Co-Infection Dynamics of SARS-CoV-2 and Dengue Virus

Co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue virus represents a pressing challenge in tropical and subtropical regions where both pathogens co-circulate. Clinical manifestations often overlap, with fever, headache, thrombocytopenia and elevated liver enzymes complicating early case identification. Co-infection may modulate disease severity through immune interference, whereby pre-existing dengue immunity alters host responses to SARS-CoV-2 and vice versa. Virological interactions in co-infected patients can influence viral replication kinetics and inflammatory profiles, potentially affecting transmissibility and clinical outcome. Diagnostic algorithms must account for serological cross-reactivity and possible antibody-dependent enhancement, while management protocols require balancing fluid resuscitation against the risk of pulmonary oedema. Improved understanding of the immunopathogenesis and epidemiology of dual infections is essential to refine surveillance, optimise treatment and guide vaccine strategies in dengue-endemic, pandemic-affected settings.

Research from Nature Portfolio

Recent work has developed predictive clinical and laboratory models to distinguish SARS-CoV-2 from dengue infection in areas of co-endemicity. By analysing cohorts presenting within five days of symptom onset, researchers identified key discriminators—such as lymphocyte count, platelet levels and specific respiratory or gastrointestinal symptoms—and constructed logistic regression tools achieving area under the curve values above 0.85. These algorithms offer practicable decision aids for frontline clinicians in resource-limited settings. Concurrent investigations into viral glycosylation have elucidated how common host-derived glycans on the SARS-CoV-2 spike protein may engage cross-reactive antibodies without neutralising effect, highlighting the need for assay designs that mitigate immunoassay interference in serosurveillance of multiple enveloped viruses.

Co-Infection Dynamics of SARS-CoV-2 and Dengue Virus publication trend

The graph below shows the total number of articles in co-infection dynamics of sars-cov-2 and dengue virus across all publications each year (not limited to Nature Index journals).

Technical terms

Co-infection: Simultaneous infection of a host by two distinct pathogens.

Serological cross-reactivity: The reaction of antibodies raised against one antigen with different, structurally related antigens from another pathogen.

Antibody-dependent enhancement (ADE): A phenomenon in which non-neutralising or sub-neutralising antibodies facilitate viral entry into host cells, potentially exacerbating disease.

Plasmablast: An activated B cell subtype that proliferates and secretes large quantities of antibodies during an acute immune response.

Non-structural protein 1 (NS1): A secreted glycoprotein of dengue virus involved in immune evasion and vascular leak, and targeted by diagnostic assays.

References

1. Differentiating coronavirus disease 2019 (COVID-19) from influenza and dengue. Scientific Reports (2021).
2. Glycan reactive anti-HIV-1 antibodies bind the SARS-CoV-2 spike protein but do not block viral entry. Scientific Reports (2021).
3. Early Release - Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020 - Volume 27, Number 2—February 2021 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2021).
4. Assessment of dengue and COVID-19 antibody rapid diagnostic tests cross-reactivity in Indonesia. Virology Journal (2021).
5. Antibodies against the SARS-CoV-2 S1-RBD cross-react with dengue virus and hinder dengue pathogenesis. Frontiers in Immunology (2022).