隐匿性严重急性呼吸综合征冠状病毒 2 型病例：在登革热和基孔肯雅热病毒流行地区的一个隐蔽但存在的危险。
Covert cases of Severe Acute Respiratory Syndrome Coronavirus 2: An obscure but present danger in regions endemic for Dengue and Chikungunya viruses.
机构信息
Laboratório Central de Saúde Pública do Estado do Espírito Santo, Secretaria de Estado da Saúde do Espírito Santo, Vitória, Brazil.
Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil.
出版信息
PLoS One. 2021 Jan 6;16(1):e0244937. doi: 10.1371/journal.pone.0244937. eCollection 2021.
BACKGROUND
The impact of SARS-CoV-2 in regions endemic for both Dengue and Chikungunya is still not fully understood. Considering that symptoms/clinical features displayed during Dengue, Chikungunya and SARS-CoV-2 acute infections are similar, undiagnosed cases of SARS-CoV-2 in co-endemic areas may be more prevalent than expected. This study was conducted to assess the prevalence of covert cases of SARS-CoV-2 among samples from patients with clinical symptoms compatible with either Dengue or Chikungunya viral infection in the state of Espírito Santo, Brazil.
METHODS
Presence of immunoglobulin G (IgG) antibody specific to SARS-CoV-2 nucleoprotein was detected using a chemiluminescent microparticle immunoassay in samples from 7,370 patients, without previous history of COVID-19 diagnosis, suspected of having either Dengue (n = 1,700) or Chikungunya (n = 7,349) from December 1st, 2019 to June 30th, 2020.
FINDINGS
Covert cases of SARS-CoV-2 were detected in 210 (2.85%) out of the 7,370 serum samples tested. The earliest undiagnosed missed case of COVID-19 dated back to a sample collected on December 18, 2019, also positive for Dengue Virus. Cross-reactivity with either Dengue virus or other common coronaviruses were not observed.
INTERPRETATION
Our findings demonstrate that concomitant Dengue or Chikungunya outbreaks may difficult the diagnosis of SARS-CoV-2 infections. To our knowledge, this is the first study to demonstrate, with a robust sample size (n = 7,370) and using highly specific and sensitive chemiluminescent microparticle immunoassay method, that covert SARS-CoV-2 infections are more frequent than previously expected in Dengue and Chikungunya hyperendemic regions. Moreover, our results suggest that SAR-CoV-2 cases were occurring prior to February, 2020, and that these undiagnosed missed cases may have contributed to the fast expansion of SARS-CoV-2 outbreak in Brazil. Data presented here demonstrate that in arboviral endemic regions, SARS-CoV-2 infection must be always considered, regardless of the existence of a previous positive diagnosis for Dengue or Chikungunya.
背景
SARS-CoV-2 在登革热和基孔肯雅热流行地区的影响仍未完全了解。鉴于登革热、基孔肯雅热和 SARS-CoV-2 急性感染期间表现出的症状/临床特征相似，因此在共流行地区，未确诊的 SARS-CoV-2 病例可能比预期更为普遍。本研究旨在评估巴西圣埃斯皮里图州有临床症状符合登革热或基孔肯雅热病毒感染的患者样本中隐匿性 SARS-CoV-2 病例的流行率。
方法
使用化学发光微粒子免疫分析检测 7370 例患者样本中针对 SARS-CoV-2 核蛋白的免疫球蛋白 G（IgG）抗体的存在情况，这些患者均无 COVID-19 诊断史，被怀疑患有登革热（n=1700）或基孔肯雅热（n=7349），时间为 2019 年 12 月 1 日至 2020 年 6 月 30 日。
结果
在 7370 例血清样本中检测到隐匿性 SARS-CoV-2 病例 210 例（2.85%）。最早的未诊断的 COVID-19 漏诊病例可追溯到 2019 年 12 月 18 日采集的样本，该样本同时也呈登革热病毒阳性。未观察到与登革热病毒或其他常见冠状病毒的交叉反应。
解释
我们的研究结果表明，同时发生的登革热或基孔肯雅热疫情可能会影响 SARS-CoV-2 感染的诊断。据我们所知，这是第一项使用具有较大样本量（n=7370）的高度特异性和敏感性化学发光微粒子免疫分析方法证明隐匿性 SARS-CoV-2 感染比以前预期更为常见的研究，这些隐匿性感染发生在登革热和基孔肯雅热高度流行地区。此外，我们的结果表明，SARS-CoV-2 病例发生在 2020 年 2 月之前，这些未诊断的漏诊病例可能导致了巴西 SARS-CoV-2 疫情的快速蔓延。这里呈现的数据表明，在虫媒病毒流行地区，无论之前是否有登革热或基孔肯雅热的阳性诊断，都必须始终考虑 SARS-CoV-2 感染的可能性。
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