‘Dengue-COVID-19 overlap’: Is it an ‘antigenic mimicry’ or coexistent two different viral genotypic diseases? Prospective, observational study in tertiary care setting in India
More details
Hide details
Professor, Pulmonary Medicine, MIMSR Medical College, Latur, India and Incharge, Venkatesh Chest Hospital and Critical Care Center, Latur, INDIA
Assistant Professor, Internal Medicine, MIMSR Medical College, Latur, INDIA
Associate Professor, Pathology Department, MIMSR Medical College, Latur, INDIA
Publication date: 2022-07-26
Electron J Gen Med 2022;19(6):em400
Dengue-COVID-19 overlap is mixture of both diseases sharing few similarities in pulmonary and extra pulmonary involvement.

Prospective, observational study, included 300 COVID-19 cases with dengue NS1 or dengue IgM positive, with lung involvement documented and categorized on HRCT thorax at entry point. All cases were subjected to dengue IgG antibody titers and dengue IgM/IgG antibody titer analysis after 12 weeks of discharge form hospital.

Hematological evaluation, white blood cell count & platelet count were having significant association with dengue-COVID-19 overlap (p<0.0076) & (p<0.00001), respectively. Clinical parameters as hypoxia have significant association with dengue-COVID-19 overlap (p<0.00001). Inflammatory markers as IL-6, CRP, and LDH has significant association in dengue-COVID-19 overlap (p<0.00001), respectively. Dengue-COVID-19 overlap was documented in 16.33% (49/300) cases. CT severity has documented significant correlation with dengue-COVID-19 overlap cases (p<0.00001). In study of 49 cases of ‘dengue-COVID-19’, post-COVID-19 lung fibrosis (p<0.004), and serological assessment in dengue IgM/IgG and COVID-19 antibody titers has significant association (p<0.00001).

‘Dengue-COVID-19’ is disease of concern in ongoing pandemic in critical care setting, and timely workup is crucial step in preventing delay in diagnosis and final adverse outcomes.

Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA. 2020;324(8):782-93. https://doi.org/10.1001/jama.2... PMid:32648899.
Guzman MG, Harris E. Dengue. Lancet. 2015;385(9966):453-65. https://doi.org/10.1016/S0140-....
Harapan H, Itoh N, Yufika A, et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020;13(5):667-73. https://doi.org/10.1016/j.jiph... PMid:32340833 PMCid:PMC7142680.
Navarro JC, Arrivillaga-Henríquez J, Salazar-Loor J, Rodriguez-Morales AJ. COVID-19 and dengue, co-epidemics in Ecuador and other countries in Latin America: Pushing strained health care systems over the edge. Travel Med Infect Dis. 2020; 37:101656. https://doi.org/10.1016/j.tmai... PMid:32268196 PMCid:PMC7130119.
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. https://doi.org/10.1016/j.tmai... PMid:32278756 PMCid:PMC7144614.
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. https://doi.org/10.1093/fampra... PMid:32374384 PMCid:PMC7239111.
Yan G, Lee CK, Lam LTM, et al. Covert COVID-19 and false-positive dengue serology in Singapore. Lancet Infect Dis. 2020;20(5):536. https://doi.org/10.1016/S1473-... PMid:32145189 PMCid:PMC7128937.
Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science. 2020;368(6490):489-93. https://doi.org/10.1126/scienc... PMid:32179701 PMCid:PMC7164387.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-....
World Health Organization. Dengue: Guidelines for diagnosis, treatment, prevention and control. World Health Organization. 2009. Available at: https://apps.who.int/iris/hand... (Accessed 12 October 2021).
World Health Organization. Clinical management of COVID-19. 2020. https://www.who.int/teams/heal... (Accessed 12 October 2021).
Verduyn M, Allou N, Gazaille V, et al. Coinfection of dengue and COVID-19: A case report. PLoS Negl Trop Dis. 2020;14(8):1-5. https://doi.org/10.1371/journa... PMid:32745101 PMCid:PMC7398491.
Epelboin L, Blondé R, Nacher M, Combe P, Collet L. COVID-19 and dengue co-infection in a returning traveller. J Travel Med. 2020;27(6):taaa114. https://doi.org/10.1093/jtm/ta... PMid:32657339 PMCid:PMC7454756.
Kembuan GJ. Dengue serology in Indonesian COVID-19 patients: Coinfection or serological overlap? ID Cases. 2020;22:e00927.https://doi.org/10.1016/j.idcr... PMid:32802747 PMCid:PMC7403131.
Estofolete CF, Machado LF, Zini N, et al. Fatal stroke as presentation of SARS-CoV-2 and dengue virus coinfection. J Med Virol. 2021;93(3):1770-5. https://doi.org/10.1002/jmv.26... PMid:32881018.
Government of India. Guidelines for management of co-infection of COVID-19 with other seasonal epidemic prone diseases. 2021. https://www.mohfw.gov.in/pdf/G... (Accessed 12 October 2021).
Ooi EE, Gubler DJ. Dengue in Southeast Asia: Epidemiological characteristics and strategic challenges in disease prevention. Cad Saude Publica. 2009;25(Suppl 1):S115-24. https://doi.org/10.1590/S0102-... PMid:19287856.
Khan E, Hasan R, Mehraj J, Mahmood S. Genetic diversity of dengue virus and associated clinical severity during periodic epidemics in South East Asia. In: Rodriguez-Morales, A. J. editor. Current topics in tropical medicine. London: Intech Open; 2012. https://doi.org/10.5772/26115.
Htun YM, Thiha K, Aung A, et al. Assessment of depressive symptoms in patients with COVID-19 during the second wave of epidemic in Myanmar: A cross-sectional single-center study. PLoS One. 2021;16(6):e0252189. https://doi.org/10.1371/journa... PMid:34086722 PMCid:PMC8177551.
Goodwin R, Wiwattanapantuwong J, Tuicomepee A, Suttiwan P, Watakakosol R, Ben-Ezra M. Anxiety, perceived control and pandemic behaviour in Thailand during COVID-19: Results from a national survey. J Psychiatr Res. 2021;135:212-7. https://doi.org/10.1016/j.jpsy... PMid:33497875 PMCid:PMC7826082.
Nguyen PH, Kachwaha S, Pant A, et al. Impact of COVID-19 on household food insecurity and interlinkages with child feeding practices and coping strategies in Uttar Pradesh, India: A longitudinal community-based study. BMJ Open. 2021;11(4):e048738. https://doi.org/10.1136/bmjope... PMid:33883156 PMCid:PMC8061560.
Lodha R, Kabra SK. COVID-19 pandemic: Impact on health care of children and the urgent need to restore regular healthcare services. Indian J Pediatr. 2021;88(3):225-6. https://doi.org/10.1007/s12098... PMid:33415552 PMCid:PMC7790718.
Tsheten T, Wangchuk S, Wangmo D, Clements ACA, Gray DJ, Wangdi K. COVID-19 response and lessons learned on dengue control in Bhutan. J Med Entomol. 2021;58(2):502-4. https://doi.org/10.1093/jme/tj... PMid:33095868 PMCid:PMC7665684.
Vasishtha G, Mohanty SK, Mishra US, Dubey M, Sahoo U. Impact of COVID-19 infection on life expectancy, premature mortality, and DALY in Maharashtra, India. BMC Infect Dis. 2021;21(1):343. https://doi.org/10.1186/s12879... PMid:33845774 PMCid:PMC8040360.
World Health Organization. Coronavirus disease 2019 (COVID-19), weekly epidemilogical update, edition 45, 22 June 2021. Available at: https://www.who.int/publicatio... (Accessed 12 October 2021).
Harjana NPA, Januraga PP, Indrayathi PA, Gesesew HA, Ward PR. Prevalence of depression, anxiety, and stress among repatriated Indonesian migrant workers during the COVID-19 pandemic. Front Public Health. 2021;9:630295. https://doi.org/10.3389/fpubh.... PMid:34026709 PMCid:PMC8131639.
Rayamajhee B, Pokhrel A, Syangtan G, et al. How well the Government of Nepal is responding to COVID-19? An experience from a resource-limited country to confront unprecedented pandemic. Front Public Health. 2021;9:597808. https://doi.org/10.3389/fpubh.... PMid:33681124 PMCid:PMC7925847.
Tsheten T, Clements ACA, Gray DJ, et al. Clinical features and outcomes of COVID-19 and dengue co-infection: A systematic review. BMC Infect Dis. 2021;21:729. https://doi.org/10.1186/s12879... PMid:34340682 PMCid: PMC8327042.
Mahajan NN, Kesarwani SN, Shinde SS, et al. Co-infection of malaria and dengue in pregnant women with SARS-CoV-2. Int J Gynaecol Obstet. 2020;151(3):459-62. https://doi.org/10.1002/ijgo.1... PMid:33090458 PMCid:PMC7611276.
Bicudo N, Bicudo E, Costa JD, Castro JALP, Barra GB. Co-infection of SARS-CoV-2 and dengue virus: A clinical challenge. Braz J Infect Dis. 2020;24(5):452-4. https://doi.org/10.1016/j.bjid... PMid:32866435 PMCid:PMC7448779.
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623. https://doi.org/10.1016/j.tmai... PMid:32179124 PMCid:PMC7102608.
Pontes RL, de Brito BB, da Silva FAF, et al. Coinfection by SARS-CoV-2 and dengue virus in a dual viral circulation setting. Travel Med Infect Dis. 2020;37:101862. https://doi.org/10.1016/j.tmai... PMid:32858249 PMCid: PMC7446720.
Ratnarathon AC, Pongpirul K, Pongpirul WA, Charoenpong L, Prasithsirikul W. Potential dual dengue and SARS-CoV-2 infection in Thailand: A case study. Heliyon. 2020;6(6):e04175. https://doi.org/10.1016/j.heli... PMid:32542206 PMCid:PMC7280131.
Huang KJ, Li SJ, Chen SC, et al. Manifestation of thrombocytopenia in dengue-2-virus-infected mice. J Gen Virol. 2000;81(Pt 9):2177-82. https://doi.org/10.1099/0022-1... PMid:10950974.
Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-8. https://doi.org/10.1007/s00277... PMid:32296910 PMCid:PMC7156897.
Sun DS, King CC, Huang HS, et al. Antiplatelet autoantibodies elicited by dengue virus non-structural protein 1 cause thrombocytopenia and mortality in mice. J Thromb Haemost. 2007;5(11):2291-9. https://doi.org/10.1111/j.1538... PMid:17958746.
Kembuan GJ. Dengue serology in Indonesian COVID-19 patients: Coinfection or serological overlap? IDCases. 2020;22:e00927.https://doi.org/10.1016/j.idcr... PMid:32802747 PMCid:PMC7403131.
Yan G, Lee CK, Lam LTM, et al. Covert COVID-19 and false-positive dengue serology in Singapore. Lancet Infect Dis. 2020;20(5):536. https://doi.org/10.1016/S1473-....
Wilder-Smith A, Tissera H, Ooi EE, Coloma J, Scott TW, Gubler DJ. Preventing dengue epidemics during the COVID-19 pandemic. Am J Trop Med Hyg. 2020;103(2):570-1. https://doi.org/10.4269/ajtmh.... PMid:32539912 PMCid:PMC7410414.
Carosella LM, Pryluka D, Maranzana A, et al. Characteristics of patients co-infected with severe acute respiratory syndrome coronavirus 2 and dengue virus, Buenos Aires, Argentina, March-June 2020. Emerg Infect Dis. 2021;27(2):348-51. https://doi.org/10.3201/eid270... PMid:33347804 PMCid:PMC7853556.
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. 2020;77(1):52-4. https://doi.org/10.31053/1853.... PMid:32238260.
Zheng W, Wu H, Liu C, et al. Identification of COVID-19 and dengue host factor interaction networks based on integrative bioinformatics analyses. Front Immunol. 2021; 2:707287. https://doi.org/10.3389/fimmu.... PMid:34394108 PMCid:PMC8356054.
Nacher M, Douine M, Gaillet M, et al. Simultaneous dengue and COVID-19 epidemics: Difficult days ahead?. PLOS Negl Trop Dis. 2020;14(8):e0008426. https://doi.org/10.1371/journa... PMid:32797035 PMCid:PMC7428060.
Kevadiya BD, Machhi J, Herskovitz J, et al. Diagnostics for SARS-CoV-2 infections. Nat Mater. 2021;20:593-605. https://doi.org/10.1038/s41563... PMid:33589798 PMCid:PMC8264308.
Mukherjee TK, Malik P, Maitra R, Hoidal JR. Ravaging SARS-CoV-2: Rudimentary diagnosis and puzzling immunological responses. Curr Med Res Opin. 2021;37(2):207-17. https://doi.org/10.1080/030079... PMid:33306409 PMCid:PMC7784827.
Lippi G, Simundic AM, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med. 2020;58:1070-6. https://doi.org/10.1515/cclm-2... PMid:32172228.
Raafat N, Blacksell SD, Maude RJ. A review of dengue diagnostics and implications for surveillance and control. Trans R Soc Trop Med Hyg. 2019;113(11):653-60. https://doi.org/10.1093/trstmh... PMid:31365115 PMCid:PMC6836713.
Shital P, Gondhali G. Does genetic makeup of corona cirus in COVID-19 disease is as predicted or is similar to other respiratory viruses like influenza? Still, we believe in Covid appropriate behavior in spite of vaccination… Show must go on! Saudi J Med. 2020;7(1):1-3. https://doi.org/10.36348/sjm.2....
Gan VC, Tan LK, Lye DC, et al. Diagnosing dengue at the point-of-care: Utility of a rapid combined diagnostic kit in Singapore. PLoS One. 2014;9(3):e90037. https://doi.org/10.1371/journa... PMid:24646519 PMCid:PMC3960091.
Firmansyah Y, Elizabeth J, Hendsun H, Gosal D. False-positive dengue non-structural protein 1 antigen in a patient with COVID-19 infection. Arch Clin Med. 2020;26(2):20-3. https://doi.org/10.21802/acm.2....
Nalbandian A, Sehgal K., Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601-15. https://doi.org/10.1038/s41591... PMid:33753937 PMCid:PMC8893149.
Long QX, Tang XJ, Shi QL, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med. 2020;26(8):1200-4. https://doi.org/10.1038/s41591... PMid:32555424.
Stadlbauer D, Amanat F, Chromikova V, et al. SARS-CoV-2 seroconversion in humans: A detailed protocol for a serological assay, antigen production, and test setup. Curr Protoc Microbiol. 2020;57(1):e100. https://doi.org/10.1002/cpmc.1... PMid:32302069 PMCid:PMC7235504.
Wu F, Wang A, Liu M, et al. Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications. medRxiv. 2020. https://doi.org/10.1101/2020.0....
Journals System - logo
Scroll to top