{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T18:28:16Z","timestamp":1767205696819,"version":"build-2238731810"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["TropicalMed"],"abstract":"<jats:p>This study aimed to determine distinguishing predictors and develop a clinical score to differentiate COVID-19 and common viral infections (influenza, respiratory syncytial virus (RSV), dengue, chikungunya (CKV), and zika (ZKV)). This retrospective study enrolled 549 adults (100 COVID-19, 100 dengue, 100 influenza, 100 RSV, 100 CKV, and 49 ZKV) during the period 2017\u20132020. CKV and ZKV infections had specific clinical features (i.e., arthralgia and rash); therefore, these diseases were excluded. Multiple binary logistic regression models were fitted to identify significant predictors, and two scores were developed differentiating influenza\/RSV from COVID-19 (Flu-RSV\/COVID) and dengue from COVID-19 (Dengue\/COVID). The five independent predictors of influenza\/RSV were age &gt; 50 years, the presence of underlying disease, rhinorrhea, productive sputum, and lymphocyte count &lt; 1000 cell\/mm3. Likewise, the five independent predictors of dengue were headache, myalgia, no cough, platelet count &lt; 150,000\/mm3, and lymphocyte count &lt; 1000 cell\/mm3. The Flu-RSV\/COVID score (cut-off value of 4) demonstrated 88% sensitivity and specificity for predicting influenza\/RSV (AUROC = 0.94). The Dengue\/COVID score (cut-off value of 4) achieved 91% sensitivity and 94% specificity for differentiating dengue and COVID-19 (AUROC = 0.98). The Flu-RSV\/COVID and Dengue\/COVID scores had a high discriminative ability for differentiating influenza\/RSV or dengue infection and COVID-19. The further validation of these scores is needed to ensure their utility in clinical practice.<\/jats:p>","DOI":"10.3390\/tropicalmed8010061","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T02:29:57Z","timestamp":1673576997000},"page":"61","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Distinguishing SARS-CoV-2 Infection and Non-SARS-CoV-2 Viral Infections in Adult Patients through Clinical Score Tools"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-5550","authenticated-orcid":false,"given":"Rujipas","family":"Sirijatuphat","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kulprasut","family":"Sirianan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navin","family":"Horthongkham","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chulaluk","family":"Komoltri","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Siriraj Medical Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nasikarn","family":"Angkasekwinai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020, April 10). Coronavirus Disease 2019 (COVID-19) Situation Reports. Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/situation-reports."},{"key":"ref_2","unstructured":"Bureau of Information, Ministry of Public Health, Thailand (2022, October 06). COVID-19 News, Available online: https:\/\/ddc.moph.go.th."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41591-020-01202-8","article-title":"Immune determinants of COVID-19 disease presentation and severity","volume":"27","author":"Brodin","year":"2021","journal-title":"Nat. Med."},{"key":"ref_4","unstructured":"COVID-19 Treatment Guidelines Panel (2022, January 31). Coronavirus Disease 2019 (COVID-19) Treatment Guidelines, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bruminhent, J., Ruangsubvilai, N., Nabhindhakara, J., Ingsathit, A., and Kiertiburanakul, S. (2020). Clinical characteristics and risk factors for coronavirus disease 2019 (COVID-19) among patients under investigation in Thailand. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239250"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Costa, J., Ferreira, E.C., and Santos, C. (2021). COVID-19, Chikungunya, Dengue and Zika Diseases: An Analytical Platform Based on MALDI-TOF MS, IR Spectroscopy and RT-qPCR for Accurate Diagnosis and Accelerate Epidemics Control. Microorganisms, 9.","DOI":"10.3390\/microorganisms9040708"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sirijatuphat, R., Suputtamongkol, Y., Angkasekwinai, N., Horthongkham, N., Chayakulkeeree, M., Rattanaumpawan, P., Koomanachai, P., Assanasen, S., Rongrungruang, Y., and Chierakul, N. (2021). Epidemiology, clinical characteristics, and treatment outcomes of patients with COVID-19 at Thailand\u2019s university-based referral hospital. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06081-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/irv.12554","article-title":"Viral etiologies of influenza-like illness and severe acute respiratory infections in Thailand","volume":"12","author":"Chittaganpitch","year":"2018","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.4269\/ajtmh.13-0321","article-title":"The complex relationship between weather and dengue virus transmission in Thailand","volume":"89","author":"Campbell","year":"2013","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_10","unstructured":"Department of Disease Control, Ministry of Public Health Thailand (2022, December 27). Situation of Vector Borne Diseases in Thailand, Available online: https:\/\/ddc.moph.go.th\/dvb\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12929-021-00778-8","article-title":"Chikungunya virus infection: Molecular biology, clinicalcharacteristics, and epidemiology in Asian countries","volume":"28","author":"Khongwichit","year":"2021","journal-title":"J. Biomed. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/S1473-3099(20)30158-4","article-title":"Covert COVID-19 and false-positive dengue serology in Singapore","volume":"20","author":"Yan","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Garg, I., Gangu, K., Shuja, H., Agahi, A., Sharma, H., Bobba, A., Nasrullah, A., Chourasia, P., Pal, S., and Sheikh, A.B. (2022). COVID-19 and Influenza Coinfection Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample. Vaccines, 10.","DOI":"10.3390\/vaccines10122159"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Han, H., Saed, Y.A., Song, W., Wang, M., and Li, Y. (2022). Prevalence of Non-SARS-CoV-2 Respiratory Pathogens and Co-Infection with SARS-CoV-2 in the Early Stage of COVID-19 Epidemic. Pathogens, 11.","DOI":"10.3390\/pathogens11111292"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Alhumaid, S., Alabdulqader, M., Al Dossary, N., Al Alawi, Z., Alnaim, A.A., Al Mutared, K.M., Al Noaim, K., Al Ghamdi, M.A., Albahrani, S.J., and Alahmari, A.A. (2022). Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis. Trop. Med. Infect. Dis., 7.","DOI":"10.3390\/tropicalmed7110380"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zepeda-Carrillo, E.A., Soria Saavedra, F.M., Mercado Villegas, M.B., L\u00f3pez Alvarado, A., Regla-Nava, J.A., and Torres-Valadez, R. (2022). SARS-CoV-2 and Dengue Virus Coinfection in a Mexican Pediatric Patient: A Case Report from Early Molecular Diagnosis. Pathogens, 11.","DOI":"10.3390\/pathogens11111360"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Anderson, K.B., Simasathien, S., Watanaveeradej, V., Weg, A.L., Ellison, D.W., Suwanpakdee, D., Klungthong, C., Phonpakobsin, T., Kerdpanich, P., and Phiboonbanakit, D. (2018). Clinical and laboratory predictors of influenza infection among individuals with influenza-like illness presenting to an urban Thai hospital over a five-year period. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0193050"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1093\/infdis\/jiw649","article-title":"Clinical and Laboratory Diagnosis of Dengue Virus Infection","volume":"215","author":"Muller","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"405","DOI":"10.4269\/ajtmh.18-0636","article-title":"Clinical and Laboratory Characteristics of an Acute Chikungunya Outbreak in Bangladesh in 2017","volume":"100","author":"Rahman","year":"2019","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_20","first-page":"20","article-title":"Zika Virus Infection, Basic and Clinical Aspects: A Review Article","volume":"48","author":"Noorbakhsh","year":"2019","journal-title":"Iran. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Azeredo, E.L., Dos Santos, F.B., Barbosa, L.S., Souza, T.M.A., Badolato-Corr\u00eaa, J., S\u00e1nchez-Arcila, J.C., Nunes, P.C.G., de-Oliveira-Pinto, L.M., de Filippis, A.M., and Dal Fabbro, M. (2018). Clinical and Laboratory Profile of Zika and Dengue Infected Patients: Lessons Learned From the Co-circulation of Dengue, Zika and Chikungunya in Brazil. PLoS Curr., 10.","DOI":"10.1371\/currents.outbreaks.0bf6aeb4d30824de63c4d5d745b217f5"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jcv.2019.07.001","article-title":"Clinical manifestations and outcomes of respiratory syncytial virus infection in adult hospitalized patients","volume":"117","author":"Chuaychoo","year":"2019","journal-title":"J. Clin. Virol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"122","DOI":"10.21315\/mjms2018.25.4.12","article-title":"Sample Size Guidelines for Logistic Regression from Observational Studies with Large Population: Emphasis on the Accuracy Between Statistics and Parameters Based on Real Life Clinical Data","volume":"25","author":"Bujang","year":"2018","journal-title":"Malays. J. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1093\/cid\/ciw589","article-title":"Viremia and Clinical Presentation in Nicaraguan Patients Infected with Zika Virus, Chikungunya Virus, and Dengue Virus","volume":"63","author":"Waggoner","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1056\/NEJMoa0906612","article-title":"Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China","volume":"361","author":"Cao","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"593595","DOI":"10.3389\/fimmu.2021.593595","article-title":"Clinical and Immunological Factors That Distinguish COVID-19 From Pandemic Influenza A(H1N1)","volume":"12","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/thoraxjnl-2021-216949","article-title":"Clinical phenotypes and outcomes of SARS-CoV-2, influenza, RSV and seven other respiratory viruses: A retrospective study using complete hospital data","volume":"77","author":"Hedberg","year":"2022","journal-title":"Thorax"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1017\/ice.2020.187","article-title":"To alert coinfection of COVID-19 and dengue virus in developing countries in the dengue-endemic area","volume":"41","author":"Wu","year":"2020","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"001369","DOI":"10.1099\/jmm.0.001369","article-title":"Archived dengue serum samples produced false-positive results in SARS-CoV-2 lateral flow-based rapid antibody tests","volume":"70","author":"Nath","year":"2021","journal-title":"J. Med. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"745","DOI":"10.4269\/ajtmh.20-0912","article-title":"Differentiating Dengue from COVID-19: Comparison of Cases in Colombia","volume":"105","author":"Rosso","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"19713","DOI":"10.1038\/s41598-021-99027-z","article-title":"Differentiating coronavirus disease 2019 (COVID-19) from influenza and dengue","volume":"11","author":"Thein","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Luvira, V., Leaungwutiwong, P., Thippornchai, N., Thawornkuno, C., Chatchen, S., Chancharoenthana, W., Tandhavanant, S., Muangnoicharoen, S., Piyaphanee, W., and Chantratita, N. (2022). False Positivity of Anti-SARS-CoV-2 Antibodies in Patients with Acute Tropical Diseases in Thailand. Trop. Med. Infect. Dis., 7.","DOI":"10.3390\/tropicalmed7070132"}],"updated-by":[{"DOI":"10.3390\/tropicalmed10120341","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000}}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/1\/61\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:44:26Z","timestamp":1765183466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/1\/61"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["tropicalmed8010061"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed8010061","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,12]]}}}