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Onoja BA, Oguzie JU, George UE, Asoh KE, Ajayi P, Omofaye TF, Igeleke IO, Eromon P, Harouna S, Parker E, Adeniji AJ, Happi CT. Whole genome sequencing unravels cryptic circulation of divergent dengue virus lineages in the rainforest region of Nigeria. Emerg Microbes Infect 2024; 13:2307511. [PMID: 38240324 PMCID: PMC10829817 DOI: 10.1080/22221751.2024.2307511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
Dengue is often misclassified and underreported in Africa due to inaccurate differential diagnoses of nonspecific febrile illnesses such as malaria, sparsity of diagnostic testing and poor clinical and genomic surveillance. There are limited reports on the seroprevalence and genetic diversity of dengue virus (DENV) in humans and vectors in Nigeria. In this study, we investigated the epidemiology and genetic diversity of dengue in the rainforest region of Nigeria. We screened 515 febrile patients who tested negative for malaria and typhoid fever in three hospitals in Oyo and Ekiti States in southern Nigeria with a combination of anti-dengue IgG/IgM/NS1 rapid test kits and metagenomic sequencing. We found that approximately 28% of screened patients had previous DENV exposure, with the highest prevalence in persons over sixty. Approximately 8% of the patients showed evidence of recent or current infection, and 2.7% had acute infection. Following sequencing of sixty samples, we assembled twenty DENV-1 genomes (3 complete and 17 partial). We found that all assembled genomes belonged to DENV-1 genotype III. Our phylogenetic analyses showed evidence of prolonged cryptic circulation of divergent DENV lineages in Oyo state. We were unable to resolve the source of DENV in Nigeria owing to limited sequencing data from the region. However, our sequences clustered closely with sequences in Tanzania and sequences reported in Chinese with travel history to Tanzania in 2019. This may reflect the wider unsampled bidirectional transmission of DENV-1 in Africa, which strongly emphasizes the importance of genomic surveillance in monitoring ongoing DENV transmission in Africa.
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Affiliation(s)
- Bernard Anyebe Onoja
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Judith Uche Oguzie
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Uwem Etop George
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Kaego Emmanuel Asoh
- Department of Medical Laboratory Science, College of Medicine, University of Ibadan, Ibadan, State Nigeria
| | - Philip Ajayi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | | | - Philomena Eromon
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Soumare Harouna
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Edyth Parker
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Christian T. Happi
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA
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Sadarangani SP, Htun HL, Ling W, Hawkins R, Yeo TW, Rivino L, MacAry PA, Leo YS. Association of systemic vitamin D on the course of dengue virus infection in adults: a single-centre dengue cohort study at a large institution in Singapore. Singapore Med J 2024; 65:332-339. [PMID: 35651103 PMCID: PMC11232714 DOI: 10.11622/smedj.2022064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Host immune responses may impact dengue severity in adults. Vitamin D has multiple immunomodulatory effects on innate and adaptive immunity. METHODS We evaluated the association between systemic 25-hydroxyvitamin D [25-(OH) D] and dengue disease severity in adults. We measured plasma for total 25-(OH) D levels with an electrochemiluminescence immunoassay using stored samples from participants with laboratory-confirmed dengue, who were prospectively enrolled in 2012-2016 at our institution. RESULTS A total of 80 participants (median age 43 years) were enrolled in the study. Six participants had severe dengue based on the World Health Organization (WHO) 1997 criteria (i.e. dengue haemorrhagic fever/dengue shock syndrome) and another six had severe dengue based on the WHO 2009 criteria. Median 25-(OH) D at the acute phase of dengue was 6.175 (interquartile range 3.82-8.21, range 3.00-15.29) mcg/L in all participants. The 25-(OH) D showed an inverse linear trend with severe dengue manifestations based on the WHO 2009 criteria (adjusted risk ratio 0.72, 95% confidence interval 0.57-0.91, P < 0.01) after adjustment for age, gender and ethnicity. CONCLUSION Limited studies have evaluated the role of systemic 25-(OH) D on dengue severity. Our study found low systemic 25-(OH) D was associated with increased dengue disease severity, particularly for severe bleeding that was not explained by thrombocytopenia. Further studies investigating the underlying immune mechanisms and effects on the vascular endothelium are needed.
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Affiliation(s)
- Sapna P Sadarangani
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Htet Lin Htun
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Weiping Ling
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Robert Hawkins
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - Tsin Wen Yeo
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Laura Rivino
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Paul A MacAry
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yee-Sin Leo
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Saidu JZ, Okojie RO. Concurrent infection of dengue virus with malaria parasites among outpatients attending healthcare facilities in Benin city, Nigeria. Porto Biomed J 2024; 9:249. [PMID: 38623419 PMCID: PMC11013702 DOI: 10.1097/j.pbj.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 04/17/2024] Open
Abstract
Background Dengue virus (DENV) and malaria parasites (MP) are among the common febrile diseases affecting the tropics and subtropics of the world. Both are mosquito-borne pathogens affecting humans and other animals. Methods Blood samples were collected from 280 consented out-patients attending the selected hospitals and were analyzed. Malaria parasites were detected using microscopy and Malaria Ag Pf/Pan Rapid Test Device. Dengue virus was detected by serology and heminested reverse transcriptase PCR (hnRT-PCR) to target the flavivirus polymerase (NS5) gene. Results Malaria parasites recorded a total positivity of 151 patients (53.9%) using microscopy, while DENV antibodies (DENV IgM and DENV IgG) were positive in 16 (5.7%) and 39 (13.9%) patients, respectively. There was a concurrent infection between MP/DENV IgM in 13 (4.6%) patients and MP/DENV IgG in 27 (9.6%) patients. Molecular identification revealed DENV serotype 2 in circulation. Conclusion This study documents molecular evidence of dengue virus coexisting with malaria parasites in the study population, hence the need for efficient surveillance and control system.
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Affiliation(s)
- Joy Zitgwai Saidu
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Rachel Obhade Okojie
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria
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The Roles of C-X-C Motif Chemokine Ligand 10 (CXCL10) in Dengue. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Early diagnosis of dengue is crucial to prevent the progression to severe dengue (SD) leading to mortality rate reduction. This study aimed to determine the role of the CXCL10 in dengue and its potential utilization as one of the biomarkers for the early diagnosis of dengue. A case-control study was conducted involving healthy subjects as control (n = 10) and 193 subjects as dengue cases. The cases were categorized into dengue without warning signs (DwoWS: n = 70; 34.5 %), dengue with warning signs (DWWS: n = 108; 23.2 %), and severe dengue (SD: n = 15; 7.4 %). The socio-demographic characteristics, clinical presentations, and laboratory parameters (platelet and hematocrit) were documented. Serum CXCL10 quantification was performed using an enzyme-linked immunosorbent assay (ELISA). The descriptive analysis and Pearson’s correlation test were used to analyze demographic data and the correlation between CXCL10, hematocrit, and platelet respectively. The difference in age (p = 0.02) and ethnicity (p = 0.02) were significant between cases and control. Males more frequently had SD in contrast to females (4:1). The frequent warning signs were abdominal pain (42.0 %), severe vomiting (38.3 %), bleeding tendency (15.0 %), and fluid accumulation (7.2 %). The increase in hematocrit (p = 0.039) and platelet reduction (p = 0.0005) were significant in SD. The mean of CXCL10 in control (134.85 ± 48.52 rg/mL) was significantly lower than in cases (545.22 ± 76.33 rg/mL, p = 0.0005). The CXCL10 is evident to be a potential biomarker in the early diagnosis of dengue.
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Patil SV, Bhadake M, Acharya A. ‘Dengue-COVID-19 overlap’: Is it an ‘antigenic mimicry’ or coexistent two different viral genotypic diseases? Prospective, observational study in tertiary care setting in India. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Raafat N, Loganathan S, Mukaka M, Blacksell SD, Maude RJ. Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009359. [PMID: 33901191 PMCID: PMC8102005 DOI: 10.1371/journal.pntd.0009359] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/06/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dengue is the world’s most common mosquito-borne virus but remains diagnostically challenging due to its nonspecific presentation. Access to laboratory confirmation is limited and thus most reported figures are based on clinical diagnosis alone, the accuracy of which is uncertain. This systematic review assesses the diagnostic accuracy of the traditional (1997) and revised (2009) WHO clinical case definitions for dengue fever, the basis for most national guidelines. Methodology/Principal findings PubMed, EMBASE, Scopus, OpenGrey, and the annual Dengue Bulletin were searched for studies assessing the diagnostic accuracy of the unmodified clinical criteria. Two reviewers (NR/SL) independently assessed eligibility, extracted data, and evaluated risk of bias using a modified QUADAS-2. Additional records were found by citation network analysis. A meta-analysis was done using a bivariate mixed-effects regression model. Studies that modified criteria were analysed separately. This systematic review protocol was registered on PROSPERO (CRD42020165998). We identified 11 and 12 datasets assessing the 1997 and 2009 definition, respectively, and 6 using modified criteria. Sensitivity was 93% (95% CI: 77–98) and 93% (95% CI: 86–96) for the 1997 and 2009 definitions, respectively. Specificity was 29% (95% CI: 8–65) and 31% (95% CI: 18–48) for the 1997 and 2009 definitions, respectively. Diagnostic performance suffered at the extremes of age. No modification significantly improved accuracy. Conclusions/Significance Diagnostic accuracy of clinical criteria is poor, with significant implications for surveillance and public health responses for dengue control. As the basis for most reported figures, this has relevance to policymakers planning resource allocation and researchers modelling transmission, particularly during COVID-19. Dengue is the most common mosquito-borne disease worldwide, with half the world’s population living in at-risk areas, yet it remains difficult to diagnose. Existing laboratory tests have highly variable performance, and access to them remains limited in most dengue-endemic regions. Thus, most dengue cases are diagnosed on clinical criteria alone. While national guidelines vary, most are based on the WHO case definitions, produced in 1997 and revised in 2009. Here, we assess the diagnostic accuracy of both definitions and find that they have good sensitivity but poor specificity, particularly problematic given the co-circulation of multiple febrile illnesses in these regions. This makes it difficult for policymakers and researchers to model transmission, assess the introduction of new pathogens to a region, and correctly prioritise control measures and vaccination programmes in a region-specific manner. This is exacerbated by the ongoing COVID-19 pandemic, given rising cases of both diseases and the stark difference in necessary control measures. As such, improvements in dengue diagnostic and reporting practice are increasingly urgent. This could be achieved by incorporating symptom absence into clinical criteria, weighting symptoms depending on strength of association with dengue or timing within disease course, or using clinical criteria to allocate limited testing resources in borderline cases.
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Affiliation(s)
- Nader Raafat
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford Medical School, University of Oxford, Oxford, United Kingdom
| | | | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart D. Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard James Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- * E-mail:
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Chamnanchanunt S, Thungthong P, Abdulkanan A, Nakhakes C. False-Positive Nonstructural Protein 1 Antigen in a Patient with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia: A Case Report with Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928865. [PMID: 33835996 PMCID: PMC8045561 DOI: 10.12659/ajcr.928865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/25/2021] [Accepted: 02/12/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND A rapid investigation of dengue viral infection is needed for physicians who manage patients with suspected dengue infection. The nonstructural protein 1 (NS1) test kit is commonly used to diagnose patients with acute febrile illness in dengue-endemic countries, although this test kit can yield false-positive results. The Dengue NS1 test kit mostly relies on cross-reaction among febrile illness patients with other viral infections rather than malignancies. CASE REPORT A 52-year-old male patient presented with 3 days of fever, intermittent gum bleeding, weight loss, and mucocutaneous bleeding. He was transferred to a second hospital with acute febrile illness. Both dengue NS1 antigen test kits were positive from the 2 hospitals where he was previously treated. Fever and cytopenia persisted, and then the dengue RT-PCR test was performed to establish the cause of illness. A peripheral blood smear was reviewed and showed blast cells. A bone marrow examination was done to test for the compatibility of lymphoblastic leukemia. The flow cytometry test showed B cells ALL with Philadelphia-positive chromosome. Finally, the result of the dengue RT-PCR test was negative. CONCLUSIONS Our patient presented with fever and viral-like illness, but he was finally diagnosed with Ph+ ALL. We demonstrated the first case of false-positive dengue NS1 antigen in a Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) patient. Moreover, we reviewed the literature to gather information on false-positive results using the dengue NS1 test kit. The dengue NS1 test kit is useful and produces reliable clinical findings, especially in patients with hematological malignancies.
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Affiliation(s)
- Supat Chamnanchanunt
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Pravinwan Thungthong
- Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Asrinda Abdulkanan
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chajchawan Nakhakes
- Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
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Yow KS, Aik J, Tan EYM, Ng LC, Lai YL. Rapid diagnostic tests for the detection of recent dengue infections: An evaluation of six kits on clinical specimens. PLoS One 2021; 16:e0249602. [PMID: 33793682 PMCID: PMC8016316 DOI: 10.1371/journal.pone.0249602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Early and rapid confirmation of dengue infections strengthens disease surveillance program and are critical to the success of vector control measures. Rapid diagnostics tests (RDTs) are increasingly used to confirm recent dengue infections due to their ease of use and short turnaround time for results. Several studies undertaken in dengue-endemic Southeast Asia have reported the performance of RDTs against enzyme-linked immunosorbent assay (ELISA), reverse transcriptase polymerase chain reaction (RT-PCR) and virus isolation methods. However, few studies have compared multiple RDTs for the detection of dengue NS1 antigen and IgM antibody in a single combo cassette. We evaluated six RDTs in Singapore for their utility in routine clinical testing to detect recent dengue infections. Methods The evaluation comprised two phases. The first phase sought to determine each RDT’s specificity to dengue NS1 and IgM using zika and chikungunya virus supernatant and zika convalescent samples. RDTs that cross-reacted with zika or chikungunya were not further tested in phase 2. The second phase sought to determine the sensitivity and specificity of the remaining RDTs to dengue NS1 and IgM using pre-characterised dengue specimens and non-dengue/chikungunya febrile clinical specimens. Results None of the RDTs cross-reacted with zika IgM in Phase 1. Truquick and Quickprofile cross reacted with zika and chikungunya viruses and were not evaluated thereafter. Standard Q had the highest dengue NS1 and IgM sensitivity at 87.0% and 84.3% respectively whereas Bioline (68.5%) and Multisure (58.3%) had the lowest dengue NS1 and IgM sensitivity respectively. Combining dengue NS1/IgM detection results greatly improved the RDT ability to detect recent dengue infection; Standard Q had the highest sensitivity at 99.1% while Multisure had the lowest at 92.6%. All the RDTs were highly specific for dengue NS1 and IgM (96.7% to 100%). All the RDTs had high positive predictive values (98.4% to 100%) for NS1, IgM and combined NS1/IgM parameters whereas Standard Q had the highest negative predictive values at 68.2% (NS1), 63.8% (IgM) and 96.8% (NS1/IgM). For the RDTs, detection of NS1 declined from acute to convalescent phase of illness whereas IgM detection rate gradually increased over time. Conclusion In our study, several RDTs were evaluated for their diagnostic accuracy and capability in detecting recent dengue infection. Standard Q demonstrated a high degree of diagnostic accuracy and capability in the detection of NS1 and IgM biomarkers. RDTs can provide rapid and accurate confirmation of recent dengue infections and augment dengue surveillance and control programmes. Further studies are required to assess the usefulness of these RDTs in other epidemiology settings.
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Affiliation(s)
- Kok-Siang Yow
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
- * E-mail:
| | - Joel Aik
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Eugene Yong-Meng Tan
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Yee-Ling Lai
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
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Chen HW, Maldonado TD, Lee CR, Williams M, Defang GN, Ellison DW, Van De Wyngaerde M, Rooney CM, Wu SJL. Independent Evaluation of Two Prototype Immunochromatographic Tests for Dengue Fever Developed by InBios. Mil Med 2021; 187:e655-e660. [PMID: 33428750 DOI: 10.1093/milmed/usaa553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Dengue fever, caused by any of the four dengue viruses (DENV1-4), is endemic in more than 100 countries around the world. Each year, up to 400 million people get infected with dengue virus. It is one of the most important arthropod-borne viral diseases. Dengue's global presence poses a medical threat to deploying military personnel and their dependents. An accurate diagnosis followed by attentive supportive care can improve outcomes in patients with severe dengue disease. Dengue diagnostic tests based on PCR and ELISA platforms have been developed and cleared by the U.S. FDA. However, these diagnostic assays are laborious and usually require highly trained personnel and specialized equipment, which presents a significant challenge when conducting operations in austere and resource-constrained areas. InBios International, Inc. (Seattle, WA) has developed two rapid and instrument-free immunochromatographic test prototype devices (multiplex and traditional formats) for dengue diagnosis. MATERIALS AND METHODS To determine the performance of the InBios immunochromatographic tests, 183 clinical samples were tested on both prototype devices. Both assays were performed without any instruments and the results were read in 20 minutes. RESULTS The traditional format had better overall performance (sensitivity: 97.4%; specificity: 90%) than the multiplex format (sensitivity: 86.9%; specificity: 63.3%). The traditional format was superior in serotype-specific detection with 100% overall sensitivity for DENV1, DENV3, and DENV4 and 93.3% sensitivity for DENV2 compared to the multiplex format (91.7%, 78.3%, 83.3%, and 96.3% for DENV1, 2, 3, and 4, respectively). The traditional format was easier to read than the multiplex format. The multiplex format was simpler and faster to set up than the traditional format. CONCLUSIONS The InBios traditional format had a better overall performance and readability profile than the multiplex format, while the multiplex format was easier to set up. Both formats were highly sensitive and specific, were easy to perform, and did not require sophisticated equipment. They are ideal for use in resource-limited settings where dengue is endemic. Based on our overall assessment, the traditional format should be considered for further development and used in the upcoming multicenter clinical trial toward FDA clearance.
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Affiliation(s)
- Hua-Wei Chen
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Tania D Maldonado
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Cheng-Rei Lee
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Maya Williams
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Gabriel N Defang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Damon W Ellison
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | - Calli M Rooney
- U.S. Army Medical Materiel Development Activity, Fort Detrick, MD 21702, USA
| | - Shuenn-Jue L Wu
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
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Chia PY, Htun HL, Leo YS, Lye DC. Safety of temporary interruption of antiplatelet therapy in dengue fever with thrombocytopenia. J Infect 2020; 82:270-275. [PMID: 33271172 DOI: 10.1016/j.jinf.2020.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Abstract
Thrombocytopenia commonly occurs in dengue and may be complicated by bleeding. Dengue can occur in adults who may be on long term antiplatelet therapy for ischemic heart disease or stroke. In these cases, clinicians may temporarily discontinue antiplatelet therapy to minimize the risk of bleeding in the absence of clear guidelines. We conducted a retrospective cohort study of laboratory-confirmed adult dengue patients on antiplatelet therapy and evaluated participants whose antiplatelet therapy was continued versus discontinued. Primary outcome was a composite outcome of major adverse cardiac and cerebrovascular events (MACCE), and all-cause mortality in-hospital and for 1-year post discharge. Secondary outcomes were platelet and blood transfusion, and occurrence of dengue haemorrhagic fever (DHF), dengue shock syndrome, dengue with warning signs and severe dengue according to World Health Organization criteria. Discontinuation of antiplatelet therapy did not result in higher composite outcome (p=0.192). Continuation of antiplatelet therapy did not result in more platelet or blood transfusion (p=0.489 and p=0.567 respectively), DHF (p=0.923). Our results suggest that discontinuation or continuation of antiplatelet therapy based on clinical judgement in dengue with thrombocytopenia, is largely safe but further studies are needed.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308422, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore.
| | - Htet Lin Htun
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics and Knowledge (OCEAN), Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Yee Sin Leo
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308422, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228, Singapore.
| | - David Chien Lye
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308422, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228, Singapore.
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Liu LT, Chen CH, Tsai CY, Lin PC, Hsu MC, Huang BY, Wang YH, Tsai JJ. Evaluation of rapid diagnostic tests to detect dengue virus infections in Taiwan. PLoS One 2020; 15:e0239710. [PMID: 32991592 PMCID: PMC7524001 DOI: 10.1371/journal.pone.0239710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/12/2020] [Indexed: 01/22/2023] Open
Abstract
Early diagnosis is important for the clinical management of diseases caused by dengue virus (DENV) infections. We investigated the performance of three commercially available DENV nonstructural protein 1 (NS1) rapid diagnostic tests (RDTs) using 173 acute-phase sera collected from dengue fever-suspected patients during the 2012-2013 DENV outbreak in Taiwan. The results of the NS1 RDTs were compared with those of qRT-PCR to calculate the sensitivity and specificity of the NS1 RDTs. The anti-DENV IgM and IgG RDT results were included to increase the probability of detecting acute DENV infection. The anti-DENV IgM/IgG RDT results were also compared with those of IgM/IgG captured ELISA. The sera from DENV qRT-PCR-positive patients were subjected to NS1 RDTs, as well as IgM/IgG captured ELISA. These results suggested that there was no significant difference in the sensitivities of the three commercially available DNEV NS1 RDTs; the SD NS1 RDT results showed the highest agreement with the qRT-PCR reference results, followed in order by the Bio-Rad and CTK NS1 RDT results when the specificity was considered. Inclusion of the IgM or IgG RDT results increased the likelihood of diagnosing either a primary or secondary DENV infection. NS1 RDTs were more sensitive for the detection of primary infections than secondary infections, related to DENV viremia levels determined by qRT-PCR. These results suggested that anti-DENV antibodies reduced the sensitivity of NS1 rapid tests. We also analyzed the sensitivity for the detection of different DENV serotypes, and the results suggested that the NS1 RDTs used in this study were valuable for rapid screening of acute DENV infection with DENV-1, DENV-2 and DENV-3. Our results suggest that the NS1 RDT is a good alternative to qRT-PCR analysis for timely dengue disease management and prevention in dengue-endemic regions where medical resources are lacking or during large dengue outbreaks. However, the relatively low sensitivity for DENV-4 might miss the detection of DENV-4-infected cases.
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Affiliation(s)
- Li-Teh Liu
- Department of Medical Laboratory Science and Biotechnology, College of Medical Technology, Chung-Hwa University of Medical Technology, Tainan City, Taiwan
| | - Chun-Hong Chen
- National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Zhunan, Taiwan
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Ching-Yi Tsai
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Chang Lin
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Miao-Chen Hsu
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Bo-Yi Huang
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Hui Wang
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jih-Jin Tsai
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Lam LTM, Chua YX, Tan DHY. Roles and challenges of primary care physicians facing a dual outbreak of COVID-19 and dengue in Singapore. Fam Pract 2020; 37:578-579. [PMID: 32374384 PMCID: PMC7239111 DOI: 10.1093/fampra/cmaa047] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Lawrence T M Lam
- National University Polyclinics, National University Health System, Pioneer Polyclinic, Ng Teng Fong General Hospital Tower A Basement 2, Singapore
| | - Ying Xian Chua
- National University Polyclinics, National University Health System, Pioneer Polyclinic, Ng Teng Fong General Hospital Tower A Basement 2, Singapore
| | - David H Y Tan
- National University Polyclinics, National University Health System, Pioneer Polyclinic, Ng Teng Fong General Hospital Tower A Basement 2, Singapore
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13
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Needs SH, Bull SP, Bravo J, Walker S, Little G, Hart J, Edwards AD. Remote videolink observation of model home sampling and home testing devices to simplify usability studies for point-of-care diagnostics. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16105.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Both home sample collection and home testing using rapid point-of-care diagnostic devices can offer benefits over attending a clinic/hospital to be tested by a healthcare professional. Usability is critical to ensure that in-home sampling or testing by untrained users does not compromise analytical performance. Usability studies can be laborious and rely on participants attending a research location or a researcher visiting homes; neither has been appropriate during COVID-19 outbreak control restrictions. We therefore developed a remote research usability methodology using videolink observation of home users. This avoids infection risks from home visits and ensures the participant follows the test protocol in their home environment. In this feasibility study, volunteers were provided with models of home blood testing and home blood sampling kits including a model lancet, sampling devices for dried blood spot collection, and model lateral flow device. After refining the study protocol through an initial pilot (n = 7), we compared instructions provided either as written instructions (n = 5), vs addition of video instructions (n = 5), vs written and video instructions plus videolink supervision by the researcher (n = 5). All users were observed via video call to define which test elements could be assessed remotely. All 22 participants in the study accessed the video call and configured their videolink allowing the researcher to clearly observe all testing tasks. The video call allowed the researcher to assess distinct errors during use including quantitative (volume of blood) and qualitative (inaccurate interpretation of results) errors many of which could compromise test accuracy. All participants completed the tasks and returned images of their completed tests (22/22) and most returned completed questionnaires (20/22). We suggest this remote observation via videolink methodology is a simple, rapid and powerful methodology to assess and optimise usability of point-of-care testing methods in the home setting.
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14
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Im J, Balasubramanian R, Ouedraogo M, Wandji Nana LR, Mogeni OD, Jeon HJ, van Pomeren T, Haselbeck A, Lim JK, Prifti K, Baker S, Meyer CG, Kim JH, Clemens JD, Marks F, Soura AB. The epidemiology of dengue outbreaks in 2016 and 2017 in Ouagadougou, Burkina Faso. Heliyon 2020; 6:e04389. [PMID: 32695907 PMCID: PMC7364030 DOI: 10.1016/j.heliyon.2020.e04389] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/27/2019] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background Dengue is prevalent in as many as 128 countries with more than 100 million clinical episodes reported annually and four billion people estimated to be at risk. While dengue fever is systematically diagnosed in large parts of Asia and South America, the disease burden in Africa is less well investigated. This report describes two consecutive dengue outbreaks in Ouagadougou, Burkina Faso in 2016 and 2017. Methods Blood samples of febrile patients received at Schiphra laboratory in Ouagadougou, Burkina Faso, were screened for dengue infection using SD Bioline Dengue Duo rapid diagnostic test kits (Standard Diagnostics, Suwon, Republic of Korea). Results A total of 1,397 and 1,882 cases were reported by a single laboratory in 2016 and 2017, respectively. Most cases were at least 15 years of age and the results corroborated reports from WHO indicating the circulation of three dengue virus serotypes in Burkina Faso. Conclusion This study complements data from other, simultaneously conducted surveillance efforts, and indicates that the dengue disease burden might be underestimated in sub-Saharan African nations. Dengue surveillance should be enhanced in African settings to determine the burden more accurately, and accelerated efforts towards a dengue vaccine should be put in place.
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Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ruchita Balasubramanian
- International Vaccine Institute, Seoul, Republic of Korea.,Princeton University, Princeton, NJ, USA
| | - Moussa Ouedraogo
- Laboratorie d'Analyses Medicales, Centre Médical avec Antenne chirurgicale Protestant Schiphra, Ouagadougou, Burkina Faso
| | - Lady Rosny Wandji Nana
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea.,The Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Tayma van Pomeren
- International Vaccine Institute, Seoul, Republic of Korea.,Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | | | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | - Stephen Baker
- The Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Christian G Meyer
- Duy Tan University, Da Nang, Viet Nam.,Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh.,University of California, Fielding School of Public Health, Los Angeles, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,The Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
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15
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Chong ZL, Sekaran SD, Soe HJ, Peramalah D, Rampal S, Ng CW. Diagnostic accuracy and utility of three dengue diagnostic tests for the diagnosis of acute dengue infection in Malaysia. BMC Infect Dis 2020; 20:210. [PMID: 32164538 PMCID: PMC7069157 DOI: 10.1186/s12879-020-4911-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dengue is an emerging infectious disease that infects up to 390 million people yearly. The growing demand of dengue diagnostics especially in low-resource settings gave rise to many rapid diagnostic tests (RDT). This study evaluated the accuracy and utility of ViroTrack Dengue Acute - a new biosensors-based dengue NS1 RDT, SD Bioline Dengue Duo NS1/IgM/IgG combo - a commercially available RDT, and SD Dengue NS1 Ag enzyme-linked immunosorbent assay (ELISA), for the diagnosis of acute dengue infection. METHODS This prospective cross-sectional study consecutively recruited 494 patients with suspected dengue from a health clinic in Malaysia. Both RDTs were performed onsite. The evaluated ELISA and reference tests were performed in a virology laboratory. The reference tests comprised of a reverse transcription-polymerase chain reaction and three ELISAs for the detection of dengue NS1 antigen, IgM and IgG antibodies, respectively. The diagnostic performance of evaluated tests was computed using STATA version 12. RESULTS The sensitivity and specificity of ViroTrack were 62.3% (95%CI 55.6-68.7) and 95.0% (95%CI 91.7-97.3), versus 66.5% (95%CI 60.0-72.6) and 95.4% (95%CI 92.1-97.6) for SD NS1 ELISA, and 52.4% (95%CI 45.7-59.1) and 97.7% (95%CI 95.1-99.2) for NS1 component of SD Bioline, respectively. The combination of the latter with its IgM and IgG components were able to increase test sensitivity to 82.4% (95%CI 76.8-87.1) with corresponding decrease in specificity to 87.4% (95%CI 82.8-91.2). Although a positive test on any of the NS1 assays would increase the probability of dengue to above 90% in a patient, a negative result would only reduce this probability to 23.0-29.3%. In contrast, this probability of false negative diagnosis would be further reduced to 14.7% (95%CI 11.4-18.6) if SD Bioline NS1/IgM/IgG combo was negative. CONCLUSIONS The performance of ViroTrack Dengue Acute was comparable to SD Dengue NS1 Ag ELISA. Addition of serology components to SD Bioline Dengue Duo significantly improved its sensitivity and reduced its false negative rate such that it missed the fewest dengue patients, making it a better point-of-care diagnostic tool. New RDT like ViroTrack Dengue Acute may be a potential alternative to existing RDT if its combination with serology components is proven better in future studies.
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Affiliation(s)
- Zhuo Lin Chong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Institute for Public Health, National Institutes of Health, Ministry of Health, Setia Alam, Selangor Malaysia
| | - Shamala Devi Sekaran
- Faculty of Medicine and Biomedical Sciences, MAHSA University, Jenjarom, Selangor Malaysia
| | - Hui Jen Soe
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Devi Peramalah
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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16
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Mata VE, Passos SRL, Santos MABD, Buonora SN, de Andrade CAF, Lima MDRQ, Costa BM, Hökerberg YHM. Diagnostic parameters and reliability of four rapid immunochromatographic tests for dengue 4. Braz J Infect Dis 2020; 24:58-64. [PMID: 31954721 PMCID: PMC9392029 DOI: 10.1016/j.bjid.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although performance of rapid immunochromatographic tests (RITs) for dengue virus (DENV) serotypes 1, 2 and 3 is relatively settled, evidence on accuracy of RITs for DENV-4 are based on studies with small sample sizes and with discrepant results. OBJECTIVES To assess accuracy and inter-observer agreement of RITs targeting dengue nonstructural protein-1 (NS1) antigen - Dengue NS1-Bioeasy™, Dengue NS1 Ag Strip-Bio-Rad™, IVB Dengue Ag NS1-Orangelife™ and Dengue NS1-K130-Bioclin™ in DENV-4 samples. METHODS Study sample (n = 324) included adults presenting at an emergency unit in Rio de Janeiro, Brazil, with fever of ≤72 h and two or more dengue symptoms. A serum sample from each patient was tested by each RIT. A positive reverse-transcription polymerase chain reaction was considered as the reference standard for dengue diagnosis. The diagnostic parameters analyzed for each RIT were sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Each RIT was read by homogeneous (two junior nurses) or heterogeneous (one junior nurse and one senior biologist) pairs. Agreement was estimated by simple kappa with 95% confidence interval, positive (Ppos) and negative (Pneg) proportion concordance and prevalence and bias adjusted kappa, rated from poor (k < 0.0) to almost perfect (0.8 < k < 1.0), and perfect (k = 1). RESULTS NS1 RITs for DENV-4 diagnosis showed high specificity (95.9%-99.4%), but low sensitivity (14.7%-45.4%). Bioeasy™ had the best performance, with a positive likelihood ratio of 26.0 (95% CI: 8.4;81.0). Inter-observer agreement was almost perfect for all evaluated RITs. Mismatches in confirmed dengue were more common for the Bioclin™ (Ppos 88.3-90.0 %) and Orangelife™ (Ppos 91.7-94.1 %) tests. CONCLUSIONS For DENV-4, the tested RITs had high specificity, but lower sensitivity compared to published results for other serotypes. They should not be used for screening purposes. Different brands may have very different performances. This should be considered upon deciding of using RITs in DENV-4 outbreaks.
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Affiliation(s)
- Veronica Elizabeth Mata
- Oswaldo Cruz Foundation, Evandro Chagas National Institute of Infectious Diseases, Laboratory of Clinical Epidemiology, Rio de Janeiro, RJ, Brazil
| | - Sonia Regina Lambert Passos
- Oswaldo Cruz Foundation, Evandro Chagas National Institute of Infectious Diseases, Laboratory of Clinical Epidemiology, Rio de Janeiro, RJ, Brazil.
| | | | - Sibelle Nogueira Buonora
- Oswaldo Cruz Foundation, Evandro Chagas National Institute of Infectious Diseases, Laboratory of Clinical Epidemiology, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Yara Hahr Marques Hökerberg
- Oswaldo Cruz Foundation, Evandro Chagas National Institute of Infectious Diseases, Laboratory of Clinical Epidemiology, Rio de Janeiro, RJ, Brazil
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Otu AA, Udoh UA, Ita OI, Hicks JP, Egbe WO, Walley J. A cross-sectional survey on the seroprevalence of dengue fever in febrile patients attending health facilities in Cross River State, Nigeria. PLoS One 2019; 14:e0215143. [PMID: 31009479 PMCID: PMC6476506 DOI: 10.1371/journal.pone.0215143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Abstract
Background In Nigeria, recent reports suggest that dengue viruses could be a major cause of acute fevers. We sought to make a cross-sectional estimate of the prevalence of current and previous dengue infections in patients presenting with fever to healthcare centres in Cross River State Nigeria. Methodology/Principal findings This cross-sectional health facility survey recruited persons with temperature ≥38°C. Dengue virus immunoglobulin M (IgM)/immunoglobulin G (IgG) antibody testing using Onsite Duo dengue Ag-IgG/IgM lateral flow immunoassay cassettes was done. Samples which tested positive were further confirmed using the RecombiLISA dengue IgM and IgG enzyme linked immunosorbent assay kits and classified into primary and secondary dengue infection. Malaria testing was carried out using microscopy. Between 4 January 2017 and 24 August 2017 a total of 420 participants were sampled across 11 health centres. The mean age was 34 (range = 1–99), 63% were female, 49% reported sleeping under a treated mosquito net in the past week and 44% reported taking an antimalarial prior to seeking care. The mean number of days fever was present prior to seeking care was 8, and many of the participants presented with symptoms indicative of respiratory or urinary tract infections. Testing indicated that 6% (95% CI: 2, 13; n = 24) had either a primary or secondary dengue infection with or without co-existing malaria, while 4% (95% CI: 2, 9; n = 16) had either a primary or secondary dengue infection without co-existing malaria. 52% (95% CI: 46, 58; n = 218) had a malaria infection with or without any dengue infection, and 50% (95% CI: 44, 57; n = 210) had a malaria infection without any dengue infection. Conclusion Our study confirms the presence of dengue at not insignificant levels in patients attending health centres with fever in this south eastern province of Nigeria. These data highlight the danger of the common presumption in this setting that fever is due to malaria. Surveillance for dengue is vital in this setting.
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Affiliation(s)
- Akaninyene A. Otu
- Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
- Foundation for Healthcare Innovation and Development (FHIND) Calabar, Cross River State, Nigeria
- * E-mail:
| | - Ubong A. Udoh
- Department of Medical Microbiology and Parasitology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Okokon I. Ita
- Department of Medical Microbiology and Parasitology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - William O. Egbe
- Foundation for Healthcare Innovation and Development (FHIND) Calabar, Cross River State, Nigeria
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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Clemen G, Angel J, Montes C, Tovar JR, Osorio L. Contribución de la prueba rápida NS1 e IgM al diagnóstico de dengue en Colombia en el periodo pre-zika. INFECTIO 2019. [DOI: 10.22354/in.v23i3.790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: Se considera que el diagnóstico del dengue es fundamentalmente clínico; sin embargo, las pruebas rápidas basadas en la detección de IgM o NS1/IgM están siendo utilizadas en los servicios de salud. Este estudio determinó la contribución de las pruebas rápidas al diagnóstico de dengue en un área endémica antes de la introducción del virus zika.Metodología: Diseño de corte transversal de pruebas diagnósticas realizado a partir del análisis secundario de un estudio previo en 14 instituciones de salud del Valle del Cauca. Se obtuvo información de 632 participantes con resultados de prueba rápida, diagnóstico clínico y pruebas de referencia ELISA NS1, ELISA IgM y RT-PCR. Se compararon la sensibilidad, especificidad, valores predictivos y razones de verosimilitud del uso solo, en serie, y paralelo de los componentes NS1, IgM, NS1/IgM de la prueba rápida y el diagnóstico clínico con las pruebas Q de Cochran y McNemar para datos pareados.Resultados: La sensibilidad del diagnóstico clínico (61,4% IC95% 56%-66,7%) fue superior a la de las pruebas rápidas (37% IC95% 29,6%-44,7%) (P<0,001). El uso en serie de la prueba NS1/IgM cuando el diagnóstico clínico fue negativo aumentó la sensibilidad a 79,5% y, el uso en serie cuando el diagnóstico clínico fue positivo aumentó la especificidad (de 66,3% a 98,7%). Sin embargo, este último disminuyó la sensibilidad a 32,2%. Todas las razones de verosimilitud negativas (LR-) fueron cercanas a 1; mientras que, el uso en serie cuando el diagnóstico clínico fue positivo tuvo LR+ mayores de 10.Conclusión: El diagnóstico clínico tiene una mayor sensibilidad que las pruebas rápidas, pero por si solo no es suficiente para confirmar o descartar dengue. Un resultado positivo en pruebas rápidas en pacientes con diagnóstico clínico de dengue es útil para confirmarlo, pero un resultado negativo no lo descarta.
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Kikuti M, Cruz JS, Rodrigues MS, Tavares AS, Paploski IAD, Silva MMO, Santana PM, Tauro LB, Silva GAOF, Campos GS, Araújo JMG, Kitron U, Reis MG, Ribeiro GS. Accuracy of the SD BIOLINE Dengue Duo for rapid point-of-care diagnosis of dengue. PLoS One 2019; 14:e0213301. [PMID: 30840708 PMCID: PMC6402663 DOI: 10.1371/journal.pone.0213301] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background Rapid diagnosis tests (RDTs) are easy to carry out, provide fast results, and could potentially guide medical treatment decisions. We investigated the performance of a commercially available RDT, which simultaneously detects the non-structural 1 (NS1) dengue virus (DENV) antigen, and IgM and IgG DENV antibodies, using representative serum samples from individuals in a dengue endemic area in Salvador, Brazil. Methodology/Principal findings We evaluated the accuracy of the SD BIOLINE Dengue Duo RDT (Abbott, Santa Clara, USA; former Alere Inc, Waltham, USA) in a random collection of sera. Samples included acute-phase sera from 246 laboratory-confirmed dengue cases and 108 non-dengue febrile patients enrolled in a surveillance study for dengue detection, 73 healthy controls living in the same surveillance community, and 73 blood donors. RDT accuracy was blindly assessed based on the combined results for the NS1 and the IgM test components. The RDT sensitivity was 46.8% (38.6% for the NS1 component and 13.8% for the IgM component). Sensitivity was greater for samples obtained from patients with secondary DENV infections (49.8%) compared to primary infections (31.1%) (P: 0.02) and was also influenced by the result in the confirmatory dengue diagnostic test, ranging from 39.7% for samples of cases confirmed by IgM-ELISA seroconversion between paired samples to 90.4% for samples of cases confirmed by a positive NS1-ELISA. The RDT specificity was 94.4% for non-dengue febrile patients, 87.7% for the community healthy controls, and 95.9% for the blood donors. Conclusions/Significance The SD BIOLINE Dengue Duo RDT showed good specificities, but low sensitivity, suggesting that it may be more useful to rule in than to rule out a dengue diagnosis in dengue endemic regions.
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Affiliation(s)
- Mariana Kikuti
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jaqueline S. Cruz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | - Aline S. Tavares
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Igor A. D. Paploski
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Department of Veterinary Population Medicine, University of Minnesota, Saint Paul, Minnesota, United States of America
| | | | - Perla M. Santana
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Laura B. Tauro
- Instituto Nacional de Medicina Tropical, CONICET, Puerto Iguazu, Misiones, Argentina
| | | | - Gúbio S. Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Josélio M. G. Araújo
- Departamento de Microbiologia e Parasitologia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Uriel Kitron
- Department of Environmental Science, Emory University, Atlanta, Georgia, United States of America
| | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Guilherme S. Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- * E-mail:
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20
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Garg A, Garg J, Singh DV, Dhole TN. Can rapid dengue diagnostic kits be trusted? A comparative study of commercially available rapid kits for serodiagnosis of dengue fever. J Lab Physicians 2019; 11:63-67. [PMID: 30983805 PMCID: PMC6437816 DOI: 10.4103/jlp.jlp_140_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dengue virus infection is an important emerging disease of the tropical and subtropical regions and is mainly diagnosed by serological detection of NS1 antigen and IgM antidengue antibodies. Since enzyme-linked immunosorbent assay (ELISA) facilities are not easily available at most diagnostic centers, so most of them use various commercially available rapid diagnostic tests (RDTs) kits. AIMS AND OBJECTIVES This study was designed to access the diagnostic accuracy of four commercially available and widely used RDTs for serodiagnosis of dengue virus infection in Indian laboratories. SUBJECTS AND METHODS The study was conducted at Department of Microbiology, G.S.V.M Medical College, Kanpur, India, to estimate the sensitivity and specificity of following RDTs: (1) Dengue Cassette (Panbio, Australia), (2) Bioline Dengue Duo (SD Diagnostics, Korea), (3) Dengue Day 1 test (J Mitra and Co., India), and (4) Dengucheck Duo (Tulip Diagnostics, India) on 72 confirmed dengue serum samples that were positive by dengue reverse transcription-polymerase chain reaction, dengue NS1, and IgM ELISA along with 80 serum samples from nondengue febrile illness patients. RESULTS The majority of the RDTs demonstrated low sensitivity but good specificity for detecting NS1 antigen. Detection of antidengue IgM antibodies by RDTs demonstrated low sensitivity ranging from 27.8% to 77.7%. However, specificity was generally higher (50%-86.2%) and more consistent across the assays. CONCLUSION The study results differed markedly from the RDTs manufacturers' claimed performance characteristics. Therefore, the RDT results should be interpreted cautiously and ELISA should be performed as far as possible for serodiagnosis of dengue virus infection.
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Affiliation(s)
- Atul Garg
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jaya Garg
- Department of Microbiology, RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dharam Veer Singh
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - TN Dhole
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Carabali M, Lim JK, Palencia DC, Lozano‐Parra A, Gelvez RM, Lee KS, Florez JP, Herrera VM, Kaufman JS, Rojas EM, Villar LA. Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia. Trop Med Int Health 2018; 23:1231-1241. [PMID: 30176107 PMCID: PMC6334506 DOI: 10.1111/tmi.13147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To estimate the age-specific incidence of symptomatic dengue and chikungunya in Colombia. METHOD A passive facility-based fever surveillance study was conducted among individuals with undifferentiated fever. Confirmatory diagnostics included serological and molecular tests in paired samples, and surveillance's underreporting was assessed using capture-recapture methods. RESULTS Of 839 febrile participants 686 completed the study. There were 33.2% (295/839) dengue infections (51% primary infections), and 35.9% (191/532) of negative dengue cases there were chikungunya cases. On average, dengue cases were younger (median = 18 years) than chikungunya cases (median = 25 years). Thrombocytopaenia and abdominal pain were the main dengue predictors, while presence of rash was the main predictor for chikungunya diagnosis. Underreporting of dengue was 31%; the estimated expansion factors indicate an underreporting rate of dengue cases of threefold for all cases and of almost sixfold for inpatients. CONCLUSIONS These findings highlight the ongoing coexistence of both arboviruses, a distinct clinical profile of each condition in the study area that could be used by clinicians to generate a differential diagnosis, and the presence of underreporting, mostly among hospitalised cases.
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Affiliation(s)
- Mabel Carabali
- Global Dengue and Aedes‐transmitted Diseases ConsortiumInternational Vaccine InstituteSeoulKorea
- McGill UniversityMontrealQCCanada
| | - Jacqueline K. Lim
- Global Dengue and Aedes‐transmitted Diseases ConsortiumInternational Vaccine InstituteSeoulKorea
| | | | | | | | - Kang Sung Lee
- Global Dengue and Aedes‐transmitted Diseases ConsortiumInternational Vaccine InstituteSeoulKorea
| | | | | | | | - Elsa M. Rojas
- Universidad Industrial de SantanderBucaramangaColombia
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22
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Chan HBY, How CH, Ng CWM. Definitive tests for dengue fever: when and which should I use? Singapore Med J 2018; 58:632-635. [PMID: 29167907 DOI: 10.11622/smedj.2017100] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dengue is a mosquito-borne viral disease that has established itself globally in both endemic and epidemic transmission cycles. While diagnostic decision-making for dengue is often guided by clinical judgement, definitive laboratory tests, including rapid point-of-care tests, have many advantages in the primary care setting. These include providing epidemiological data and diagnostic clarity for atypical cases, as well as contributing to patient education and compliance. This article discussed the types of diagnostic methods for dengue, when to use them and the appropriateness of each test. Viral detection diagnostic methods such as NS1 antigen assays are generally used within the first week of illness onset, whereas dengue serology testing is most appropriate after that time frame. Locally available rapid point-of-care tests, which include both assays in one convenient test kit, can enhance dengue diagnosis in an endemic setting.
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Affiliation(s)
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
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23
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Cia CT, Ko WC. Suboptimal diagnostic performance of dengue non-structural protein 1 antigen rapid test during non-endemic periods in southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:856-857. [PMID: 30193824 DOI: 10.1016/j.jmii.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Cong-Tat Cia
- Division of Critical Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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24
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Hishamshah M, Ahmad N, Mohd Ibrahim H, Nur Halim NA, Nawi S, Amran F. Demographic, clinical and laboratory features of leptospirosis and dengue co-infection in Malaysia. J Med Microbiol 2018; 67:806-813. [PMID: 29724267 DOI: 10.1099/jmm.0.000750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose. In this study, we aim to describe and compare the demographical, clinical and laboratory features of leptospirosis and dengue co-infections (LDCI) against single leptospirosis infections in Malaysia.Methodology. Data of patients admitted to various hospitals in Malaysia from 2011 to 2015 diagnosed with leptospirosis in our laboratory were obtained from their admission records. Co-infection with dengue was determined by collecting dengue serology results. Multivariate analysis and multiple logistic regression were used to differentiate features between single leptospirosis infection and confirmed LDCI.Results/Key findings. Only 602 (29.11 %) out of 2068 leptospira-positive patients were concurrently tested for dengue during their admission in which 44 (7.31 %) patients had positive non-structural protein 1 (confirmed LDCI) while 140 (23.26 %) were positive for dengue IgM (probable LDCI) with the highest number of cases recorded in high-density suburban districts. Myalgia and arthralgia were the only significant distinguishing clinical feature of LDCI while significant laboratory features were thrombocytopenia and high levels of alanine and aspartate transaminases. Only thrombocytopenia displayed a predictive value for LDCI from analysis of multiple logistic regression. Death occurred in 19 (3.16 %) patients in this dataset studied but only three (0.50 %) were attributed to LDCI.Conclusion. There is a considerable prevalence of LDCI in this country of which overlapping demographic, clinical and laboratory presentations pose diagnostic and therapeutic challenges. Efforts to raise awareness regarding LDCI, better access to diagnostic services and further prospective studies are warranted.
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Affiliation(s)
| | - Norazah Ahmad
- Institute for Medical Research, Kuala Lumpur, Malaysia
| | | | | | - Salbiah Nawi
- Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Fairuz Amran
- Institute for Medical Research, Kuala Lumpur, Malaysia
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Htun HL, Yeo TW, Tam CC, Pang J, Leo YS, Lye DC. Metformin Use and Severe Dengue in Diabetic Adults. Sci Rep 2018; 8:3344. [PMID: 29463812 PMCID: PMC5820327 DOI: 10.1038/s41598-018-21612-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/02/2018] [Indexed: 01/07/2023] Open
Abstract
Diabetes mellitus is a risk factor for severe dengue in adults, but few studies have examined the association between metformin use and disease severity in dengue. In addition to its effect on glucose control, metformin has been associated with pleiotropic properties in preclinical studies. Using a cohort of laboratory-confirmed adult (≥21 years) dengue patients with diabetes mellitus admitted to Tan Tock Seng Hospital, we conducted a retrospective cohort study involving 131 (58.7%) metformin users and 92 (41.3%) non-users. Dengue severity was categorized as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) in World Health Organization (WHO) 1997 criteria and severe dengue (SD) in WHO 2009 criteria. Multivariable Poisson regression with robust error variance was used to estimate risk ratio (RR). Compared with non-use, metformin use was associated with a decreased risk of developing severe dengue (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI]: 0.37–0.98, P = 0.04). Additionally, there was an inverse dose-response relationship (aRR = 0.69, 95% CI: 0.49–0.98, P = 0.04) with dengue severity as classified by WHO 2009 criteria. Use of metformin, however, was not associated with dengue severity based on WHO 1997 criteria; and no dose-response relationship was noted. Our results suggest metformin use could attenuate disease severity in dengue-infected diabetes mellitus individuals.
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Affiliation(s)
- Htet Lin Htun
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tsin Wen Yeo
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yee Sin Leo
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David C Lye
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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26
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Rosso F, Pineda JC, Sanz AM, Cedano JA, Caicedo LA. Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review. Braz J Infect Dis 2018; 22:63-69. [PMID: 29353669 PMCID: PMC9425690 DOI: 10.1016/j.bjid.2018.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/22/2017] [Accepted: 01/01/2018] [Indexed: 12/02/2022] Open
Abstract
Dengue fever is a vector-transmitted viral infection. Non-vectorial forms of transmission can occur through organ transplantation. We reviewed medical records of donors and recipients with suspected dengue in the first post-transplant week. We used serologic and molecular analysis to confirm the infection. Herein, we describe four cases of dengue virus transmission through solid organ transplantation. The recipients had positive serology and RT-PCR. Infection in donors was detected through serology. All cases presented with fever within the first week after transplantation. There were no fatal cases. After these cases, we implemented dengue screening with NS1 antigen detection in donors during dengue outbreaks, and no new cases were detected. In the literature review, additional cases had been published through August 2017. Transmission of Dengue virus can occur through organ donation. In endemic regions, it is important to suspect and screen for dengue in febrile and thrombocytopenic recipients in the postoperative period.
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Affiliation(s)
- Fernando Rosso
- Fundación Valle del Lili, Departamento de Medicina Interna - Enfermedades Infecciosas, Cali, Colombia; Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia; Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia.
| | - Juan C Pineda
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
| | - Ana M Sanz
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
| | - Jorge A Cedano
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
| | - Luis A Caicedo
- Fundación Valle del Lili, División de Cirugía de Trasplante, Cali, Colombia
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27
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Lim JK, Alexander N, Di Tanna GL. A systematic review of the economic impact of rapid diagnostic tests for dengue. BMC Health Serv Res 2017; 17:850. [PMID: 29284474 PMCID: PMC5747037 DOI: 10.1186/s12913-017-2789-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dengue fever is rapidly expanding geographically, with about half of the world's population now at risk. Among the various diagnostic options, rapid diagnostic tests (RDTs) are convenient and prompt, but limited in terms of accuracy and availability. METHODS A systematic review was conducted of published data on the use of RDTs for dengue with respect to their economic impact. The search was conducted with combinations of key search terms, including "((Dengue[Title]) AND cost/economic)" and "rapid diagnostic test/assay (or point-of-care)". Articles with insufficient report on cost/economic aspect of dengue RDTs, usually on comparison of different RDTs or assessment of novel rapid diagnostic tools, were excluded. This review has been registered in the PROSPERO International prospective register of systematic reviews (registry #: CRD42015017775). RESULTS Eleven articles were found through advanced search on Pubmed. From Embase and Web of Science, two and 14 articles were obtained, respectively. After removal of duplicate items, title screening was done on 21 published works and 12 titles, including 2 meeting abstracts, were selected for abstract review. For full-text review, by two independent reviewers, 5 articles and 1 meeting abstract were selected. Among these, the abstract was referring to the same study results as one of the articles. After full text review, two studies (two articles and one abstract) were found to report on cost-wise or economic benefits of dengue RDTs and were selected for data extraction. One study found satisfactory performance of IgM-based Panbio RDT, concluding that it would be cost-effective in endemic settings. The second study was a modeling analysis and showed that a dengue RDT would not be advantageous in terms of cost and effectiveness compared to current practice of antibiotics prescription for acute febrile illness. CONCLUSIONS Despite growing use of RDTs in research and clinical settings, there were limited data to demonstrate an economic impact. The available two studies reached different conclusions on the cost-effectiveness of dengue RDTs, although only one of the two studies reported outcomes from cost-effectiveness analysis of dengue and the other was considering febrile illness more generally. Evidence of such an impact would require further quantitative economic studies.
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Affiliation(s)
- Jacqueline Kyungah Lim
- Global Dengue and Aedes-transmitted Diseases Consortium (GDAC), International Vaccine Institute (IVI), SNU Research Park, Gwankak-ro 1, Seoul, Gwanak-gu 151-191 South Korea
- Epidemiology and Public Health Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Neal Alexander
- Epidemiology and Public Health Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Gian Luca Di Tanna
- Centre for Primary Care and Public health, Queen Mary University of London, London, UK
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Progress and Challenges towards Point-of-Care Diagnostic Development for Dengue. J Clin Microbiol 2017; 55:3339-3349. [PMID: 28904181 DOI: 10.1128/jcm.00707-17] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dengue detection strategies involve viral RNA, antigen, and/or antibody detection. Each strategy has its advantages and disadvantages. Optimal, user-friendly, rapid diagnostic tests based on immunochromatographic assays are pragmatic point-of-care tests (POCTs) in regions where dengue is endemic where there are limited laboratory capabilities and optimal storage conditions. Increasingly, there is a greater public health significance for a multiplexing assay that differentiates dengue from Zika or pathogens with similar clinical presentations. Although there have been many assay/platform developments toward POCTs, independent validation and implementation remain very limited. This review highlights the current key progress and challenges toward the development of a dengue POCT.
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29
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Mata VE, Passos SRL, Hökerberg YHM, Berardinelli GM, dos Santos MAB, Fukuoka LVB, Maciel ACFSR, dos Santos Rodrigues CD, da Silva Santos A, de Vasconcellos Carvalhaes de Oliveira R. Precisão e confiabilidade de um teste imuno-cromatográfico rápido NS1 para diagnóstico DENV-1 no ponto de atendimento e no laboratório. BMC Infect Dis 2017; 17:594. [PMID: 28851293 PMCID: PMC5576130 DOI: 10.1186/s12879-017-2679-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/10/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rapid immunochromatographic tests (ICT) for dengue non-structural protein 1 (NS1) have shown good performance for diagnosing acute-phase dengue in serum in laboratory settings, but rarely have been assessed in whole blood and at point of care (POC). This study compare the accuracy and inter- and intra-observer reliability of the NS1 Bioeasy™ ICT in whole blood at POC versus serum in the laboratory, during a DENV-1 epidemic. METHODS Cross-sectional study involving 144 adults spontaneously demanding care in an emergency department within 4 days of onset of acute febrile illness. Accuracy of NS1 Bioeasy™ ICT was compared in whole blood and serum, both at 15 and 30 min, blinded to the reference RT-PCR or NS1 ELISA. Non-dengue patients were also tested for Zika virus with RT-PCR. Reliability of whole blood and serum readings by the same or different observers was measured by simple kappa (95% CI). RESULTS At 15 min, sensitivity (Sn) of NS1 Bioeasy™ ICT in whole blood/POC was 76.7% (95% CI: 68.0-84.1) and specificity (Sp) was 87.0% (95% CI: 66.4-97.2). Sn in serum/laboratory was 82% (95% CI: 74.1-88.6) and Sp 100% (95% CI: 85.8-100). Positive likelihood ratio was 5.9 (95% CI: 2.0-17.0) for whole blood/POC and 19.8 (95% CI: 2.9-135.1) for serum/laboratory. Reliability of matched readings of whole blood/POC and serum/laboratory by the same observer (k = 0.83, 95% CI: 0.74-0.93) or different observers (k = 0.81, 95% CI: 0.72-0.92) was almost perfect, with higher discordant levels in the absence of dengue. Results did not differ statistically at 5%. CONCLUSIONS NS1 Bioeasy™ ICT in DENV-1 epidemics is a potentially confirmatory test. Invalid results at 15 min should be reread at 30 min. To optimize impact of implementing ICT in the management of false-negatives it should be incorporated into an algorithm according to setting and available specimen. TRIAL REGISTRATION UTN U1111-1145-9451 .
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Vickers I, Harvey K, Nelson K, Brown M, Bullock-DuCasse M, Lindo J. Evaluation of OneStep Dengue NS1 RapiDip™ InstaTest and OneStep Dengue Fever IgG/IgM RapiCard™ InstaTest during the course of a dengue type 1 epidemic. Diagn Microbiol Infect Dis 2017; 89:271-275. [PMID: 29021087 DOI: 10.1016/j.diagmicrobio.2017.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/26/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
We determined the diagnostic performance of the OneStep NS1 and the OneStep IgG/IgM RDT kits against a panel of samples which comprised of 174 dengue positive and 165 dengue negative sera characterized by three reference enzyme-linked immunosorbent assays (ELISAs). The diagnostic sensitivities of the OneStep kits for the detection of individual biomarkers of NS1, IgM and IgG were 90% (95% CI: 82.1-94.7), 32.4% (95% CI: 24.8-40.8) and 44.4% (95% CI: 38.2-50.7), respectively. The combination of the OneStep IgG/IgM kit with the OneStep NS1 kit demonstrated significantly higher sensitivities for the combined NS1/IgM (96.8%; 95% CI: 90.9-99.3) and NS1/IgM/IgG (99.5%; 95% CI: 97.1-99.9)(P<0.001). In conclusion, the OneStep NS1 kit has high sensitivity and specificity and is highly recommended for use. The low sensitivities for IgG (44.4%) and for IgM (32.4%) of the OneStep IgG/IgM kit when used alone suggest it is best used in combination with the OneStep NS1 kit to enhance its overall diagnostic performance.
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Affiliation(s)
- Ivan Vickers
- Department of Microbiology, The University of the West Indies, Mona, Kingston 7, Jamaica.
| | | | - Kereann Nelson
- Department of Microbiology, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Michelle Brown
- Department of Microbiology, The University of the West Indies, Mona, Kingston 7, Jamaica
| | | | - John Lindo
- Department of Microbiology, The University of the West Indies, Mona, Kingston 7, Jamaica
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Tan Q, Hildon ZJL, Singh S, Jing J, Thein TL, Coker R, Vrijhoef HJM, Leo YS. Comparing patient and healthcare worker experiences during a dengue outbreak in Singapore: understanding the patient journey and the introduction of a point-of-care test (POCT) toward better care delivery. BMC Infect Dis 2017; 17:503. [PMID: 28724363 PMCID: PMC5517990 DOI: 10.1186/s12879-017-2580-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers' perspectives and patient experiences of dengue at surge times. METHODS Focus group discussions were conducted with dengue patients, from before and after the POCT implementation period. In-depth interviews with semi-structured components with healthcare workers were carried out. A patient centred process mapping technique was used for evaluation, which mapped the patient's journey and was mirrored from the healthcare worker's perspective. RESULTS Patients and healthcare workers confirmed a wide range of symptoms in adults, making it challenging to determine diagnosis. There were multiple routes to help seeking, and no 'typical patient journey', with patients either presenting directly to the hospital emergency department, or being referred there by a primary care provider. Patients groups diagnosed before and after POCT implementation expressed some differences between speed of diagnoses and attitudes of doctors, yet shared negative feelings about waiting times and a lack of communication and poor information delivery. However, the POCT did not in its current implementation do much to help waiting times. Healthcare workers expressed that public perceptions of dengue in recent years was a major factor in changing patient management, and that the POCT kit was helpful in improving the speed and accuracy of diagnoses. CONCLUSIONS Health service delivery for dengue patients in Singapore was overall perceived to be of an acceptable clinical standard, which was enhanced by the introduction of the POCT. However, improvements can be focused on Adapting to outbreaks by reducing and rendering Waiting experiences more comfortable; Advancing education about symptom recognition, while also Recognising better communication strategies; and Expanding follow-up care options. This is presented as the Dengue AWARE model of care delivery.
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Affiliation(s)
- Qinghui Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549 Singapore
- Biological Resource Centre, Agency for Science, Technology and Research (A*Star), Singapore, Singapore
| | - Zoe J-L Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549 Singapore
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Johns Hopkins Bloomberg School of Public Health, Centre for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202 USA
| | - Shweta Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549 Singapore
| | - Jin Jing
- Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre; Tan Tock Seng Hospital, Moulmein Road, Singapore, 308433 Singapore
| | - Tun Linn Thein
- Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre; Tan Tock Seng Hospital, Moulmein Road, Singapore, 308433 Singapore
| | - Richard Coker
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mahidol University, 9th Floor, Satharanaukwisit Bldg, 420/1 Rajwithi Rd, Bangkok, -10400 Thailand
| | - Hubertus J. M. Vrijhoef
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549 Singapore
- National University Health System, Singapore, Singapore
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yee Sin Leo
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549 Singapore
- Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre; Tan Tock Seng Hospital, Moulmein Road, Singapore, 308433 Singapore
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Pang J, Hildon ZJL, Thein TL, Jin J, Leo YS. Assessing changes in knowledge, attitude and practices on dengue diagnosis and management among primary care physicians after the largest dengue epidemic in Singapore. BMC Infect Dis 2017; 17:428. [PMID: 28619082 PMCID: PMC5472871 DOI: 10.1186/s12879-017-2525-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dengue results in high morbidity and mortality globally. The knowledge, attitude and practices (KAP) of dengue management, including diagnosis, among primary care physicians (PCPs) are important to reduce dengue transmission and burden. However, there is a lack of understanding on the impact of dengue epidemic on dengue management. Hence, the aim of this study is to examine the changes in KAP on dengue management among PCPs before and after the largest dengue epidemic in 2013 in Singapore. METHODS Surveys were mailed to 2000 and 1514 PCPs registered under the Singapore Medical Council in March of year 2011 and 2014, respectively. Survey data were then collected between April and June of that year. Chi-square or Fisher's exact test was used for comparing categorical variables. A multivariate logistic regression model was implemented to determine independent factors for frequent use of dengue diagnostic tests (DDTs). All tests were conducted at 5% level of significance. Adjusted odds ratio and corresponding 95% confidence intervals were reported, where applicable. Qualitative data were descriptively coded for themes and analysis. RESULTS Among PCPs surveyed in 2011 and 2014, 89.9% and 86% had good knowledge on dengue management respectively. The usage of DDTs had increased significantly in 2014 (N = 164;56%) as compared to 2011 (N = 107;29.5%) in both private and public clinics (p < 0.001). Dengue Duo point-of-care test (POCT) kits was independently associated with frequent use of DDTs (adjusted odds ratio = 2.15; 95% confidence interval = 1.25-3.69). There was a significant reduction in referral of dengue patients to hospital (31.4% in 2011; 13.3% in 2014; p < 0.001), and a significant increase in frequency of clinic follow-ups (18.4% in 2011; 28.5% in 2014; p = 0.003). One key theme highlighted was that dengue management can be improved with availability of POCT kit, better awareness of the disease and any revised clinical guidelines. CONCLUSION The knowledge on dengue management remained high, while the attitude and practices, particularly on the usage of DDTs improved significantly after a large epidemic. Furthermore, PCPs had more confident in managing dengue patients in primary care settings and in educating patients on the importance of vector control and dengue warning signs to reduce dengue transmission and burden.
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Affiliation(s)
- Junxiong Pang
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 144 Moulmein Road, Singapore, 308089, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, USA.,Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tun Linn Thein
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 144 Moulmein Road, Singapore, 308089, Singapore
| | - Jing Jin
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 144 Moulmein Road, Singapore, 308089, Singapore
| | - Yee Sin Leo
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 144 Moulmein Road, Singapore, 308089, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Increased Serum Hyaluronic Acid and Heparan Sulfate in Dengue Fever: Association with Plasma Leakage and Disease Severity. Sci Rep 2017; 7:46191. [PMID: 28393899 PMCID: PMC5385535 DOI: 10.1038/srep46191] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/10/2017] [Indexed: 02/03/2023] Open
Abstract
Plasma leakage is a major pathogenic mechanism of severe dengue, but the etiology remains unclear. The association between endothelial glycocalyx integrity and vascular permeability in older adults with dengue has not been evaluated. A prospective cohort study of adults with undifferentiated fever screened for dengue by RT-PCR or NS1 antigen testing was performed. Patients were assessed daily while symptomatic and at convalescence. Serum hyaluronic acid (HA), heparan sulfate (HS) and selected cytokines (TNF-α, IL-6, IL-10) were measured on enrollment and convalescence. Patients were diagnosed as dengue fever (DF, n = 30), dengue hemorrhagic fever (DHF, n = 20) and non-dengue (ND) febrile illness (n = 11). Acute HA and HS levels were significantly higher in all dengue patients compared to ND (p = 0.0033 and p = 0.0441 respectively), but not different between DF and DHF (p = 0.3426 and p = 0.9180 respectively). Enrolment HA inversely correlated with serum albumin, protein and platelets in all dengue and DHF (p < 0.05). HA and HS in all dengue patients decreased significantly at convalescence. Serum IL-10 was significantly associated with HA in all dengue patients (p = 0.002). Serum HA and HS levels were increased in adult dengue and HA was associated with markers of disease severity. Endothelial glycocalyx damage may have a role in vascular leakage in dengue.
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Granger D, Leo YS, Lee LK, Theel ES. Serodiagnosis of dengue virus infection using commercially available antibody and NS1 antigen ELISAs. Diagn Microbiol Infect Dis 2017; 88:120-124. [PMID: 28389145 DOI: 10.1016/j.diagmicrobio.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 11/27/2022]
Abstract
Accuracy of the InBios DENV Detect IgM, IgG and NS1 antigen (Ag) ELISAs (Seattle, WA) for detection of dengue virus (DENV) infection were evaluated using 100 retrospectively selected sera from acutely febrile patients presenting to a Singapore hospital. The InBios DENV NS1, IgM and IgG ELISAs had an overall sensitivity of 83.6%, 40% and 58.2% and an overall specificity of 97.8%, 97.8% and 55.6%, respectively. Simultaneous testing for NS1 and IgM-antibodies yielded a sensitivity and specificity of 85.5% and 95.5%, respectively, which did not significantly differ from testing for NS1 Ag alone. Using sera positive for IgM- or IgG-class antibodies to six common arboviruses, the InBios IgM and IgG ELISAs showed an overall analytic specificity of 89.2% and 66.4%, respectively. This study suggests that recent DENV infection can reliably be detected by the InBios NS1 Ag ELISA alone and that InBios DENV IgG reactivity should be interpreted with caution.
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Affiliation(s)
- D Granger
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Y S Leo
- Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - L K Lee
- Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - E S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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35
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[Autochthonous dengue]. Arch Pediatr 2016; 23:1284-1290. [PMID: 27789173 DOI: 10.1016/j.arcped.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/22/2022]
Abstract
Dengue is the arboviral disease that has massively spread in intertropical regions these past few years. The rise in imported cases of dengue and the rapid spread of the Aedes vector mosquitoes in continental France since 2004 explain the occurrence of indigenous dengue cases among the nonimmune population and points to an epidemic risk. Severe dengue cases are rare, but lethality is highest among children under 5 years of age. Like pediatricians in tropical regions, we must learn how dengue presents in metropolitan France and how it can be managed, and pay special attention to severe and potentially fatal forms. The epidemiological, pathophysiological, clinical, diagnostic, and therapeutic characteristics of dengue are presented herein.
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Her Z, Kam YW, Gan VC, Lee B, Thein TL, Tan JJL, Lee LK, Fink K, Lye DC, Rénia L, Leo YS, Ng LFP. Severity of Plasma Leakage Is Associated With High Levels of Interferon γ-Inducible Protein 10, Hepatocyte Growth Factor, Matrix Metalloproteinase 2 (MMP-2), and MMP-9 During Dengue Virus Infection. J Infect Dis 2016; 215:42-51. [PMID: 28077582 DOI: 10.1093/infdis/jiw494] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/12/2016] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Dengue virus infection typically causes mild dengue fever, but, in severe cases, life-threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) occur. The pathophysiological hallmark of DHF and DSS is plasma leakage that leads to enhanced vascular permeability, likely due to a cytokine storm. METHODS Ninety patients with dengue during 2010-2012 in Singapore were prospectively recruited and stratified according to their disease phase, primary and secondary infection status, and disease severity, measured by plasma leakage. Clinical parameters were recorded throughout the disease progression. The levels of various immune mediators were quantified using comprehensive multiplex microbead-based immunoassays for 46 immune mediators. RESULTS Associations between clinical parameters and immune mediators were analyzed using various statistical methods. Potential immune markers, including interleukin 1 receptor antagonist, interferon γ-inducible protein 10, hepatocyte growth factor, soluble p75 tumor necrosis factor α receptor, vascular cell adhesion molecule 1, and matrix metalloproteinase 2, were significantly associated with significant plasma leakage. Secondary dengue virus infections were also shown to influence disease outcome in terms of disease severity. CONCLUSIONS This study identified several key markers for exacerbated dengue pathogenesis, notably plasma leakage. This will allow a better understanding of the molecular mechanisms of DHF and DSS in patients with dengue.
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Affiliation(s)
- Zhisheng Her
- Singapore Immunology Network, Agency for Science, Technology, and Research
| | - Yiu-Wing Kam
- Singapore Immunology Network, Agency for Science, Technology, and Research
| | - Victor C Gan
- Communicable Disease Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology, and Research
| | - Tun-Linn Thein
- Communicable Disease Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital
| | - Jeslin J L Tan
- Singapore Immunology Network, Agency for Science, Technology, and Research
| | | | - Linda K Lee
- Communicable Disease Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital
| | - Katja Fink
- Singapore Immunology Network, Agency for Science, Technology, and Research
| | - David C Lye
- Communicable Disease Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital
| | - Laurent Rénia
- Singapore Immunology Network, Agency for Science, Technology, and Research
| | - Yee-Sin Leo
- Communicable Disease Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital.,Saw Swee Hock School of Public Health, National University of Singapore
| | - Lisa F P Ng
- Singapore Immunology Network, Agency for Science, Technology, and Research.,Institute of Infection and Global Health, University of Liverpool, United Kingdom
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Vivek R, Ahamed SF, Kotabagi S, Chandele A, Khanna I, Khanna N, Nayak K, Dias M, Kaja MK, Shet A. Evaluation of a pan-serotype point-of-care rapid diagnostic assay for accurate detection of acute dengue infection. Diagn Microbiol Infect Dis 2016; 87:229-234. [PMID: 27955870 DOI: 10.1016/j.diagmicrobio.2016.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/01/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
The catastrophic rise in dengue infections in India and globally has created a need for an accurate, validated low-cost rapid diagnostic test (RDT) for dengue. We prospectively evaluated the diagnostic performance of NS1/IgM RDT (dengue day 1) using 211 samples from a pediatric dengue cohort representing all 4 serotypes in southern India. The dengue-positive panel consisted of 179 dengue real-time polymerase chain reaction (RT-PCR) positive samples from symptomatic children. The dengue-negative panel consisted of 32 samples from dengue-negative febrile children and asymptomatic individuals that were negative for dengue RT-PCR/NS1 enzyme-linked immunosorbent assay/IgM/IgG. NS1/IgM RDT sensitivity was 89.4% and specificity was 93.8%. The NS1/IgM RDT showed high sensitivity throughout the acute phase of illness, in primary and secondary infections, in different severity groups, and detected all 4 dengue serotypes, including coinfections. This NS1/IgM RDT is a useful point-of-care assay for rapid and reliable diagnosis of acute dengue and an excellent surveillance tool in our battle against dengue.
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Affiliation(s)
- Rosario Vivek
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - Syed Fazil Ahamed
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - Shalini Kotabagi
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - Anmol Chandele
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Ira Khanna
- Mammalian Biology, Recombinant Gene Products Laboratory, Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Navin Khanna
- Mammalian Biology, Recombinant Gene Products Laboratory, Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Kaustuv Nayak
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Mary Dias
- Department of Microbiology, St. John's Medical College Hospital, Bangalore, 560034, India
| | - Murali-Krishna Kaja
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, 110067, India; Department of Pediatrics, Emory University, 1760 Haygood Drive, Atlanta, GA, 30322, USA
| | - Anita Shet
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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Applications of a Rapid and Sensitive Dengue DUO Rapid Immunochromatographic Test Kit as a Diagnostic Strategy during a Dengue Type 2 Epidemic in an Urban City. PLoS One 2016; 11:e0158437. [PMID: 27415767 PMCID: PMC4945082 DOI: 10.1371/journal.pone.0158437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/15/2016] [Indexed: 12/03/2022] Open
Abstract
Dengue infection is a major health problem in tropical and subtropical countries. A prospective observational study in a university-affiliated hospital was conducted between August 2015 and September 2015. Patients who visited the emergency department (ED) with a presentation of any symptoms of dengue were eligible for the dengue non-structural protein 1 (NS1), IgM/IgG rapid immunochromatographic tests and real-time polymerase chain reaction (RT-PCR) to evaluate the performance of the rapid tests. Considering the RT-PCR as the gold standard for the dengue diagnosis, the ideal primary results of sensitivity (80–100%), specificity (60–84%), positive predicted value(75%-95%), and negative predicted value (70–100%) suggested that the NS1-based test with or without a combination of IgM and IgG tests have good diagnostic performances in detecting dengue infections, even in the afebrile or elderly populations.
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The Use of NS1 Rapid Diagnostic Test and qRT-PCR to Complement IgM ELISA for Improved Dengue Diagnosis from Single Specimen. Sci Rep 2016; 6:27663. [PMID: 27278716 PMCID: PMC4899743 DOI: 10.1038/srep27663] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
Timely and accurate dengue diagnosis is important for differential diagnosis and immediate implementation of appropriate disease control measures. In this study, we compared the usefulness and applicability of NS1 RDT (NS1 Ag Strip) and qRT-PCR tests in complementing the IgM ELISA for dengue diagnosis on single serum specimen (n = 375). The NS1 Ag Strip and qRT-PCR showed a fair concordance (κ = 0.207, p = 0.001). While the NS1 Ag Strip showed higher positivity than qRT-PCR for acute (97.8% vs. 84.8%) and post-acute samples (94.8% vs. 71.8%) of primary infection, qRT-PCR showed higher positivity for acute (58.1% vs. 48.4%) and post-acute (50.0% vs.41.4%) samples in secondary infection. IgM ELISA showed higher positivity in samples from secondary dengue (74.2–94.8%) than in those from primary dengue (21.7–64.1%). More primary dengue samples showed positive with combined NS1 Ag Strip/IgM ELISA (99.0% vs. 92.8%) whereas more secondary samples showed positive with combined qRT-PCR/IgM ELISA (99.4% vs. 96.2%). Combined NS1 Ag Strip/IgM ELISA is a suitable combination tests for timely and accurate dengue diagnosis on single serum specimen. If complemented with qRT-PCR, combined NS1 Ag Strip/IgM ELISA would improve detection of secondary dengue samples.
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Use of a Rapid Test for Diagnosis of Dengue during Suspected Dengue Outbreaks in Resource-Limited Regions. J Clin Microbiol 2016; 54:2090-5. [PMID: 27225409 DOI: 10.1128/jcm.00521-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/23/2016] [Indexed: 12/19/2022] Open
Abstract
Dengue is major public health problem, globally. Timely verification of suspected dengue outbreaks allows for public health response, leading to the initiation of appropriate clinical care. Because the clinical presentation of dengue is nonspecific, dengue diagnosis would benefit from a sensitive rapid diagnostic test (RDT). We evaluated the diagnostic performance of an RDT that detects dengue virus (DENV) nonstructural protein 1 (NS1) and anti-DENV IgM during suspected acute febrile illness (AFI) outbreaks in four countries. Real-time reverse transcription-PCR and anti-DENV IgM enzyme-linked immunosorbent assay were used to verify RDT results. Anti-DENV IgM RDT sensitivity and specificity ranged from 55.3 to 91.7% and 85.3 to 98.5%, respectively, and NS1 sensitivity and specificity ranged from 49.7 to 92.9% and 22.2 to 89.0%, respectively. Sensitivity varied by timing of specimen collection and DENV serotype. Combined test results moderately improved the sensitivity. The use of RDTs identified dengue as the cause of AFI outbreaks where reference diagnostic testing was limited or unavailable.
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Buonora SN, Passos SRL, do Carmo CN, Quintela FM, de Oliveira DNR, dos Santos FB, Hökerberg YHM, Nogueira RMR, Daumas RP. Accuracy of clinical criteria and an immunochromatographic strip test for dengue diagnosis in a DENV-4 epidemic. BMC Infect Dis 2016; 16:37. [PMID: 26822788 PMCID: PMC4731992 DOI: 10.1186/s12879-016-1368-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/22/2016] [Indexed: 11/21/2022] Open
Abstract
Background Early diagnosis of dengue infection is important for decision-making and timely implementation of therapeutic measures. Although rapid NS1 assays have been used for dengue diagnosis since 2008, their performance in DENV-4 cases has not yet been fully assessed. Methods We evaluated the accuracy of NS1 Bioeasy™ immunochromatographic strip test and of three clinical criteria for dengue diagnosis. Patients presenting at an emergency care center within 72 h of an acute febrile illness during the 2013 DENV-4 epidemic in Rio de Janeiro were consecutively enrolled for clinical and laboratory evaluation. We classified patients as suspected dengue or not according to three clinical criteria: WHO 2009, WHO 1997, and INI-FIOCRUZ. Dengue diagnosis was defined by RNA detection using RT-PCR and the negative cases were negative for all dengue serotypes and also Platelia™ NS1 ELISA. We obtained accuracy indices for NS1 Bioeasy™ alone and in combination with the clinical criteria. Results RT-PCR for DENV-4 was positive in 148 out of 325 patients. Positive likelihood ratio, sensitivity, and specificity of NS1 Bioeasy™ with WHO 2009, WHO 1997, and INI-FIOCRUZ criteria were 22.6 (95 % CI 7.2–70.6), 40.6 % (95 % CI 32.3–49.3), and 98.2 % (95 % CI 94.9–99.6); 18.3 (95 % CI 6.8–49.2), 44.2 (95 % CI 35.8–52.9), 97.6 (95 % CI 94.0–99.3); 26.2 (95 % CI 6.5–106.5), 29.7 (95 % CI 22.4–37.8), 98.9 (95 % CI 96.0–99.9), respectively. WHO 1997 clinical criteria presented high sensitivity to rule out disease, but extremely low specificity. INI-FIOCRUZ had moderate sensitivity and specificity, and could target a group to a more specific test. Conclusions Although the large rates of false negative results using NS1 Bioeasy™ rapid test advise against its use for triaging (rule out) purposes in DENV-4 epidemics, it could be used as a confirmatory tool in a bedside algorithm.
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Affiliation(s)
- Sibelle Nogueira Buonora
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Sonia Regina Lambert Passos
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | | | - Fernanda Moisés Quintela
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Diana Neves Rodrigues de Oliveira
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | | | - Yara Hahr Marques Hökerberg
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | | | - Regina Paiva Daumas
- Germano Sinval Faria Teaching Primary Care Center, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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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 prospective case-control study to investigate retinal microvascular changes in acute dengue infection. Sci Rep 2015; 5:17183. [PMID: 26603217 PMCID: PMC4658599 DOI: 10.1038/srep17183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/16/2015] [Indexed: 12/31/2022] Open
Abstract
Dengue infection can affect the microcirculation by direct viral infection or activation of inflammation. We aimed to determine whether measured retinal vascular parameters were associated with acute dengue infection. Patients with acute dengue were recruited from Communicable Diseases Center, Singapore and age-gender-ethnicity matched healthy controls were selected from a population-based study. Retinal photographs were taken on recruitment and convalescence. A spectrum of quantitative retinal microvascular parameters (retinal vascular caliber, fractal dimension, tortuosity and branching angle) was measured using a semi-automated computer-based program. (Singapore I Vessel Assessment, version 3.0). We included 62 dengue patients and 127 controls. Dengue cases were more likely to have wider retinal arteriolar and venular calibers (158.3 μm vs 144.3 μm, p < 0.001; 227.7 μm vs 212.8 μm, p < 0.001; respectively), higher arteriolar and venular fractal dimensions (1.271 vs 1.249, p = 0.002; 1.268 vs. 1.230, p < 0.001, respectively), higher arteriolar and venular tortuosity (0.730 vs 0.546 [x104], p < 0.001; 0.849 vs 0.658 [x104], p < 0.001; respectively), compared to controls. Resolution of acute dengue coincided with decrease in retinal vascular calibers and venular fractal dimension. Dengue patients have altered microvascular network in the retina; these changes may reflect pathophysiological processes in the immune system.
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Shan X, Wang X, Yuan Q, Zheng Y, Zhang H, Wu Y, Yang J. Evaluation of the diagnostic accuracy of nonstructural protein 1 Ag-based tests for dengue virus in Asian population: a meta-analysis. BMC Infect Dis 2015; 15:360. [PMID: 26293345 PMCID: PMC4545931 DOI: 10.1186/s12879-015-1088-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022] Open
Abstract
Background Nonstructural protein 1 (NS1) Ag-based tests are useful for detecting dengue virus (DENV), but there is lack of evidence on the diagnostic accuracy of NS1 Ag-based tests in Asian population. Thus, we conducted this meta-analysis to obtain the overall estimated and summarized performance of the NS1 Ag-based tests in the detection of DENV in Asia. Methods PubMed, Embase and Medline were searched for studies that evaluated the diagnostic validity of NS1 Ag-based tests between January 1990 and November 2014. Data were analyzed by Meta-Disc and STATA software. Results A total of 18 studies including 3342 dengue cases and 1904 control cases which fulfilled the inclusion criteria were considered for analysis. The pooled sensitivity and specificity for NS1 Ag-based tests was 66 % (95 % CI 64.5–67.5) and 97.9 % (95 % CI 97.3–100), respectively. STRIP has the overall highest sensitivity (72.9 %, 95 % CI 70.1–75.5). According to viral serotype, the test with the highest sensitivity for DENV1, DENV2 and DENV3 were Platelia (83.7 %, 95 % CI 79.7–87.1), Panbio (71.8 %, 95 % CI 65.5–80.9) and STRIP (81.9 %, 95 % CI 75.5–87.2) respectively. The highest sensitivity for primary infection was Platelia (95.1 %, 95 % CI 92.6–96.9) and for secondary infection was STRIP (64 %, 95 % CI 53.2–73.9). Conclusion Our meta-analysis suggests that NS1 Ag-based test is a good diagnostic method for DENV with a high specificity. However, viral serotype, serological status, clinical severity and the duration of illness are the main factors influencing the diagnostic accuracy.
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Affiliation(s)
- Xiaoyun Shan
- Department of Clinical Laboratory, Jin Hua Hospital, Zhejiang University, 351 Ming Yue Street, Jin Hua, 321000, , Zhejiang, China.
| | - Xiangmei Wang
- Department of Clinical Laboratory, Jin Hua Hospital, Zhejiang University, 351 Ming Yue Street, Jin Hua, 321000, , Zhejiang, China.
| | - Qing Yuan
- Department of Clinical Laboratory, Jin Hua Hospital, Zhejiang University, 351 Ming Yue Street, Jin Hua, 321000, , Zhejiang, China.
| | - Yaping Zheng
- Department of Clinical Laboratory, Jin Hua Hospital, Zhejiang University, 351 Ming Yue Street, Jin Hua, 321000, , Zhejiang, China.
| | - Honghe Zhang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing ChunRoad, Hangzhou, 310003, , Zhejiang, China.
| | - Yihua Wu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing ChunRoad, Hangzhou, 310003, , Zhejiang, China. .,Department of Public Health, Hangzhou Normal University School of Medicine, 16 Xuelin Street, Hangzhou, 310016, Zhejiang, China.
| | - Jun Yang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing ChunRoad, Hangzhou, 310003, , Zhejiang, China. .,Department of Public Health, Hangzhou Normal University School of Medicine, 16 Xuelin Street, Hangzhou, 310016, Zhejiang, China.
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Tambyah PA, Ching CS, Sepramaniam S, Ali JM, Armugam A, Jeyaseelan K. microRNA expression in blood of dengue patients. Ann Clin Biochem 2015; 53:466-76. [PMID: 26290515 DOI: 10.1177/0004563215604001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dengue is the most common arboviral illness worldwide. While most infected patients recover, a proportion of them develop severe complications or fatality. Nevertheless, the pathophysiological mechanisms which distinguish the disease severity and associated complications are not clearly understood. We studied blood profiles of dengue patients in order to identify microRNAs that could play a role in these pathophysiological mechanisms. METHODS Blood samples from 26 dengue-infected patients were collected within 0-14 days of infection. Together with samples obtained from six healthy individuals, microRNA profiles were generated to identify significantly altered microRNAs upon dengue infection. Profiles of patients with influenza were also used to determine the disease specificity of these altered microRNAs. Their discriminative power to distinguish dengue from influenza was then tested statistically. RESULTS Several significantly altered microRNAs were identified in patients with dengue. Twelve microRNAs were specifically altered upon acute dengue whereas 14 microRNAs exhibited similar expression between dengue and influenza. Seventeen microRNAs which could potentially distinguish dengue-related complications were also identified. Expression of miR-24-1-5p, miR-512-5p and miR-4640-3p distinguished mild dengue from those exhibiting liver complications whereas miR-383 was significantly upregulated in mild dengue compared to those diagnosed as severe dengue with fluid accumulation. CONCLUSIONS We identified two panels of microRNAs - one specific for dengue and the other common to dengue and influenza. We also report on the differentially expressed microRNAs in patients with mild versus severe dengue, which could be the basis for the complications seen in them.
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Affiliation(s)
- Paul A Tambyah
- Department of Medicine, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore
| | - Chai S Ching
- Department of Biochemistry, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore
| | - Sugunavathi Sepramaniam
- Department of Biochemistry, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore
| | - Jaminah M Ali
- Department of Medicine, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore
| | - Arunmozhiarasi Armugam
- Department of Biochemistry, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore
| | - Kandiah Jeyaseelan
- Department of Biochemistry, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Vickers IE, Harvey KM, Brown MG, Nelson K, DuCasse MB, Lindo JF. The performance of the SD BIOLINE Dengue DUO® rapid immunochromatographic test kit for the detection of NS1 antigen, IgM and IgG antibodies during a dengue type 1 epidemic in Jamaica. J Biomed Sci 2015; 22:55. [PMID: 26173484 PMCID: PMC4502463 DOI: 10.1186/s12929-015-0164-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/03/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Dengue is an important mosquito-borne viral infection that affects millions of persons worldwide. Early diagnosis is necessary to effect appropriate management and decrease mortality. Immunochromatographic tests are advantageous in producing dengue test results within 30 min but these results should be sensitive and specific. In this study we evaluated the diagnostic performance of the SD BIOLINE Dengue DUO® rapid immunochromatographic test kit. A panel of 309 dengue and 30 non-dengue single serum samples characterized by using reference enzyme-linked immunosorbent assays (ELISAs) was used. These samples were received in the virology laboratory for routine testing during a dengue type 1 outbreak between October to December, 2012. RESULTS The overall diagnostic sensitivities of the SD BIOLINE Dengue DUO® rapid testfor IgM, IgG and NSI were 49.3% (95% CI: 41.3-57.4), 39.1% (95% CI: 33.3-45.2) and 90% (95% CI: 82.1-94.7), respectively. The IgM and IgG detection rates were significantly lower than that of the NSI (p < 0.001). However the combination of the IgM detection with NS1 detection or both NS1 and IgG resulted in a significant (p < 0.001) increase in sensitivity to 97.5% (95 % CI: 92.9-99.2) and 98.9% (95 % CI: 96.0-99.7), respectively. These higher sensitivities were achieved without any decrease in specificities. CONCLUSIONS This study revealed that combining two or more parameters of the SD BIOLINE Dengue DUO® rapid kit significantly improved the sensitivity of diagnosis of dengue virus infection and supports its usefulness in the Jamaican setting.
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Affiliation(s)
- Ivan E Vickers
- Department of Microbiology, The University of the West Indies, Kingston 7, Mona, Jamaica.
| | | | - Michelle G Brown
- Department of Microbiology, The University of the West Indies, Kingston 7, Mona, Jamaica.
| | - Kereann Nelson
- Department of Microbiology, The University of the West Indies, Kingston 7, Mona, Jamaica.
| | | | - John F Lindo
- Department of Microbiology, The University of the West Indies, Kingston 7, Mona, Jamaica.
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Noyd DH, Sharp TM. Recent Advances in Dengue: Relevance to Puerto Rico. PUERTO RICO HEALTH SCIENCES JOURNAL 2015; 34:65-70. [PMID: 26061055 PMCID: PMC4587385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Dengue represents an increasingly important public health challenge in Puerto Rico, with recent epidemics in 2007, 2010, and 2012-2013. Although recent advances in dengue vaccine development offer hope for primary prevention, the role of health professionals in the diagnosis and management of dengue patients is paramount. Case definitions for dengue, dengue with warning signs, and severe dengue provide a framework to guide clinical decision-making. Furthermore, the differentiation between dengue and other acute febrile illnesses, such as leptospirosis and chikungunya, is necessary for the appropriate diagnosis and management of cases. An understanding of dengue epidemiology and surveillance in Puerto Rico provides context for clinicians in epidemic and non-epidemic periods. This review aims to improve health professionals' ability to diagnose dengue, and as highlight the relevance of recent advances in dengue prevention and management in Puerto Rico.
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Affiliation(s)
- David H. Noyd
- Oregon Health & Science University, Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
| | - Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
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Osorio L, Uribe M, Ardila GI, Orejuela Y, Velasco M, Bonelo A, Parra B. The use of rapid dengue diagnostic tests in a routine clinical setting in a dengue-endemic area of Colombia. Mem Inst Oswaldo Cruz 2015; 110:510-6. [PMID: 25993399 PMCID: PMC4501415 DOI: 10.1590/0074-02760140359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/01/2015] [Indexed: 12/03/2022] Open
Abstract
There is insufficient evidence of the usefulness of dengue diagnostic tests under
routine conditions. We sought to analyse how physicians are using dengue diagnostics
to inform research and development. Subjects attending 14 health institutions in an
endemic area of Colombia with either a clinical diagnosis of dengue or for whom a
dengue test was ordered were included in the study. Patterns of test-use are
described herein. Factors associated with the ordering of dengue diagnostic tests
were identified using contingency tables, nonparametric tests and logistic
regression. A total of 778 subjects were diagnosed with dengue by the treating
physician, of whom 386 (49.5%) were tested for dengue. Another 491 dengue tests were
ordered in subjects whose primary diagnosis was not dengue. Severe dengue
classification [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5], emergency
consultation (OR 1.9; 95% CI 1.4-2.5) and month of the year (OR 3.1; 95% CI 1.7-5.5)
were independently associated with ordering of dengue tests. Dengue tests were used
both to rule in and rule out diagnosis. The latter use is not justified by the
sensitivity of current rapid dengue diagnostic tests. Ordering of dengue tests appear
to depend on a combination of factors, including physician and institutional
preferences, as well as other patient and epidemiological factors.
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Affiliation(s)
- Lyda Osorio
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia
| | - Marcela Uribe
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia
| | - Gloria Ines Ardila
- Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Yaneth Orejuela
- Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Margarita Velasco
- Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Anilza Bonelo
- Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Beatriz Parra
- Departamento de Microbiología, Universidad del Valle, Cali, Colombia
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Hapuarachchi HC, Chua RCR, Shi Y, Thein TL, Lee LK, Lee KS, Lye DC, Ng LC, Leo YS. Clinical outcome and genetic differences within a monophyletic Dengue virus type 2 population. PLoS One 2015; 10:e0121696. [PMID: 25811657 PMCID: PMC4374945 DOI: 10.1371/journal.pone.0121696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/03/2015] [Indexed: 12/28/2022] Open
Abstract
The exact mechanisms of interplay between host and viral factors leading to severe dengue are yet to be fully understood. Even though previous studies have implicated specific genetic differences of Dengue virus (DENV) in clinical severity and virus attenuation, similar studies with large-scale, whole genome screening of monophyletic virus populations are limited. Therefore, in the present study, we compared 89 whole genomes of DENV-2 cosmopolitan clade III isolates obtained from patients diagnosed with dengue fever (DF, n = 58), dengue hemorrhagic fever (DHF, n = 30) and dengue shock syndrome (DSS, n = 1) in Singapore between July 2010 and January 2013, in order to determine the correlation of observed viral genetic differences with clinical outcomes. Our findings showed no significant difference between the number of primary and secondary infections that progressed to DHF and DSS (p>0.05) in our study cohort. Despite being highly homogenous, study isolates possessed 39 amino acid substitutions of which 10 substitutions were fixed in three main groups of virus isolates. None of those substitutions were specifically associated with DHF and DSS. Notably, two evolutionarily unique virus groups possessing C-P43T+NS1-S103T+NS2A-V83I+NS3-R337K+ NS3-I600T+ NS5-P136S and NS2A-T119N mutations were exclusively found in patients with DF, the benign form of DENV infections. Those mutants were significantly associated with mild disease outcome. These observations indicated that disease progression into DHF and DSS within our patient population was more likely to be due to host than virus factors. We hypothesize that selection for potentially less virulent groups of DENV-2 in our study cohort may be an evolutionary adaptation of viral strains to extend their survival in the human-mosquito transmission cycle.
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Affiliation(s)
| | - Rachel Choon Rong Chua
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05-08, Singapore 138667
| | - Yuan Shi
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05-08, Singapore 138667
| | - Tun Lin Thein
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Linda Kay Lee
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Kim Sung Lee
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, 535 Clementi Road, Singapore 599489
| | - David Chien Lye
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way, #06-05-08, Singapore 138667
- * E-mail:
| | - Yee Sin Leo
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
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Carter MJ, Emary KR, Moore CE, Parry CM, Sona S, Putchhat H, Reaksmey S, Chanpheaktra N, Stoesser N, Dobson ADM, Day NPJ, Kumar V, Blacksell SD. Rapid diagnostic tests for dengue virus infection in febrile Cambodian children: diagnostic accuracy and incorporation into diagnostic algorithms. PLoS Negl Trop Dis 2015; 9:e0003424. [PMID: 25710684 PMCID: PMC4340051 DOI: 10.1371/journal.pntd.0003424] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Dengue virus (DENV) infection is prevalent across tropical regions and may cause severe disease. Early diagnosis may improve supportive care. We prospectively assessed the Standard Diagnostics (Korea) BIOLINE Dengue Duo DENV rapid diagnostic test (RDT) to NS1 antigen and anti-DENV IgM (NS1 and IgM) in children in Cambodia, with the aim of improving the diagnosis of DENV infection. METHODOLOGY AND PRINCIPAL FINDINGS We enrolled children admitted to hospital with non-localised febrile illnesses during the 5-month DENV transmission season. Clinical and laboratory variables, and DENV RDT results were recorded at admission. Children had blood culture and serological and molecular tests for common local pathogens, including reference laboratory DENV NS1 antigen and IgM assays. 337 children were admitted with non-localised febrile illness over 5 months. 71 (21%) had DENV infection (reference assay positive). Sensitivity was 58%, and specificity 85% for RDT NS1 and IgM combined. Conditional inference framework analysis showed the additional value of platelet and white cell counts for diagnosis of DENV infection. Variables associated with diagnosis of DENV infection were not associated with critical care admission (70 children, 21%) or mortality (19 children, 6%). Known causes of mortality were melioidosis (4), other sepsis (5), and malignancy (1). 22 (27%) children with a positive DENV RDT had a treatable other infection. CONCLUSIONS The DENV RDT had low sensitivity for the diagnosis of DENV infection. The high co-prevalence of infections in our cohort indicates the need for a broad microbiological assessment of non-localised febrile illness in these children.
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Affiliation(s)
- Michael J. Carter
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Kate R. Emary
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Catherine E. Moore
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia
| | - Christopher M. Parry
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Soeng Sona
- Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia
| | - Hor Putchhat
- Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia
| | - Sin Reaksmey
- Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia
| | | | - Nicole Stoesser
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew D. M. Dobson
- Biological and Environmental Sciences, University of Stirling, Stirling, United Kingdom
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Varun Kumar
- Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia
| | - Stuart D. Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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