Abstract
Background: Coronavirus disease 2019 (COVID-19) and dengue fever are difficult to distinguish given shared clinical and laboratory features. Failing to consider COVID-19 due to false-positive dengue serology can have serious implications. We aimed to assess this possible cross-reactivity.
Methods: We analyzed clinical data and serum samples from 55 individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To assess dengue serology status, we used dengue-specific antibodies by means of lateral-flow rapid test, as well as enzyme-linked immunosorbent assay (ELISA). Additionally, we tested SARS-CoV-2 serology status in patients with dengue and performed in-silico protein structural analysis to identify epitope similarities.
Results: Using the dengue lateral-flow rapid test we detected 12 positive cases out of the 55 (21.8%) COVID-19 patients versus zero positive cases in a control group of 70 healthy individuals (P = 2.5E-5). This includes 9 cases of positive immunoglobulin M (IgM), 2 cases of positive immunoglobulin G (IgG), and 1 case of positive IgM as well as IgG antibodies. ELISA testing for dengue was positive in 2 additional subjects using envelope protein directed antibodies. Out of 95 samples obtained from patients diagnosed with dengue before September 2019, SARS-CoV-2 serology targeting the S protein was positive/equivocal in 21 (22%) (16 IgA, 5 IgG) versus 4 positives/equivocal in 102 controls (4%) (P = 1.6E-4). Subsequent in-silico analysis revealed possible similarities between SARS-CoV-2 epitopes in the HR2 domain of the spike protein and the dengue envelope protein.
Conclusions: Our findings support possible cross-reactivity between dengue virus and SARS-CoV-2, which can lead to false-positive dengue serology among COVID-19 patients and vice versa. This can have serious consequences for both patient care and public health.
Keywords: COVID-19; West Nile; dengue.
【저자키워드】 COVID-19, Dengue, West Nile, 【초록키워드】 coronavirus disease, public health, antibodies, SARS-CoV-2, IgG, IgM, Coronavirus disease 2019, coronavirus, S protein, serology, antibody, Infection, severe acute respiratory syndrome Coronavirus, ELISA, Spike protein, cross-reactivity, Protein, enzyme-linked immunosorbent assay, Epitopes, Dengue fever, Immunoglobulin G, Rapid test, Immunoglobulin, Dengue, IgG antibodies, IgA, Patient, Control, envelope protein, dengue virus, respiratory, in-silico, epitope, SARS-CoV-2 epitopes, False-positive, Analysis, Structural analysis, similarity, COVID-19 patient, Laboratory features, immunoglobulin M, lead, Support, Patient care, acute respiratory syndrome, Implications, control group, acute respiratory syndrome coronavirus, serum samples, acute respiratory syndrome coronavirus 2, Clinical data, subject, enzyme, individual, domain, similarities, West, positive, serum sample, ELISA testing, consequence, enzyme-linked immunosorbent, tested, analyzed, identify, performed, include, diagnosed, the spike protein, the S protein, healthy individual, SARS-CoV-2 epitope, 【제목키워드】 SARS-CoV-2, coronavirus 2, Potential,