ArticlePloS one2021
Covert cases of Severe Acute Respiratory Syndrome Coronavirus 2: An obscure but present danger in regions endemic for Dengue and Chikungunya viruses.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Seroprevalence of SARS-CoV-2 in Brazil: A systematic review and meta-analysis.Clinics (Sao Paulo, Brazil) · 2023Pooled it
- Atypical manifestations of dengue in pediatric patients hospitalized during the 2023-2024 epidemic in Argentina: a multicenter registry.European journal of pediatrics · 2026Article
- Complexity of the COVID-19 pandemic in Maringá.Scientific reports · 2023Article
- Potential impact of SARS COV-2 infection on the performance of serological assays used to diagnose arboviral diseases.Journal of immunological methods · 2022Article
- Neurological Complications of Dengue Fever.Current neurology and neuroscience reports · 2022Review
- Article
- Impact of the COVID-19 Pandemic on Infectious Diseases in Brazil: A Case Study on Dengue Infections.Epidemiologia (Basel, Switzerland) · 2022Article
- Detection of SARS-CoV-2 antibodies in febrile patients from an endemic region of dengue and chikungunya in Peru.PloS one · 2022Article
- Pulmonary hemorrhage in dengue: differential diagnosis with acute viral respiratory syndromes including COVID-19.Revista do Instituto de Medicina Tropical de Sao Paulo · 2022Article
- Competitive ELISA for a serologic test to detect dengue serotype-specific anti-NS1 IgGs using high-affinity UB-DNA aptamers.Scientific reports · 2021Article
- Decrypting the role of predicted SARS-CoV-2 miRNAs in COVID-19 pathogenesis: A bioinformatics approach.Computers in biology and medicine · 2021Article
- Chikungunya and COVID-19 in Brazil: The danger of an overlapping crises.Journal of medical virology · 2021Article
- The Pandemic Experience in Southeast Asia: Interface Between SARS-CoV-2, Malaria, and Dengue.Frontiers in tropical diseases · 2021Article
- COVID-19 and dengue coinfection in Latin America: A systematic review.New microbes and new infectionsReview
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
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.
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