Distinguishing non severe cases of dengue from COVID-19 in the context of co-epidemics: A cohort study in a SARS-CoV-2 testing center on Reunion island

Abstract

Background As coronavirus 2019 (COVID-19) is spreading globally, several countries are handling dengue epidemics. As both infections are deemed to share similarities at presentation, it would be useful to distinguish COVID-19 from dengue in the context of co-epidemics. Hence, we performed a retrospective cohort study to identify predictors of both infections. Methodology/Principal findings All the subjects suspected of COVID-19 between March 23 and May 10, 2020, were screened for COVID-19 within the testing center of the University hospital of Saint-Pierre, Reunion island. The screening consisted in a questionnaire surveyed in face-to-face, a nasopharyngeal swab specimen for the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) reverse transcription polymerase chain-reaction and a rapid diagnostic orientation test for dengue. Factors independently associated with COVID-19 or with dengue were sought using multinomial logistic regression models, taking other febrile illnesses (OFIs) as controls. Adjusted Odds ratios (OR) and 95% Confidence Intervals (95%CI) were assessed. Over a two-month study period, we diagnosed 80 COVID-19, 61 non-severe dengue and 872 OFIs cases eligible to multivariate analysis. Among these, we identified delayed presentation (>3 days) since symptom onset (Odds ratio 1.91, 95% confidence interval 1.07–3.39), contact with a COVID-19 positive case (OR 3.81, 95%CI 2.21–6.55) and anosmia (OR 7.80, 95%CI 4.20–14.49) as independent predictors of COVID-19, body ache (OR 6.17, 95%CI 2.69–14.14), headache (OR 5.03, 95%CI 1.88–13.44) and retro-orbital pain (OR 5.55, 95%CI 2.51–12.28) as independent predictors of dengue, while smoking was less likely observed with COVID-19 (OR 0.27, 95%CI 0.09–0.79) and upper respiratory tract infection symptoms were associated with OFIs. Conclusions/Significance Although prone to potential biases, these data suggest that non-severe dengue may be more symptomatic than COVID-19 in a co-epidemic setting with higher dengue attack rates. At clinical presentation, nine basic clinical and epidemiological indicators may help to distinguish COVID-19 or dengue from each other and other febrile illnesses.

Impact of Recent SARS-CoV-2 Infection on the Course and Severity of Dengue in Children: A Prospective Observational Study from North India

“…In addition, a false‐positive serology for dengue has been noted in patients with confirmed COVID‐19. 23 , 24 In a study in adults, Joubert et al 25 have observed that nonsevere dengue cases were more symptomatic than mild to moderate COVID-19. Body aches, headache, and retro-orbital pain were the presentations in dengue, whereas anosmia and delayed presentation (> 3 days post onset) were suggestive of COVID-19.…”

SARS-CoV-2 and dengue virus coinfection in an adult with beta-thalassemia (trait): A case report from Bangladesh with literature review

“…Recent papers underlined the difficulties in distinguishing the non-severe case of Dengue from COVID-19 in dengue epidemic regions. [ 18 ] Another recent piece of evidence highlighted the need for the adoption of a rapid strategy to prevent a possible outbreak of dengue during the COVID-19 pandemic in Bangladesh. [ 11 ] Here we report a case of heterozygous beta-thalassemia (previously undiagnosed) or beta-thalassemia trait, coinfected with COVID-19 and dengue fever simultaneously and well managed at the COVID-19 unit of icddr,b.…”

Both Full-Length and Protease-Cleaved Products of Osteopontin Are Elevated in Infectious Diseases

“…These findings suggest that patients with high levels of Ud-OPN are not likely to suffer from COVID-19. These findings may also explain why non-severe forms of dengue are more symptomatic than COVID-19 [164]. However, it might be early to conclude that the titers of Ud-OPN can differentiate DF, CV, or CP, because DF, DHF, and leptospirosis patients were from Manila in the Philippines, while the CV and CP patients were from Sendai, Japan.…”

“…Body ache, headache, and retro-orbital pain were indicative of dengue, whereas contact with a COVID-19-positive case, anosmia, delayed presentation (>3 days post-symptom onset), and the absence of active smoking were indicative of COVID-19. Based on the study, basic clinical and epidemiological indicators may help distinguish COVID-19 and dengue from each other and other febrile illnesses [164].…”