Highlights We reported dengue and COVID-19 co-infection for the first time in Indonesia. We revealed possible cross-reactivity between SARS-CoV-2 and DENV antibodies based on rapid serological tests. Cross-reactivity of SARS-CoV-2 and DENV will be a significant hurdle to have a simple point-of-care test for COVID-19 in dengue-endemic countries.

Background: Coronavirus disease-2019 (COVID-19) is a novel coronavirus type infection disease that was first reported at Wuhan city, Hubei province, China in December 2019. Cases of COVID-19 in Indonesia were increasing, reaching up to 287,008 confirmed cases on 30th September 2020. Sanjiwani general hospital Gianyar, Bali, one of the COVID-19 referral hospital at Gianyar, Bali, has treated as many as 149 confirmed COVID-19 cases from August to October 2020. The most significant laboratory parameter associated with COVID-19 severity was C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR).Methods: This study is a descriptive cross-sectional study. Data were gathered through secondary data from the medical records using the total sampling method. Descriptive analyses were performed to describe the samples characteristics and to calculate the mean CRP level. Meanwhile, the chi-square test was done to investigate the association between CRP level and the severity level of COVID-19. The result is considered statistically significant if the p value is <0.05Results: Most of the samples are >60 years old (24.4%), female (56.6%), and have diabetes mellitus as their comorbid (46,7%). The mean CRP level is 8.9 mg/L. CRP level >8.9 mg/l significantly affects COVID-19 patients’ severity with the p value of 0.000 (p<0.005). The higher the initial CRP level of COVID-19 patients, the higher the severity level will be.Conclusions: There is an association between the increased CRP level at the beginning of hospital admission and the severity of COVID-19 patients.

Background Biomarkers that are cost-effective and accurate for predicting severe coronavirus disease 2019 (COVID-19) are urgently needed. We would like to assess the role of various inflammatory biomarkers on admission as disease severity predictors and determine the optimal cut-off of the neutrophile-to-lymphocyte ratio (NLR) for predicting severe COVID-19. Methods We conducted a cross-sectional study in six hospitals in Bali and recruited real-time PCR-confirmed COVID-19 patients aged &gt;18 y from June to August 2020. Data collection included each patient's demographic, clinical, disease severity and hematological data. Multivariate and receiver operating characteristic curve analyses were performed. Results A total of 95 Indonesian COVID-19 patients were included. The highest NLR among severe patients was 11.5±6.2, followed by the non-severe group at 3.3±2.8. The lowest NLR was found in the asymptomatic group (1.9±1.1). The CD4+ and CD8+ values were lowest in the critical and severe disease groups. The area under the curve of NLR was 0.959. Therefore, the optimal NLR cut-off value for predicting severe COVID-19 was ≥3.55, with sensitivity at 90.9% and a specificity of 16.7%. Conclusions Lower CD4+ and CD8+ and higher NLR values on admission are reliable predictors of severe COVID-19 among Indonesian people. NLR cut-off ≥3.55 is the optimal value for predicting severe COVID-19.

The treatment of corona virus disease 2019 (COVID-19)remains in debate, and the use of chloroquine has not been validated by accurate clinical trials.The aim of this study was to provide the possible cardiotoxicity effect of chloroquine in patients with COVID-19. This study was a case-series of prolonged QT interval of COVID-19 patients treated with chloroquine in a hospital in Bali, Indonesia. There were two cases of COVID-19 with exhibited a prolonged QT interval after being administrated of chloroquine. The prolonged QT interval returned to normal after chloroquine was stopped.These cases alert us the cardiotoxicity effect of chloroquine and the need for serial electro-cardiography monitoring before and during therapy. In conclusion, although antiviral and anti-inflammation properties of chloroquine on COVID-19 are promising, its cardiotoxicity effects should be monitored closely for less harm to the patients.

Tuberculosis remains a global issue throughout the world. Indonesia currently ranks 4th worldwide. Although rarely reported, TB could be one of the etiologies of Acute Respiratory Distress Syndrome. A 27-year-old woman was admitted with shortness of breath 12 days post partum with cough, loss of appetite and malaise. Chest examination revealed increased fremitus on both lungs and rhonchi on 2/3 lower part of the lung. There was edema on both of the leg. Radiologic finding suggested reticulogranuler pattern on both lungs. Laboratory showed granulocytosis, anemia and hypoalbumin with severe hypoxemia and PaO2/FIO2 ratio of 107. Transthoracic Echocardiography showed PCWP of 12,25 mmHg. Patient was diagnosed with moderate Acute Respiratory Distress Syndrome but there was no improvement after definitive antibiotic therapy. Based on clinical judgment, patients suspected of having tuberculosis and given anti tuberculosis drugs with a regimen of rifampicin, isoniazid, ethambutol, pyrazinamide, and streptomycin along with methylprednisolone and supportive therapy. Microscopic examination of acid-fast bacilli sputum shows positive result one day after the treatment started. Patient was showing significant improvement and declare cured after completed 6 month of therapy. Conclusions: Although the incidence is rare, tuberculosis can act as the primary cause of ARDS. Early diagnosis of tuberculosis is the key point of this case. Initial therapy along with good supportive therapy should be given to ARDS patient while the underlying cause is treated.