Abstract
BackgroundThe impact of SARS-CoV-2 in regions endemic for both Dengue and Chikungunya is still not fully understood. Considering that symptoms/clinical features displayed during Dengue, Chikungunya and SARS-CoV-2 acute infections are similar, undiagnosed cases of SARS-CoV-2 in co-endemic areas may be more prevalent than expected. This study was conducted to assess the prevalence of covert cases of SARS-CoV-2 among samples from patients with clinical symptoms compatible with either Dengue or Chikungunya viral infection in the state of Espírito Santo, Brazil.MethodsPresence of immunoglobulin G (IgG) antibody specific to SARS-CoV-2 nucleoprotein was detected using a chemiluminescent microparticle immunoassay in samples from 7,370 patients, without previous history of COVID-19 diagnosis, suspected of having either Dengue (n = 1,700) or Chikungunya (n = 7,349) from December 1st, 2019 to June 30th, 2020.FindingsCovert cases of SARS-CoV-2 were detected in 210 (2.85%) out of the 7,370 serum samples tested. The earliest undiagnosed missed case of COVID-19 dated back to a sample collected on December 18, 2019, also positive for Dengue Virus. Cross-reactivity with either Dengue virus or other common coronaviruses were not observed.InterpretationOur findings demonstrate that concomitant Dengue or Chikungunya outbreaks may difficult the diagnosis of SARS-CoV-2 infections. To our knowledge, this is the first study to demonstrate, with a robust sample size (n = 7,370) and using highly specific and sensitive chemiluminescent microparticle immunoassay method, that covert SARS-CoV-2 infections are more frequent than previously expected in Dengue and Chikungunya hyperendemic regions. Moreover, our results suggest that SAR-CoV-2 cases were occurring prior to February, 2020, and that these undiagnosed missed cases may have contributed to the fast expansion of SARS-CoV-2 outbreak in Brazil. Data presented here demonstrate that in arboviral endemic regions, SARS-CoV-2 infection must be always considered, regardless of the existence of a previous positive diagnosis for Dengue or Chikungunya.
Highlights
In December 2019, after several cases of severe pneumonia of unknown etiology emerged in China, the causative agent was y identified as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), a member of Coronaviridae family (Betacoronavirus genus) and associated with the onset of a severe respiratory disease termed “COVID-19” (COronaVIrus Disease 2019) [1,2,3]
When the first SARS-CoV-2 case was officially announced by the Brazilian Ministry of Health on February 26th, 2020, incidence of Dengue and Chikungunya infections were soaring in the state of Espırito Santo
It is important to emphasize that 131 (62.4%) out of 210 SARS-CoV-2 positive patients displaying symptoms compatible with arboviral infection were negative for either Dengue or Chikungunya (Table 3), indicating that SARS-CoV-2 was not considered in the diagnostic strategy
Summary
In December 2019, after several cases of severe pneumonia of unknown etiology emerged in China, the causative agent was y identified as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), a member of Coronaviridae family (Betacoronavirus genus) and associated with the onset of a severe respiratory disease termed “COVID-19” (COronaVIrus Disease 2019) [1,2,3]. Symptoms associated with SARS-CoV-2 infection vary widely, from asymptomatic disease to multisystem organ failure and, even death [7]. The fast expansion of COVID-19 raised several public health concerns, one of them is associated with the possibility of misdiagnosing SARS-CoV-2 infections in regions where arboviral diseases, such as Dengue fever or Chikungunya, are concomitantly endemic [8]. Considering that symptoms/clinical features displayed during Dengue, Chikungunya and SARS-CoV-2 acute infections are similar, undiagnosed cases of SARS-CoV2 in co-endemic areas may be more prevalent than expected. This study was conducted to assess the prevalence of covert cases of SARS-CoV-2 among samples from patients with clinical symptoms compatible with either Dengue or Chikungunya viral infection in the state of Espırito Santo, Brazil
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