Does dengue and COVID-19 co-infection have worse outcomes? A systematic review of current evidence

Severe dengue in the intensive care unit

Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.

Effective Preventative Measures are Essential to Lower Disease Burden From Dengue and COVID-19 Co-infection in Bangladesh

Bangladesh is widely recognized as one of the dengue prone nations, and empirical evidence has consistently demonstrated an upward trend in the severity of the disease over time. With the persistent occurrence of dengue in Bangladesh and the ongoing presence of COVID-19, which has not been fully eradicated and may persist for an uncertain period of time, there is a high probability of co-infection between these 2 illnesses. Given the circumstances, the concurrent occurrence of the COVID-19 and dengue epidemics, along with the potential co-infection, may pose an overwhelming burden on healthcare systems that are already grappling with challenges in meeting the existing demand. Due to a lack of awareness, an inadequate health infrastructure, and ineffective disease prevention initiatives, the country is now more susceptible to the threat posed by a co-infection that has been found to be associated with more severe outcomes, marked by significant morbidity and mortality. The objective of this opinion piece is to explore the gravity of co-infection in Bangladesh, as well as the potential challenges to overcome and the preventative measures that need to be implemented to address the severity. This opinion piece proposes a set of modern preventative strategies that, when integrated with conventional methods, have the potential to mitigate disease severity, avert the occurrence of co-infection between COVID-19 and dengue, and halt the co-epidemics of COVID-19 and dengue.

Management of Dengue: An Updated Review

Dengue is an important public health problem with a wide clinical spectrum. The World Health Organization classifies dengue into probable dengue, dengue with warning signs, and severe dengue. Severe dengue, characterized by plasma leakage, severe bleeding, or organ impairment, entails significant morbidity and mortality if not treated timely. There are no definitive curative medications for dengue; management is supportive. Judicious fluid resuscitation during the critical phase of dengue is the cornerstone of management. Crystalloids are the initial fluid of choice. Prophylactic platelet transfusion is not recommended. Organ involvement in severe dengue should be carefully looked for and managed. Secondary hemophagocytic lymphohistiocytosis is a potentially fatal complication of dengue that needs to be recognized, as specific management with steroids or intravenous immunoglobulin may improve outcomes. Several compounds with anti-dengue potential are being studied; no anti-dengue drug is available so far.

COVID-19 and monkeypox co-infection: A rapid systematic review

In this paper we aimed to study the characteristics, laboratory data and outcomes of monkeypox virus (MPV) and COVID-19 co-infection. On 2^nd October 2022, we used the search term "("monkeypox virus" OR "MPV" OR "monkey pox" OR "monkeypox") AND ("COVID-19" OR "COVID 19" OR "novel coronavirus" OR "SARS-CoV-2")" in five databases to collect the relevant articles. We found three male patients, who had sex with men prior to the infection, had multiple comorbid conditions, were diagnosed with PCR, and were admitted to the hospital. The length of hospital stay was 4, 6, and 9 days. On admission, two cases had multiple vesicular lesions on various sites of the body associated with tonsillar inflammation, while the third case had genital ulcers and inguinal lymph node enlargement. All cases were managed in the hospital and recovered well. It might still be too early to establish solid evidence about the exact cause-effect association between SARS-CoV-2 and MPV co-infection and patient's outcomes because of the current low sample size. Accordingly, future relevant investigations, estimating the risk ratio of this association are needed to formulate definite evidence.

COVID-19 and dengue coinfection in Latin America: A systematic review

Introduction

Methods

Results

Conclusion

Antibodies against the SARS-CoV-2 S1-RBD cross-react with dengue virus and hinder dengue pathogenesis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally since December 2019. Several studies reported that SARS-CoV-2 infections may produce false-positive reactions in dengue virus (DENV) serology tests and vice versa. However, it remains unclear whether SARS-CoV-2 and DENV cross-reactive antibodies provide cross-protection against each disease or promote disease severity. In this study, we confirmed that antibodies against the SARS-CoV-2 spike protein and its receptor-binding domain (S1-RBD) were significantly increased in dengue patients compared to normal controls. In addition, anti-S1-RBD IgG purified from S1-RBD hyperimmune rabbit sera could cross-react with both DENV envelope protein (E) and nonstructural protein 1 (NS1). The potential epitopes of DENV E and NS1 recognized by these antibodies were identified by a phage-displayed random peptide library. In addition, DENV infection and DENV NS1-induced endothelial hyperpermeability in vitro were inhibited in the presence of anti-S1-RBD IgG. Passive transfer anti-S1-RBD IgG into mice also reduced prolonged bleeding time and decreased NS1 seral level in DENV-infected mice. Lastly, COVID-19 patients’ sera showed neutralizing ability against dengue infection in vitro. Thus, our results suggest that the antigenic cross-reactivity between the SARS-CoV-2 S1-RBD and DENV can induce the production of anti-SARS-CoV-2 S1-RBD antibodies that cross-react with DENV which may hinder dengue pathogenesis.

False Positivity of Anti-SARS-CoV-2 Antibodies in Patients with Acute Tropical Diseases in Thailand

Serology remains a useful indirect method of diagnosing tropical diseases, especially in dengue infection. However, the current literature regarding cross-reactivity between SARS-CoV-2 and dengue serology is limited and revealed conflicting results. As a means to uncover relevant serological insight involving antibody classes against SARS-CoV-2 and cross-reactivity, anti-SARS-CoV-2 IgA, IgM, and IgG ELISA, based on spike and nucleocapsid proteins, were selected for a fever-presenting tropical disease patient investigation. The study was conducted at the Faculty of Tropical Medicine during March to December 2021. The study data source comprised (i) 170 non-COVID-19 sera from 140 adults and children presenting with acute undifferentiated febrile illness and 30 healthy volunteers, and (ii) 31 COVID-19 sera from 17 RT-PCR-confirmed COVID-19 patients. Among 170 non-COVID-19 samples, 27 were false positives (15.9%), of which IgA, IgM, and IgG cross-reactive antibody classes were detected in 18 (10.6%), 9 (5.3%), and 3 (1.8%) cases, respectively. Interestingly, one case exhibited both IgA and IgM false positivity, while two cases exhibited both IgA and IgG false positivity. The false positivity rate in anti-SARS-CoV-2 IgA and IgM was reported in adults with dengue infection (11.3% and 5%) and adults with other tropical diseases (16.7% and 13.3%). The urea dissociation method applied to mitigate false positivity resulted in significantly decreased ELISA-based false and true positives. In conclusion, the analysis of antibody against SARS-CoV-2 in sera of patients with different tropical diseases showed that high IgA and IgM false positivity thus potentially limits serological assay utility in fever-presenting patients in tropical areas.