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Kalra C, Mittal G, Gupta P, Agarwal RK, Ahmad S. Role of IgM/ IgG Ratio in Distinguishing Primary and Secondary Dengue Viral Infections: A Cross-Sectional Study. Cureus 2024; 16:e66714. [PMID: 39262559 PMCID: PMC11390035 DOI: 10.7759/cureus.66714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 09/13/2024] Open
Abstract
Objectives In recent years, Uttarakhand, a state in North India has become one of the prime spots for tourism all over the world. Thereby, a tremendous increase in the epidemics of dengue infection has been observed recently. Secondary dengue causes more severe disease in comparison with primary, thus to differentiate the two is very crucial. We aim to find out the cut-off values of the IgM:IgG ratio for early detection of secondary dengue which could further help clinicians to prevent the complications. Methods A cross-sectional study was conducted over one year involving around 936 suspected cases of dengue. Samples were tested using the commercially available capture enzyme linked Immunosorbent assay (ELISA) method for IgM and IgG. Real-time and nested polymerase chain reaction (PCR) tests were also done to find out the prevalent serotype. IgM:IgG ratio was evaluated by using receiver operating characteristic curve analysis for the differentiation of primary and secondary dengue. Results Among the total 91 serologically confirmed dengue patients, forty-seven (51.6%) were found to be primary, and forty-four (48.4%) were secondary dengue infections with male preponderance. Using the WHO diagnostic criteria, patients with dengue fever (DF) without warning signs added up to 51.6%, with warning signs 42.9% and severe dengue 5.5% of the total cases. The cut-off ratio of IgM:IgG ratio = 1.59 found the best discrimination between primary and secondary infection. Forty out of ninety-one (44%) patients exhibited ratios of > 1.59 whereas the rest fifty-one (56%) exhibited ratios of < 1.59. Dengue virus - 2 (DENV- 2) was found to be the most prevalent serotype. Conclusion Our study recommends the cut-off values for IgM:IgG ratio as 1.59. Therefore it is hoped that this will guide the clinicians to early distinguish between primary and secondary dengue. Furthermore, it can reduce morbidity and mortality because of dengue infections in the future.
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Affiliation(s)
- Charu Kalra
- Microbilogy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Garima Mittal
- Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Priyanka Gupta
- Microbiology, Gautam Buddha Chikitsa Mahavidyalaya, Subharti University, Dehradun, IND
| | - Rajiv Kumar Agarwal
- Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Sohaib Ahmad
- Internal Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
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2
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Giri S, Anirvan P, Vaidya A, Praharaj DL. Dengue-related acute liver failure-A scoping review. Indian J Gastroenterol 2024; 43:407-424. [PMID: 38687431 DOI: 10.1007/s12664-024-01570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/09/2024] [Indexed: 05/02/2024]
Abstract
Infection by dengue virus is common in tropical countries. Hepatic involvement in dengue can range from asymptomatic elevation of transaminases to life-threatening acute liver failure (ALF). Dengue-related ALF (DALF) is responsible for significant morbidity and mortality, especially in Southeast Asia. However, there is a scarcity of literature on DALF, necessitating a thorough examination of its clinical determinants and management strategies. All relevant studies related to DALF were reviewed until December 2023. Case reports, case series and studies reporting ALF in dengue infection were included. Demographics, clinical profiles, management and outcomes of DALF cases were analyzed, which revealed a predominance of DALF incidence in pediatric patients (1.1% to 15.8%) and an upward trend over the years, particularly in India. The proportion of ALF cases attributable to dengue was also higher among pediatric ALF patients (6.7% to 34.3%). Age ≤ 40 years, persistent nausea, vomiting and elevated serum bilirubin and alkaline phosphatase (ALP) with aspartate aminotransferase (AST) > 1000 IU/mL within the first five days of illness, more than 10% of atypical lymphocytes in peripheral blood, platelet count of < 50,000/cu·mm, severe hepatitis at presentation and baseline model for end-stage liver disease (MELD) > 15 were the risk factors for the development of DALF. Histopathological features of DALF included multi-lobular hepatic necrosis, steatosis and occasional cholestasis. Mortality in DALF ranged from 0% to 80%; admission pH and lactate strongly predicted mortality, while mortality was found to be significantly higher in patients with cirrhosis. N-Acetyl cysteine (NAC) has been used as a treatment modality with varying results. There is limited evidence regarding the use of extra-corporeal support systems, while candidate selection for liver transplantation (LT) in DALF remains poorly defined.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751 024, India
| | - Prajna Anirvan
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Arun Vaidya
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, 400 012, India
| | - Dibya Lochan Praharaj
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751 024, India.
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3
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Thergarajan G, Sekaran SD. Diagnostic approaches for dengue infection. Expert Rev Mol Diagn 2023; 23:643-651. [PMID: 37417532 DOI: 10.1080/14737159.2023.2234815] [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] [Received: 03/20/2023] [Accepted: 07/06/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Every year, a significant rise in dengue incidence observed is responsible for 10% of fever episodes in children and adolescents in endemic countries. Considering that the symptoms of dengue are similar to those of many other viruses, early diagnosis of the disease has long been difficult, and lack of sensitive diagnostic tools may be another factor contributing to a rise in dengue incidence. AREAS COVERED This review will highlight dengue diagnostics strategies and discuss other possible targets for dengue diagnosis. Understanding the dynamics of the immune response and how it affects viral infection has enabled informed diagnosis. As more technologies emerge, precise assays that include some clinical markers need to be included. EXPERT OPINION Future diagnostic strategies will require the use both viral and clinical markers in a serial manner with the use of artificial intelligence technology to determine from the first point of illness to better determine severity status and management. A definitive endpoint is not in the horizon as the disease as well as the virus is constantly evolving and hence many developed assays need to be constantly changing some of their reagents periodically as newer genotypes and probably too serotypes emerge.
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4
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Badoni G, Gupta PK, Gupta P, Kaistha N, Mathuria YP, Pai MO, Kant R. Dengue-chikungunya infection in the tertiary care hospital of northern India: Cross-sectional latent class cluster analysis in viral infection. Heliyon 2023; 9:e14019. [PMID: 36925523 PMCID: PMC10011203 DOI: 10.1016/j.heliyon.2023.e14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Cases of dengue and chikungunya fever are escalating all over India. Both viruses share a common vector, the "Aedes" mosquito. Due to similar clinical symptoms, both the dengue (DENV) and chikungunya (CHIKV) virus can circulate as co-infection. There is very limited data available on dengue-chikungunya co-infection in Uttarakhand, India. The purpose of this study was to determine the seroprevalence of dengue and chikungunya virus infections, as well as their co-infection, in patients presenting with clinical symptoms. Serum samples of clinically suspected patients from the tertiary care hospital of Uttarakhand were collected, and Latent Class Cluster Analysis was performed for clinical profiling. ELISA was performed for DENV and CHIKV. 279 cases were enrolled, out of which 222 (79.5%) came positive for dengue NS1 Ag, 143 (51.2%) for dengue IgM, 98 (35.1%) for IgG followed by 16 (5.7%) of CHIKV IgM, and 4 (1.4%) were NS1 Ag with CHIKV IgM. Among the clinical features, fever (n = 270, 96.8%) was the most common symptom in all suspected dengue and chikungunya cases. Other symptoms like chills (n = 254, 91.0%), arthralgia (n = 241, 86.4%), and headache (n = 240, 86.0%) were present in a significant number. Results showed fewer odds of getting both DENV and CHIKV infection simultaneously, but the risk is still not negligible. This study explores the clinical presentation of the suspected dengue-chikungunya case. The increasing incidence of dengue and chikungunya and their co-infection necessitate the authorities' active surveillance of endemic regions and effective patient care management.
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Affiliation(s)
- Gaurav Badoni
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Puneet Kumar Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
- Corresponding author.
| | - Neelam Kaistha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Manju O. Pai
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ravi Kant
- Department of General Medicine, All India Institute of Medical Sciences, Rishikesh, India
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5
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The Specificity of the Persistent IgM Neutralizing Antibody Response in Zika Virus Infections among Individuals with Prior Dengue Virus Exposure. J Clin Microbiol 2021; 59:e0040021. [PMID: 33980647 DOI: 10.1128/jcm.00400-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Dengue viruses (DENV) and Zika virus (ZIKV) are related mosquito-borne flaviviruses with similar disease manifestations, vector ecologies, and geographic ranges. The ability to differentiate these viruses serologically is vital due to the teratogenic nature of ZIKV and the potential confounding of preexisting cross-reactive anti-DENV antibodies. Here, we illustrate the kinetics of the IgM neutralizing antibody (NAb) response using longitudinal samples ranging from acute ZIKV infection to late convalescence from individuals with evidence of prior DENV infection. By serially depleting antibody isotypes prior to the neutralization assay, we determined that IgM contributes predominantly to ZIKV neutralization and is less cross-reactive than the IgG NAb. The IgM NAb peaked around 14 days (95% confidence interval [95% CI], 13 to 15) and had a median duration of 257 days (95% CI, 133 to 427). These results demonstrate the persistence of IgM NAb after ZIKV infection and imply its potential role in diagnosis, vaccine evaluation, serosurveillance, and research on flavivirus-host interactions.
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6
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Falconi-Agapito F, Kerkhof K, Merino X, Michiels J, Van Esbroeck M, Bartholomeeusen K, Talledo M, Ariën KK. Dynamics of the Magnitude, Breadth and Depth of the Antibody Response at Epitope Level Following Dengue Infection. Front Immunol 2021; 12:686691. [PMID: 34290707 PMCID: PMC8289389 DOI: 10.3389/fimmu.2021.686691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
Dengue is a major public health problem in tropical and sub-tropical regions worldwide. Since the Zika epidemic and the increased co-circulation of other arboviruses, the serology-based diagnosis of dengue has become more problematic due to the high antigenic resemblance, especially among the flavivirus family. Therefore, a more comprehensive understanding of the diversity, specificity and temporal evolution of the antibody response following dengue infection is needed. In order to close this knowledge gap, we used a high-density peptide microarray of 9,072 linear peptides covering the entire proteome diversity of dengue, Zika, yellow fever and chikungunya viruses. The IgM and IgG antibody responses were measured against the designed microarray in symptomatic dengue infected individuals from an arbovirus endemic area in Peru and in overseas travelers returning to Belgium, as representatives of multiple-exposed and primary infections, respectively. Serum samples were collected longitudinally across four time points over the period of six months in Peru and over two time points in travelers. We show that epitopes eliciting the strongest flavivirus cross-reactive antibodies, in both primary and secondary infections were concentrated in the capsid, E, NS1, NS3 and NS5 proteins. The IgG antibody responses against NS1 and NS3 followed a rise-and-fall pattern, with peak titers between two to four weeks after onset of illness. The response to the E and NS5 proteins increased rapidly in the acute phase and was maintained at stable levels until at least 6 months after illness. A more scattered IgM antibody reactivity across the viral proteome was observed in the acute phase of the disease and that persisted through the 6-month window. The magnitude, breadth (i.e. number of unique epitopes targeted) and depth (i.e. number of epitope variants recognized) of the IgG response was higher in secondary infections compared to primary infections. For IgM antibodies, the magnitude of the response was higher in primary infected individuals whereas the breadth and depth of the response was lower in this group compared with the endemic subjects. Finally, through this arboviral proteome-wide epitope mapping, we were able to identify IgM and IgG dengue-specific epitopes which can be useful serological markers for dengue diagnosis and serostatus determination.
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Affiliation(s)
- Francesca Falconi-Agapito
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karen Kerkhof
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Xiomara Merino
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Johan Michiels
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, National Reference Center for Arboviruses, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Bartholomeeusen
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael Talledo
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kevin K. Ariën
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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7
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Kinetics of IgG Antibodies in Previous Cases of Dengue Fever-A Longitudinal Serological Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186580. [PMID: 32917033 PMCID: PMC7557381 DOI: 10.3390/ijerph17186580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022]
Abstract
Guangzhou is believed to be the most important epicenter of dengue outbreaks in southern China. In this study, a longitudinal serological investigation of previous cases of dengue fever in Guangzhou was conducted to explore the persistence of IgG antibodies and related factors affecting the changes of antibody level. We recruited 70 dengue virus type 1 (DENV-1) primary infection cases at two years post infection for serological investigation and conducted a second follow-up in the 5th year of prognosis. An enzyme-linked immunosorbent assay (ELISA) for DENV IgG antibody was examined in all study subjects. Potential factors associated with the concentration of serum total IgG antibody were determined by the generalized estimation equation (GEE). No significant difference in serum total IgG antibody positive rate between two follow-ups was observed (χ2 = 3.066, p = 0.080). However, there was a significant difference in the concentration of serum total IgG antibody between the two follow-ups (Z = 7.154, p < 0.001). The GEE showed that the antibody level in the five-year prognosis was mainly affected by the antibody level in the two-year prognosis (OR: 1.007, 95%CI: 1.005–1.009). In conclusion, the serum IgG antibodies of previous dengue fever cases can persist for a long time.
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8
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Lee CYP, Carissimo G, Chen Z, Lum FM, Abu Bakar F, Rajarethinam R, Teo TH, Torres-Ruesta A, Renia L, Ng LF. Type I interferon shapes the quantity and quality of the anti-Zika virus antibody response. Clin Transl Immunology 2020; 9:e1126. [PMID: 32346479 PMCID: PMC7184064 DOI: 10.1002/cti2.1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives Zika virus (ZIKV) is a mosquito-borne flavivirus that re-emerged in 2015. The association between ZIKV and neurological complications initiated the development of relevant animal models to understand the mechanisms underlying ZIKV-induced pathologies. Transient inhibition of the type I interferon (IFN) pathway through the use of an IFNAR1-blocking antibody, MAR1-5A3, could efficiently permit active virus replication in immunocompetent animals. Type I IFN signalling is involved in the regulation of humoral responses, and thus, it is crucial to investigate the potential effects of type I IFN blockade towards B-cell responses. Methods In this study, comparative analysis was conducted using serum samples collected from ZIKV-infected wild-type (WT) animals either administered with or without MAR1-5A3. Results Serological assays revealed a more robust ZIKV-specific IgG response and subtype switching upon inhibition of type I IFN due to the abundance of antigen availability. This observation was corroborated by an increase in germinal centres, plasma cells and germinal centre B cells. Interestingly, although both groups of animals recognised different B-cell linear epitopes in the E and NS1 regions, there was no difference in neutralising capacity. Further characterisation of these epitopes in the E protein revealed a detrimental role of antibodies that were generated in the absence of type I IFN. Conclusion This study highlights the role of type I IFN in shaping the anti-ZIKV antibody response to generate beneficial antibodies and will help guide development of better vaccine candidates triggering efficient neutralising antibodies and avoiding detrimental ones.
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Affiliation(s)
- Cheryl Yi-Pin Lee
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,NUS Graduate School for Integrative Sciences and Engineering National University of Singapore Singapore
| | - Guillaume Carissimo
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore
| | - Zheyuan Chen
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,School of Medicine Dentistry & Biomedical Sciences Queen's University Belfast Belfast UK
| | - Fok-Moon Lum
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore
| | - Farhana Abu Bakar
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,School of Biological Sciences Nanyang Technological University Singapore Singapore
| | - Ravisankar Rajarethinam
- Institute of Molecular and Cell Biology Agency of Science, Technology and Research (ASTAR) Singapore
| | - Teck-Hui Teo
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Present address: Institut Pasteur Unite de Pathogenie Microbienne Moleculaire Paris France
| | - Anthony Torres-Ruesta
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Department of Biochemistry Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Laurent Renia
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore
| | - Lisa Fp Ng
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Department of Biochemistry Yong Loo Lin School of Medicine National University of Singapore Singapore.,Institute of Infection and Global Health University of Liverpool Liverpool UK
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9
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Kerkhof K, Falconi-Agapito F, Van Esbroeck M, Talledo M, Ariën KK. Reliable Serological Diagnostic Tests for Arboviruses: Feasible or Utopia? Trends Microbiol 2019; 28:276-292. [PMID: 31864844 DOI: 10.1016/j.tim.2019.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Infections with arthropod-borne viruses are increasing globally as a result of climate and demographic changes, global dispersion of insect vectors, and increased air travel. The similar symptomatology of arboviral diseases and the cocirculation of different arboviruses in Africa, Asia, and South America complicate diagnosis. Despite the high sensitivity and specificity of molecular diagnostic tests, their utility is limited to the short viremic phase of arbovirus infections, and therefore the diagnosis of infection is frequently missed in clinical practice. Conversely, the duration of antibody responses provides a wider window of opportunity, making diagnosis more dependent on IgM/IgG detection. This review discusses the issues underlying the low specificity of antibody-detection assays, and addresses the challenges and strategies for discovering more specific biomarkers to enable a more accurate diagnosis.
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Affiliation(s)
- Karen Kerkhof
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Francesca Falconi-Agapito
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium; Molecular Epidemiology Laboratory, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, National Reference Center for Arboviruses, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael Talledo
- Molecular Epidemiology Laboratory, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kevin K Ariën
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
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10
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Farias LABG, Beserra FLCN, Fernandes L, Teixeira AAR, Ferragut JM, Girão ES, Pires Neto RDJ. Myocarditis Following Recent Chikungunya and Dengue Virus Coinfection: A Case Report. Arq Bras Cardiol 2019; 113:783-786. [PMID: 31553384 PMCID: PMC7020867 DOI: 10.5935/abc.20190187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - Lucas Fernandes
- Universidade Federal do Ceará (UFC) - Faculdade de Medicina, Fortaleza, CE - Brazil
| | | | | | | | - Roberto da Justa Pires Neto
- Hospital São José de Doenças Infecciosas, Fortaleza, CE - Brazil.,Faculdade de Medicina da Universidade Federal do Ceará - Departamento de Saúde Comunitária, Fortaleza, CE - Brazil
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11
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Chelluboina S, Robin S, Aswathyraj S, Arunkumar G. Persistence of antibody response in chikungunya. Virusdisease 2019; 30:469-473. [PMID: 31803816 DOI: 10.1007/s13337-019-00534-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/15/2019] [Indexed: 10/26/2022] Open
Abstract
Chikungunya is a mosquito-borne viral illness associated with chronic arthritic symptoms that persist for months. The IgM antibody appears within a week post any infection and declines at 2-3 months. The present study was aimed to demonstrate the presence of specific IgM antibody among chikungunya confirmed cases. Blood samples were collected from chikungunya PCR positive patients at the time of diagnosis, at 1-week, 1, 8, 10 and 12 months post infection. All acute and follow-up serum samples were evaluated for chikungunya virus-specific IgM antibodies using ELISA technique. Our findings indicate the persistence of anti-chikungunya IgM up to 10-months post-infection in a majority of chikungunya virus infected persons. Interpretation of results should be carefully done as only IgM ELISA is used to diagnose acute infection, especially post chikungunya outbreak. The presence of IgM antibody does not rule out the absence of any other diagnosis due to its persistence. Thus, we hypothesize that real-time PCR is more reliable for the detection of acute chikungunya cases in endemic areas while IgM detection may be useful in identifying exposure to this disease.
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Affiliation(s)
- Shweta Chelluboina
- Manipal Centre for Virus Research, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka 576104 India
| | - S Robin
- Manipal Centre for Virus Research, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka 576104 India
| | - S Aswathyraj
- Manipal Centre for Virus Research, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka 576104 India
| | - G Arunkumar
- Manipal Centre for Virus Research, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka 576104 India
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12
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Nguyen NM, Duong BT, Azam M, Phuong TT, Park H, Thuy PTB, Yeo SJ. Diagnostic Performance of Dengue Virus Envelope Domain III in Acute Dengue Infection. Int J Mol Sci 2019; 20:ijms20143464. [PMID: 31311082 PMCID: PMC6679088 DOI: 10.3390/ijms20143464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
Dengue, one of the most prevalent illnesses caused by dengue viruses that are members of the genus Flavivirus, is a significant global health problem. However, similar clinical symptoms and high antigenic homologies with other Flaviviruses in the endemic area pose difficulties for differential diagnosis of dengue from other arbovirus infections. Here, we investigated four types of recombinant envelope protein domain III (DV-rED III) derived from four dengue virus (DENV) serotypes for diagnostic potential in detecting IgM in acute phase (mainly 2–3 days after onset of fever). Each independent DV-1, -3, and -4-rED III-ELISA showed less than 60% sensitivity, but the combined results of DV-1, -3, and -4-rED III-ELISA led to sensitivity of 81.82% (18/22) (95% CI, 59.72 to 94.81) and 100% specificity (46/46) (95% CI, 92.29 to 100.00) as each antigen compensated the other antigen-derived negative result. In conclusion, the independent combination of data derived from each recombinant antigen (DV1-, DV3-, and DV4-rED III) showed comparable efficacy for the detection of IgM in patients with acute-phase dengue infection.
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Affiliation(s)
- Ngoc Minh Nguyen
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 570-749, Korea
| | - Bao Tuan Duong
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 570-749, Korea
| | - Mudsser Azam
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 570-749, Korea
| | | | - Hyun Park
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 570-749, Korea
| | - Phung Thi Bich Thuy
- Department of Research of Biomolecular for Infectious Disease, National Children's Hospital, Hanoi 100000, Vietnam.
| | - Seon-Ju Yeo
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 570-749, Korea.
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13
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Le Turnier P, Bonifay T, Mosnier E, Schaub R, Jolivet A, Demar M, Bourhy P, Nacher M, Djossou F, Epelboin L. Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana. Open Forum Infect Dis 2019; 6:ofz323. [PMID: 31660403 PMCID: PMC6735690 DOI: 10.1093/ofid/ofz323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Objective Leptospirosis and dengue fever (DF) are hard-to-differentiate diseases in cocirculating areas, especially during DF epidemics. Misdiagnosis and ensuing lack of antibiotic therapy can be detrimental in leptospirosis. The objective of this study was to identify factors that help differentiate acute leptospirosis from dengue fever on admission. Method Patients with leptospirosis (positive serology or polymerase chain reaction) were compared with patients with DF (positive nonstructural 1 [NS1] antigen) in a case-control study with age matching. Data on admission were compared using bivariate analysis and multivariate analysis. Results Seventy-two patients with leptospirosis were compared to 216 patients with DF. In bivariate analysis, the factors associated with leptospirosis were male gender, cough, anemia, and elevated blood levels of C-reactive protein (CRP), leukocytes, creatinine, bilirubin, and creatine phosphokinase. Exanthema, purpura, myalgia, headache, and neutropenia were associated with DF. In multivariate analysis, elevated blood levels of leukocytes, bilirubin, and CRP were associated with leptospirosis. The CRP threshold of 50 mg/L taken alone had elevated sensitivity and specificity. Conclusions The CRP level, an easy-to-obtain biomarker, was a powerful tool to differentiate on admission leptospirosis and DF. Facing a dengue-like syndrome in cocirculating areas and awaiting new specific rapid diagnostic tests, CRP dosing could help the clinician to promptly consider the diagnosis of leptospirosis and initiate antibiotic therapy early.
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Affiliation(s)
- Paul Le Turnier
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Timothée Bonifay
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Département de Médecine Générale, Université Antilles Guyane, Pointe-à-Pitre, Guadeloupe
| | - Emilie Mosnier
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Centres Délocalisés de Prévention et de Soins, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Roxane Schaub
- Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Centre d'Investigation Clinique Antilles Guyane, INSERM CIC 1424, Cayenne, French Guiana
| | - Anne Jolivet
- Service de Santé Publique, Hopital Franck Joly, Saint-Laurent du Maroni, French Guiana
| | - Magalie Demar
- Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pascale Bourhy
- Institut Pasteur, Centre National de Référence de la Leptospirose, Paris, France
| | - Mathieu Nacher
- Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Centre d'Investigation Clinique Antilles Guyane, INSERM CIC 1424, Cayenne, French Guiana
| | - Félix Djossou
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana
| | - Loïc Epelboin
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana
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14
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de Los Ángeles Ribas M, Tejero Y, Cordero Y, Pérez D, Sausy A, Muller CP, Hübschen JM. Identification of human parvovirus B19 among measles and rubella suspected patients from Cuba. J Med Virol 2019; 91:1351-1354. [PMID: 30817853 DOI: 10.1002/jmv.25444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Abstract
Between September 2014 and December 2015, 298 sera from rash and fever patients from all over Cuba were investigated for specific IgM antibodies against measles, rubella, dengue, human parvovirus B19 (B19V) and human herpesvirus 6 (HHV6) using a commercial enzyme-linked immunosorbent assay kits. B19V IgM positive and equivocal samples were investigated by a polymerase chain reaction and genotyping. No measles, rubella or dengue cases were detected. HHV6-IgM antibodies were confirmed in 5.7% and B19V-IgM antibodies in 10.7% of the patients. A total of 31.3% of the B19V cases were between 5 and 9 years old and 34.4% were 20 years and older. The only B19V sequence obtained belonged to genotype 1a. Diagnosis was established for only 16% of the rash and fever patients, suggesting that other diseases such as Zika or Chikungunya may play a role.
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Affiliation(s)
- María de Los Ángeles Ribas
- Virology Department, National Reference Laboratory of Measles, Mumps, Rubella, Pedro Kourí Institute of Tropical Medicine, Havana, Cuba
| | - Yahisel Tejero
- Virology Department, National Reference Laboratory of Measles, Mumps, Rubella, Pedro Kourí Institute of Tropical Medicine, Havana, Cuba
| | - Yanislet Cordero
- Virology Department, National Reference Laboratory of Measles, Mumps, Rubella, Pedro Kourí Institute of Tropical Medicine, Havana, Cuba
| | - Daileny Pérez
- Virology Department, National Reference Laboratory of Measles, Mumps, Rubella, Pedro Kourí Institute of Tropical Medicine, Havana, Cuba
| | - Aurélie Sausy
- Department of Infection and Immunity, Infectious Diseases Research Unit, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Claude P Muller
- Department of Infection and Immunity, Infectious Diseases Research Unit, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.,Institute of Immunology, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Judith M Hübschen
- Department of Infection and Immunity, Infectious Diseases Research Unit, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
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15
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Bhargava A, Ralph R, Chatterjee B, Bottieau E. Assessment and initial management of acute undifferentiated fever in tropical and subtropical regions. BMJ 2018; 363:k4766. [PMID: 30498133 DOI: 10.1136/bmj.k4766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Department of Medicine, McGill University, Montreal, Canada
| | - Ravikar Ralph
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Biswaroop Chatterjee
- Department of Microbiology, IQ City Medical College, Durgapur, West Bengal, India
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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16
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Klitting R, Fischer C, Drexler JF, Gould EA, Roiz D, Paupy C, de Lamballerie X. What Does the Future Hold for Yellow Fever Virus? (II). Genes (Basel) 2018; 9:E425. [PMID: 30134625 PMCID: PMC6162518 DOI: 10.3390/genes9090425] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023] Open
Abstract
As revealed by the recent resurgence of yellow fever virus (YFV) activity in the tropical regions of Africa and South America, YFV control measures need urgent rethinking. Over the last decade, most reported outbreaks occurred in, or eventually reached, areas with low vaccination coverage but that are suitable for virus transmission, with an unprecedented risk of expansion to densely populated territories in Africa, South America and Asia. As reflected in the World Health Organization's initiative launched in 2017, it is high time to strengthen epidemiological surveillance to monitor accurately viral dissemination, and redefine vaccination recommendation areas. Vector-control and immunisation measures need to be adapted and vaccine manufacturing must be reconciled with an increasing demand. We will have to face more yellow fever (YF) cases in the upcoming years. Hence, improving disease management through the development of efficient treatments will prove most beneficial. Undoubtedly, these developments will require in-depth descriptions of YFV biology at molecular, physiological and ecological levels. This second section of a two-part review describes the current state of knowledge and gaps regarding the molecular biology of YFV, along with an overview of the tools that can be used to manage the disease at the individual, local and global levels.
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Affiliation(s)
- Raphaëlle Klitting
- Unité des Virus Émergents (UVE: Aix-Marseille Univ⁻IRD 190⁻Inserm 1207⁻IHU Méditerranée Infection), 13385 Marseille CEDEX 05, France.
| | - Carlo Fischer
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, 10117 Berlin, Germany.
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany.
| | - Jan F Drexler
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, 10117 Berlin, Germany.
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany.
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, 119991 Moscow, Russia.
| | - Ernest A Gould
- Unité des Virus Émergents (UVE: Aix-Marseille Univ⁻IRD 190⁻Inserm 1207⁻IHU Méditerranée Infection), 13385 Marseille CEDEX 05, France.
| | - David Roiz
- UMR Maladies Infectieuses et Vecteurs: Écologie, Génétique Évolution et Contrôle (MIVEGEC: IRD, CNRS, Univ. Montpellier), 34394 Montpellier, France.
| | - Christophe Paupy
- UMR Maladies Infectieuses et Vecteurs: Écologie, Génétique Évolution et Contrôle (MIVEGEC: IRD, CNRS, Univ. Montpellier), 34394 Montpellier, France.
| | - Xavier de Lamballerie
- Unité des Virus Émergents (UVE: Aix-Marseille Univ⁻IRD 190⁻Inserm 1207⁻IHU Méditerranée Infection), 13385 Marseille CEDEX 05, France.
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17
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Chien YW, Liu ZH, Tseng FC, Ho TC, Guo HR, Ko NY, Ko WC, Perng GC. Prolonged persistence of IgM against dengue virus detected by commonly used commercial assays. BMC Infect Dis 2018; 18:156. [PMID: 29609533 PMCID: PMC5880084 DOI: 10.1186/s12879-018-3058-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Initial symptoms of dengue fever are non-specific, and thus definite diagnosis requires laboratory confirmation. Detection of IgM against dengue virus (DENV) has become widely used for dengue diagnosis. Understanding the persistence of anti-DENV IgM in subjects after acute infection is essential in order to interpret test results correctly. Although the longevity of anti-DENV IgM has been vehemently investigated in symptomatic children, anti-DENV IgM persistence in adults and in asymptomatically infected people have seldom been reported. METHODS We prospectively investigated 44 adults with detectable anti-DENV IgM in a serosurvey conducted in the 2015 dengue epidemic in Tainan, Taiwan. Among subjects within the cohort, 17 were classified to be symptomatic and 27 were asymptomatic. The enzyme-linked immunosorbent assay (ELISA) from Standard Diagnostic (SD) and Focus Diagnostic were used to detect anti-DENV IgM for specimens collected initially, at 6 and 12 months. Regression analyses were used to estimate the duration of anti-DENV IgM fell below the detectable level. Rapid dengue tests from Standard Diagnostics had been widely adopted to detect anti-DENV IgM in Taiwan during the 2015 dengue outbreak. As such, collected specimens were also evaluated with the SD rapid dengue test in parallel. RESULTS Anti-DENV IgM was detectable in 70.5 and 46.2% of the 44 subjects at 6 months and 12 months by the SD ELISA, respectively, while 13.6 and 7.7%, respectively, by the Focus ELISA. There was no significant difference in anti-DENV IgM detection for the follow-up specimens between subjects with symptomatic and asymptomatic infections. The regression analysis estimated that anti-DENV IgM persistence fell to the undetectable level at 338.3 days (95% CI 279.7-446.9) by SD ELISA, while at 175.7 days (95% CI 121.9-221.1) by Focus ELISA. The detectable frequency of anti-DENV IgM by rapid tests was 86.4%, 68.2 and 35.9% at initial, 6 and 12 months, respectively. CONCLUSION Anti-DENV IgM was found to persist much longer than previously thought, suggesting a necessity of re-evaluation of the use of anti-DENV IgM for both the diagnosis of dengue and serological surveillance, especially when large outbreaks have occurred in the preceding year.
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Affiliation(s)
- Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zi-Hu Liu
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fan-Chen Tseng
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Tzu-Chuan Ho
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - How-Ran Guo
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Guey Chuen Perng
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Abstract
Since the emergence and dissemination of Zika virus (ZIKV) in late 2015, our understanding of the biology, transmission, clinical disease, and potential sequelae associated with infection has markedly expanded. Over the past 2 years, the number of diagnostic assays for ZIKV has increased from none in 2015 to 5 serological assays and 14 molecular assays in 2017, all with emergency use authorization granted through the U.S. Food and Drug Administration. Here we provide an update on ZIKV, addressing what we have collectively learned since the outbreak began, including a summary of currently available diagnostic assays for this virus.
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20
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Chatterjee SS, Sharma A, Choudhury S, Chumber SK, Bage R, Parkhe N, Khanduri U. Dengue fever in a south Asian metropolis: a report on 219 cases. IRANIAN JOURNAL OF MICROBIOLOGY 2017; 9:174-185. [PMID: 29225757 PMCID: PMC5719512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Yearly epidemics of Dengue fever occur post-monsoon in India's capital, Delhi. A prospective observational study was conducted during the outbreak months to understand the epidemiology and outcome of this infection and its economic impact. MATERIALS AND METHODS Febrile hospitalized (n=219) patients with dengue fever diagnosed by a combination of MAC-ELISA, GAC-ELISA and NS1Antigen-ELISA were enrolled. Epidemiologic (including economic) parameters, clinical, radiological and laboratory manifestations were noted and patients followed up over the period of hospital stay. Patient management means and outcome were recorded and analysed. RESULTS As per WHO-2009, 153 (69.9%) and 27 (12.3%) patients were classified as dengue with warning signs and Severe Dengue respectively while according to WHO-1997 guidelines 39 (17.8%) and 18 (8.2%) patients were classified as DHF and DSS respectively. 216 patients were from the city while three were travellers; hospitalization was more frequent among the young and male gender. Fever, vomiting, aches and abdominal pain were the most common troublesome manifestations; classical dengue triad was present in 55 (25.1%) patients; hemorrhagic, neurologic and mucocutaneous manifestations were present in 44 (20.1%), 8 (3.7%) and 70 (32%) patients. Ascitis, pleural effusion, and Gall bladder wall oedema was found in 53 (24.2%), 31 (14.1%) and 45 (20.5%) patients respectively. Mortality was 1.4% (3 deaths); in addition there was an intra-uterine fetal death; mean expenditure per patient during the illness was US$ 377.25. CONCLUSION Dengue virus infection results in immense morbidity and substantial mortality.
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Affiliation(s)
- Shiv Sekhar Chatterjee
- Department of Laboratory Diagnostic Services, St Stephen Hospital, Delhi, India,Corresponding author: Dr. Shiv Sekhar Chatterjee, Assistant Professor, Department of Laboratory Diagnostic Services, St Stephen Hospital, Delhi, India. Tel: +9103325644070, +919748732366,
| | - Ankush Sharma
- Department of Laboratory Diagnostic Services, St Stephen Hospital, Delhi, India
| | | | | | - Ras Bage
- Department of Medicine, St Stephen Hospital, Delhi, India
| | - Nittin Parkhe
- Department of Radiology, St Stephen Hospital, Delhi, India
| | - Uma Khanduri
- Department of Laboratory Diagnostic Services, St Stephen Hospital, Delhi, India
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Chatterjee SS, Sharma A, Choudhury S, Chumber SK, Kaur M, Bage R, Parkhe N, Khanduri U. Significance of IgG optical density ratios (index value) in single reactive anti-Dengue virus IgG capture ELISA. IRANIAN JOURNAL OF MICROBIOLOGY 2016; 8:395-400. [PMID: 28491251 PMCID: PMC5420395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES A single reactive IgG anti-Dengue virus ELISA test in the absence of IgM antibodies or NS1 antigen may denote current infection or past exposure to the virus. To determine whether IgG index value can be used to identify true current dengue infection we conducted a prospective observational study. MATERIALS AND METHODS Suspected dengue patients (n =1745) were tested in their first specimen by MAC-ELISA, GAC-ELISA and NS1 antigen ELISA. Patients with MAC-ELISA and NS1Antigen non-reactive but GAC-ELISA reactive results (n =57) in their first test were followed up and repeated sampling was asked for IgG index values were calculated according to the manufacturer's instruction and classified as: low (2.2-2.5), medium (2.5-4.0) and high (>4.0). RESULTS 16 out of 57 patients (28.1%) had low IgG Index value whereas 26 cases (45.6%) were categorized as medium and 15(26.3%) were classified as patients with high IgG index. Nine patients with paired reactive serology or antigen positive status were categorised as serologically confirmed dengue fever, 11 patients as not dengue with categorical evidence of other infections while the rest 37 casas with clinical, radiological and laboratory parameters suggestive of dengue but no serological confirmation as possible dengue. Among confirmed, possible and non-Dengue cases, 33.3, 32.4 and 0.0% had high Index value in comparison with 22.2, 29.7 and 27.3% showing low Index values, respectively. CONCLUSION Our results suggested a high IgG response in favour of true dengue infection than past exposure while no conclusions should drawn from a low or medium reactive GAC-ELISA results in the absence of IgM antibodies and NS1 Ag.
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Affiliation(s)
- Shiv Sekhar Chatterjee
- Corresponding author: Shiv Sekhar Chatterjee MD, FNB, Department of Laboratory Diagnostic Services, Stephen Hospital, Delhi, India; Microbiology, Nil Ratan Sircar Medical College, Kolkata, India. Tel: +919748732366, +913325644070, Fax: +91-33-2265-8179,
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Safronetz D, Sacko M, Sogoba N, Rosenke K, Martellaro C, Traoré S, Cissé I, Maiga O, Boisen M, Nelson D, Oottamasathien D, Millett M, Garry RF, Branco LM, Doumbia S, Feldmann H, Traoré MS. Vectorborne Infections, Mali. Emerg Infect Dis 2016; 22:340-2. [PMID: 26812625 PMCID: PMC4734548 DOI: 10.3201/eid2202.150688] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Affiliation(s)
- Yin Mo
- Ministry of Health Holdings, University Medicine Cluster, National University Health System, 1 Maritime Square, Singapore 099253, Singapore Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, 119228, Singapore
| | - Brenda Mae Alferez Salada
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, 119228, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, 119228, Singapore Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, Singapore 117597, Singapore
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Chiriboga J, Barragan V, Arroyo G, Sosa A, Birdsell DN, España K, Mora A, Espín E, Mejía ME, Morales M, Pinargote C, Gonzalez M, Hartskeerl R, Keim P, Bretas G, Eisenberg JNS, Trueba G. High Prevalence of Intermediate Leptospira spp. DNA in Febrile Humans from Urban and Rural Ecuador. Emerg Infect Dis 2016; 21:2141-7. [PMID: 26583534 PMCID: PMC4672404 DOI: 10.3201/eid2112.140659] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Intermediate clusters may cause disease in areas where dengue and malaria are present, so differential diagnosis is necessary. Leptospira spp., which comprise 3 clusters (pathogenic, saprophytic, and intermediate) that vary in pathogenicity, infect >1 million persons worldwide each year. The disease burden of the intermediate leptospires is unclear. To increase knowledge of this cluster, we used new molecular approaches to characterize Leptospira spp. in 464 samples from febrile patients in rural, semiurban, and urban communities in Ecuador; in 20 samples from nonfebrile persons in the rural community; and in 206 samples from animals in the semiurban community. We observed a higher percentage of leptospiral DNA–positive samples from febrile persons in rural (64%) versus urban (21%) and semiurban (25%) communities; no leptospires were detected in nonfebrile persons. The percentage of intermediate cluster strains in humans (96%) was higher than that of pathogenic cluster strains (4%); strains in animal samples belonged to intermediate (49%) and pathogenic (51%) clusters. Intermediate cluster strains may be causing a substantial amount of fever in coastal Ecuador.
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Marrs C, Olson G, Saade G, Hankins G, Wen T, Patel J, Weaver S. Zika Virus and Pregnancy: A Review of the Literature and Clinical Considerations. Am J Perinatol 2016; 33:625-39. [PMID: 26939047 PMCID: PMC5214529 DOI: 10.1055/s-0036-1580089] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The latest Zika virus (ZIKV) outbreak has reached epidemic proportions as it spreads throughout South and Central America. In November 2015, the Brazilian Ministry of Health reported a 20-fold increase in the number of cases of neonatal microcephaly, which corresponds geographically and temporally to the ZIKV outbreak. Case reports have provided some evidence of a causal link between maternal ZIKV infection, fetal microcephaly, and intracranial calcifications. The sparse data regarding ZIKV in pregnancy come solely from case reports and personal communications, and recommendations for management of ZIKV exposure during pregnancy are rapidly evolving. Our objective is to review and synthesize the current literature regarding ZIKV as it pertains to pregnancy and provide some assistance to clinicians who may have to manage a pregnant patient with potential exposure to ZIKV. We will also explore certain aspects of related viruses in pregnancy in hopes to shed light on this little-known topic.
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Affiliation(s)
- Caroline Marrs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Gayle Olson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - George Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Gary Hankins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Tony Wen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Janak Patel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The University of Texas Medical Branch, Galveston, Texas
| | - Scott Weaver
- Departments of Pathology and Microbiology and Immunology, The University of Texas Medical Branch, Galveston, Texas
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Plennevaux E, Sabchareon A, Limkittikul K, Chanthavanich P, Sirivichayakul C, Moureau A, Boaz M, Wartel TA, Saville M, Bouckenooghe A. Detection of dengue cases by serological testing in a dengue vaccine efficacy trial: Utility for efficacy evaluation and impact of future vaccine introduction. Vaccine 2016; 34:2707-12. [PMID: 27102820 DOI: 10.1016/j.vaccine.2016.04.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/29/2016] [Accepted: 04/11/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dengue diagnosis confirmation and surveillance are widely based on serological assays to detect anti-dengue IgM or IgG antibodies since such tests are affordable/user-friendly. The World Health Organization identified serological based diagnosis as a potential tool to define probable dengue cases in the context of vaccine trials, while acknowledging that this may have to be interpreted with caution. METHODS In a phase IIb randomized, placebo-controlled trial assessing the efficacy of a tetravalent dengue vaccine (CYD-TDV) in Thai schoolchildren, case definition was based on virological confirmation by either serotype-specific RT-PCRs or by NS1-antigen ELISA (Clinicaltrials.gov NCT00842530). Here, we characterized suspected dengue cases using IgM and IgG ELISA to assess their utility in evaluating probable dengue cases in the context of vaccine efficacy trials, comparing virologically-confirmed and serologically diagnosed dengue in the vaccine and placebo groups. Serologically probable cases were defined as: (1) IgM positive acute- or convalescent-phase samples, or (2) IgG positive acute-phase sample and ≥4-fold IgG increase between acute and convalescent-phase samples. RESULTS Serological diagnosis had good sensitivity (97.1%), but low specificity (85.1%) compared to virological confirmation. A high level of false positivity through serology diagnosis particularly in the 2 months post-vaccination was observed, and is most likely related to detection of the immune response to the dengue vaccine. This lack of specificity and bias with vaccination demonstrates the limitation of using IgM and IgG antibody responses to explore vaccine efficacy. CONCLUSION Reliance on serological assessments would lead to a significant number of false positives during routine clinical practice and surveillance following the introduction of the dengue vaccine.
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Affiliation(s)
- Eric Plennevaux
- Chief Medical Office, Sanofi Pasteur, Marcy l'Etoile, Lyon, France.
| | - Arunee Sabchareon
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kriengsak Limkittikul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pornthep Chanthavanich
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Annick Moureau
- Chief Medical Office, Sanofi Pasteur, Marcy l'Etoile, Lyon, France
| | - Mark Boaz
- Global Clinical Immunology, Sanofi Pasteur, Swiftwater, PA, United States
| | - T Anh Wartel
- Clinical Sciences and Medical Affairs Asia, Sanofi Pasteur, Singapore
| | - Melanie Saville
- Chief Medical Office, Sanofi Pasteur, Marcy l'Etoile, Lyon, France
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27
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Braga C, Albuquerque MDFPMD, Cordeiro MT, Castanha PMS, Ramesh A, Alexander N, Mello MJGD, Marques ETA, Martelli CMT. Prospective birth cohort in a hyperendemic dengue area in Northeast Brazil: methods and preliminary results. CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000100601. [PMID: 26886185 DOI: 10.1590/0102-311x00095815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/28/2015] [Indexed: 11/22/2022] Open
Abstract
Dengue cases have increased in younger age groups in Brazil. Maternal anti-dengue antibodies can have a protective effect in the first months of life, but their decline can increase the risk of severe dengue. A prospective birth cohort was established in 2011-2012 in the city of Recife, Pernambuco State, Brazil, to determine the incidence of serotype-specific dengue infection and the kinetics of transferred maternal anti-dengue antibodies in the first years of life. This article describes the design, methods and preliminary results of this cohort study. 354 children underwent clinical and laboratory monitoring for two years, with 15% losses to follow-up. The overall rate of new infections was approximately 10% in the first year of follow-up. Information on the force of serotype-specific dengue infection and the evaluation of transferred maternal antibodies can contribute to understanding dengue etiopathogenesis.
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Affiliation(s)
- Cynthia Braga
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
| | | | | | | | - Anita Ramesh
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
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28
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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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29
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Pozzetto B, Memmi M, Garraud O. Is transfusion-transmitted dengue fever a potential public health threat? World J Virol 2015; 4:113-123. [PMID: 25964876 PMCID: PMC4419115 DOI: 10.5501/wjv.v4.i2.113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/29/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
Dengue is an arboviruses due to single-stranded enveloped ribonucleic acid viruses, named dengue viruses (DENV), that include four serotypes and are mainly transmitted via the bite of mosquitoes of the genus Aedes (A. aegypti and A. albopictus). The distribution of the disease was historically limited to intertropical areas; however, during the last thirty years, the perimeter of the disease extended considerably and temperate areas are now at risk of outbreaks. The present global burden of dengue is considerable: 2.5 billion people over more than 100 countries are concerned; 50 to 100 million infections occur every year, with a number of fatal cases of approximately 20000. Although frequently asymptomatic or limited to a mild fever, dengue is responsible for severe cases mainly consecutive to the occurrence of hemorrhagic complications that can lead to shock and death, notably in children from poor-resource settings. The place of DENV as a transfusion-transmitted pathogen has been recognized only in 2008. At the present time, only five cases of transfusion-transmitted dengue, including one case of dengue hemorrhagic fever, have been formerly documented. This review provides a general overview of dengue, its viruses and their vectors. It replaces the disease in the context of other viral diseases transmitted by arthropods. It discusses the threat of dengue on the supply of blood products in endemic and non endemic areas. Finally, it describes the specific and non specific measures available for improving the security of blood products with regards to this emerging risk. Interestingly, in 2009, the American Association of Blood Banks placed DENV in the highest category of emerging infectious agents for their potential impact on transfusion recipient safety for the next years in North America.
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30
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Chikungunya virus RNA and antibody testing at a National Reference Laboratory since the emergence of Chikungunya virus in the Americas. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 22:291-7. [PMID: 25540275 DOI: 10.1128/cvi.00720-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since first reported in the Americas in December 2013, chikungunya virus (CHIKV) infections have been documented in travelers returning from the Caribbean, with many cases identified by CHIKV antibody and/or RNA testing at our laboratory. We used our large data set to characterize the relationship between antibody titers and RNA detection and to estimate IgM persistence. CHIKV RNA was measured by nucleic acid amplification and CHIKV IgG/IgM by indirect immunofluorescence. Of the 1,306 samples submitted for RNA testing in January through September 2014, 393 (30%) were positive; for 166 RNA-positive samples, CHIKV antibody testing was also ordered, and 84% were antibody negative. Of the 6,971 sera submitted for antibody testing in January through September 2014, 1,811 (26%) were IgM positive; 1,461 IgM positives (81%) were also IgG positive. The relationship between the CHIKV antibody titers and RNA detection was evaluated using 376 IgM-positive samples (138 with RNA testing ordered and 238 deidentified and tested for RNA). RNA detection showed no significant association with the IgM titer but was inversely related to the IgG titer; 63% of the IgG negative sera were RNA positive, compared to 36% of sera with low IgG titers (1:10 to 1:80) and 16% with IgG titers of ≥1:160. Using second-sample results from 62 seroconverters, we estimated that CHIKV IgM persists for 110 days (95% confidence interval, 78 to 150 days) after the initial antibody-negative sample. These findings indicate that (i) RNA detection is more sensitive than antibody detection early in CHIKV infection, (ii) in the absence of RNA results, the IgG titer of the IgM-positive samples may be a useful surrogate for viremia, and (iii) CHIKV IgM persists for approximately 4 months after symptom onset.
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Corbett KS, Katzelnick L, Tissera H, Amerasinghe A, de Silva AD, de Silva AM. Preexisting neutralizing antibody responses distinguish clinically inapparent and apparent dengue virus infections in a Sri Lankan pediatric cohort. J Infect Dis 2014; 211:590-9. [PMID: 25336728 DOI: 10.1093/infdis/jiu481] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Dengue viruses (DENVs) are mosquito-borne flaviviruses that infect humans. The clinical presentation of DENV infection ranges from inapparent infection to dengue hemorrhagic fever and dengue shock syndrome. We analyzed samples from a pediatric dengue cohort study in Sri Lanka to explore whether antibody responses differentiated clinically apparent infections from clinically inapparent infections. In DENV-naive individuals exposed to primary DENV infections, we observed no difference in the quantity or quality of acquired antibodies between inapparent and apparent infections. Children who experienced primary infections had broad, serotype-cross-neutralizing antibody responses that narrowed in breadth to a single serotype over a 12-month period after infection. In DENV immune children who were experiencing a repeat infection, we observed a strong association between preexisting neutralizing antibodies and clinical outcome. Notably, children with preexisting monospecific neutralizing antibody responses were more likely to develop fever than children with cross-neutralizing responses. Preexisting DENV neutralizing antibodies are correlated with protection from dengue disease.
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Affiliation(s)
- Kizzmekia S Corbett
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill
| | - Leah Katzelnick
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill Centre of Pathogen Evolution, University of Cambridge, United Kingdom
| | | | | | | | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill
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32
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Advances in the understanding, management, and prevention of dengue. J Clin Virol 2014; 64:153-9. [PMID: 25453329 DOI: 10.1016/j.jcv.2014.08.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/25/2014] [Indexed: 01/09/2023]
Abstract
Dengue causes more human morbidity globally than any other vector-borne viral disease. Recent research has led to improved epidemiological methods that predict disease burden and factors involved in transmission, a better understanding of immune responses in infection, and enhanced animal models. In addition, a number of control measures, including preventative vaccines, are in clinical trials. However, significant gaps remain, including the need for better surveillance in large parts of the world, methods to predict which individuals will develop severe disease, and immunologic correlates of protection against dengue illness. During the next decade, dengue will likely expand its geographic reach and become an increasing burden on health resources in affected areas. Licensed vaccines and antiviral agents are needed in order to effectively control dengue and limit disease.
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Abstract
Dengue viruses cause mild disease in the majority of infected individuals. In most cases, the disease is characterised by fever, headache, pain behind the eyes, muscle ache, joint pains, vomiting and diarrhoea. In a low percentage of patients, bleeding and loss of plasma (haemorrhage and plasma leakage) may occur. The hyper-permeability syndrome results in plasma leakage and, if the compensatory mechanisms of the body fail to control the plasma leakage or if medical intervention is late, shock may set in. Profound shock will subsequently lead to acidic blood (metabolic acidosis) and development of disseminated intravascular coagulation (DIC). During DIC multiple micro thromboses occur, leading to organ failure. The mechanisms governing pathogenesis of these forms of severe disease are not clear. High amounts of virus in the blood are believed to cause vascular fragility which, together with infection of endothelial cells and high levels of cytokines and other soluble mediators, may result in bleeding. In the absence of a correlation between the amount of virus in the blood and disease severity, it is likely that response to infection is an important cause of disease. The aberrant immune response to infection is believed to result in a cytokine storm, defined as an imbalance between cytokines driving an inflammation (pro-inflammatory) and those silencing an inflammation (anti-inflammatory). Several lines of evidence indicate that displacement of viral genotype and host genetic background are key factors driving the production of a cytokine storm. Several cytokines are known to induce apoptosis, a form of cell suicide (cause of haemorrhage), and/or affect adherens junctions (cause permeability) in vitro. Whether these cytokines may have such effects in vivo remains to be established.
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Mather S, Scott S, Temperton N, Wright E, King B, Daly J. Current progress with serological assays for exotic emerging/re-emerging viruses. Future Virol 2013. [DOI: 10.2217/fvl.13.60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent decades have witnessed an unprecedented rise in the outbreak occurrence of infectious and primarily zoonotic viruses. Contributing factors to this phenomenon include heightened global connectivity via air travel and international trade links, as well as man-made environmental alterations, such as deforestation and climate change, which all serve to bring humans into closer contact with animal reservoirs and alter the habitat of vectors, thus facilitating the transmission of viruses between species. Serological assays are integral to tracking the epidemiological spread of a virus and evaluating mass vaccination programs by quantifying neutralizing antibody responses raised against antigenic epitopes on the viral surface. However, conventional serological tests are somewhat marred by equipment and reagent costs, the necessity for high-containment laboratories for studying many emerging viruses, and interlaboratory variability, among other issues. This review details ‘next-generation’ assays aimed at addressing some of the persistent problems with viral serology, focusing on how manipulating the genomes of RNA viruses can produce attenuated or chimeric viruses that can be exploited as surrogate viruses in neutralization assays. Despite the undoubted promise of such novel serological platforms, it must be remembered that these assays have to withstand rigorous validation and standardization measures before they can play an integral role in curtailing the severity of future emerging virus outbreaks.
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Affiliation(s)
- Stuart Mather
- Viral Pseudotype Unit (Medway), School of Pharmacy, University of Kent, Chatham, Kent, ME4 4TB, UK
| | - Simon Scott
- Viral Pseudotype Unit (Medway), School of Pharmacy, University of Kent, Chatham, Kent, ME4 4TB, UK
| | - Nigel Temperton
- Viral Pseudotype Unit (Medway), School of Pharmacy, University of Kent, Chatham, Kent, ME4 4TB, UK
| | - Edward Wright
- Viral Pseudotype Unit (Fitzrovia), School of Life Sciences, University of Westminster, London, W1W 6UW, UK
| | - Barnabas King
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, UK
| | - Janet Daly
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, UK
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Abstract
Early diagnosis of dengue, the most common mosquito-borne disease globally, remains challenging. Dengue presents initially as undifferentiated fever, with symptoms becoming more pathognomonic in the later stages of illness. This limits the timeliness in the delivery of appropriate supportive interventions. Laboratory tests are useful for diagnosis although the short-lived viremia and the presence of secondary infection with one of the four heterologous viral serotypes collectively complicate the choice and interpretation of laboratory tests. In this article, the authors review the various approaches for diagnosis of dengue and discuss the appropriate tests to use, including when a dengue vaccine, which is in the late stages of development, is licensed for use. The ensuing reduced dengue prevalence could make diagnosis for vaccine efficacy and escape-mutant monitoring even more challenging.
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Affiliation(s)
- Kin Fai Tang
- Program in Emerging Infectious Disease, Duke-NUS Graduate Medical School Singapore, 8 College Road, 169857 Singapore.
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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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