Dengue NS1 antigen as a marker of severe clinical disease

Abstract

BackgroundEarly detection of complications significantly reduces dengue associated mortality and morbidity. We set out to determine if the NS1 rapid antigen detection test could be used as a point of care test to predict severe disease.Methods186 adult patients with confirmed dengue were enrolled during day 3-8 of illness. Clinical and laboratory parameters were recorded during the course of the illness and NS1 antigen levels were determined using both the Panbio dengue early ELISA (Panbio, Australia) and a NS1 rapid antigen detection kit (SD Bioline, South Korea).Results59.1% of patients presented to hospital on day 5-6 of illness when NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47) and the NS1 antigen levels were significantly higher (p = 0.03) in those who went on to develop shock. Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts. The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort.ConclusionNS1 antigen positivity is associated with a higher risk of developing severe dengue especially when positive beyond day 5 of illness in our cohort, and while further validation studies are required, the test can therefore potentially be used as a bedside point of care test as a warning sign of severe dengue.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0570-8) contains supplementary material, which is available to authorized users.

Dengue NS1 antigen contributes to disease severity by inducing interleukin (IL)-10 by monocytes

“…Dengue NS1 antigen has been shown previously to associate with DHF, and indeed we found that it could also be considered as a marker of severe clinical disease [10]. In addition, our previous studies showed that serum IL-10 levels were also associated with severe dengue [7,8].…”

“…It has also been shown that dengue NS1 protein was associated with severe clinical disease and that a level of > 600 ng/ml in the first 72 h of illness was associated with the development of DHF . We also found that dengue NS1 antigen persisted in patients with DHF and that it could be possibly used as a marker of severe dengue .…”

Dengue NS1 Antigen for Early Detection of Dengue Infection

“…The study done by Paranavitane et al, (2014), found that platelet counts were lower in those who were NS1 antigen positive at the time of admission, but this was not significant. However, interestingly serum NS1 antigen levels significantly correlated with a serum interleukin (IL)-10 levels which are suggested as a possible marker of severe clinical disease.…”

“…However, due to the need for advanced laboratory facilities these two methods may not be suitable for routine diagnosis of dengue virus infection early in the disease in resource poor communities (Paranavitane et al, 2014). Serological diagnosis offers many advantages including more flexible schedules for testing, lower cost, and more widely available reagents.…”

Analytical Study of Viral Fever Cases Admitted in a Tertiary Care Hospital, Nellore, A.P.

“…Hence, the positivity to NS1 antigen should alert the treating clinician to closely monitor these children for early detection of the complications. 14,15 Thrombocytopenia was more commonly seen among children who were admitted in intensive care unit in comparison to those in the paediatric wards. Thrombocytopenia is defined as a platelet count below 1,50,000/cumm.…”