Introduction The spectrum of illness and outcomes of coronavirus disease 2019 (COVID-19) patients may vary. This study reports the characteristics of COVID-19 patients in Bali, Indonesia, and evaluates the diagnostic value of their clinical symptoms. Method This observational study was conducted in eight hospitals. The patients were classified as non-severe COVID-19, severe COVID-19, and non-COVID-19. Demographics, clinical, laboratory, and radiologic characteristics, and outcomes of COVID-19 patients were collected. Factors associated with the severity and outcomes were assessed using the chi-squared test or ANOVA when appropriate. We also compared the clinical features of non-severe COVID-19 and non-COVID-19 patients to evaluate the diagnostic accuracy. Results This study included 92 patients: 41 non-COVID-19 and 51 COVID-19 patients, comprising 45 non-severe and six severe cases. The most common symptoms of COVID-19 were cough (47.1%), fever (31.0%), and dyspnea (25.3%). Cough, fatigue, and anosmia have high accuracy, and combining these complaints in clinical diagnostics offered a higher accuracy in predicting COVID-19 patients (60.1%). We found lower lymphocyte counts and interleukin-1R levels and higher levels of C-reactive protein, interleukin-6, and interleukin-8 in severe compared than in non-severe COVID-19 patients. Lactate dehydrogenase was associated with intensive care unit admission and ventilator use, while other markers such as neutrophil-lymphocyte ratio, C-reactive protein, and interleukin-6 were not. Conclusion A battery of symptoms, including cough, fatigue, and anosmia, is likely associated with COVID-19 in Bali. Clinicians should be aware of these symptoms to ensure a prompt diagnostic test for COVID-19, beyond other causes of acute febrile illnesses.

Introduction Dengue infection poses significant public health problems in tropical and subtropical regions worldwide. The clinical manifestations of dengue vary from asymptomatic to severe dengue manifestations. This serological survey highlighted the high incidence of asymptomatic cases. This study aimed to determine the prevalence of dengue in healthy and ill adults in Bali. Methods Cross-sectional seroprevalence surveys were performed between July 2020 and June 2021 among healthy and ill adults in Denpasar Bali. Blood samples were collected from 539 randomly selected urban sites in Denpasar. Immunoglobulin G antibodies against the dengue virus were detected in serum using a commercial enzyme-linked immunosorbent assay kit. Results Overall, the dengue seroprevalence rate among the 539 clinically healthy and ill adults was high (85.5%). The median age was 34.1 (18–86.1). Most of the participants in the study were younger than 40 years (61.2%). Men were the dominant sex (54.5%). The study found a significant association between dengue seropositivity among people aged > 40 years and healthy status (p = 0.005; odds ratio [OR] = 0.459 and p < 0.001; OR = 0.336, respectively). The study reported that as many as 60% of the subjects had a history of previously suspected dengue infection. This study reflected the proportion of asymptomatic dengue patients requiring better assessment with a serological test. Conclusion The current study highlighted that real cases of dengue infection may be higher than reported, with a high prevalence of dengue seropositivity and a relatively dominant proportion of asymptomatic cases. The study guides physicians to be aware of every dengue infection in tropical countries and prevent the spread of the disease.

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.

Introduction: Dengue infection poses significant public health problems in tropical and subtropical regions all over the world. The clinical manifestation of dengue varies from asymptomatic cases to severe dengue manifestation. The detection of clinical cases enables us to measure the incidence of dengue infection, whereas serological surveys give insights into the prevalence of infection. This study aimed to determine the dengue prevalence among healthy adult patients in Bali. Method: Cross-sectional seroprevalence surveys were performed from July 2020 to June 2021 among healthy and adult patients in Denpasar Bali. Blood samples were collected from 539 randomly selected samples from urban sites in Denpasar. IgG antibodies against DENV were detected in serum using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results: Overall, the positive dengue seroprevalence rate among 539 clinically healthy adult patients was high (85.5%). The subject’s median age was 34.1 (range between 18-86.1) years old. Most participants in the study were younger than 40 years old (61.2%). The gender is dominated by males (54.5%). The study found a significant association of dengue seropositivity among people age more than 40 years old with healthy status ( p= 0.005 and p<0.001, respectively). Another seroprevalence study reported a lower rate of dengue infection in children in Indonesia (69.4%). The difference may be associated with less probability of Aedes bites among the children.  The study reflected the proportion of asymptomatic dengue that needs better assessment with a serological test. Conclusion: The current study highlighted a high prevalence of dengue seropositive with a relatively dominant proportion of asymptomatic cases. The study guides the physicians o to beware of every dengue infection in tropical countries and prevents the spread of the disease.