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. 2022 Feb:3:801276.
doi: 10.3389/fitd.2022.801276. Epub 2022 Feb 15.

Coinfection With SARS-CoV-2 and Dengue Virus: A Case Report Highlighting Diagnostic Challenges

Prasetyo Hariadi  1 , Dewi Lokida  1   2 , Adhella Menur Naysilla  2 , Nurhayati Lukman  2 , Herman Kosasih  2 , Yan Mardian  2 , Gestana Andru  1 , Inggar Pertiwi  1 , Retna I Sugiyono  2 , Antonius A Pradana  2 , Gustiani Salim  2 , Deni P Butar-Butar  2 , Chuen-Yen Lau  3 , Muhammad Karyana  2   4
Affiliations

Coinfection With SARS-CoV-2 and Dengue Virus: A Case Report Highlighting Diagnostic Challenges

Prasetyo Hariadi et al. Front Trop Dis. 2022 Feb.

Abstract

Background: Since its emergence in China, SARS-CoV-2 has infected more than 240 million people worldwide, including in regions where dengue virus (DENV) is hyperendemic such as Latin America and Southeast Asia, including Indonesia. Diagnosis of COVID-19 in dengue endemic regions as well as DENV and SARS-CoV-2 co-infection can be challenging.

Case presentation: We describe a 68-year-old woman with diabetes mellitus type II who was admitted to the Tangerang District Hospital on 14 April 2020. She lived in a neighborhood where a few people were contracting dengue fever. She presented with five days of fever, malaise, anorexia, nausea, myalgia, and arthralgia. Hematology revealed anemia, thrombocytopenia, normal leukocyte count, increased neutrophil proportion, and decreased lymphocyte proportion and absolute lymphocytes. Her chest X-ray showed right pericardial infiltrates. Although dengue was clinically suspected, she was also tested for SARS-CoV-2 infection as she met screening criteria. After being confirmed SARS-CoV-2 positive by RT-PCR, she was treated with ceftriaxone, paracetamol, azithromycin, oseltamivir, and chloroquine. She was clinically improved four days later and discharged from the hospital on 25 April 2020 after SARS-CoV-2 RT-PCR was negative on two consecutive samples. Dengue was diagnosed retrospectively based on sero-conversion of dengue IgM and a very high dengue IgG index (ELISA, Focus Diagnostics®, Cypress, CA, USA), and sero-conversion of dengue IgM and positive IgG (Rapid test, PanBio ®Dengue duo cassette, Inverness Medical Innovations, QLD, AU), which was equivalent to high Hemagglutination Inhibition (HI) antibody titer (≥1280) found in secondary dengue infection.

Conclusion: The overlapping clinical presentations of COVID-19 and dengue; limited diagnostic capacity of laboratories in resource constrained settings; and complexities of interpreting results make identification of COVID-19 in the dengue endemic setting challenging. Clinicians in endemic areas must be aware of diagnostic challenges and maintain a high index of suspicion for COVID-19 coinfection with DENV and other tropical pathogens.

Keywords: SARS-CoV-2; coinfection; dengue virus; diagnostic challenge; serology.

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Conflict of interest statement

Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1 |
FIGURE 1 |
Chest X-ray on day of hospitalization. Pericardial infiltrates suggest bronchopneumonia.
FIGURE 2 |
FIGURE 2 |
Time course of clinical and laboratory findings. COVID-19 data is shown in the top panel; clinical course is shown in the middle panel; dengue data is shown in the bottom panel. Procedures highlighted in yellow were performed retrospectively for research purposes.
See this image and copyright information in PMC

References

    1. WHO. Weekly Epidemiological Update on Covid-19 19 October 2021. (2021). Available at:. https://www.who.int/publications/m/item/weekly-epidemiological-update-on.... (Accessed on 20 October 2021)
    1. Saavedra-Velasco M, Chiara-Chilet C, Pichardo-Rodriguez R, Grandez-Urbina A, Inga-Berrospi F. Coinfection Between Dengue and Covid-19: Need for Approach in Endemic Zones. Rev Fac Cien Med Univ Nac Cordoba (2020) 77(1):52–4. doi: 10.31053/1853.0605.v77.n1.28031 - DOI - PubMed
    1. Lam LTM, Chua YX, Tan DHY. Roles and Challenges of Primary Care Physicians Facing a Dual Outbreak of COVID-19 and Dengue in Singapore. Fam Pract (2020) 37(4):578–9. doi: 10.1093/fampra/cmaa047 - DOI - PMC - PubMed
    1. Wu D, Lu J, Liu Q, Ma X, He W. To Alert Coinfection of COVID-19 and Dengue Virus in Developing Countries in the Dengue-Endemic Area. Infect Control Hosp Epidemiol (2020) 41(12):1482. doi: 10.1017/ice.2020.187 - DOI - PMC - PubMed
    1. Lorenz C, Azevedo TS, Chiaravalloti-Neto F. COVID-19 and Dengue Fever: A Dangerous Combination for the Health System in Brazil. Travel Med Infect Dis (2020) 35:101659. doi: 10.1016/j.tmaid.2020.101659 - DOI - PMC - PubMed

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