Case Report: False-Positive Dengue Non-Structural Protein 1 Antigen in a Patient with COVID-19 Infection

  • Yohanes Firmansyah Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
  • Jessica Elizabeth Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
  • Hendsun Hendsun Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
  • Darren Gosal Faculty of Medicine, Atmajaya University, Jakarta, Indonesia
Keywords: Non-Structural Protein 1 (NS1) Antigen, Dengue, COVID-19, False-Positive


Abstract: Early diagnosis of dengue fever and COVID-19 is made very easy due to technological advancements. The  non-structural protein 1 antigen test strips are widely used in various regions; however, false-positive events have begun to be reported in the dengue-endemic areas with the COVID-19 pandemic, even though statistically non-structural protein 1 antigens are very specific to dengue infection. We reported a case of the false-positive non-structural protein 1 test in a patient with COVID-19 infection.


Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity. 2020;109:102433. Available from:

Schulmeyer MCC. COVID-19. Revista Chilena de Anestesia. 2020;49(3). Available from:

Kannan S, Shaik Syed Ali P, Sheeza A et al. COVID-19 (Novel Coronavirus 2019) - recent trends. Eur Rev Med Pharmacol Sci. 2020;24(4):2006-2011. Available from:

Zhou P, Yang X-L, Wang X-G et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-273. Available from:

Sohrabi C, Alsafi Z, O'Neill N et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-76. Available from:

Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. Available from:

World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. World Health Organization. 2020.

Kemenkes RI. Situasi COVID-19. Kementerian Kesehatan RI. 2020.

Kemenkes RI. Pedoman Kesiapsiagaan Menghadapi Coronavirus Disease (COVID-19). Direkorat Jenderal Pencegah dan Pengendali Penyakit. 2020.

World Health Organization. Dengue guidelines for diagnosis, treatment, prevention and control: new edition. World Health Organization. c2009. 147p.

Simmons CP, Farrar JJ, van Vinh Chau N et al. Dengue. N Engl J Med. 2012;366(15):1423-1432. Available from:

Sun P, Lu X, Xu C et al. Understanding of COVID-19 based on current evidence. J Med Virol. 2020;92(6):548-551. Available from:

Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview. J Chin Med Assoc. 2020;83(3):217-220. Available from:

Shereen MA, Khan S, Kazmi A et al. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of Advanced Research. 2020;24. Available from:

Karyanti MR, Uiterwaal CSPM, Kusriastuti R et al. The changing incidence of Dengue Haemorrhagic Fever in Indonesia: a 45-year registry-based analysis. BMC Infect Dis. 2014;14(1):412. Available from:

Andries AC, Duong V, Ngan C et al. Field evaluation and impact on clinical management of a rapid diagnostic kit that detects dengue NS1, IgM and IgG. PLoS Negl Trop Dis. 2012;6(12):e1993. Available from:

Gan VC, Tan LK, Lye DC et al. Diagnosing dengue at the point-of-care: Utility of a rapid combined diagnostic kit in Singapore. PLoS One. 2014;9(3):e90037. Available from:

Blacksell SD, Jarman RG, Bailey MS et al. Evaluation of six commercial point-of-care tests for diagnosis of acute dengue infections: the need for combining NS1 antigen and IgM/IgG antibody detection to achieve acceptable levels of accuracy. Clin Vaccine Immunol. 2011;18(12):2095-2101. Available from:

Yan G, Lee CK, Lam LTM et al. Covert COVID-19 and false-positive dengue serology in Singapore. Lancet Infect Dis. 2020;20(5):536. Available from:

Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):e177. Available from:

Guan W, Ni Z, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-1720. Available from:

Yang L, Chen Y, Yan H et al. A survey of the 2014 dengue fever epidemic in Guangzhou, China. Emerg Microbes Infect. 2015;4(9):e57. Available from:

Wu D, Lu J, Liu Q et al. To alert co-infection of SARS-COV-2 and dengue virus in developing countries in the dengue-endemic area. Infect Control Hosp Epidemiol. 2020;1. Available from:

Colombo TE, Vedovello D, Araki CS et al. Dengue-4 false negative results by Panbio® Dengue Early ELISA assay in Brazil. J Clin Virol. 2013;58(4):710-712. Available from:

Felix AC, Romano CM, Centrone C de C et al. Low Sensitivity of NS1 Protein Tests Evidenced during a Dengue Type 2 Virus Outbreak in Santos, Brazil, in 2010. Clin Vaccine Immunol. 2012;19(12):1972-1976. Available from:

Pok K-Y, Lai Y-L, Sng J et al. Evaluation of Nonstructural 1 Antigen Assays for the Diagnosis and Surveillance of Dengue in Singapore. Vector Borne Zoonotic Dis. 2010;10(10):1009-1016. Available from:

Chuansumrit A, Chaiyaratana W, Pongthanapisith V et al. The Use of Dengue Nonstructural Protein 1 Antigen for the Early Diagnosis During the Febrile Stage in Patients With Dengue Infection. Pediatr Infect Dis J. 2008;27(1):43-48. Available from:

Wang SM, Sekaran SD. Evaluation of a Commercial SD Dengue Virus NS1 Antigen Capture Enzyme-Linked Immunosorbent Assay Kit for Early Diagnosis of Dengue Virus Infection. J Clin Microbiol. 2010;48(8):2793-2797. Available from:

Fry SR, Meyer M, Semple MG et al. The Diagnostic Sensitivity of Dengue Rapid Test Assays Is Significantly Enhanced by Using a Combined Antigen and Antibody Testing Approach. Guzman MG, editor. PLoS Negl Trop Dis. 2011;5(6):e1199. Available from:

Phuong HL, Thai KTD, Nga TTT et al. Detection of dengue nonstructural 1 (NS1) protein in Vietnamese patients with fever. Diagn Microbiol Infect Dis. 2009;63(4):372-378. Available from:

Ramanathan M, Duraisamy G. Haemophagocytosis in dengue haemorrhagic fever: a case report. Ann Acad Med Singapore. 1991;20(6):803-804.

Rueda E, Méndez A, González G. Hemophagocytic syndrome associated with dengue hemorrhagic fever. Biomedica. 2002;22(2):160-166. [published in Spanish]. Available from:

Case Reports