Laboratório de Pesquisa em Virologia, Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil.
Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States.
Front Cell Infect Microbiol. 2024 Nov 8;14:1429309. doi: 10.3389/fcimb.2024.1429309. eCollection 2024.
Since its emergence in 2019, coronavirus disease (COVID-19) has spread worldwide and consumed public health resources. However, the world still has to address the burdens of other infectious diseases that continue to thrive. Countries in the tropics and neotropics, including Brazil, are affected by annual, cyclic dengue epidemics. Little is known about the impact of subsequent infections between DENV and SARS-CoV-2. Our study was performed on 400 serum samples collected from laboratory-confirmed COVID-19 patients between January and June 2021, months historically known for DENV outbreaks in Brazil. The samples were tested by serology and molecular assays for the presence of DENV and other arboviruses. While no DENV PCR results were detected, 6% were DENV IgM-positive, and 0.25% were DENV NS1-positive according to ELISA. IgM antibodies were isolated by chromatography, and 62.5% of the samples were positive for neutralizing antibodies (FRNT) against DENV IgM, suggesting a recent infection. We also observed increased IL-10, TNF-α, and IL-1β levels in patients with overlapping SARS-CoV-2/DENV infections. Intriguingly, diabetes was the only relevant comorbidity (p=0.046). High rates of hospitalization (94.9%) and mortality (50%) were found, with a significant increase in invasive mechanical ventilatory support (86.96%) in SARS-CoV-2/DENV- infected patients, suggesting an impact on patient clinical outcomes. When analyzing previous exposure to DENV, secondary dengue patients infected with SARS-CoV-2 more frequently presented with dyspnea and respiratory distress, longer hospital and intensive care unit (ICU) stays (4 and 20.29 days, respectively) and a higher mortality rate (60%). However, a greater proportion of patients with primary DENV infection had fever and cough than patients with secondary dengue (87.50% vs. 33.33%, p=0.027 for fever). Our data demonstrate that differentiating between the two diseases is a great concern for tropical countries and should be explored to improve patient management.
自 2019 年出现以来，冠状病毒病（COVID-19）已在全球范围内传播，并消耗了公共卫生资源。然而，世界仍需应对其他继续流行的传染病的负担。包括巴西在内的热带和新热带国家每年都会受到周期性登革热疫情的影响。对于 DENV 和 SARS-CoV-2 之间随后感染的影响知之甚少。我们的研究是在 2021 年 1 月至 6 月期间从实验室确诊的 COVID-19 患者中采集的 400 份血清样本上进行的，这几个月是巴西登革热爆发的历史时期。这些样本通过血清学和分子检测法检测 DENV 和其他虫媒病毒的存在。虽然没有检测到 DENV PCR 结果，但根据 ELISA 检测，有 6%的样本为 DENV IgM 阳性，0.25%的样本为 DENV NS1 阳性。通过色谱法分离出 IgM 抗体，有 62.5%的样本对 DENV IgM 具有中和抗体（FRNT），表明最近发生了感染。我们还观察到重叠 SARS-CoV-2/DENV 感染患者的 IL-10、TNF-α 和 IL-1β 水平升高。有趣的是，糖尿病是唯一相关的合并症（p=0.046）。我们发现重叠感染 SARS-CoV-2/DENV 的患者的住院率（94.9%）和死亡率（50%）较高，需要侵入性机械通气支持的患者显著增加（86.96%），这表明对患者临床结果有影响。在分析以前对 DENV 的暴露情况时，感染 SARS-CoV-2 的继发登革热患者更常出现呼吸困难和呼吸窘迫，住院时间和重症监护病房（ICU）停留时间更长（分别为 4 天和 20.29 天），死亡率更高（60%）。然而，原发性 DENV 感染患者的发热和咳嗽比例高于继发登革热患者（87.50%对 33.33%，p=0.027）。我们的数据表明，区分这两种疾病是热带国家的一个重要关注点，应加以探讨以改善患者管理。
