Journal
CLINICAL INFECTIOUS DISEASES
Volume 73, Issue 7, Pages E2444-E2449Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa1207
Keywords
COVID-19; dengue; West Nile
Categories
Funding
- Nehemia Rubin Excellence in Biomedical Research-The TELEM Program
- Sagol Institute for Longevity Research
- Barry and Eleanore Reznik Family Cancer Research Fund
- Steven B. Rubenstein Research Fund for Leukemia and Other Blood Disorders
- Rising Tide Foundation
- Applebaum Foundation
- ISF [450/16]
- Abraham E. Kazan Chair in Structural Biology, Tel Aviv University
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Analysis of serum status of COVID-19 and dengue virus shows possible cross-reactivity, leading to false-positive dengue serology among COVID-19 patients. In-silico analysis also indicates potential similarities in protein structures between the two viruses.
Background. Coronavirus disease 2019 (COVID-19) and dengue fever are difficult to distinguish given shared clinical and laboratory features. Failing to consider COVID-19 due to false-positive dengue serology can have serious implications. We aimed to assess this possible cross-reactivity. Methods. We analyzed clinical data and serum samples from 55 individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To assess dengue serology status, we used dengue-specific antibodies by means of lateral-flow rapid test, as well as enzyme-linked immunosorbent assay (ELISA). Additionally, we tested SARS-CoV-2 serology status in patients with dengue and performed in-silico protein structural analysis to identify epitope similarities. Results. Using the dengue lateral-flow rapid test we detected 12 positive cases out of the 55 (21.8%) COVID- 19 patients versus zero positive cases in a control group of 70 healthy individuals (P = 2.5E-5). This includes 9 cases of positive immunoglobulin M (IgM), 2 cases of positive immunoglobulin G (IgG), and 1 case of positive IgM as well as IgG antibodies. ELISA testing for dengue was positive in 2 additional subjects using envelope protein directed antibodies. Out of 95 samples obtained from patients diagnosed with dengue before September 2019, SARS-CoV-2 serology targeting the S protein was positive/equivocal in 21 (22%) (16 IgA, 5 IgG) versus 4 positives/equivocal in 102 controls (4%) (P = 1.6E-4). Subsequent in-silico analysis revealed possible similarities between SARS-CoV-2 epitopes in the HR2 domain of the spike protein and the dengue envelope protein. Conclusions. Our findings support possible cross-reactivity between dengue virus and SARS-CoV-2, which can lead to false-positive dengue serology among COVID-19 patients and vice versa. This can have serious consequences for both patient care and public health.
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