Dengue serology in Indonesian COVID-19 patients: Coinfection or serological overlap?

Abstract

Dengue fever is an extremely common infection in Indonesia, with an estimated 77.96 cases / 100.000 person-years in 2016. However, in 2020 the threat of extremely contagious SARS CoV-2 or COVID-19 in Indonesia emerged, which has infected more than 100.303 persons by July 28, 2020, and expected to grow exponentially except if very strict measures were implemented. There are similar symptoms and laboratory findings with both dengue fever and COVID-19, paving way to dangerous possibilities such as incorrect or delayed initial treatment. This is especially worrisome in the context of the pandemic, where COVID-19 positive patients must be promptly identified, isolated and contact-traced, and eluded diagnosis might possibly endanger communities and healthcare workers. We present cases of patients who initially presented with symptoms and laboratory findings of dengue fever, including positive NS1 and/or IgM serology results. During the course of illness these patients fail to show characteristic dengue symptoms, and two cases begin to show respiratory symptoms. Upon further investigation with chest X-ray or contact tracing, the patients were indicated for COVID-19 swab test, which yielded positive results. Repeat dengue IgM/IgG returned positive in one case, suggesting dengue coinfection; however in all other cases, the repeat testing returned negative, suggesting that the initial serologies were false positives. These cases highlight the importance of comprehensively studying patients with apparent dengue fever symptoms and serology, and using the appropriate adjuvant test according to the course of the disease, since a serological overlap may exist between the two diseases.

Serological cross-reaction and coinfection of dengue and COVID-19 in Asia: Experience from Indonesia

“…One of the easiest, the most convenient, and the fastest point-of-care testing to diagnose dengue and COVID-19 is by rapid serology tests. However, cross-reactivity between COVID-19 and dengue has been reported in Singapore ( Yan et al, 2020 ), Thailand ( Prasitsirikul et al, 2020 ), and Indonesia ( Kembuan, 2020 ) where dengue antibodies were detected in confirmed COVID-19 patients (i.e. false-positive dengue serology among COVID-19 patients).…”

Development and performance evaluation of a rapid in-house ELISA for retrospective serosurveillance of SARS-CoV-2

“…For tropical and sub-tropical dengue-endemic countries [ 46 ] developing serological tests specific to COVID-19 is quite challenging, for serological and symptomatologic overlap between the diseases in question [ 47 , 48 ]. Misdiagnosis of COVID-19 as dengue due to serological cross-reactivity has already been reported in Indonesia [ 49 , 50 ]. Singapore [ 51 ] and Thailand [ 52 ] and vice-versa for rapid COVID-19 antibody kits in India [ 53 ].…”

How super-spreader cities, highways, hospital bed availability, and dengue fever influenced the COVID-19 epidemic in Brazil

“…This year a few reports have indicated the occurrence of serological cross-reactivity between dengue fever and COVID-19 [34-37]. For instance, Lustig et al reported that in a group of 55 patients who tested positive for SARS-Cov-2, 12 patients tested positive for dengue (nine cases positive IgM, 2 positive IgG, and 1 for both).…”