The Usefulness of Peripheral Blood Cell Counts to Distinguish COVID-19 from Dengue during Acute Infection

Abstract

COVID-19 and dengue disease are challenging to tell apart because they have similarities in clinical and laboratory features during the acute phase of infection, leading to misdiagnosis and delayed treatment. The present study evaluated peripheral blood cell count accuracy to distinguish COVID-19 non-critical patients from non-severe dengue cases between the second and eleventh day after symptom onset. A total of 288 patients infected with SARS-CoV-2 (n = 105) or dengue virus (n = 183) were included in this study. Neutrophil, platelet, and lymphocyte counts were used to calculate the neutrophil–lymphocyte ratio (NLR), the platelet–lymphocyte ratio (PLR), and the neutrophil–lymphocyte*platelet ratio (NLPR). The logistic regression and ROC curves analysis revealed that neutrophil and platelet counts, NLR, LPR, and NLPR were higher in COVID-19 than dengue. The multivariate predictive model showed that the neutrophils, platelets, and NLPR were independently associated with COVID-19 with a good fit predictive value (p = 0.1041). The neutrophil (AUC = 0.95, 95% CI = 0.84–0.91), platelet (AUC = 0.89, 95% CI = 0.85–0.93) counts, and NLR (AUC = 0.88, 95% CI = 0.84–0.91) were able to discriminate COVID-19 from dengue with high sensitivity and specificity values (above 80%). Finally, based on predicted probabilities on combining neutrophils and platelets with NLR or NLPR, the adjusted AUC was 0.97 (95% CI = 0.94–0.98) to differentiate COVID-19 from dengue during the acute phase of infection with outstanding accuracy. These findings might suggest that the neutrophil, platelet counts, and NLR or NLPR provide a quick and cost-effective way to distinguish between dengue and COVID-19 in the context of co-epidemics in low-income tropical regions.

Dengue clinical features and predictors of severity in the diabetic patient: a retrospective cohort study on Reunion island, 2019

“…we hypothesize that it could be indicative of both systemic inflammation [26] and early platelet-neutrophil interactions aimed at clearing the virus through neutrophil extracellular traps (NETs), this latter mechanism to be triggered by activated platelets in dengue [27] but also well-known to be at work in diabetes through a different pathway [28].…”

“…To the best of our knowledge, this ratio had not been used previously in dengue neither for diagnosis nor for prognosis purpose. Given it was correlated both to NLPR and NLR (data not shown), we hypothesize that it could be indicative of both systemic inflammation [26] and early platelet-neutrophil interactions aimed at clearing the virus through neutrophil extracellular traps (NETs), this latter mechanism to be triggered by activated platelets in dengue [27] but also well-known to be at work in diabetes through a different pathway [28].…”

Obstacles from the synchroneity of Dengue and Corona virus infections

“…Aside from the preliminary closeness in the clinical presentation, there are several resemblances between these two infections such as certain risk factors for severe illness, immune-pathogenesis, antibody and T cell responses, cytokine storms, endothelial dysfunction and multi-organ failure. Owing to the co-existence of DENV and SARS-CoV-2, both illnesses have similar clinical manifestations, therefore, a substantial clinical misdiagnosis should be considered during the initial 10 days after the viral infection [4]. Thus, it is obligatory to identify and discriminate the patients with COVID-19 from the cases of dengue appropriately to improve patient condition.…”