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Lima MRQ, Nunes PCG, Dos Santos FB. Serological Diagnosis of Dengue. Methods Mol Biol 2022; 2409:173-196. [PMID: 34709642 DOI: 10.1007/978-1-0716-1879-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A reliable and specific diagnosis is imperative in viral diagnosis, both for clinical management and surveillance, and to ensure that early treatment and control measures are carried out. The number of days of illness is important to choose the most appropriate method to be used and for the correct interpretation of the results obtained. Specific IgM is elicited after that period, indicating an active infection and usually lasts up to 3 months. However, in DENV secondary infections, IgM levels may be significantly lower or undetectable. After 10-12 days, a lifetime specific IgG is produced. Routinely, the laboratory diagnosis of DENV infections can be performed by viral isolation and/or detection of viral nucleic acid, serological assays for the detection of specific antibodies (IgM/IgG), antigen (NS1) and the detection of viral antigens in tissues, which are suitable during certain phases of the disease. For serological diagnosis, serum, plasma, or cerebrospinal fluid (CSF) samples may be investigated. If the test is carried out a few days after collection, the specimens can be stored at 4 °C, since the immunoglobulins are stable in serum or plasma. If the storage period is extended, the material must be kept at -20 °C or -70 °C. In serology, several methods can be used to detect specific viral antigens and/or antibodies, produced by the host in response to DENV infection. Routinely, serological tests include the hemagglutination inhibition (HI) assay, the plaque reduction neutralizing test (PRNT), the gold standard assay for dengue immune response characterization, and ELISAs to detect IgM (MAC-ELISA) and IgG (IgG-ELISA).
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Affiliation(s)
- Monique R Q Lima
- Laboratório Estratégico de Diagnóstico (LED), Centro de Desenvolvimento Científico, Instituto Butantan, São Paulo, Brazil
| | - Priscila C G Nunes
- Laboratório Municipal de Saúde Pública (LASP), Laboratório de Virologia e Biotério, Subsecretaria de Vigilância, Fiscalização Sanitária e Controle de Zoonoses, Rio de Janeiro, Brazil
- Superintendência de Informações Estratégicas de Vigilância em Saúde (SIEVS/RJ), Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Flávia B Dos Santos
- Laboratório de Imunologia Viral (LIV), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
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Mata VE, Andrade CAFD, Passos SRL, Hökerberg YHM, Fukuoka LVB, Silva SAD. Rapid immunochromatographic tests for the diagnosis of dengue: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2020; 36:e00225618. [PMID: 32520127 DOI: 10.1590/0102-311x00225618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/18/2020] [Indexed: 11/22/2022] Open
Abstract
Dengue is an important arthropod-borne viral disease in terms of morbidity, mortality, economic impact and challenges in vector control. Benchmarks are expensive, time consuming and require trained personnel. Preventing dengue complications with rapid diagnosis has been based on the testing of easy-to-perform optimized immunochromatographic methods (ICT). This is a systematic meta-analysis review of the diagnostic accuracy of IgA, NS1, IgM and/or IgG ICT studies in suspected cases of acute or convalescent dengue, using a combination of RT-PCR, ELISA NS1, IgM IgG or viral isolation as a reference standard. This protocol was registered in PROSPERO (CRD42014009885). Two pairs of reviewers searched the PubMed, BIREME, Science Direct, Scopus, Web of Science, Ovid MEDLINE JBrigs, SCIRUS and EMBASE databases, selected, extracted, and quality-assessed by QUADAS 2. Of 3,783 studies, we selected 57, of which 40 in meta-analyses according to the analyte tested, with high heterogeneity (I2 > 90%), as expected for diagnostic tests. We detected higher pooled sensitivity in acute phase IgA (92.8%) with excellent (90%) specificity. ICT meta-analysis with NS1/IgM/IgG showed 91% sensitivity and 96% specificity. Poorer screening performance was for IgM/IgG ICT (sensitivity = 56%). Thus, the studies with NS1/IgM/IgG ICT showed the best combined performance in the acute phase of the disease.
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Rodriguez-Manzano J, Chia PY, Yeo TW, Holmes A, Georgiou P, Yacoub S. Improving Dengue Diagnostics and Management Through Innovative Technology. Curr Infect Dis Rep 2018; 20:25. [PMID: 29882167 PMCID: PMC5992235 DOI: 10.1007/s11908-018-0633-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Dengue continues to be a major global public health threat. Symptomatic infections can cause a spectrum of disease ranging from a mild febrile illness to severe and potentially life-threatening manifestations. Management relies on supportive treatment with careful fluid replacement. The purpose of this review is to define the unmet needs and challenges in current dengue diagnostics and patient monitoring and outline potential novel technologies to address these needs. RECENT FINDINGS There have been recent advances in molecular and point-of-care (POC) diagnostics as well as technologies including wireless communication, low-power microelectronics, and wearable sensors that have opened up new possibilities for management, clinical monitoring, and real-time surveillance of dengue. Novel platforms utilizing innovative technologies for POC dengue diagnostics and wearable patient monitors have the potential to revolutionize dengue surveillance, outbreak response, and management at population and individual levels. Validation studies of these technologies are urgently required in dengue-endemic areas.
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Affiliation(s)
- Jesus Rodriguez-Manzano
- Centre for Bio-inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Po Ying Chia
- Communicable Diseases Centre, Institute for Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tsin Wen Yeo
- Communicable Diseases Centre, Institute for Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
| | - Alison Holmes
- Department of Medicine, Imperial College London, London, UK
| | - Pantelis Georgiou
- Centre for Bio-inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Sophie Yacoub
- Department of Medicine, Imperial College London, London, UK.
- Singapore-MIT Alliance for Research and Technology, Singapore, Singapore.
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam.
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Dengue Specific Immunoglobulin A Antibody is Present in Urine and Associated with Disease Severity. Sci Rep 2016; 6:27298. [PMID: 27250703 PMCID: PMC4890044 DOI: 10.1038/srep27298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 05/16/2016] [Indexed: 11/09/2022] Open
Abstract
The kinetics of dengue virus (DENV)-specific IgA antibody in urine and the potential correlation with disease severity remain elusive. In this study, 262 serial urine samples from 78 laboratory-confirmed patients were assayed by a commercial immunoglobulin A (IgA) kit against DENV. All cases were classified into dengue fever (DF) and severe dengue (SD) according to the 2009 WHO/TDR guideline. The total positive rate of IgA in urine was 59%. DENV-specific IgA was detected in urine from day 2 to day 13 after the onset of illness in DF patients; While for SD patients, anti-DENV IgA could be detected till day 14. The positive rate of IgA in patients with secondary infection was higher than that in patients with primary infection. Importantly, during 4-7 days after the onset of illness, the IgA positive rate of SD patients was significantly higher than that of DF patients. Especially, the intensity of IgA signal in SD patients was obviously stronger than that in DF patient at the recovery stage. Overall, our results suggested that the existence of DENV-specific IgA antibodies in urine might be a warning sign for the severity of disease and its measurement might provide valuable guidance for proper patient management.
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Rapid Point-of-Care Diagnosis of Malaria and Dengue Infection. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A meta-analysis of the diagnostic accuracy of dengue virus-specific IgA antibody-based tests for detection of dengue infection. Epidemiol Infect 2015; 144:876-86. [DOI: 10.1017/s0950268815001922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYImmunoglobulin A (IgA)-based tests have been evaluated in different studies for their utility in diagnosing dengue infections. In most of the studies, the results were inconclusive because of a small sample size. Hence, a meta-analysis involving nine studies with 2096 samples was performed to assess the diagnostic accuracy of IgA-based tests in diagnosing dengue infections. The analysis was conducted using Meta-Disc software. The results revealed that IgA-based tests had an overall sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios of 73·9%, 95·2%, 66·7, 22·0 and 0·25, respectively. Significant heterogeneity was observed between the studies. The type of test, infection status and day of sample collection influenced the diagnostic accuracy. The IgA-based diagnostic tests showed a greater accuracy when the samples were collected 4 days after onset of symptoms and for secondary infections. The results suggested that IgA-based tests had a moderate level of accuracy and are diagnostic of the disease. However, negative results cannot be used alone for dengue diagnosis. More prospective studies comparing the diagnostic accuracy of combinations of antigen-based tests with either IgA or IgM are needed and might be useful for suggesting the best strategy for dengue diagnosis.
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De Decker S, Vray M, Sistek V, Labeau B, Enfissi A, Rousset D, Matheus S. Evaluation of the diagnostic accuracy of a new dengue IgA capture assay (Platelia Dengue IgA Capture, Bio-Rad) for dengue infection detection. PLoS Negl Trop Dis 2015; 9:e0003596. [PMID: 25803718 PMCID: PMC4372552 DOI: 10.1371/journal.pntd.0003596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/05/2015] [Indexed: 11/19/2022] Open
Abstract
Considering the short lifetime of IgA antibodies in serum and the key advantages of antibody detection ELISAs in terms of sensitivity and specificity, Bio-Rad has just developed a new ELISA test based on the detection of specific anti-dengue IgA. This study has been carried out to assess the performance of this Platelia Dengue IgA Capture assay for dengue infection detection. A total of 184 well-characterized samples provided by the French Guiana NRC sera collection (Laboratory of Virology, Institut Pasteur in French Guiana) were selected among samples collected between 2002 and 2013 from patients exhibiting a dengue-like syndrome. A first group included 134 sera from confirmed dengue-infected patients, and a second included 50 sera from non-dengue infected patients, all collected between day 3 and day 15 after the onset of fever. Dengue infection diagnoses were all confirmed using reference assays by direct virological identification using RT-PCR or virus culture on acute sera samples or on paired acute-phase sera samples of selected convalescent sera. This study revealed: i) a good overall sensitivity and specificity of the IgA index test, i.e., 93% and 88% respectively, indicating its good correlation to acute dengue diagnosis; and ii) a good concordance with the Panbio IgM capture ELISA. Because of the shorter persistence of dengue virus-specific IgA than IgM, these results underlined the relevance of this new test, which could significantly improve dengue diagnosis accuracy, especially in countries where dengue virus is (hyper-) endemic. It would allow for additional refinement of dengue diagnostic strategy.
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Affiliation(s)
- Sophie De Decker
- Institut Pasteur, Laboratoire de Virologie, Cayenne, Guyane Française
| | - Muriel Vray
- Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France
| | - Viridiana Sistek
- Institut Pasteur, Laboratoire de Virologie, Cayenne, Guyane Française
| | - Bhety Labeau
- Institut Pasteur, Laboratoire de Virologie, Cayenne, Guyane Française
| | - Antoine Enfissi
- Institut Pasteur, Laboratoire de Virologie, Cayenne, Guyane Française
| | - Dominique Rousset
- Institut Pasteur, Laboratoire de Virologie, Cayenne, Guyane Française
| | - Séverine Matheus
- Institut Pasteur, Laboratoire de Virologie, Cayenne, Guyane Française
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De La Cruz Hernández SI, Puerta-Guardo H, Flores-Aguilar H, González-Mateos S, López-Martinez I, Ortiz-Navarrete V, Ludert JE, Del Angel RM. A strong interferon response correlates with a milder dengue clinical condition. J Clin Virol 2014; 60:196-9. [PMID: 24793964 DOI: 10.1016/j.jcv.2014.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/28/2013] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Type 1 interferon (IFNα/β) has a significant role in establishing protection against virus infections. It has been well documented by in vitro studies that dengue virus (DENV) activates a robust IFNα/β response. However, DENV also induces a down-regulation of the JAK/STAT pathway, inhibiting the induction of interferon regulated genes. As a consequence, the role played by the IFN type 1 response in the protection of dengue patients is not fully understood. OBJECTIVE To compare IFN-α levels in dengue patients with dengue fever (DF) or dengue hemorrhagic fever (DHF) undergoing primary or secondary infections. STUDY DESIGN Two hundred and four serum samples were analyzed for IFN-α level by cytometric bead array. Patients' clinical condition was assigned following the WHO 1997 criteria and specific IgG and IgM antibodies were measured using commercial assays to determine primary and secondary infections. The infecting serotype was determined by qRT-PCR. RESULTS AND CONCLUSION The IFN-α levels were found significantly higher in DF than DHF patients irrespective of the infecting serotype (DENV1 or 2), and were found to decline rapidly at day 3 after fever onset. For DENV2 infections, higher IFN-α level was found during primary than secondary infections. These results suggest that an early strong interferon response correlates with a better clinical condition.
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Affiliation(s)
- Sergio Isaac De La Cruz Hernández
- Department of Virology, Institute for Diagnosis and Epidemiological Reference (InDRE), Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico; Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico
| | - Henry Puerta-Guardo
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico
| | - Hilario Flores-Aguilar
- Department of Inmunology and Inmunogenetics-InDRE, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico
| | - Silvia González-Mateos
- Department of Virology, Institute for Diagnosis and Epidemiological Reference (InDRE), Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico
| | - Irma López-Martinez
- Department of Virology, Institute for Diagnosis and Epidemiological Reference (InDRE), Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico
| | - Vianney Ortiz-Navarrete
- Department of Biomedicine, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico
| | - Juan E Ludert
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico.
| | - Rosa María Del Angel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico D.F., Mexico.
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Evaluation of efficacy of various immunochromatographic rapid tests for dengue diagnosis. Pak J Med Sci 2014; 30:166-71. [PMID: 24639854 PMCID: PMC3955565 DOI: 10.12669/pjms.301.4173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/08/2013] [Accepted: 10/12/2013] [Indexed: 11/15/2022] Open
Abstract
Objective: The immunochromatographic rapid tests facilitate the early diagnosis of dengue by providing evidence of the presence of virus specific proteins (antigens/ antibody) in human blood. Many products for rapid dengue diagnosis are available in the market; the performance of few selected products was evaluated and compared with enzyme linked immuno sorbent assays (ELISA). Methods: Sera from a large number of patients (n=184) admitted to National Institute of Blood Diseases & Bone Marrow Transplantation (NIBD) were used to determine the efficiency of non-structural (NS) 1, IgA, IgG and IgM based rapid test devices for dengue diagnosis. Results: The dengue NS1 antigen based device was least efficient while among the antibody based devices the dengue IgA rapid test (RDT) was comparatively better (specificity: 80.95%; sensitivity: 85.21%). This device could detect both primary and secondary dengue infection and was found to be the most sensitive device at all point of sample collection. Conclusion: The dengue IgA RDT could be a cost effective and efficient rapid test device for timely dengue diagnosis at all levels of healthcare settings.
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De La Cruz Hernández SI, Flores-Aguilar H, González-Mateos S, López-Martínez I, Ortiz-Navarrete V, Ludert JE, Del Angel RM. Viral load in patients infected with dengue is modulated by the presence of anti-dengue IgM antibodies. J Clin Virol 2013; 58:258-61. [DOI: 10.1016/j.jcv.2013.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 11/16/2022]
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de la Cruz-Hernández SI, Flores-Aguilar H, González-Mateos S, López-Martinez I, Alpuche-Aranda C, Ludert JE, del Angel RM. Determination of viremia and concentration of circulating nonstructural protein 1 in patients infected with dengue virus in Mexico. Am J Trop Med Hyg 2013; 88:446-54. [PMID: 23339203 DOI: 10.4269/ajtmh.12-0023] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Higher levels of viremia and circulating nonstructural protein 1 (NS1) have been associated with dengue disease severity. In this study, viremia and circulating NS1 levels were determined in 225 serum samples collected from patients in Mexico infected with dengue virus serotypes 1 and 2 (DENV-1 and DENV-2). Patients with dengue hemorrhagic fever (DHF) who were infected with DENV-1 showed higher levels of circulating NS1 than patients with dengue fever (DF) (P = 0.0175). Moreover, NS1 levels were higher in patients with primary infections with DENV-1 than in patient infected with DENV-2 (P < 0.0001) and in patients with primary infections with DENV-2 than in patients with secondary infections with DENV-2 (P = 0.0051). Unexpectedly, viremia levels were higher in patients with DF than in those with DHF infected with either DENV-1 or DENV-2 (P = 0.0019 and P = 0.001, respectively) and in patients with primary infections than those with secondary DENV-2 infections (P < 0.0001). Results indicate that levels of circulating NS1 vary according to the infecting serotype, immunologic status (primary or secondary infection), and dengue disease severity.
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Affiliation(s)
- Sergio I de la Cruz-Hernández
- Departament of Virology, Instituto de Diagnóstico y Referencia Epimiológicos, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico.
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Rathakrishnan A, Sekaran SD. New development in the diagnosis of dengue infections. ACTA ACUST UNITED AC 2012; 7:99-112. [DOI: 10.1517/17530059.2012.718759] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Commercial dengue rapid diagnostic tests for point-of-care application: recent evaluations and future needs? J Biomed Biotechnol 2012; 2012:151967. [PMID: 22654479 PMCID: PMC3357944 DOI: 10.1155/2012/151967] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 02/11/2012] [Indexed: 12/16/2022] Open
Abstract
Dengue fever, dengue haemorrhagic fever, and dengue shock syndrome (DF/DHF/DSS) are tropical diseases that cause significant humanitarian and economic hardship. It is estimated that more than 2.5 billion people are at risk of infection and more than 100 countries have endemic dengue virus transmission. Laboratory tests are essential to provide an accurate diagnosis of dengue virus infection so that appropriate treatment and patient management may be administered. In many dengue endemic settings, laboratory diagnostic resources are limited and simple rapid diagnostic tests (RDTs) provide opportunities for point-of-care diagnosis. This paper addresses current issues relating to the application of commercial dengue RDTs for the diagnosis of acute dengue virus infection, recent diagnostic evaluations, and identifies future needs.
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de la Cruz Hernández SI, González Mateos S, Flores Aguilar H, López Martinez I, Alpuche Aranda C, Ludert JE, Del Angel RM. Evaluation of a novel commercial rapid test for dengue diagnosis based on specific IgA detection. Diagn Microbiol Infect Dis 2012; 72:150-5. [PMID: 22248735 DOI: 10.1016/j.diagmicrobio.2011.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/31/2011] [Accepted: 11/08/2011] [Indexed: 01/31/2023]
Abstract
The performance of the novel commercial test ASSURE® Dengue IgA Rapid test (MP Diagnostics) was evaluated using a panel of 172 sera collected from dengue patients and 47 sera from healthy blood donors. The overall specificity and sensitivity were 61.0% and 85.1%, respectively. However, the positivity rate for IgA went from 33.3% for sera collected the same day of fever onset to 81.2% for sera collected 5 days after fever onset. Infections with serotype 2 viruses were detected more efficiently than those with serotype 1 viruses, and no sera from infections with serotypes 3 and 4 were available. In addition, the kit was twice more efficient at detecting secondary infections than at detecting primary infections. Finally, the ASSURE® test showed good repeatability and reproducibility. The results of this study suggest that the ASSURE® Dengue IgA Rapid test may become a useful and easy-to-use test for early dengue diagnosis.
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Affiliation(s)
- Sergio Isaac de la Cruz Hernández
- Departamento de Virología, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico D.F., Mexico
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Fry SR, Meyer M, Semple MG, Simmons CP, Sekaran SD, Huang JX, McElnea C, Huang CY, Valks A, Young PR, Cooper MA. The diagnostic sensitivity of dengue rapid test assays is significantly enhanced by using a combined antigen and antibody testing approach. PLoS Negl Trop Dis 2011; 5:e1199. [PMID: 21713023 PMCID: PMC3119643 DOI: 10.1371/journal.pntd.0001199] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 04/15/2011] [Indexed: 12/14/2022] Open
Abstract
Background Serological tests for IgM and IgG are routinely used in clinical laboratories for the rapid diagnosis of dengue and can differentiate between primary and secondary infections. Dengue virus non-structural protein 1 (NS1) has been identified as an early marker for acute dengue, and is typically present between days 1–9 post-onset of illness but following seroconversion it can be difficult to detect in serum. Aims To evaluate the performance of a newly developed Panbio® Dengue Early Rapid test for NS1 and determine if it can improve diagnostic sensitivity when used in combination with a commercial IgM/IgG rapid test. Methodology The clinical performance of the Dengue Early Rapid was evaluated in a retrospective study in Vietnam with 198 acute laboratory-confirmed positive and 100 negative samples. The performance of the Dengue Early Rapid in combination with the IgM/IgG Rapid test was also evaluated in Malaysia with 263 laboratory-confirmed positive and 30 negative samples. Key Results In Vietnam the sensitivity and specificity of the test was 69.2% (95% CI: 62.8% to 75.6%) and 96% (95% CI: 92.2% to 99.8) respectively. In Malaysia the performance was similar with 68.9% sensitivity (95% CI: 61.8% to 76.1%) and 96.7% specificity (95% CI: 82.8% to 99.9%) compared to RT-PCR. Importantly, when the Dengue Early Rapid test was used in combination with the IgM/IgG test the sensitivity increased to 93.0%. When the two tests were compared at each day post-onset of illness there was clear differentiation between the antigen and antibody markers. Conclusions This study highlights that using dengue NS1 antigen detection in combination with anti-glycoprotein E IgM and IgG serology can significantly increase the sensitivity of acute dengue diagnosis and extends the possible window of detection to include very early acute samples and enhances the clinical utility of rapid immunochromatographic testing for dengue. Dengue is a serious public health concern with around 3 billion people at risk of infection. Severe forms of the infection can be fatal and with no licensed vaccine or effective therapeutic currently available, early detection is important to assist with the clinical management of symptoms. Isolation of the virus and the detection of viral RNA using RT-PCR are commonly used methods for early diagnosis but are time-consuming, expensive and require skilled operation. Rapid immunochromatographic tests (ICT) are relatively simple, inexpensive and easy to perform at or near the point of care. Here, we report on the clinical performance of a new rapid ICT for the non-structural protein 1 (NS1) of dengue virus, a marker of acute infection. At two clinical study sites, NS1 was detected in 60–70% of laboratory-confirmed dengue cases and specificity of the test was >95%. We have also shown that a combined testing approach for both circulating NS1 antigen and antibody responses to the glycoprotein E of the virus can significantly improve diagnostic sensitivity compared to the detection of NS1 alone. Importantly, the combined antigen and antibody testing approach also provides an expanded window of detection from as early as day 1 post-onset of illness.
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Affiliation(s)
- Scott R. Fry
- Research and Development, Alere, Brisbane, Australia
| | | | | | - Cameron P. Simmons
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Shamala Devi Sekaran
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Johnny X. Huang
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | | | | | - Andrea Valks
- Research and Development, Alere, Brisbane, Australia
| | - Paul R. Young
- Centre for Infectious Disease Research, School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia
| | - Matthew A. Cooper
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
- * E-mail:
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