Abstract/Background
Dengue is the most important arthropod borne viral disease worldwide in terms
of morbidity and mortality and is caused by any of the four serotypes of
dengue virus (DENV-1 to 4). Brazil is responsible for approximately
80% of dengue cases in the Americas, and since the introduction of
dengue in 1986, a total of 5,944,270 cases have been reported including
21,596 dengue hemorrhagic fever and 874 fatal cases. DENV can infect many
cell types and cause diverse clinical and pathological effects. The goal of
the study was to investigate the usefulness of NS1 capture tests as an
alternative tool to detect DENV in tissue specimens from previously
confirmed dengue fatal cases (n = 23)
that occurred in 2002 in Brazil.
Methodology/Principal Findings
A total of 74 tissue specimens were available: liver
(n = 23), lung
(n = 14), kidney
(n = 04), brain
(n = 10), heart
(n = 02), skin
(n = 01), spleen
(n = 15), thymus
(n = 03) and lymph nodes
(n = 02). We evaluated three tests
for NS1 antigen capture: first generation Dengue Early ELISA (PanBio
Diagnostics), Platelia NS1 (BioRad Laboratories) and the rapid test NS1 Ag
Strip (BioRad Laboratories). The overall dengue fatal case diagnosis based
on the tissues analyzed by Dengue Early ELISA, Platelia NS1 and the NS1 Ag
Strip was 34.7% (08/23), 60.8% (14/23) and 91.3%
(21/23), respectively. The Dengue Early ELISA detected NS1 in 22.9%
(17/74) of the specimens analyzed and the Platelia NS1 in 45.9%
(34/74). The highest sensitivity (78.3%; 58/74) was achieved by the
NS1 Ag Strip, and the differences in the sensitivities were statistically
significant (p<0.05). The NS1 Ag Strip was the most
sensitive in liver (91.3%; 21/23), lung (71.4%; 10/14), kidney
(100%; 4/4), brain (80%; 8/10), spleen (66.6%, 10/15)
and thymus (100%, 3/3) when compared to the other two ELISA
assays.
Conclusions/Significance
This study shows the DENV NS1 capture assay as a rapid and valuable approach
to postmortem dengue confirmation. With an increasing number of DHF and
fatal cases, the availability of new approaches useful for cases
confirmation plays an important tool for the disease surveillance.