulse ۹۰ beats per minute, respiratory rate ۱۵ per minute and auscultation of heart and lung was normal. In neurological finding he had disorientation episodes, in addition to, had bizarre behavior and hallucination about his surrounding, nevertheless, other examination was normal. After admission, taken laboratory test (Table.۱) and polymerase chain reaction (PCR) nasopharyngeal swab test for COVID-۱۹ and influenza were positive. Computed tomography (CT) of brain, electrocardiogram and chest CT were normal with no pathological finding (Fig۱,۲ respectively). According to the infectious and psychiatric specialists’ prescription and considering COVID-۱۹ and influenza treatment was started. At the emergency department medication prescription including intravenous acetaminophen ۱mg soluble in sodium chloride ۰.۹% serum (۵۰۰ml) with injection of vitamin c (۵۰۰/۵ml) in serum, oral tablet aspirin ۳۲۵mg, oral pearl vitamin D۳ ۱۰۰۰ u, injection ampule haloperidol ۵mg/ml and biperiden ۵mg/ml. Afterwards, starting the treatment the patient's fever was abated on ۶th days and had been psychiatric consultation daily. In addition to, his vital sign was monitored three times a day. In the infectious ward medication prescription contains of oral tablet famotidine ۴۰mg (q۱۲h), oral syrup zinc sulfate ۱۲۰ml (۵cc/ q۸h), oral tablet quetiapine ۲۵mg (q۱۲h), oral tablet risperidone ۲mg daily, oral tablet valproate sodium ۲۰۰mg daily, oral capsule oseltamivir ۷۵mg (q۱۲h) and oral tablet clonazepam ۱mg one hour before sleep. Cardiac monitoring was performed while taking risperidone, and no significant signs were noted like Q-T prolongation. Finally, during ۱۰ days hospitalization patient discharge on ۵th January ۲۰۲۲ with good vital sign and vigilance though, had recommended go to psychiatric patient after ۱۰ days later. After an outpatient visit to a psychiatric clinic, oral tablet sodium valproate (۱۰۰mg) daily and oral tablet clonazepam (۰.۵ mg) daily were continued for ۴۰ days, after this period drugs were discontinued and the patient had no problems.بحث و نتیجه گیری: In summary a ۱۶-year-old boy who was hospitalized with co-infection with COVID-۱۹ and the influenza and developed delirium and hallucination on the fifth day of the illness without a history of previous mental or psychiatric illness and use of illegal medication. Although in this case report the co-infection influenza and COVID-۱۹ with psychotic feature is notable. Dadashi et al. (۲۰۲۱), mentioned that the frequency of co-infection was ۰.۴ percent in the America and ۴.۵ percent in Asia and may dangerously warning for public health (۱۰, ۱۱).Also, Hashemi et al. (۲۰۲۱), found that co-infection influenza and COVID-۱۹ ۲۲.۳ percent in northeastern of Iran (۱۲). According to Sarvodaya et al. (۲۰۲۱), over a during of six months after COVID-۱۹ diagnosis, ۱.۴۰% of people diagnosed with psychotic disorder and ۱۷.۴% of with anxiety disorder (۱۰). Alosaim et al. (۲۰۲۱), suggested that some risk factors due to co-infection COVID-۱۹ and influenza involving older age, hypertension, diabetes, cardiovascular disease and kidney disorder (۱۳). As well as, Kacper et al. (۲۰۲۱), announcement first psychotic event in COVID-۱۹ patients were ۰.۴۲% and cytokine storm including IL-۶, IL-۱ and TNF-alpha might be damage central nervous systems (۱۱). Mark et al. (۲۰۱۳), mentioned influenza disease can be a trigger for psychiatric symptoms. However, the mechanism of suddenly happens psychosis during influenza not recognized, but some patients suffer from insomnia, anxiety, psychosis, depression, suicidal thoughts and neuralgia (۱۲). Interestingly, Adrianna et al. (۲۰۲۱), clarified the connection among influenza disease and psychosis. They supposed that activation of cytokine networks and microglial are potentially harmful for central nervous system and cause trigger of schizophrenia and psychosis (۱۳). Also, Al-Busaidi et al. (۲۰۲۱), mentioned a patient had psychosis symptoms after infected with COVID-۱۹. Some viruses like HIV, Brucella, Toxoplasma gondii, Chlamydia trachomatis and SARS-CoV-۲ are neurotropic and cause of mental and psychiatric disorder due to dysfunction of cytokines systems and impairment blood-brain barrier (۱۴). Teimouri-Jervekani et al. (۲۰۲۱), implied that bizarre behavior presentation of COVID-۱۹ arise from invasion to the brain cause of encephalopathy and hyperinflammation (۱۵). Nevertheless, Oseltamivir is a drug for treatment influenza but on the other hand Rabih et al. (۲۰۱۹), mentioned this drug can be induced neuropsychiatric events among the patients with aged ten to nineteen years old after ۲۴ hours of started, but our patient had psychotic symptoms before administration this drug(۱۶-۱۸)

کلیدواژه ها:

Influenza ، Human ، Coronavirus ، Psychotic Disorders ، Hallucinations