Occurrence of False-Positive Tests and Cross-reactions Between COVID-19 and Dengue With Implications During Diagnosis: A Mixed Evidence Synthesis

Abstract This review aimed to assess the occurrence of false-positive serological reaction between dengue and coronavirus disease 2019 (COVID-19) and its implications for diagnosis. Evidence syntheses were conducted by systematically reviewing available literature using multiple databases, including Web of Science, PubMed, Google Scholar and medRxiv. Among a total of 16 presented cases from clinical settings, cross-reaction to COVID-19 serological tests was observed in two (12.5%) dengue-positive patients, while 14 patients (87.5%) confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) showed a cross-reaction with dengue serological tests, leading to misdiagnosis and mismanagement by attending clinicians. Of 1789 SARS-CoV-2-positive sera, cross-reaction to dengue serological tests was observed in 180 sera (10%), which is higher than the cross-reaction observed for SARS-CoV-2 in archived pre-COVID-19 sera positive for a dengue infection (75 of 811, 9.2%, P = 0.674). Clinicians in tropical regions are therefore advised to interpret serological tests with caution and use a more pragmatic approach to triage these infections.