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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 73-74

COVID antibodies: An innocent bystander or a harbinger of ongoing inflammation and immune dysfunction

1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pediatrics, PGIMER, Chandigarh, India

Date of Submission29-Mar-2022
Date of Acceptance08-Apr-2022
Date of Web Publication12-May-2022

Correspondence Address:
Dr. Karthi Nallasamy
Department of Pediatrics, PGIMER, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcc.jpcc_26_22

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How to cite this article:
Ravikumar N, Nallasamy K. COVID antibodies: An innocent bystander or a harbinger of ongoing inflammation and immune dysfunction. J Pediatr Crit Care 2022;9:73-4

How to cite this URL:
Ravikumar N, Nallasamy K. COVID antibodies: An innocent bystander or a harbinger of ongoing inflammation and immune dysfunction. J Pediatr Crit Care [serial online] 2022 [cited 2023 Jun 2];9:73-4. Available from: http://www.jpcc.org.in/text.asp?2022/9/3/73/345093

Dengue and SARS-CoV-2 share overlapping clinical features. Possible antigenic cross-reactivity poses diagnostic challenges between these two viral infections.[1] Although co-infection results in high morbidity and mortality, computational modeling studies hypothesized that pre-exposure to dengue virus could be protective against COVID-19 severity as dengue antibodies may bind to SARS-CoV-2 receptor binding sites.[2] Conversely, in the South East Asian regions and other dengue-endemic countries, there was a fear of increased severity of dengue in those exposed to SARS-CoV-2 due to possible antibody-dependent enhancement.[3]

The authors have studied the effect of SARS-CoV-2 antibodies on the outcomes of hospitalized children with dengue.[4] As over two-thirds had NS1Ag positivity, cross-reaction of antibodies could be less likely at this early stage. This study did not show any difference in the mortality, duration of respiratory support, and length of hospital stay. However, the cohort consisted of over 95% of nonsevere dengue, and hence, this result is expected. In a similar study published recently where 68% of cases were severe dengue and 43% needed intensive care, the authors found a trend toward lesser severity of dengue in children recently exposed to SARS-CoV-2.[5]

A plethora of manifestations lasting for months after acute symptomatic SARS-CoV-2 infection termed as “long COVID” or “chronic COVID” is believed to be due to an ongoing inflammatory process and immunological mechanisms affecting multiple organ systems.[6] Among these, immune exhaustion is seen resulting in reduced cytotoxic T lymphocytes, reduced natural killer cells, and impairment in T cell proliferation and memory cell response, particularly in those affected with severe COVID-19. A series of bioinformatic analyses conducted to understand the mechanisms for co-infection showed shared host factors and signaling pathways.[7] Although more organ dysfunction was found in SARS-CoV-2–unexposed group in one of the studies, there was no difference in the total leukocyte count and interleukin-6 levels.[5] Sample size remains a major limitation in both the studies to draw concrete conclusions.

The dilemma remains as to whether cross-reactive antibodies would provide partial protection against severe dengue infection or lead to increased severity due to the well-known phenomenon of antibody-dependent enhancement seen in dengue. As we gear up to fight future waves of COVID-19, this should not side-line dengue control measures as even non-severe dengue remains more symptomatic than COVID-19 in a co-epidemic setting.[8] With COVID-19 shifting from a pandemic to being an endemic illness, whether mild or asymptomatic COVID-19 infection could affect immunological responses to other infections remains to be answered in the near future.

  References Top

Tsheten T, Clements AC, Gray DJ, Adhikary RK, Wangdi K. Clinical features and outcomes of COVID-19 and dengue co-infection: A systematic review. BMC Infect Dis 2021;21:729.  Back to cited text no. 1
Lustig Y, Keler S, Kolodny R, Ben-Tal N, Atias-Varon D, Shlush E, et al. Potential antigenic cross-reactivity between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue viruses. Clin Infect Dis 2021;73:e2444-9.  Back to cited text no. 2
Dash N, Rose W, Nallasamy K. India's lockdown exit: Are we prepared to lock horns with COVID-19 and dengue in the rainy season? Pediatr Res 2021;89:1047-8.  Back to cited text no. 3
Kolla S, Balleda L, Thimmapuram CS. Effect of severe acute respiratory syndrome coronavirus 2 antibodies on outcomes of dengue infected children: A retrospective observational study. J Pediatr Crit Care 2022;9: 80-3.  Back to cited text no. 4
  [Full text]  
Ravikumar N, Randhawa MS, Nallasamy K, Angurana SK, Kumar M, Mohi GK, et al. Impact of recent SARS-CoV-2 infection on the course and severity of dengue in children: A prospective observational study from North India. Am J Trop Med Hyg 2021;105:751-5.  Back to cited text no. 5
Ramakrishnan RK, Kashour T, Hamid Q, Halwani R, Tleyjeh IM. Unraveling the mystery surrounding post-acute sequelae of COVID-19. Front Immunol 2021;12:686029.  Back to cited text no. 6
Zheng W, Wu H, Liu C, Yan Q, Wang T, Wu P, et al. Identification of COVID-19 and dengue host factor interaction networks based on integrative bioinformatics analyses. Front Immunol 2021;12:707287.  Back to cited text no. 7
Joubert A, Andry F, Bertolotti A, Accot F, Koumar Y, Legrand F, et al. Distinguishing non severe cases of dengue from COVID-19 in the context of co-epidemics: A cohort study in a SARS-CoV-2 testing center on Reunion Island. PLoS Negl Trop Dis 2021;15:e0008879.  Back to cited text no. 8


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