Abstract
BackgroundThe coronavirus disease 2019 (COVID-19) pandemic remains ongoing around the world, including in areas where dengue is endemic. Dengue and COVID-19, to some extent, have similar clinical and laboratory features, which can lead to misdiagnosis, delayed treatment and patient’s isolation. The use of rapid diagnostic tests (RDT) is easy and convenient for fast diagnosis, however there may be issues with cross-reactivity with antibodies for other pathogens.MethodsWe assessed the possibility of cross-reactivity between SARS-CoV-2 and dengue antibodies by: (1) testing five brands of COVID-19 IgG / IgM RDTs on 60 RT-PCR-confirmed dengue samples; (2) testing 95 RT-PCR-confirmed COVID-19 samples on dengue RDT; and (3) testing samples positive for COVID-19 IgG and/or IgM on dengue RDT.ResultsWe observed a high specificity across all five brands of COVID-19 RDTs, ranging from 98.3 to 100%. Out of the confirmed COVID-19 samples, one patient tested positive for dengue IgM only, another tested positive for dengue IgG only. One patient tested positive for dengue IgG, IgM, and NS1, suggesting a co-infection. In COVID-19 IgG and/or IgM samples, 6.3% of COVID-19 IgG-positive samples also tested positive for dengue IgG, while 21.1% of COVID-19 IgM-positive samples also tested positive for dengue IgG.ConclusionDespite the high specificity of the COVID-19 RDT, we observed cross-reactions and false-positive results between dengue and COVID-19. Dengue and COVID-19 co-infection was also found. Health practitioners in dengue endemic areas should be careful when using antibody RDT for the diagnosis of dengue during the COVID-19 pandemic to avoid misdiagnosis.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic remains ongoing around the world, including in areas where dengue is endemic
The specificity evaluation of COVID-19 immunoglobulin G (IgG) / immunoglobulin M (IgM) rapid diagnostic tests (RDT) against confirmed dengue samples was performed in a laboratory that is internationally certified for Good Clinical Laboratory Practice (GCLP) at the Eijkman Institute, Jakarta, Indonesia
One sample which tested positive for COVID-19 IgG using SD Biosensor Dengue RDT was a 17-year-old male, with fever day onset of 2 days, infected with Dengue virus (DENV)-4, and tested positive for anti-dengue IgG and IgM
Summary
The coronavirus disease 2019 (COVID-19) pandemic remains ongoing around the world, including in areas where dengue is endemic. Dengue fever and COVID19 have similar clinical and laboratory features, which can lead to misdiagnosis, delayed treatment, and isolation [3] In both cases, patients often report acute fever, myalgia, fatigue, and other flu-like symptoms, as well as present with thrombocytopenia and leukopenia [1, 3]. Most commercial rapid diagnostic tests (RDT) available in the market are for the detection of SARS-CoV-2 antibodies, with relatively high sensitivity and specificity, especially when samples are taken later in the disease progression [6]. It is hampered by the apparent cross-reactivity resulting in false-positive results [7]. Immunochromatographic tests for the detection of dengue virus nonstructural protein 1 (NS1) antigen, IgM, IgG, and IgA antibodies have been developed by a number of commercial companies and have found wide application because of their ease of use and rapidity of results [8, 9]
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