SARS-CoV-2 and dengue virus co-infection: Epidemiology, pathogenesis, diagnosis, treatment, and management

Abstract

SARS-CoV-2 and dengue virus co-infection cases have been on the rise in dengue-endemic regions as coronavirus disease 2019 (COVID-19) spreads over the world, posing a threat of a co-epidemic. The risk of comorbidity in co-infection cases is greater than that of a single viral infection, which is a cause of concern. Although the pathophysiologies of the two infections are different, the viruses have comparable effects within the body, resulting in identical clinical symptoms in the case of co-infection, which adds to the complexity. Overlapping symptoms and laboratory features make proper differentiation of the infections important. However, specific biomarkers provide precise results that can be utilised to diagnose and treat a co-infection, whether it is simply COVID-19, dengue, or a co-infection. Though their treatment is distinguished, it becomes more complicated in circumstances of co-infection. As a result, regardless of whatever infection the first symptom points to, confirmation diagnosis of both COVID-19 and dengue should be mandatory, particularly in dengue-endemic regions, to prevent health deterioration in individuals treated for a single infection. There is still a scarcity of concise literature on the epidemiology, pathophysiology, diagnosis, therapy, and management of SARS-CoV-2 and dengue virus co-infection. The epidemiology of SARS-CoV-2 and dengue virus co-infection, the mechanism of pathogenesis, and the potential impact on patients are summarised in this review. The possible diagnosis with biomarkers, treatment, and management of the SARS-CoV-2 and dengue viruses are also discussed. This review will shed light on the appropriate diagnosis, treatment, and management of the patients suffering from SARS-CoV-2 and dengue virus co-infection.

Keywords: SARS-CoV-2; biomarkers; co-infection; dengue virus; epidemiology; management; mechanism.

FIGURE 1

Epidemiological summary of SARS‐CoV‐2 and dengue viruses (DENV) co‐infection cases. A total of 31 cases of SARS‐CoV‐2 and DENV co‐infections have been reported throughout the world so far. Sixteen were male, thirteen were female, while two patients' genders were not reported. The majority (24) of the patients were within the 20–60 age group, while two were below 20 and the remaining 3 were older than 60 years. Eighteen patients were suffered from mild symptoms, whereas seven had moderate symptoms, and five endured severe symptoms. Twenty‐six of the patients in the case studies survived; however, five died

FIGURE 2

Global distribution of SARS‐CoV‐2 and dengue viruses (DENV) co‐infection. The map illustrates the global cases of coronavirus disease 2019 (COVID‐19) along with dengue‐endemic regions with varying incidence. The countries with the 31 SARS‐CoV‐2 and DENV co‐infection cases are also indicated on the map. The cases were primarily observed in the South American, South African, and South Asian regions

FIGURE 3

Pathophysiology of SARS‐CoV‐2 and dengue viruses (DENV) co‐infection. The schematic figure shows possible mechanisms and pathophysiology of co‐infection with SARS‐CoV‐2 and DENV. DENV infects cells through FcγR, particularly astrocytes and microglia, induces the discharge of inflammatory mediators (IL‐6, vascular endothelial growth factor (VEGF), TNF‐α, IFN‐γ, IL‐1β and IL‐10, MCP‐1) and metalloproteinases. Similarly, SARS‐CoV‐2 infects cells through ACE2 receptor and release inflammatory mediators (IL‐1, IL‐2, IL‐6, IFN‐ γ, IFN‐α), which arbitrate the downregulation of adherents and tight junction proteins, resulting in increased blood‐brain barrier (BBB) permeability, pulmonary embolism (PE), thrombocytopaenia, diffuse alveolar damage (DAD), and can cause immune‐mediated encephalopathy and encephalitis

FIGURE 4

Biomarkers of SARS‐CoV‐2 and dengue virus (DENV) co‐infection

FIGURE 5

Common symptoms of SARS‐CoV‐2 and dengue virus (DENV) co‐infection