Hariadi Prasetyo, Lokida Dewi, Naysilla Adhella Menur, Lukman Nurhayati, Kosasih Herman, Mardian Yan, Andru Gestana, Pertiwi Inggar, Sugiyono Retna I, Pradana Antonius A, Salim Gustiani, Butar-Butar Deni P, Lau Chuen-Yen, Karyana Muhammad
Tangerang District Hospital, Tangerang, Indonesia.
Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia.
Front Trop Dis. 2022 Feb;3. doi: 10.3389/fitd.2022.801276. Epub 2022 Feb 15.
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.
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.
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.
自新型冠状病毒（SARS-CoV-2）在中国出现以来，全球已有超过2.4亿人感染，包括登革热病毒（DENV）高度流行的地区，如拉丁美洲和东南亚，包括印度尼西亚。在登革热流行地区诊断新型冠状病毒肺炎（COVID-19）以及DENV和SARS-CoV-2合并感染可能具有挑战性。
我们描述了一名68岁的II型糖尿病女性患者，于2020年4月14日入住坦格朗区医院。她居住的社区有几个人感染了登革热。她出现了五天的发热、乏力、厌食、恶心、肌痛和关节痛。血液学检查显示贫血、血小板减少、白细胞计数正常、中性粒细胞比例增加、淋巴细胞比例和绝对淋巴细胞数减少。她的胸部X线显示右心包浸润。尽管临床上怀疑是登革热，但由于她符合筛查标准，也接受了SARS-CoV-2感染检测。经逆转录聚合酶链反应（RT-PCR）确诊为SARS-CoV-2阳性后，她接受了头孢曲松、对乙酰氨基酚、阿奇霉素、奥司他韦和氯喹治疗。四天后她的临床症状有所改善，并于2020年4月25日出院，此前连续两次SARS-CoV-2 RT-PCR检测均为阴性。登革热是根据登革热IgM的血清转化和非常高的登革热IgG指数（酶联免疫吸附测定，焦点诊断公司，美国加利福尼亚州赛普拉斯）以及登革热IgM的血清转化和IgG阳性（快速检测，泛生物登革热双试剂盒，英维利斯医疗创新公司，澳大利亚昆士兰州）进行回顾性诊断的，这相当于在登革热二次感染中发现的高血凝抑制（HI）抗体滴度（≥1280）。
COVID-19和登革热临床表现重叠；资源有限地区实验室诊断能力有限；以及结果解读的复杂性使得在登革热流行地区识别COVID-19具有挑战性。流行地区的临床医生必须意识到诊断挑战，并对COVID-19与DENV及其他热带病原体的合并感染保持高度怀疑。
