Diagnosis of dengue fever: roles of different laboratory test methods

Abstract

Background: Dengue fever is currently the most important arthropod borne viral disease. Since occurrence of dengue infections has been an epidemic in many parts of India and complications like DHF and DSS are increasing, while at the same time the diagnosis is challenging, particularly the laboratory diagnosis is confusing, this study was conducted to evaluate the different laboratory test methods and to compare their respective efficacy, timing, advantages and disadvantages.Methods: This study was done in the Department of Microbiology in collaboration with the Department of Medicine and Pediatrics in two tertiary care medical colleges and hospitals in eastern India. Blood samples from 319 patients with clinical features suggestive of Dengue fever were included in this study. Laboratory investigations were done which included immunological assays that were performed using commercially available kits - SD dengue duo NS1Ag + Ab combo rapid test, NS1 Ag capture ELISA, IgM capture ELISA, IgG capture ELISA test for dengue and other routine tests -full blood cell count, coagulation tests, routine biochemical and lipid profile were also done. Ethical considerations were taken care of and statistical evaluations were done.Results: An increased detection of IgM antibody (46.15%) was seen in the early febrile period (1-5 days) as compared to the mid-febrile period (6-10 days), and late febrile period (6-10 days) when it is 6.89%. IgG antibody is much less in early febrile period (4.16%). Compared to mid-febrile period (24.13%), and late febrile period (62.5%). IgM antibodies were detected in 44.5% of the samples, IgG antibodies were detected in 43.5% of the samples, Rapid test was positive in 36.9% and NS1AG ELISA was detected in 43.5% of the samples in the study.Conclusions: It can be inferred from our study that for detection of dengue in the early febrile period (1-5 days), estimation of dengue-specific serum IgM is the most sensitive antibody detection method.

Gender and age based evaluation of clinical signs and symptoms of dengue: A secondary data analysis

“…antibodies in the patient's blood whereas ELISA is used to differentiate between primary and secondary dengue infections [8]. For rapid diagnosis of the dengue virus, NS1 antigens are detected in the patient's blood [9].…”

Dilemma in laboratory diagnosis of Dengue, Chikungunya and Zika viruses

“…However, this is gradually being replaced by real time reverse transcriptase polymerase chain reaction (RT-PCR) method for more rapid diagnosis. 67 However, the tests are almost impractical in most places because of requirement of specialized laboratory facilities and are also laborious. They are feasible only in rare centers of national importance, and hence in most or almost all laboratory serological methods are being performed.…”

“…Thus, while the Rapid test can be more feasible in small peripheral laboratories and in field situations, in wellestablished laboratories, the concomitant performance of the Rapid test, with confirmation by the ELISA on those samples, ensures both rapidity as well as quality of reported results. 67 Whichever the test, the complexity of Dengue, Chikungunya and Zika virus diagnosis cannot be disregarded, showing thereby that a single assay alone cannot be totally relied upon. Thus, a diagnosis of a particular virus should always be made taking into account the clinical presentation of the patient, the performance characteristics of the serological test employed and the knowledge of the virus circulating in that particular geographical region.…”

Correlation of Temperature with Platelet Count and Total Leukocyte Count in Dengue: Findings from a Secondary Data Analysis

“…The treatment plan depends upon detection of IgM and IgG antibodies in the patient's blood whereas ELISA is used to differentiate between primary and secondary dengue infections. [9] For rapid diagnosis of the dengue virus, NS1 antigens are detected in the patient's blood. [10]The treatment of the infection is decided on the basis of severity of clinical features and level of fluids in the body.…”

“…[11]Viral prevention strategies include properly disposing off waste, up gradation of water storage system and proper usage of repellents. [9] There is no recommended vaccine yet for the eradication of the virus though a new live attenuated tetravalent vaccine is undergoing clinical trials. [12] To the best of author's knowledge, local data evaluating any potential association of fever with platelet count and total leukocyte count in the context of dengue fever are limited at best.…”