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Gomes LHF, Marques AB, Dias ICDM, Gabeira SCDO, Barcelos TR, Guimarães MDO, Ferreira IR, Guida LC, Lucena SL, Rocha AD. Validation of Gene Expression Patterns for Oral Feeding Readiness: Transcriptional Analysis of Set of Genes in Neonatal Salivary Samples. Genes (Basel) 2024; 15:936. [PMID: 39062715 PMCID: PMC11275400 DOI: 10.3390/genes15070936] [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: 05/20/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Neonatal health assessment is crucial for detecting and intervening in various disorders. Traditional gene expression analysis methods often require invasive procedures during sample collection, which may not be feasible or ideal for preterm infants. In recent years, saliva has emerged as a promising noninvasive biofluid for assessing gene expression. Another trend that has been growing is the use of "omics" technologies such as transcriptomics in the analysis of gene expression. The costs for carrying out these analyses and the difficulty of analysis make the detection of candidate genes necessary. These genes act as biomarkers for the maturation stages of the oral feeding issue. METHODOLOGY Salivary samples (n = 225) were prospectively collected from 45 preterm (<34 gestational age) infants from five predefined feeding stages and submitted to RT-qPCR. A better description of the targeted genes and results from RT-qPCR analyses were included. The six genes previously identified as predictive of feeding success were tested. The genes are AMPK, FOXP2, WNT3, NPHP4, NPY2R, and PLXNA1, along with two reference genes: GAPDH and 18S. RT-qPCR amplification enabled the analysis of the gene expression of AMPK, FOXP2, WNT3, NPHP4, NPY2R, and PLXNA1 in neonatal saliva. Expression results were correlated with the feeding status during sample collection. CONCLUSIONS In summary, the genes AMPK, FOXP2, WNT3, NPHP4, NPY2R, and PLXNA1 play critical roles in regulating oral feeding and the development of premature infants. Understanding the influence of these genes can provide valuable insights for improving nutritional care and support the development of these vulnerable babies. Evidence suggests that saliva-based gene expression analysis in newborns holds great promise for early detection and monitoring of disease and understanding developmental processes. More research and standardization of protocols are needed to fully explore the potential of saliva as a noninvasive biomarker in neonatal care.
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Affiliation(s)
- Leonardo Henrique Ferreira Gomes
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Andressa Brito Marques
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Isabel Cristina de Meireles Dias
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Sanny Cerqueira de O. Gabeira
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Tamara Rosa Barcelos
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Mariana de Oliveira Guimarães
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Igor Ribeiro Ferreira
- Rural and Remote Support Services, Department of Health, Integrated Cardiovascular Clinical Network SA, Adelaide, SA 5042, Australia
| | - Letícia Cunha Guida
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Sabrina Lopes Lucena
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
| | - Adriana Duarte Rocha
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil; (L.H.F.G.)
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da Fonseca LLCG, Rocha DN, Cintra HA, de Araújo LL, dos Santos GLM, de Faria LL, Salú MDS, Leite SHDS, Rocha AD, Lopes MDCB, Ferreira IR, Gomes LHF, Guida LC. Establishing a Standardized DNA Extraction Method Using NaCl from Oral Mucosa Cells for Its Application in Imprinting Diseases Such as Prader-Willi and Angelman Syndromes: A Preliminary Investigation. Genes (Basel) 2024; 15:641. [PMID: 38790270 PMCID: PMC11120874 DOI: 10.3390/genes15050641] [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: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Diagnosing imprinting defects in neonates and young children presents challenges, often necessitating molecular analysis for a conclusive diagnosis. The isolation of genetic material from oral swabs becomes crucial, especially in settings where blood sample collection is impractical or for vulnerable populations like newborns, who possess limited blood volumes and are often too fragile for invasive procedures. Oral swab samples emerge as an excellent source of DNA, effectively overcoming obstacles associated with rare diseases. METHODS In our study, we specifically addressed the determination of the quality and quantity of DNA extracted from oral swab samples using NaCl procedures. RESULTS We compared these results with extractions performed using a commercial kit. Subsequently, the obtained material underwent MS-HRM analysis for loci associated with imprinting diseases such as Prader-Willi and Angelman syndromes. CONCLUSIONS Our study emphasizes the significance of oral swab samples as a reliable source for obtaining DNA for MS-HRM analysis. NaCl extraction stands out as a practical and cost-effective method for genetic studies, contributing to a molecular diagnosis that proves particularly beneficial for patients facing delays in characterization, ultimately influencing their treatment.
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Affiliation(s)
- Letícia Lopes Cabral Guimarães da Fonseca
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Danielle Nascimento Rocha
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Hiago Azevedo Cintra
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Luiza Loureiro de Araújo
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Gabrielle Leal Monteiro dos Santos
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Leonardo Lima de Faria
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Margarida dos Santos Salú
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Silvia Helena dos Santos Leite
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Adriana Duarte Rocha
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Maria da Conceição Borges Lopes
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Igor Ribeiro Ferreira
- Rural and Remote Support Services, Department of Health, Integrated Cardiovascular Clinical Network SA, Adelaide 5042, Australia
| | - Leonardo Henrique Ferreira Gomes
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Letícia Cunha Guida
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
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Frazer JL, Norton R. Dengue: A review of laboratory diagnostics in the vaccine age. J Med Microbiol 2024; 73. [PMID: 38722305 DOI: 10.1099/jmm.0.001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Background. Dengue is an important arboviral infection of considerable public health significance. It occurs in a wide global belt within a variety of tropical regions. The timely laboratory diagnosis of Dengue infection is critical to inform both clinical management and an appropriate public health response. Vaccination against Dengue virus is being introduced in some areas.Discussion. Appropriate diagnostic strategies will vary between laboratories depending on the available resources and skills. Diagnostic methods available include viral culture, the serological detection of Dengue-specific antibodies in using enzyme immunoassays (EIAs), microsphere immunoassays, haemagglutination inhibition or in lateral flow point of care tests. The results of antibody tests may be influenced by prior vaccination and exposure to other flaviviruses. The detection of non-structural protein 1 in serum (NS1) has improved the early diagnosis of Dengue and is available in point-of-care assays in addition to EIAs. Direct detection of viral RNA from blood by PCR is more sensitive than NS1 antigen detection but requires molecular skills and resources. An increasing variety of isothermal nucleic acid detection methods are in development. Timing of specimen collection and choice of test is critical to optimize diagnostic accuracy. Metagenomics and the direct detection by sequencing of viral RNA from blood offers the ability to rapidly type isolates for epidemiologic purposes.Conclusion. The impact of vaccination on immune response must be recognized as it will impact test interpretation and diagnostic algorithms.
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Affiliation(s)
| | - Robert Norton
- Pathology Queensland, Townsville QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Magalhaes T, Portilho MM, Moreira PSS, Marinho ML, Dias WP, Gonçalves NM, Rodrigues OAS, Montes J, Reis L, Jesus DF, Silva TO, Dultra LS, Nery JS, Ribeiro GS. Validation of the use of dried blood spots in a chikungunya virus IgG serological assay. J Immunol Methods 2023; 522:113571. [PMID: 37742825 DOI: 10.1016/j.jim.2023.113571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
Dried blood spot (DBS) sampling is a simple, fast, and minimally invasive blood collection method that is particularly useful for diagnostic or epidemiological studies in hard-to-reach populations. Nevertheless, the use of DBS in assays that have been optimized with gold-standard samples (serum or plasma) must be optimized to yield reliable results. Here, we describe the validation of DBS in a commercial assay to measure IgG against chikungunya virus (CHIKV IgG ELISA; Euroimmun, Lübeck, Germany). During a health survey of people experiencing homelessness in Salvador, Brazil, between September 2021 and February 2022, a subset (75/523; 14.3%) of the study participants had paired capillary (for DBS preparation) and venous (for serum separation) blood samples collected. A pilot optimization test was initially performed with 17 paired samples to compare the CHIKV IgG ELISA absorbance values between serum and three different dilutions of DBS. Based on the preliminary results, the best DBS dilution was selected for a final evaluation comparing paired serum and DBS samples from 58 participants. The sensitivity and specificity of the CHIKV ELISA of DBS compared to sera were 100% (95% C.I.: 85.8-100%) and 100% (95% C.I.: 93-100%), respectively. In the linear regression analysis, a coefficient of determination (R2) value of 0.98 indicated the excellent performance of DBS in predicting the serum levels of IgG CHIKV antibodies. Our findings suggest that DBS at an optimized dilution is reliable for investigating the prevalence of CHIKV IgG antibodies during population surveys in the commercial assay tested here.
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Affiliation(s)
- Tereza Magalhaes
- Department of Entomology, Texas A&M University, College Station, EUA, United States of America; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Moyra M Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BraZil
| | | | - Milena L Marinho
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Wiler P Dias
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Jane Montes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Leila Reis
- Centro de Estudos Afro-Orientais, Universidade Federal da Bahia, Salvador, Brazil
| | - Dilma F Jesus
- Secretaria Municipal de Saúde de Salvador, Salvador, Brazil
| | - Tarcísio O Silva
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Lua S Dultra
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil; Secretaria Municipal de Saúde de Salvador, Salvador, Brazil; Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
| | - Joilda S Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Guilherme S Ribeiro
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BraZil.
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Würsch D, Rojas-Montes O, Maldonado-Rodríguez A, Sevilla-Reyes E, Cevallos AM, Sánchez-Burgos G, Chávez-Negrete A, Lira R. Dried Serum Samples for Antibody Detection in Arthropod-Borne Virus Infections Are an Effective Alternative to Serum Samples. Am J Trop Med Hyg 2023; 109:933-936. [PMID: 37640289 PMCID: PMC10551088 DOI: 10.4269/ajtmh.22-0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
The disease burden of arthropod-borne infections is particularly high in low- and middle-income countries, where the availability of resources for surveillance and testing is limited. The lack of local infrastructure demands that biological samples be sent to central laboratories by refrigerated transport, which increases costs and the risk of sample degradation. Dried blood spot samples are an alternative for ensuring sample integrity during transportation and storage. They can be used for the detection of nucleic acids and proteins, such as antigens or antibodies. Here, we compared anti-chikungunya IgM, anti-dengue IgM, anti-dengue IgG, and anti-Zika IgG detection between paired serum and dried serum samples (DSSs); the agreement between results was found to be 90.6%, 94.1%, 85.9%, and 95.5%, respectively, indicating a strong correlation. Our results suggest that DSSs provide a reliable alternative for detection of specific antibodies in arthropod-borne infections.
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Affiliation(s)
- Daniela Würsch
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Othon Rojas-Montes
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Angélica Maldonado-Rodríguez
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Edgar Sevilla-Reyes
- Laboratorio de Transcriptómica e Inmunología Molecular, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de Mexico, Mexico
| | - Ana María Cevallos
- Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
| | - Gilma Sánchez-Burgos
- Unidad de Investigación Médica Yucatán, Instituto Mexicano del Seguro Social, Mérida, Mexico
| | - Adolfo Chávez-Negrete
- Educación e Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rosalía Lira
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Maia AC, de Souza Cardoso Quintão T, de Oliveira PM, Cassemiro ÉM, Alves DCC, de Melo Alves PP, Dos Anjos Pereira Martins F, Araujo ELL, da Costa Gurgel H, Noronha EF, Ramalho WM, Pereira AL, Slavov SN, de Araújo WN, Haddad R. Nasopharyngeal swabs as alternative specimens for the diagnosis of dengue virus infection. J Infect 2023:S0163-4453(23)00195-0. [PMID: 37003524 DOI: 10.1016/j.jinf.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
| | - Tatyane de Souza Cardoso Quintão
- Center for Tropical Medicine, University of Brasilia, Federal District, Brazil; Molecular Diagnostics Laboratory, University Hospital of Brasilia/EBSERH, Federal District, Brazil
| | - Pâmela Maria de Oliveira
- Center for Tropical Medicine, University of Brasilia, Federal District, Brazil; Molecular Diagnostics Laboratory, University Hospital of Brasilia/EBSERH, Federal District, Brazil
| | - Évelin Mota Cassemiro
- Center for Tropical Medicine, University of Brasilia, Federal District, Brazil; Molecular Diagnostics Laboratory, University Hospital of Brasilia/EBSERH, Federal District, Brazil
| | - Daiani Cristina Cilião Alves
- Molecular Diagnostics Laboratory, University Hospital of Brasilia/EBSERH, Federal District, Brazil; Euro-American University Centre-UNIEURO, Brasilia, Federal District, Brazil
| | | | | | | | - Helen da Costa Gurgel
- Laboratory the Geography, Environment and Health, University of Brasilia, Federal District, Brazil
| | - Elza Ferreira Noronha
- Center for Tropical Medicine, University of Brasilia, Federal District, Brazil; Molecular Diagnostics Laboratory, University Hospital of Brasilia/EBSERH, Federal District, Brazil
| | - Walter Massa Ramalho
- Faculty of Ceilândia, University of Brasilia, Federal District, Brazil; Center for Tropical Medicine, University of Brasilia, Federal District, Brazil
| | | | - Svetoslav Nanev Slavov
- Butantan Institute, São Paulo, Brazil; Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wildo Navegantes de Araújo
- Faculty of Ceilândia, University of Brasilia, Federal District, Brazil; Center for Tropical Medicine, University of Brasilia, Federal District, Brazil; National Institute for Science and Technology for Health Technology Assessment, Porto Alegre/RS, Brazil
| | - Rodrigo Haddad
- Faculty of Ceilândia, University of Brasilia, Federal District, Brazil; Center for Tropical Medicine, University of Brasilia, Federal District, Brazil; Molecular Diagnostics Laboratory, University Hospital of Brasilia/EBSERH, Federal District, Brazil.
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Evaluation of Whatman FTA cards for the preservation of yellow fever virus RNA for use in molecular diagnostics. PLoS Negl Trop Dis 2022; 16:e0010487. [PMID: 35704565 PMCID: PMC9200311 DOI: 10.1371/journal.pntd.0010487] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022] Open
Abstract
Yellow fever virus (YFV) is a flavivirus that frequently causes outbreaks of hemorrhagic fever in Africa and South America and is considered a reemerging public health threat. Accurate diagnosis of yellow fever (YF) disease is critical as one confirmed case constitutes an outbreak and may trigger a mass vaccination campaign. Highly sensitive and specific molecular diagnostics have been developed; however, these assays require maintenance of cold-chain during transport of specimens to prevent the degradation of viral RNA prior to testing. Such cold-chain requirements are difficult to meet in some regions. In this study, we investigated Whatman FTA cards as an alternative stabilization method of YFV RNA for use in molecular diagnosis. Using contrived specimens, linear regression analysis showed that RNA detection from a single 6mm FTA card punch was significantly less sensitive than traditional RNA extraction; however, pooling RNA extracted from two FTA punches significantly lowered the limit of detection to be equal to that of the traditional RNA extraction gold standard. In experiments addressing the ability of FTA card methodology to stabilize YFV RNA at variable temperature, RNA could be detected for more than two weeks following storage at 25°C. Even more promising, YFV RNA was detectable on cards held at 37°C from two days to over two weeks depending on viral input. FTA cards were also shown to stabilize YFV RNA at high humidity if cards were desiccated prior to inoculation. These results support that FTA cards could be cost effective and easy to use in molecular diagnosis of YF, preserving viral RNA to allow for positive diagnoses in situations where maintaining cold-chain is not feasible.
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Martins EB, Silva MFB, Tassinari WS, de Bruycker-Nogueira F, Moraes ICV, Rodrigues CDS, Santos CC, Sampaio SA, Pina-Costa A, Fabri AA, Guerra-Campos V, Santos NA, Faria NRC, Filippis AMB, Brasil P, Calvet GA. Detection of Chikungunya virus in bodily fluids: The INOVACHIK cohort study. PLoS Negl Trop Dis 2022; 16:e0010242. [PMID: 35255099 PMCID: PMC8929700 DOI: 10.1371/journal.pntd.0010242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/17/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chikungunya is a widely distributed, re-emerging tropical disease caused by the chikungunya virus (CHIKV). Little is known about the duration for which CHIK RNA are detectable in bodily fluids, especially genital secretions, and current evidence is based on small series or case reports. An understanding of viral dynamics across different body compartments can inform diagnostic testing algorithms and public health prevention interventions. Methodology A prospective cohort study was conducted to assess the presence and duration of detectable levels of CHIKV RNA in blood, urine, saliva, semen, and vaginal secretions. Men and women (≥ 18 years) with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test for CHIKV in the acute phase (1–14 days) of the disease were included. After enrollment, clinical data and samples were collected every 15 days over the first 2 months, and a final collection was performed 3 months after recruitment. The Kaplan–Meier interval-censoring method and the parametric Weibull model were fitted to estimate the median time of viral persistence until the lack of CHIKV RNA detection among all body fluids. Punctual estimates of the median time of CHIKV RNA persistence for each fluid were estimated using a 95% confidence interval (CI). Results From April to December 2019, 170 participants were screened. Of these, 152 (100 women) were enrolled in the study. The median and interquartile range (IQR) ages for men and women were 39.3 (IQR: 26.9, 50.7) and 43.5 (IQR: 33.8, 53.6) years, respectively. CHIKV RNA was detected in 80.3% (122/152) of serum samples, 23.0% (35/152) of urine samples, 30.3% (46/152) of saliva samples, 14.3% (6/42) of semen samples, and 20.2% (20/99) of vaginal secretion samples. The median time until the loss of CHIKV RNA detection was 19.6 days (95% CI, 17.5–21.7) in serum, 25.3 days (95% CI, 17.8–32.8) in urine, 23.1 days (95% CI, 17.9–28.4) in saliva, and 25.8 days (95% CI, 20.6–31.1) in vaginal secretion. The number of semen samples available was too small to make statistical estimates, but a last positive sample was obtained from a participant 56 days after the onset of symptoms. Conclusions CHIKV RNA could be detected in all bodily fluids studied, including genital secretions during the acute and convalescent phases and additional studies on viral infectivity in semen and vaginal secretions are warranted. This prospective cohort study of adult patients aimed to estimate the presence and duration of detectable levels of chikungunya virus RNA in bodily fluids, including genital secretions, among participants in the acute and convalescent phases of the disease. In addition to the fluids usually used for diagnosis in humans (serum and plasma), we reported the detection of chikungunya virus RNA in all body fluids. Reports have shown that chikungunya virus RNA in serum declines to undetectable levels within 1–2 weeks after symptom onset. The viral persistence in the serum in our study was longer than expected. In addition, we showed that saliva and urine contained detectable viral RNA in both the acute and convalescent phases of the disease. To the best of our knowledge, this is the first cohort study assessing the presence and persistence of CHIKV in genital fluids (vaginal secretions and semen). Knowledge of viral persistence can help inform recommendations for the control, treatment, and prevention of the disease. Additional studies on viral infectivity are warranted.
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Affiliation(s)
- Ezequias B. Martins
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Michele F. B. Silva
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wagner S. Tassinari
- Mathematics Department, Exact Sciences Institute, Federal Rural University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Isabella C. V. Moraes
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cintia D. S. Rodrigues
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina C. Santos
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone A. Sampaio
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anielle Pina-Costa
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allison A. Fabri
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vinícius Guerra-Campos
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nayara A. Santos
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nieli R. C. Faria
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Maria B. Filippis
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme A. Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Holroyd TA, Schiaffino F, Chang RH, Wanyiri JW, Saldanha IJ, Gross M, Moss WJ, Hayford K. Diagnostic accuracy of dried blood spots for serology of vaccine-preventable diseases: a systematic review. Expert Rev Vaccines 2021; 21:185-200. [PMID: 34852211 DOI: 10.1080/14760584.2022.2013821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Venous serum and plasma are optimal specimens for serological testing but may be logistically infeasible. Dried blood spots (DBS) are a feasible alternative, provided results are adequately sensitive and specific. We aimed to assess the diagnostic accuracy of DBS to measure IgG and IgM antibodies for vaccine-preventable diseases and compare test validity of DBS with venous blood. AREAS COVERED In October 2020, we searched seven databases for peer-reviewed studies assessing the diagnostic accuracy of DBS specimens compared with serum in detecting antibodies to VPDs in humans. We extracted data and assessed risk of bias in all included studies. We calculated sensitivity and specificity with 95% confidence intervals for each index-reference test comparison. We narratively synthesized the identified evidence on diagnostic accuracy and blood collection and processing methods for DBS. Studies on measles and rubella IgG and IgM were the most frequently identified and reported generally high sensitivity and specificity. EXPERT OPINION Lack of standardization in collection, storage, and testing methods limited systematic comparison across studies. Our findings indicate a need for additional validation studies on the diagnostic accuracy of DBS to expand their use in serological surveillance. We recommend practical considerations to improve standardized reporting for DBS validation studies.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francesca Schiaffino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel H Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Margaret Gross
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Arkell P, Angelina J, do Carmo Vieira A, Wapling J, Marr I, Monteiro M, Matthews A, Amaral S, da Conceicao V, Kim SH, Bailey D, Yan J, Fancourt's NSS, Vaz Nery S, Francis JR. Integrated serological surveillance of acute febrile illness in the context of a lymphatic filariasis survey in Timor-Leste: a pilot study using dried blood spots. Trans R Soc Trop Med Hyg 2021; 116:531-537. [PMID: 34850241 PMCID: PMC9157677 DOI: 10.1093/trstmh/trab164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute febrile illnesses (AFIs), including dengue, scrub typhus and leptospirosis, cause significant morbidity and mortality in Southeast Asia. Serological surveillance can be used to investigate the force and distribution of infections. Dried blood spot (DBS) samples are an attractive alternative to serum because they are easier to collect and transport and require less cold storage. We conducted a pilot study to determine the feasibility of integrating serological surveillance for dengue, scrub typhus and leptospirosis into a population-representative lymphatic filariasis seroprevalence survey in Timor-Leste using DBSs. Methods A total of 272 DBSs were collected from healthy community participants. DBSs were analysed at the National Health Laboratory using commercially available enzyme-linked immunosorbent assays. To validate assays for DBSs, 20 anonymised serum samples of unknown serostatus were used to create dried serum spots (DSSs). These were analysed with optical densities compared with those of serum. Where low variance was observed (dengue assay) the published kit cut-offs for serum were applied to the analysis of DBSs. For the other assays (scrub typhus and leptospirosis), index values (IVs) were calculated and cut-offs were determined to be at 2 standard deviations (SDs) above the mean. Results Of the 272 samples analysed, 19 (7.0% [95% confidence interval {CI} 4.3 to 10.7]) were positive for dengue immunoglobulin G (IgG), 11 (4.0% [95% CI 2.1 to 7.1]) were positive for scrub typhus IgG and 16 (5.9% [95% CI 3.4 to 9.4%]) were positive for leptospira IgG. Conclusions While dengue seroprevalence was lower than in nearby countries, results represent the first evidence of scrub typhus and leptospirosis transmission in Timor-Leste. Integrated programmes of serological surveillance could greatly improve our understanding of infectious disease epidemiology in remote areas and would incur minimal additional fieldwork costs. However, when planning such studies, the choice of assays, their validation for DBSs and the laboratory infrastructure and technical expertise at the proposed location of analysis must be considered.
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Affiliation(s)
- Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Imperial College London, London, UK
| | | | | | - Johanna Wapling
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ian Marr
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Merita Monteiro
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Ministry of Health, Dili, Timor-Leste
| | | | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Virginia da Conceicao
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,National Health Laboratory, Dili, Timor-Leste
| | | | - Daniel Bailey
- Rare and Imported Pathogens Laboratory, Porton Down, UK
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
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11
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Humaidi M, Tien WP, Yap G, Chua CR, Ng LC. Non-Invasive Dengue Diagnostics-The Use of Saliva and Urine for Different Stages of the Illness. Diagnostics (Basel) 2021; 11:diagnostics11081345. [PMID: 34441280 PMCID: PMC8393275 DOI: 10.3390/diagnostics11081345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Dengue diagnosis is largely dependent on clinical symptoms and routinely confirmed with laboratory detection of dengue virus in patient serum samples collected via phlebotomy. This presents a challenge to patients not amenable to venipuncture. Non-invasive methods of dengue diagnosis have the potential to enhance the current dengue detection algorithm. In this study, samples from dengue infected patients were collected between January 2012 until September 2012 and September 2013 until December 2013 in two different setups. Panel A samples (blood, urine, and saliva) were collected daily when the 39 patients were hospitalised and during their follow-up visits while Panel B samples (saliva) were collected from 23 patients during the acute stage of dengue. Using DENV PCR on Panel A, from day 2 to day 4 post fever onset, serum showed the best overall positivity followed by saliva and urine (100%/82.1%/67.9%). From day 5 until day 10 post fever onset, serum and urine had similar positivity (67.4%/61.2%), followed by saliva (51.3%). Beyond day 10 post fever onset, DENV was undetectable in sera, but urine and saliva showed 56.8% and 28.6% positivity, respectively. DENV in urine was detectable up until 32 days post fever. Panel B results showed overall sensitivity of 32.4%/36% (RNA/NS1) for DENV detection in saliva. Our results suggest that the urine-based detection method is useful especially for late dengue detection, where DENV is undetected in sera but still detectable in urine. This provides a potential tool for the physician to pick up new cases in an area where there is ongoing dengue transmission and subsequently prompt for intensified vector control activities.
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Affiliation(s)
- Mahathir Humaidi
- Environmental Health Institute, National Environment Agency, Singapore 138667, Singapore; (W.P.T.); (G.Y.); (C.R.C.)
- Correspondence: (M.H.); (L.C.N.)
| | - Wei Ping Tien
- Environmental Health Institute, National Environment Agency, Singapore 138667, Singapore; (W.P.T.); (G.Y.); (C.R.C.)
| | - Grace Yap
- Environmental Health Institute, National Environment Agency, Singapore 138667, Singapore; (W.P.T.); (G.Y.); (C.R.C.)
| | - Choon Rong Chua
- Environmental Health Institute, National Environment Agency, Singapore 138667, Singapore; (W.P.T.); (G.Y.); (C.R.C.)
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore 138667, Singapore; (W.P.T.); (G.Y.); (C.R.C.)
- School of Biological Science, Nanyang Technological University, Singapore 639798, Singapore
- Correspondence: (M.H.); (L.C.N.)
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12
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Waggoner JJ, Stittleburg V, Natrajan MS, Paniagua-Avila A, Bauer D, Olson D, El Sahly HM, Asturias EJ, Anderson EJ, Munoz FM. Sensitive and Prolonged Detection of Dengue Virus RNA in Whole Blood. Am J Trop Med Hyg 2021; 104:1734-1736. [PMID: 33755591 PMCID: PMC8103463 DOI: 10.4269/ajtmh.20-1497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/03/2021] [Indexed: 01/19/2023] Open
Abstract
Molecular detection of dengue virus (DENV) RNA from serum or plasma provides an accurate acute-phase diagnostic (< 7 days after symptom onset). Detection may be prolonged in whole blood, although data are limited. We tested for DENV by real-time reverse transcription-PCR in 345 paired acute-phase plasma and whole blood samples from individuals with a Flavivirus-like illness in southwestern Guatemala. In 18/18 cases with detectable DENV RNA in plasma, whole blood samples were positive and yielded similar cycle threshold values. In seven individuals with convalescent samples obtained 2-3 weeks later, DENV RNA remained detectable in whole blood but not plasma. In three additional cases, DENV RNA was only detectable in whole blood at the acute visit. In two cases, whole blood detection was linked to a virologically confirmed DENV infection 6-11 weeks earlier. Whole blood DENV RNA detection is sensitive for acute dengue infection and may remain positive for weeks to months.
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Affiliation(s)
- Jesse J. Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia;,Address correspondence to Jesse J. Waggoner, Division of Infectious Diseases, Department of Medicine, Emory University, 1760 Haygood Dr. NE, Rm. E-169, Atlanta, GA 30322. E-mail:
| | - Victoria Stittleburg
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | - Muktha S. Natrajan
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Desiree Bauer
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Daniel Olson
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado;,Division of Infectious Diseases and Epidemiology, Department of Pediatrics, University of Colorado at Denver, Aurora, Colorado
| | - Hana M. El Sahly
- Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Edwin J. Asturias
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado;,Division of Infectious Diseases and Epidemiology, Department of Pediatrics, University of Colorado at Denver, Aurora, Colorado
| | - Evan J. Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia;,Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Flor M. Munoz
- Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas;,Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
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13
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Koliopoulos P, Kayange NM, Daniel T, Huth F, Gröndahl B, Medina-Montaño GC, Pretsch L, Klüber J, Schmidt C, Züchner A, Ulbert S, Mshana SE, Addo M, Gehring S. Multiplex-RT-PCR-ELISA panel for detecting mosquito-borne pathogens: Plasmodium sp. preserved and eluted from dried blood spots on sample cards. Malar J 2021; 20:66. [PMID: 33526038 PMCID: PMC7851927 DOI: 10.1186/s12936-021-03595-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/15/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Children are the most vulnerable group affected by malaria and other tropical, vector-borne diseases in low-resource countries. Infants presenting with acute onset fever represent a major sector of outpatient care in the Lake Victoria region. Misclassification and overuse of antibiotics and anti-malarial medications are consistent problems. Identifying the prevalent mosquito-borne pathogens in the region will reduce the prescription of non-indicated medicines. METHODS The literature was reviewed focusing on the mosquito-borne pathogens most prevalent in sub-Saharan Africa. Accordingly, an assay comprised of a multiplex-reverse transcriptase-polymerase chain reaction and an enzyme-linked immunosorbent assay (multiplex-RT-PCR-ELISA) was designed and validated in its ability to identify and differentiate nine human mosquito-borne pathogens including eight arboviruses and Plasmodium sp., the aetiologic agents of malaria. Blood samples obtained from 132 children suspected of having malaria were spotted and preserved on Whatman® 903 protein sample cards. Multiplex-RT-PCR-ELISA analysis was assessed and compared to results obtained by blood smear microscopy and the malaria rapid diagnostic test (RDT). RESULTS Nine out of nine pathogens were amplified specifically by the multiplex-RT-PCR-ELISA panel. Twenty-seven out of 132 paediatric patients presenting with acute fever were infected with Plasmodium sp., confirmed by multiplex-RT-PCR. The results of blood smear microscopy were only 40% sensitive and 92.8% specific. The malaria RDT, on the other hand, detected acute Plasmodium infections with 96.3% sensitivity and 98.1% specificity. The preservation of Plasmodium sp. in clinical sera and whole blood samples spotted on sample cards was evaluated. The duration of successful, sample card storage was 186 to 312 days. CONCLUSIONS Reliable, easy-to-use point of care diagnostic tests are a powerful alternative to laboratory-dependent gold standard tests. The multiplex-RT-PCR-ELISA amplified and identified nine vector-borne pathogens including Plasmodium sp. with great accuracy. Translation of improved diagnostic approaches, i.e., multiplex-RT-PCR-ELISA, into effective treatment options promises to reduce childhood mortality and non-indicated prescriptions.
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Affiliation(s)
- Philip Koliopoulos
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Neema Mathias Kayange
- Department of Pediatric and Adolescent Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Tim Daniel
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Florian Huth
- Department of Infectiology and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Eppendorf, Germany
| | - Britta Gröndahl
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany.
| | | | - Leah Pretsch
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Julia Klüber
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Christian Schmidt
- Department of Pediatric and Adolescent Medicine, St. Vinzenz-Hospital, Dinslaken, Germany
| | - Antke Züchner
- Department of Pediatric and Adolescent Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Sebastian Ulbert
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Steven E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Marylyn Addo
- Department of Infectiology and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Eppendorf, Germany
| | - Stephan Gehring
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
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14
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Daag JV, Ylade M, Jadi R, Adams C, Cuachin AM, Alpay R, Aportadera ETC, Yoon IK, de Silva AM, Lopez AL, Deen J. Performance of Dried Blood Spots Compared with Serum Samples for Measuring Dengue Seroprevalence in a Cohort of Children in Cebu, Philippines. Am J Trop Med Hyg 2020; 104:130-135. [PMID: 33146119 PMCID: PMC7790110 DOI: 10.4269/ajtmh.20-0937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Dengue seroprevalence data are useful for understanding epidemiologic trends and transmission dynamics, and for making decisions about implementation of dengue control programs. A logistical challenge to seroprevalence surveys is the collection and transport of serum samples. For conducting large and repeated dengue serosurveys, dried blood spots (DBS) would allow easier sample collection, shipment, transport, and storage than standard serum collection methods. Further evidence is needed to understand how well DBS performs compared with standard serum collection methods in laboratory assays. We evaluated the detection of anti-dengue antibodies by IgG indirect ELISA when using DBS compared with sera. Specimens were collected from healthy children in Cebu, Philippines, who would be 9–14 years of age at the time of a mass dengue vaccination program. Using an ELISA index value cutoff of 0.9, 1,285/1,488 (86.4%) of the DBS were seropositive and 203 (13.6%) were seronegative, compared with 1,292/1,488 (86.8%) seropositive and 196 (13.2%) seronegative serum samples. Compared with sera, the DBS method had a 98.3% sensitivity, 92.4% specificity, 98.9% positive predictive value, and 89.2% negative predictive value. Considering the advantages in terms of sample collection, shipment, and storage, DBS sampling may be appropriate for dengue population serosurveys.
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Affiliation(s)
- Jedas Veronica Daag
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Michelle Ylade
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Ramesh Jadi
- 2Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cameron Adams
- 2Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anna Maureen Cuachin
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Riacarl Alpay
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Emma Teresa Carmela Aportadera
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - In-Kyu Yoon
- 3Coalition for Epidemic Preparedness Innovations, Washington, District of Columbia
| | - Aravinda M de Silva
- 2Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anna Lena Lopez
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Jacqueline Deen
- 1Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
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15
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Curren EJ, Tufa AJ, Hancock WT, Biggerstaff BJ, Vaifanua-Leo JS, Montalbo CA, Sharp TM, Fischer M, Hills SL, Gould CV. Reverse Transcription-Polymerase Chain Reaction Testing on Filter Paper-Dried Serum for Laboratory-Based Dengue Surveillance-American Samoa, 2018. Am J Trop Med Hyg 2020; 102:622-624. [PMID: 31933466 DOI: 10.4269/ajtmh.19-0800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Laboratory-based surveillance for arboviral diseases is challenging in resource-limited settings. We evaluated the use of filter paper-dried sera for detection of dengue virus (DENV) RNA during an outbreak in American Samoa. Matched liquid and filter paper-dried sera were collected from patients with suspected dengue and shipped to a reference laboratory for diagnostic testing. RNA was extracted from each sample and tested for DENV RNA by real-time reverse transcription-polymerase chain reaction (RT-PCR). Of 18 RT-PCR-positive liquid specimens, 14 matched filter paper-dried specimens were positive for a sensitivity of 78% (95% CI, 55-91%). Of 82 RT-PCR-negative liquid specimens, all filter paper-dried specimens were negative for a specificity of 100% (95% CI, 96-100%). Shipping of filter paper-dried specimens was similarly timely but less expensive than shipping liquid sera. Using filter paper-dried serum or blood can be a cost-effective and sustainable approach to surveillance of dengue and other arboviral diseases in resource-limited settings.
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Affiliation(s)
- Emily J Curren
- Epidemic Intelligence Service, CDC, Atlanta, Georgia.,Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado
| | | | | | - Brad J Biggerstaff
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado
| | | | | | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado
| | - Marc Fischer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado
| | - Susan L Hills
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado
| | - Carolyn V Gould
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado
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16
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Othman NH, Lee KY, Radzol ARM, Mansor W. Optimal ELM-RBF model and SERS Analysis of Saliva for Classification of NS1. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3551-3554. [PMID: 31946645 DOI: 10.1109/embc.2019.8857281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Extreme Learning Machine (ELM) with Radial Basis Function (RBF) Kernel has demonstrated strong capability in pattern recognition and classification problems. NS1 is a biomarker for flavivirus related diseases, where current detection methods are serum based and hence invasive. Our previous work has captured NS1 molecular fingerprint in saliva using Surface Enhanced Raman Spectroscopy (SERS) that could amount to non-invasive detection method. SERS is an improved Raman spectroscopic technique, which can amplify spectral intensity by 103 to l07 times, to yield usable spectra of low concentration NS1 in saliva. The spectra produced contain 1801 features for each of the 284 samples collected. Principal Component Analysis (PCA) transforms a high dimensional data to a lower dimension principal components (PCs), at no sacrifice of important information of the original data. Both termination criteria of PCA and kernel parameters of ELM have effect on performance of the classifier models. This paper aims to unravel an optimal ELM-RBF classifier model for classification of NS1 salivary SERS spectra. Performance of a total of 864 classifier models are examined and compared in terms of [accuracy, kappa, precision, sensitivity and specificity]. Results show that CPV- and EOC-ELM-RBF classifier models are on par and outperform the Scree-ELM-RBF classifier models.
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17
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Othman NH, Radzol ARM, Lee KY, Mansor W. Reduced Featured k-NN Classifier Model Optimal for Classification of Dengue Fever from Salivary Raman Spectra. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:471-474. [PMID: 31945940 DOI: 10.1109/embc.2019.8856427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Current diagnostic methods based on nonstructural protein 1 (NS1) for dengue infection use blood as the medium and hence are invasive. Worry for blood infected diseases, pain from pricking, overcrowded public hospitals and ignorance are just a few of the causes for delayed diagnosis that contributes to mortality from dengue fever (DF). NS1 has also been reported in saliva, but sensitivity of detection is much lower than that of blood. If saliva is to be a medium, detection of NS1 requires a more specific and sensitive technique. In this study, we are exploiting the advantages of saliva and Surface Enhanced Raman Spectroscopy (SERS) to develop a non-invasive early detection method for DF. Significant features from Raman spectra of saliva samples of dengue suspected patients and healthy volunteers were extracted with Principal Component Analysis (PCA) and served as input to k-Nearest Neighbour (k-NN) for classification. Cumulative Percentage Variance (CPV) is the criterion for feature extraction. Two k-NN distance rules (Cosine and Manhattan) combined with k-values ranging from 3 to 17 were varied to obtain an optimal k-NN classifier. Then, performance of the different k-NN classifier models is benchmarked against Panbio Dengue Early ELISA and SD BIOLINE Dengue Duo technique from the clinical laboratory. The finding is encouraging with the best performance achieved, 82.14% for accuracy, 85.71% for sensitivity and 78.57% for specificity.
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18
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Collins MH. Serologic Tools and Strategies to Support Intervention Trials to Combat Zika Virus Infection and Disease. Trop Med Infect Dis 2019; 4:E68. [PMID: 31010134 PMCID: PMC6632022 DOI: 10.3390/tropicalmed4020068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 12/30/2022] Open
Abstract
Zika virus is an emerging mosquito-borne flavivirus that recently caused a large epidemic in Latin America characterized by novel disease phenotypes, including Guillain-Barré syndrome, sexual transmission, and congenital anomalies, such as microcephaly. This epidemic, which was declared an international public health emergency by the World Health Organization, has highlighted shortcomings in our current understanding of, and preparation for, emerging infectious diseases in general, as well as challenges that are specific to Zika virus infection. Vaccine development for Zika virus has been a high priority of the public health response, and several candidates have shown promise in pre-clinical and early phase clinical trials. The optimal selection and implementation of imperfect serologic assays are among the crucial issues that must be addressed in order to advance Zika vaccine development. Here, I review key considerations for how best to incorporate into Zika vaccine trials the existing serologic tools, as well as those on the horizon. Beyond that, this discussion is relevant to other intervention strategies to combat Zika and likely other emerging infectious diseases.
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Affiliation(s)
- Matthew H Collins
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA 30030, USA.
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Niedrig M, Patel P, El Wahed AA, Schädler R, Yactayo S. Find the right sample: A study on the versatility of saliva and urine samples for the diagnosis of emerging viruses. BMC Infect Dis 2018; 18:707. [PMID: 30594124 PMCID: PMC6311079 DOI: 10.1186/s12879-018-3611-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/10/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The emergence of different viral infections during the last decades like dengue, West Nile, SARS, chikungunya, MERS-CoV, Ebola, Zika and Yellow Fever raised some questions on quickness and reliability of laboratory diagnostic tests for verification of suspected cases. Since sampling of blood requires medically trained personal and comprises some risks for the patient as well as for the health care personal, the sampling by non-invasive methods (e.g. saliva and/ or urine) might be a very valuable alternative for investigating a diseased patient. MAIN BODY To analyse the usefulness of alternative non-invasive samples for the diagnosis of emerging infectious viral diseases, a literature search was performed on PubMed for alternative sampling for these viral infections. In total, 711 papers of potential relevance were found, of which we have included 128 in this review. CONCLUSIONS Considering the experience using non-invasive sampling for the diagnostic of emerging viral diseases, it seems important to perform an investigation using alternative samples for routine diagnostics. Moreover, during an outbreak situation, evaluation of appropriate sampling and further processing for laboratory analysis on various diagnostic platforms are very crucial. This will help to achieve optimal diagnostic results for a good and reliable case identification.
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Affiliation(s)
| | | | - Ahmed Abd El Wahed
- Division of Microbiology and Animal Hygiene, University of Goettingen, Goettingen, Germany
| | | | - Sergio Yactayo
- Control of Epidemic Diseases (CED), World Health Organization, Geneva, Switzerland
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Salivary Detection of Dengue Virus NS1 Protein with a Label-Free Immunosensor for Early Dengue Diagnosis. SENSORS 2018; 18:s18082641. [PMID: 30103543 PMCID: PMC6111667 DOI: 10.3390/s18082641] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/04/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022]
Abstract
Dengue virus (DENV) is a highly pathogenic, arthropod-borne virus transmitted between people by Aedes mosquitoes. Despite efforts to prevent global spread, the potential for DENV epidemics is increasing world-wide. Annually, 3.6 billion people are at risk of infection. With no licensed vaccine, early diagnosis of dengue infection is critical for clinical management and patient survival. Detection of DENV non-structural protein 1 (NS1) is a clinically accepted biomarker for the early detection of DENV infection. Unfortunately, virtually all of the laboratory and commercial DENV NS1 diagnostic methods require a blood draw for sample analysis, limiting point-of-care diagnostics and decreases patient willingness. Alternatively, NS1 in human saliva has been identified for the potential early diagnosis of DENV infection. The collection of saliva is simple, non-invasive, painless, and inexpensive, even by minimally trained personnel. In this study, we present a label-free chemiresistive immunosensor for the detection of the DENV NS1 protein utilizing a network of single-walled carbon nanotubes functionalized with anti-dengue NS1 monoclonal antibodies. NS1 was successfully detected in adulterated artificial human saliva over the range of clinically relevant concentrations with high sensitivity and selectivity. It has potential application in clinical diagnosis and the ease of collection allows for self-testing, even within the home.
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Rasinhas ADC, da Silva MAN, Caldas GC, Jácome FC, Leonardo R, dos Santos FB, Nunes PCG, Barth OM, Barreto-Vieira DF. First detection of dengue virus in the saliva of immunocompetent murine model. Mem Inst Oswaldo Cruz 2018; 113:e170208. [PMID: 29412340 PMCID: PMC5851051 DOI: 10.1590/0074-02760170208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/04/2017] [Indexed: 12/17/2022] Open
Abstract
The lack of an experimental animal model for the study of dengue pathogenesis is a limiting factor for the development of vaccines and drugs. In previous studies, our group demonstrated the susceptibility of BALB/c mice to infection by dengue virus (DENV) 1 and 2, and the virus was successfully isolated in several organs. In this study, BALB/c mice were experimentally infected intravenously with DENV-4, and samples of their saliva were collected. Viral RNA extracted from the saliva samples was subjected to qRT-PCR, with a detection limit of 0.002 PFU/mL. The presence of DENV-4 viral RNA was detected in the saliva of two mice, presenting viral titers of 109 RNA/mL. The detection of DENV RNA via saliva sampling is not a common practice in dengue diagnosis, due to the lower detection rates in human patients. However, the results observed in this study seem to indicate that, as in humans, detection rates of DENV RNA in mouse saliva are also low, correlating the infection in both cases. This study reports the first DENV detection in the saliva of BALB/c immunocompetent mice experimentally infected with non-neuroadapted DENV-4.
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Affiliation(s)
- Arthur da Costa Rasinhas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Marcos Alexandre Nunes da Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Gabriela Cardoso Caldas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Fernanda Cunha Jácome
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Raphael Leonardo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Flávia Barreto dos Santos
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Imunologia Viral, Rio de Janeiro, RJ, Brasil
| | | | - Ortrud Monika Barth
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Debora Ferreira Barreto-Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz,
Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
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Radzol ARM, Lee KY, Mansor W, Wong PS, Looi I. PCA-MLP SVM distinction of salivary Raman spectra of dengue fever infection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2875-2878. [PMID: 29060498 DOI: 10.1109/embc.2017.8037457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dengue fever (DF) is a disease of major concern caused by flavivirus infection. Delayed diagnosis leads to severe stages, which could be deadly. Of recent, non-structural protein (NS1) has been acknowledged as a biomarker, alternative to immunoglobulins for early detection of dengue in blood. Further, non-invasive detection of NS1 in saliva makes the approach more appealing. However, since its concentration in saliva is less than blood, a sensitive and specific technique, Surface Enhanced Raman Spectroscopy (SERS), is employed. Our work here intends to define an optimal PCA-SVM (Principal Component Analysis-Support Vector Machine) with Multilayer Layer Perceptron (MLP) kernel model to distinct between positive and negative NS1 infected samples from salivary SERS spectra, which, to the best of our knowledge, has never been explored. Salivary samples of DF positive and negative subjects were collected, pre-processed and analyzed. PCA and SVM classifier were then used to differentiate the SERS analyzed spectra. Since performance of the model depends on the PCA criterion and MLP parameters, both are examined in tandem. Its performance is also compared to our previous works on simulated NS1 salivary samples. It is found that the best PCA-SVM (MLP) model can be defined by 95 PCs from CPV criterion with P1 and P2 values of 0.01 and -0.2 respectively. A classification performance of [76.88%, 85.92%, 67.83%] is achieved.
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Abstract
Background Dried blood and serum samples are useful resources for detecting antiviral antibodies. The conditions for elution of the sample need to be optimized for each disease. Dengue is a widespread disease in Mexico which requires continuous surveillance. In this study, we standardized and validated a protocol for the specific detection of dengue antibodies from dried serum spots (DSSs). Methods Paired serum and DSS samples from 66 suspected cases of dengue were collected in a clinic in Veracruz, Mexico. Samples were sent to our laboratory, where the conditions for optimal elution of DSSs were established. The presence of anti-dengue antibodies was determined in the paired samples. Results DSS elution conditions were standardized as follows: 1 h at 4°C in 200 µl of DNase-, RNase-, and protease-free PBS (1x). The optimal volume of DSS eluate to be used in the IgG assay was 40 µl. Sensitivity of 94%, specificity of 93.3%, and kappa concordance of 0.87 were obtained when comparing the antidengue reactivity between DSSs and serum samples. Conclusion DSS samples are useful for detecting anti-dengue IgG antibodies in the field.
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Abstract
Over the last 10 years there have been only a handful of publications dealing with the oral virome, which is in contrast to the oral microbiome, an area that has seen considerable interest. Here, we survey viral infections in general and then focus on those viruses that are found in and/or are transmitted via the oral cavity; norovirus, rabies, human papillomavirus, Epstein‐Barr virus, herpes simplex viruses, hepatitis C virus, and HIV. Increasingly, viral infections have been diagnosed using an oral sample (e.g. saliva mucosal transudate or an oral swab) instead of blood or urine. The results of two studies using a rapid and semi‐quantitative lateral flow assay format demonstrating the correlation of HIV anti‐IgG/sIgA detection with saliva and serum samples are presented. When immediate detection of infection is important, point‐of‐care devices that obtain a non‐invasive sample from the oral cavity can be used to provide a first line diagnosis to assist in determining appropriate counselling and therapeutic path for an increasing number of diseases.
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Radzol ARM, Lee KY, Mansor W, Omar IS. PCA criterion for SVM (MLP) classifier for flavivirus biomarker from salivary SERS spectra at febrile stage. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:6206-6209. [PMID: 28269669 DOI: 10.1109/embc.2016.7592146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Non-structural protein (NS1) has been conceded as one of the biomarkers for flavivirus that causes diseases with life threatening consequences. NS1 is an antigen that allows detection of the illness at febrile stage, mostly from blood samples currently. Our work here intends to define an optimum model for PCA-SVM with MLP kernel for classification of flavivirus biomarker, NS1 molecule, from SERS spectra of saliva, which to the best of our knowledge has never been explored. Since performance of the model depends on the PCA criterion and MLP parameters, both are examined in tandem. Input vector to classifier determined by each PCA criterion is subjected to brute force tuning of MLP parameters for entirety. Its performance is also compared to our previous works where a Linear and RBF kernel are used. It is found that the best PCA-SVM (MLP) model can be defined by 5 PCs from Cattel's Scree test for PCA, together with P1 and P2 values of 0.1 and -0.2 respectively, with a classification performance of [96.9%, 93.8%, 100.0%].
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Lamb LE, Bartolone SN, Kutluay SB, Robledo D, Porras A, Plata M, Chancellor MB. Advantage of urine based molecular diagnosis of Zika virus. Int Urol Nephrol 2016; 48:1961-1966. [DOI: 10.1007/s11255-016-1406-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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Bonaldo MC, Ribeiro IP, Lima NS, dos Santos AAC, Menezes LSR, da Cruz SOD, de Mello IS, Furtado ND, de Moura EE, Damasceno L, da Silva KAB, de Castro MG, Gerber AL, de Almeida LGP, Lourenço-de-Oliveira R, Vasconcelos ATR, Brasil P. Isolation of Infective Zika Virus from Urine and Saliva of Patients in Brazil. PLoS Negl Trop Dis 2016; 10:e0004816. [PMID: 27341420 PMCID: PMC4920388 DOI: 10.1371/journal.pntd.0004816] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) is an emergent threat provoking a worldwide explosive outbreak. Since January 2015, 41 countries reported autochthonous cases. In Brazil, an increase in Guillain-Barré syndrome and microcephaly cases was linked to ZIKV infections. A recent report describing low experimental transmission efficiency of its main putative vector, Ae. aegypti, in conjunction with apparent sexual transmission notifications, prompted the investigation of other potential sources of viral dissemination. Urine and saliva have been previously established as useful tools in ZIKV diagnosis. Here, we described the presence and isolation of infectious ZIKV particles from saliva and urine of acute phase patients in the Rio de Janeiro state, Brazil. METHODOLOGY/PRINCIPAL FINDINGS Nine urine and five saliva samples from nine patients from Rio de Janeiro presenting rash and other typical Zika acute phase symptoms were inoculated in Vero cell culture and submitted to specific ZIKV RNA detection and quantification through, respectively, NAT-Zika, RT-PCR and RT-qPCR. Two ZIKV isolates were achieved, one from urine and one from saliva specimens. ZIKV nucleic acid was identified by all methods in four patients. Whenever both urine and saliva samples were available from the same patient, urine viral loads were higher, corroborating the general sense that it is a better source for ZIKV molecular diagnostic. In spite of this, from the two isolated strains, each from one patient, only one derived from urine, suggesting that other factors, like the acidic nature of this fluid, might interfere with virion infectivity. The complete genome of both ZIKV isolates was obtained. Phylogenetic analysis revealed similarity with strains previously isolated during the South America outbreak. CONCLUSIONS/SIGNIFICANCE The detection of infectious ZIKV particles in urine and saliva of patients during the acute phase may represent a critical factor in the spread of virus. The epidemiological relevance of this finding, regarding the contribution of alternative non-vectorial ZIKV transmission routes, needs further investigation.
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Affiliation(s)
- Myrna C. Bonaldo
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Ieda P. Ribeiro
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Noemia S. Lima
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Alexandre A. C. dos Santos
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Lidiane S. R. Menezes
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Stephanie O. D. da Cruz
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Iasmim S. de Mello
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Nathália D. Furtado
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Elaine E. de Moura
- Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Luana Damasceno
- Laboratório de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Kely A. B. da Silva
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Marcia G. de Castro
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Alexandra L. Gerber
- Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro, Brazil
| | | | - Ricardo Lourenço-de-Oliveira
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Patrícia Brasil
- Laboratório de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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Poloni TR, Dornas FP, Dos Santos NN, Soares AM, Amarilla AA, Alfonso HL, Trigueiro S, Lavrador MAS, Yamamoto AY, Aquino VH. High prevalence of clinically unsuspected dengue disease among children in Ribeirao Preto city, Brazil. J Med Virol 2016; 88:1711-9. [PMID: 27004990 DOI: 10.1002/jmv.24533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/12/2022]
Abstract
The aim of this study was to analyze the characteristics of Dengue virus (DENV)-infected children and the accuracy of dengue diagnosis based on clinical presentations. The inclusion criteria were children ≥1-year-old presenting febrile illness with 1-7 days of onset. Children (n = 110) aged 2-15 years were included in this study. DENV infection was confirmed with virological tests using serum, salvia, and/or urine samples. The attending pediatricians classified 56/110 (50.91%) of the children as suspected dengue cases. The DENV infection was confirmed by specific laboratory tests in 52/56 (92.9%) of the suspected dengue cases but also in 44/54 (81.5%) of the unsuspected dengue cases; total of 96/110 (87.27%) confirmed dengue cases. The clinical diagnosis gave an overall sensitivity of 54.2% (52/96) and a specificity of 71.4% (10/14). The positive predictive value of the clinical diagnosis was 92.8% and negative predictive value was 18.5%. After the third day of onset of symptoms, the DENV genome detection rate was similar in serum and saliva samples, suggesting that saliva samples represent an alternative to blood samples for early dengue diagnosis. Vaccination against Yellow fever virus did not influence the antibody response against DENV-1, DENV-2, and DENV-3, which circulated during the study period. Although the signs and symptoms were compatible with dengue, the attending pediatricians did not suspect the disease in several children. Therefore, the inclusion of virological tests for early diagnosis in the protocols for dengue surveillance would help in the implementation of prompt treatment of patients and epidemic containment strategies. J. Med. Virol. 88:1711-1719, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Telma Regina Poloni
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fabio Pio Dornas
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Nilton Nascimento Dos Santos
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Adriana Moreira Soares
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Alberto Anastacio Amarilla
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Helda Liz Alfonso
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Sabrina Trigueiro
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Marco Aurélio Sicchiroli Lavrador
- Laboratory of Bioinformatics and Biostatistics, Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Aparecida Yulie Yamamoto
- Department of Pediatrics, School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Victor Hugo Aquino
- Laboratory of Virology, Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Pre-cut Filter Paper for Detecting Anti-Japanese Encephalitis Virus IgM from Dried Cerebrospinal Fluid Spots. PLoS Negl Trop Dis 2016; 10:e0004516. [PMID: 26986061 PMCID: PMC4795698 DOI: 10.1371/journal.pntd.0004516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/14/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The use of filter paper as a simple, inexpensive tool for storage and transportation of blood, 'Dried Blood Spots' or Guthrie cards, for diagnostic assays is well-established. In contrast, there are a paucity of diagnostic evaluations of dried cerebrospinal fluid (CSF) spots. These have potential applications in low-resource settings, such as Laos, where laboratory facilities for central nervous system (CNS) diagnostics are only available in Vientiane. In Laos, a major cause of CNS infection is Japanese encephalitis virus (JEV). We aimed to develop a dried CSF spot protocol and to evaluate its diagnostic performance using the World Health Organisation recommended anti-JEV IgM antibody capture enzyme-linked immunosorbent assay (JEV MAC-ELISA). METHODOLOGY AND PRINCIPAL FINDINGS Sample volumes, spotting techniques and filter paper type were evaluated using a CSF-substitute of anti-JEV IgM positive serum diluted in Phosphate Buffer Solution (PBS) to end-limits of detection by JEV MAC-ELISA. A conventional protocol, involving eluting one paper punch in 200 μl PBS, did not detect the end-dilution, nor did multiple punches utilising diverse spotting techniques. However, pre-cut filter paper enabled saturation with five times the volume of CSF-substitute, sufficiently improving sensitivity to detect the end-dilution. The diagnostic accuracy of this optimised protocol was compared with routine, neat CSF in a pilot, retrospective study of JEV MAC-ELISA on consecutive CSF samples, collected 2009-15, from three Lao hospitals. In comparison to neat CSF, 132 CSF samples stored as dried CSF spots for one month at 25-30 °C showed 81.6% (65.7-92.3 95%CI) positive agreement, 96.8% (91.0-99.3 95%CI) negative agreement, with a kappa coefficient of 0.81 (0.70-0.92 95%CI). CONCLUSIONS/SIGNIFICANCE The novel design of pre-cut filter paper saturated with CSF could provide a useful tool for JEV diagnostics in settings with limited laboratory access. It has the potential to improve national JEV surveillance and inform vaccination policies. The saturation of filter paper has potential use in the wider context of pathogen detection, including dried spots for detecting other analytes in CSF, and other body fluids.
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Andries AC, Duong V, Ly S, Cappelle J, Kim KS, Lorn Try P, Ros S, Ong S, Huy R, Horwood P, Flamand M, Sakuntabhai A, Tarantola A, Buchy P. Value of Routine Dengue Diagnostic Tests in Urine and Saliva Specimens. PLoS Negl Trop Dis 2015; 9:e0004100. [PMID: 26406240 PMCID: PMC4583371 DOI: 10.1371/journal.pntd.0004100] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/31/2015] [Indexed: 11/23/2022] Open
Abstract
Background Dengue laboratory diagnosis is essentially based on detection of the virus, its components or antibodies directed against the virus in blood samples. Blood, however, may be difficult to draw in some patients, especially in children, and sampling during outbreak investigations or epidemiological studies may face logistical challenges or limited compliance to invasive procedures from subjects. The aim of this study was to assess the possibility of using saliva and urine samples instead of blood for dengue diagnosis. Methodology/Principal Findings Serial plasma, urine and saliva samples were collected at several time-points between the day of admission to hospital until three months after the onset of fever in children with confirmed dengue disease. Quantitative RT-PCR, NS1 antigen capture and ELISA serology for anti-DENV antibody (IgG, IgM and IgA) detection were performed in parallel on the three body fluids. RT-PCR and NS1 tests demonstrated an overall sensitivity of 85.4%/63.4%, 41.6%/14.5% and 39%/28.3%, in plasma, urine and saliva specimens, respectively. When urine and saliva samples were collected at the same time-points and tested concurrently, the diagnostic sensitivity of RNA and NS1 detection assays was 69.1% and 34.4%, respectively. IgG/IgA detection assays had an overall sensitivity of 54.4%/37.4%, 38.5%/26.8% and 52.9%/28.6% in plasma, urine and saliva specimens, respectively. IgM were detected in 38.1% and 36% of the plasma and saliva samples but never in urine. Conclusions Although the performances of the different diagnostic methods were not as good in saliva and urine as in plasma specimens, the results obtained by qRT-PCR and by anti-DENV antibody ELISA could well justify the use of these two body fluids to detect dengue infection in situations when the collection of blood specimens is not possible. Dengue is the most important arthropod-borne disease affecting humans and represents a huge public health burden in affected countries. Symptoms are often non-specific hence the need for an early, sensitive and specific diagnosis of dengue for appropriate management as well as for early epidemic detection. Currently, almost all laboratory diagnostic methods require a blood specimen that may be sometimes be difficult or inconvenient to obtain. In this study, we assessed the possibility to use saliva and urine samples as alternatives to blood specimens in dengue diagnosis. We demonstrated that the performances of the different diagnostic methods (RT-PCR, NS1 antigen detection and anti-DENV IgM/IgG/IgA ELISAs) were in general not as good in saliva and urine as in plasma, but that the use of these body fluids obtained by non-invasive methods could be of value in certain circumstances such as outbreak investigations or in young children (once they are old enough to comply to instructions), in addition to the situations when blood cannot be easily collected (e.g., lack of phlebotomist, refusal of the procedure, etc.).
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Affiliation(s)
| | - Veasna Duong
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Sowath Ly
- Institut Pasteur in Cambodia, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Julien Cappelle
- Institut Pasteur in Cambodia, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Unité AGIRs, Montpellier, France
| | - Kim Srorn Kim
- Kampong Cham Provincial Hospital, Pediatric Department, Kampong Cham, Cambodia
| | - Patrich Lorn Try
- Kampong Cham Provincial Hospital, Pediatric Department, Kampong Cham, Cambodia
| | - Sopheaktra Ros
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Sivuth Ong
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Rekol Huy
- Ministry of Health, Centre National de Malariologie, Phnom Penh, Cambodia
| | - Paul Horwood
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Marie Flamand
- Institut Pasteur, Structural Virology Unit & CNRS UMR 3569, Paris, France
| | - Anavaj Sakuntabhai
- Institut Pasteur, Functional Genetics of Infectious Diseases Unit, Paris, France
- Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, Paris, France
| | - Arnaud Tarantola
- Institut Pasteur in Cambodia, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Philippe Buchy
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
- GlaxoSmithKline Vaccines, Vaccine Value and Health Sciences, Singapore, Singapore
- * E-mail:
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Radzol ARM, Lee KY, Mansor W. Nonstructural protein 1 characteristic peak from NS1-saliva mixture with Surface-Enhanced Raman spectroscopy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:2396-9. [PMID: 24110208 DOI: 10.1109/embc.2013.6610021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surface Enhanced Raman spectroscopy (SERS) is an enhanced technique of Raman spectroscopy, which amplifies the intensity of Raman scattering to a practical range with adsorption of analyte onto nano-size plasmonic material such as gold, silver or copper. This feature of SERS has given it a niche in tracing molecular structure, especially useful for marking diseases specific biomarker. NS1 protein has been clinically accepted as an alternative biomarker for diseases caused by flavivirus. Detection of Nonstructural Protein 1 (NS1) will allow early diagnosis of the diseases. Its presence in the blood serum has been reported as early as first day of infection. With gold substrate, our work here intends to explore if SERS is suitable to detect NS1 from saliva, with saliva becoming the most favored alternative to blood as diagnostic fluid due to its advantages in sample collection. Our experimental results find both gold coated slide (GS) and saliva being Raman inactive, but the molecular fingerprint of NS1 protein at Raman shift 1012 cm(-1), which has never been reported before. The distinct peak is discovered to be attributed by breathing vibration of the benzene ring structure of NS1 side chain molecule. The characteristic peak is also found to vary in direct proportion to concentration of the NS1-saliva mixture, with a correlation coefficient of +0.96118 and a standard error estimation of 0.11382.
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Radzol ARM, Lee KY, Mansor W. Model Selection for PCA-Linear SVM for automated detection of NS1 molecule from Raman spectra of salivary mixture. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:2824-2827. [PMID: 26736879 DOI: 10.1109/embc.2015.7318979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Of recent, detection of Non-structural Protein 1 (NS1) in saliva has become appealing, as it may lead to a noninvasive detection method for NS1-related diseases at the febrile phase, before complication developed. NS1 is found to have a molecular fingerprint with the use of SERS technique. Our work here intends to determine an optimum PCA-Linear SVM model for automated detection of NS1 molecules from Raman spectra of NS1 adulterated saliva. Raman spectra of normal saliva (n=64) and saliva adulterated with low concentration NS1 (n=64) are used. Since Raman features extracted for each spectrum numbered at 1801, ranking and selection of features in order of their contribution is important prior to classification, for efficient computation. Hence, PCA for feature selection and SVM with linear kernel for classification are integrated. It is found that the Cattel's Scree test is the best stopping criteria for PCA with a selection of 5 PCs and a box constraint of 20 is optimum for Linear SVM. Together they achieve a classification performance, [accuracy sensitivity, specificity], of [98.71% 98.97% 98.44%].
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Dauner AL, Gilliland TC, Mitra I, Pal S, Morrison AC, Hontz RD, Wu SJL. Evaluation of nucleic acid stabilization products for ambient temperature shipping and storage of viral RNA and antibody in a dried whole blood format. Am J Trop Med Hyg 2015; 93:46-53. [PMID: 25940193 PMCID: PMC4497903 DOI: 10.4269/ajtmh.15-0110] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/24/2015] [Indexed: 11/07/2022] Open
Abstract
Loss of sample integrity during specimen transport can lead to false-negative diagnostic results. In an effort to improve upon the status quo, we used dengue as a model RNA virus to evaluate the stabilization of RNA and antibodies in three commercially available sample stabilization products: Whatman FTA Micro Cards (GE Healthcare Life Sciences, Pittsburgh, PA), DNAstāble Blood tubes (Biomātrica, San Diego, CA), and ViveST tubes (ViveBio, Alpharetta, GA). Both contrived and clinical dengue-positive specimens were stored on these products at ambient temperature or 37°C for up to 1 month. Antibody and viral RNA levels were measured by enzyme-linked immunosorbent assay (ELISA) and quantitative reverse transcription polymerase chain reaction (qRT-PCR) assays, respectively, and compared with frozen unloaded controls. We observed reduced RNA and antibody levels between stabilized contrived samples and frozen controls at our earliest time point, and this was particularly pronounced for the FTA cards. However, despite some time and temperature dependent loss, a 94.6-97.3% agreement was observed between stabilized clinical specimens and their frozen controls for all products. Additional considerations such as cost, sample volume, matrix, and ease of use should inform any decision to incorporate sample stabilization products into a diagnostic testing workflow. We conclude that DNAstāble Blood and ViveST tubes are useful alternatives to traditional filter paper for ambient temperature shipment of clinical specimens for downstream molecular and serological testing.
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Affiliation(s)
| | | | | | - Subhamoy Pal
- *Address correspondence to Subhamoy Pal, Viral and Rickettsial Diseases Department, Naval Medical Research Center, Building 17, Suite 2B, NSA Bethesda, MD 20889. E-mail:
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Anders KL, Nga LH, Thuy NTV, Ngoc TV, Tam CT, Tai LTH, Truong NT, Duyen HTL, Trung VT, Kien DTH, Wolbers M, Wills B, Chau NVV, Tho ND, Simmons CP. Households as foci for dengue transmission in highly urban Vietnam. PLoS Negl Trop Dis 2015; 9:e0003528. [PMID: 25680106 PMCID: PMC4332484 DOI: 10.1371/journal.pntd.0003528] [Citation(s) in RCA: 42] [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: 09/17/2014] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dengue control programs commonly employ reactive insecticide spraying around houses of reported cases, with the assumption that most dengue virus (DENV) transmission occurs in the home. Focal household transmission has been demonstrated in rural settings, but it is unclear whether this holds true in dense and mobile urban populations. We conducted a prospective study of dengue clustering around households in highly urban Ho Chi Minh City, Vietnam. METHODS We enrolled 71 index cases with suspected dengue (subsequently classified as 52 dengue cases and 19 non-dengue controls); each initiated the enrollment of a cluster of 25-35 household members and neighbors who were followed up over 14 days. Incident DENV infections in cluster participants were identified by RT-PCR, NS1-ELISA, and/or DENV-IgM/-IgG seroconversion, and recent infections by DENV-IgM positivity at baseline. PRINCIPAL FINDINGS/CONCLUSIONS There was no excess risk of DENV infection within dengue case clusters during the two-week follow-up, compared to control clusters, but the prevalence of recent DENV infection at baseline was two-fold higher in case clusters than controls (OR 2.3, 95%CI 1.0-5.1, p = 0.05). Prevalence of DENV infection in Aedes aegypti was similar in case and control houses, and low overall (1%). Our findings are broadly consistent with household clustering of dengue risk, but indicate that any clustering is at a short temporal scale rather than sustained chains of localized transmission. This suggests that reactive perifocal insecticide spraying may have a limited impact in this setting.
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Affiliation(s)
- Katherine L. Anders
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | - Le Hong Nga
- Preventive Medicine Centre, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Van Thuy
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Tran Van Ngoc
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Cao Thi Tam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Huynh Thi Le Duyen
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Vu Tuan Trung
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Duong Thi Hue Kien
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Marcel Wolbers
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Bridget Wills
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Cameron P. Simmons
- Oxford University Clinical Research Unit—Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
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Korhonen EM, Huhtamo E, Virtala AMK, Kantele A, Vapalahti O. Approach to non-invasive sampling in dengue diagnostics: exploring virus and NS1 antigen detection in saliva and urine of travelers with dengue. J Clin Virol 2014; 61:353-8. [PMID: 25242312 DOI: 10.1016/j.jcv.2014.08.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/22/2014] [Accepted: 08/24/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dengue diagnostics currently relies on serum and plasma tests. Although the proof of concept for detecting dengue virus (DENV) RNA and nonstructural protein 1 (NS1) antigen from urine and saliva has been demonstrated, few studies have explored their use in diagnostics. OBJECTIVES To investigate the occurrence, excretion kinetics, and diagnostic potential of DENV-RNA and NS1 antigen in the urine and saliva of dengue patients. STUDY DESIGN We examined serial serum, urine (n=50) and saliva (n=48) samples of 14 Finnish travelers with dengue. All samples were analyzed by NS1 ELISA and DENV RT-PCR, and the first and last serum specimens were tested for DENV IgG and IgM. In addition, biochemical parameters were studied from the urine and clinical and laboratory data of the patients were collected. RESULTS DENV-NS1 protein and RNA proved detectable from saliva and urine using tests developed for serum samples. RNA/NS1 detection showed a diagnostic sensitivity of 64%/54% and 60%/56% for urine and saliva, respectively. RNA analyses performed on days 7-13 after onset of symptoms revealed the sensitivity for urine (72%) to be greater than for serum (31%) or saliva (50%). The concentration of urine samples had no impact on RNA detection. CONCLUSIONS Noninvasive sampling enables an alternative approach to dengue diagnostics. The performance of the NS1 antigen assay may be improved by optimizing it for urine and saliva samples. The prolonged excretion of DENV-RNA in urine extends the sampling time window for molecular diagnostics and surveillance.
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Affiliation(s)
- Essi M Korhonen
- Department of Virology, Haartman Institute, Faculty of Medicine, P.O. Box 21 (Haartmaninkatu 3), FIN-00014 University of Helsinki, Helsinki, Finland.
| | - Eili Huhtamo
- Department of Virology, Haartman Institute, Faculty of Medicine, P.O. Box 21 (Haartmaninkatu 3), FIN-00014 University of Helsinki, Helsinki, Finland
| | - Anna-Maija K Virtala
- Division of Microbiology and Epidemiology, Department of Basic Veterinary Sciences, P.O. Box 66 (Agnes Sjöbergin katu 2), FIN-00014 University of Helsinki, Helsinki, Finland
| | - Anu Kantele
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland; Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Olli Vapalahti
- Department of Virology, Haartman Institute, Faculty of Medicine, P.O. Box 21 (Haartmaninkatu 3), FIN-00014 University of Helsinki, Helsinki, Finland; Division of Microbiology and Epidemiology, Department of Basic Veterinary Sciences, P.O. Box 66 (Agnes Sjöbergin katu 2), FIN-00014 University of Helsinki, Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory (HUSLAB), P.O. Box 400 (Haartmaninkatu 3), 00029 HUS, Finland
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Tissera H, Amarasinghe A, De Silva AD, Kariyawasam P, Corbett KS, Katzelnick L, Tam C, Letson GW, Margolis HS, de Silva AM. Burden of dengue infection and disease in a pediatric cohort in urban Sri Lanka. Am J Trop Med Hyg 2014; 91:132-7. [PMID: 24865684 DOI: 10.4269/ajtmh.13-0540] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dengue is the most significant arthropod-borne viral infection of humans. Persons infected with dengue viruses (DENV) have subclinical or clinically apparent infections ranging from undifferentiated fever to dengue hemorrhagic fever/shock syndrome. Although recent studies estimated that the Indian subcontinent has the greatest burden of DENV infection and disease worldwide, we do not have reliable, population-based estimates of the incidence of infection and disease in this region. The goal of this study was to follow-up a cohort of 800 children living in a heavily urbanized area of Colombo, Sri Lanka to obtain accurate estimates of the incidence of DENV infection and disease. Annual blood samples were obtained from all children to estimate dengue seroprevalence at enrollment and to identify children exposed to new DENV infections during the study year. Blood was also obtained from any child in whom fever developed over the course of the study year to identify clinically apparent DENV infections. At enrollment, dengue seroprevalence was 53.07%, which indicated high transmission in this population. Over the study year, the incidence of DENV infection and disease were 8.39 (95% confidence interval = 6.56-10.53) and 3.38 (95% confidence interval = 2.24-4.88), respectively, per 100 children per year. The ratio of clinically inapparent to apparent infections was 1.48. These results will be useful for obtaining more accurate estimates of the burden of dengue in the region and for making decisions about testing and introduction of vaccines.
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Affiliation(s)
- Hasitha Tissera
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Ananda Amarasinghe
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aruna Dharshan De Silva
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Pradeep Kariyawasam
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kizzmekia S Corbett
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Leah Katzelnick
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Clarence Tam
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - G William Letson
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Harold S Margolis
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aravinda M de Silva
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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da Costa VG, Marques-Silva AC, Moreli ML. A meta-analysis of the diagnostic accuracy of two commercial NS1 antigen ELISA tests for early dengue virus detection. PLoS One 2014; 9:e94655. [PMID: 24728377 PMCID: PMC3984211 DOI: 10.1371/journal.pone.0094655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Dengue virus (DENV) NS1 antigen detection is regarded as an early diagnostic marker. Accordingly, several studies have evaluated the performance of tests that utilize NS1 capture, but the results of individual studies may be limited due to the restricted sample size of the patients recruited. Therefore, our objective was to perform a meta-analysis of the diagnostic accuracy of two commercial NS1 ELISAs (Panbio and Platelia). Methods and Results Studies of interest were found in PubMed, Embase and Google Scholar databases using defined inclusion/exclusion criteria. A total of 30 studies containing 12,105 total enrolled patients were included. The results were as follows: 1) Panbio assays showed low overall performance, sensitivity 66% (95% confidence interval (CI) 61–71), specificity 99% (95% CI 96–100), positive likelihood ratio (LR+) 98 (95% CI 20–464), negative likelihood ratio (LR-) 0.3 (95% CI 0.2–0.4), diagnostic odds ratio (DOR) 289 (95% CI 59–1412); 2) Platelia assays showed high overall performance, sensitivity 74% (95% CI 63–82), specificity 99% (95% CI 97–100), LR+ 175 (95% CI 28–1099), LR- 0.3 (95% CI 0.2–0.4), DOR 663 (95% CI 98–4478). The lowest sensitivity values were for secondary infections (57% [95% CI 47–67] and 66% [95% CI 53–77] for Panbio and Platelia, respectively) and for the detection of DENV4. Regarding clinical manifestations, the sensitivity of Platelia was 69% (95% CI 43–86) and 60% (95% CI 48–70) for fever and dengue hemorrhagic fever, respectively. In addition, the sensitivity of both tests was slightly lower for samples from Southeast Asia and Oceania. Conclusion DENV1 samples gave higher sensitivity results for both tests. We observed that factors negatively influencing the tests, such as the type of infection, geographical origins of samples and viral serotypes, require further investigation to optimize the diagnostic accuracy.
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Affiliation(s)
- Vivaldo G. da Costa
- Virology Laboratory, Federal University of Goiás, Jataí, Brazil
- * E-mail: (VGC); (MLM)
| | | | - Marcos L. Moreli
- Virology Laboratory, Federal University of Goiás, Jataí, Brazil
- * E-mail: (VGC); (MLM)
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Matheus S, Pham TB, Labeau B, Huong VTQ, Lacoste V, Deparis X, Marechal V. Kinetics of dengue non-structural protein 1 antigen and IgM and IgA antibodies in capillary blood samples from confirmed dengue patients. Am J Trop Med Hyg 2014; 90:438-43. [PMID: 24470561 DOI: 10.4269/ajtmh.13-0458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Large-scale epidemiological surveillance of dengue in the field and dengue patient management require simple methods for sample collection, storage, and transportation as well as effective diagnostic tools. We evaluated the kinetics of three biological markers of dengue infection-non-structural protein 1 (NS1) antigen, immunoglobulin M (IgM), and IgA-in sequential capillary blood samples collected from fingertips of confirmed dengue patients. The overall sensitivities and specificities of the tests were 96% and 100%, respectively, for NS1, 58.1% and 100%, respectively, for IgM, and 33% and 100%, respectively, for IgA. During the acute phase of the disease, NS1 was the best marker of dengue infection, with a sensitivity of 98.7%, whereas from day 5, all three markers exhibited relevant levels of sensitivity. This first descriptive study of the kinetics of biological markers of dengue in capillary blood samples confirms the usefulness of this biological compartment for dengue diagnosis and argues for its exploitation in community-level and remote settings.
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Affiliation(s)
- Séverine Matheus
- Laboratoire de Virologie, Centre National de Référence des Arbovirus, Laboratoire Associé, Région Antilles Guyane, Institut Pasteur de la Guyane, Cayenne, French Guiana; Far East Medical Vietnam Limited, Ho Chi Minh City, Vietnam; Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam; Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne, French Guiana; Centre d'Epidémiologie et de Santé Publique des Armées, Marseille, France; Unité Mixte de Recherche Scientifique 872, Pôle 4, Equipe 16, Institut National de la Santé et de la Recherche Médicale, Centre de Recherches Biomédicales des Cordeliers, Paris, France
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Gan VC. Dengue: Moving from Current Standard of Care to State-of-the-Art Treatment. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014; 6:208-226. [PMID: 25999799 PMCID: PMC4431705 DOI: 10.1007/s40506-014-0025-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Treatment of dengue remains supportive in the absence of targeted antiviral therapy or approved vaccines. Responsive fluid management is key to preventing progression to shock or other severe manifestations. The dynamic natural history of dengue infection and its influence on hemodynamic homeostasis needs to be carefully considered in the planning of individualized therapy. Though largely self-limiting, the sheer burden of dengue disease on the global population will result in atypical manifestations especially in children, older adults, and comorbid patients. Management of these has not yet been systematized. The failure of recent randomized controlled trials to show utility for antiviral and immunomodulatory agents in dengue is disappointing. Vaccine candidates hold promise, but growing outbreaks require more robust, evidence-based management guidelines to inform clinicians, especially in novel epidemic situations.
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Affiliation(s)
- Victor C. Gan
- Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
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40
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Muller DA, Young PR. The flavivirus NS1 protein: molecular and structural biology, immunology, role in pathogenesis and application as a diagnostic biomarker. Antiviral Res 2013; 98:192-208. [PMID: 23523765 DOI: 10.1016/j.antiviral.2013.03.008] [Citation(s) in RCA: 363] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/02/2013] [Accepted: 03/05/2013] [Indexed: 11/25/2022]
Abstract
The flavivirus nonstructural glycoprotein NS1 is an enigmatic protein whose structure and mechanistic function have remained somewhat elusive ever since it was first reported in 1970 as a viral antigen circulating in the sera of dengue-infected patients. All flavivirus NS1 genes share a high degree of homology, encoding a 352-amino-acid polypeptide that has a molecular weight of 46-55 kDa, depending on its glycosylation status. NS1 exists in multiple oligomeric forms and is found in different cellular locations: a cell membrane-bound form in association with virus-induced intracellular vesicular compartments, on the cell surface and as a soluble secreted hexameric lipoparticle. Intracellular NS1 co-localizes with dsRNA and other components of the viral replication complex and plays an essential cofactor role in replication. Although this makes NS1 an ideal target for inhibitor design, the precise nature of its cofactor function has yet to be elucidated. A plethora of potential interacting partners have been identified, particularly for the secreted form of NS1, with many being implicated in immune evasion strategies. Secreted and cell-surface-associated NS1 are highly immunogenic and both the proteins themselves and the antibodies they elicit have been implicated in the seemingly contradictory roles of protection and pathogenesis in the infected host. Finally, NS1 is also an important biomarker for early diagnosis of disease. In this article, we provide an overview of these somewhat disparate areas of research, drawing together the wealth of data generated over more than 40 years of study of this fascinating protein.
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Affiliation(s)
- David A Muller
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
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