Laboratory diagnosis of dengue viral infection learn. Plennevaux e, moureau a, arredondogarcia jl, et al. Quality management for optimal control of the laboratory investigation process and increased awareness of the possible inaccuracy in diagnosis of dengue infection will still be the two main focus. Since the febrile infection is difficult to diagnose clinically, laboratory tests play an essential role in identifying dengue infections. Laboratory confirmation can be made from a single acutephase serum specimen obtained early. Clinical features and pitfalls in the laboratory diagnosis. Tests available for the laboratory diagnosis of chikungunya, dengue and zika infection at the niddl test diagnostic window sample required sample storage condition turnaround time rtpcr 1,2 acute less than 14 days after onset 500 l serum or other sample type frozen 80oc 4 days igm elisa1 day 5 day 90 postinfection 250 l serum. The results are highly accurate and specific, which is an advantage over the more common antibody tests that. Given that dengue virus infection elicits such a broad range of clinical symptoms, early and accurate laboratory diagnosis is essential for appropriate patient. Department of viral and rickettsial diseases, naval medical research center, usa. In the standardised guidelines for epidemiological monitoring and laboratory diagnosis of infection with zika virus in mexico, it is proposed that 10% of patients with confirmed zika virus infection will be tested for dengue and chikungunya to identify coinfections. Laboratory diagnosis of dengue virus infection can be made by the detection of specific virus, viral antigen, genomic sequence, andor antibodies 33, 35, 36, 94, 99. How to diagnose dengue fever with lab tests healthfully. Evaluation of a commercial dengue ns1 antigencapture.
Quality management for optimal control of the laboratory investigation process and increased awareness of the possible inaccuracy in diagnosis of. Reservoir hosts for the virus are monkeys and above all, humans. Serological diagnosis of dengue fever with igm detection 118 dengue bulletin vol 27, 2003 for the rapid diagnosis of acute viral infection. In november 2009, the world health organization who issued a new guideline that classifies symptomatic cases as dengue or severe dengue. Jan 11, 2018 the diagnosis of dengue fever is usually confirmed in the laboratory by serologic tests on blood samples from the patient. Early and accurate diagnosis of dengue fever df, the leading arthropodborne viral. Tests available for the laboratory diagnosis of chikungunya. Early diagnosis the most important laboratory analyses for early diagnosis of dengue are detection of the viral ns1 antigen nonstructural protein 1, viral rna or the virus itself.
Pcr testing is most sensitive on serum specimens collected within 5 days of illness onset. Challenges in the laboratory diagnosis and management of. Serum is the specimen of choice for both pcr and serology. The requirements of a diagnostic test are specificity, sensitivity, ease of performance and a reasonable cost. Dengue chapter 4 2020 yellow book travelers health cdc. Dengue is a febrile illness caused by infection with one of four dengue viruses denv transmitted by aedes aegypti or aedes albopictus mosquitoes during the taking of a blood meal. The two basic methods for establishing a laboratory diagnosis of dengue infection are detection of the virus e.
Between september 2011 and january 20, all consecutive inpatients aged between 1 and 15 years and. Annex 1 laboratory and clinical diagnosis of dengue fever an essential aspect of the laboratory diagnosis of dengue is proper collection, storage and shipment of specimens. The importance of accurate diagnosis of dengue fever medscape. Laboratory diagnosis method for confirming dengue viral infection involves use of one or combination of any of the following four different methods. Impact of dengue vaccination on serological diagnosis. Infection may be asymptomatic or present with a broad range of clinical manifestations including a mild febrile illness to a lifethreatening shock syndrome. We undertook a clinical study at the national paediatric hospital in phnom penh to evaluate clinical diagnostic parameters for dengue and predictors of disease outcome. Naats should be performed on serum specimens collected 7 days or less after symptom onset. Laboratory diagnosis of vhf has traditionally taken place in highly specialized reference laboratories. Laboratory diagnosis methods for confirming dengue virus infection may involve detection of the virus, viral nucleic acid, antigens or antibodies, or a combination of these techniques. Dengue chapter 4 2020 yellow book travelers health. Dengue infections can be diagnosed using other laboratory tests specific for the virus.
Of the 65 patient records a diagnosis establishes that 53 individuals have been con. Pdf clinical and laboratory diagnosis of dengue virus infection. This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are. Previously in our laboratory, from the middle of 1996 to the end of 1999, the dengue igm blot genelabs diagnostics, a qualitative enzyme immunoblot assay, was used for the detection of dengue igm. Future challenges in the study of dengue and dhf include the application of modern techniques, such. The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physicianadvanced practice provider and the microbiologists who provide enormous value to the healthcare team. Laboratory diagnosis and diagnostic tests dengue ncbi. Among 1,031 seronegative patients presenting in the acute phase of illness at our travel clinic, five were tested positive by rtpcr during the. Laboratory guidance and diagnostic testing dengue cdc. Dengue and dengue hemorrhagic fever dhf are mosquitoborne viral disease caused by dengue virus, an arbovirus arthropod borne virus. In general, the dengue s laboratory diagnosis aims. At present, the three basic methods used by most laboratories for the diagnosis of dengue virus infection are viral isolation and characterization, detection of the genomic. Clinical and laboratory guidelines for dengue fever and. Virus detection and serological conversion have been the main targets of diagnostic assessment for many years, however crossreactivity of antibody responses among the.
Diagnosis of dengue infection laboratory testing is done on serum to detect virus, viral nucleic acid, or virusspecific immunoglobulin and neutralizing antibodies. Several enzymelinked immunosorbent assay elisakits are commercially available for the rapid diagnosis of dengue infection, and have demonstrated good sensitivity and specificity in paired serum samples. Laboratory methods precise laboratory diagnosis of dengue infection is important not only for appropriate, specialist clinical care but. A definitive diagnosis of dengue infection can be made only in the laboratory and depends on isolating the virus, detecting viral antigen or rna in serum or tissues, or detecting specific antibodies in the patients serum 47, 55, 148. Pdf laboratory diagnosis of dengue virus infection. Disease case report cd1 pdf format word format dengue case investigation report cdc 56. Your doctor may recommend that you drink plenty of fluids to avoid dehydration from vomiting and a high fever. Clinical findings include nausea, vomiting, rash, aches and pains, a positive tourniquet test, leukopenia, and the following.
Many laboratories now prefer to receive blood specimens in vials or tubes rather than blotted on paper, since the latter require special pretest processing. Because dengue is a nationally notifiable disease, all suspected cases should be reported to the state or local health department. Dengue is endemic throughout cambodia, a country faced with significant health and economic challenges. Jul 21, 2006 therefore, to increase the sensitivity of an early diagnosis of dengue, it is highly recommended to perform both dengue rtpcr and dengue emspecific capture igm and igg elisa if available 6, 8. An estimated 50 million dengue infections occur annually. Focus diagnostics has been a leader in the development of infectious disease immunology assays for more than 25 years. Laboratory testing options for emerging mosquitoborne diseases. Since the second edition of dengue haemorrhagic fever. Dengue diagnosis was one of the topics discussed at the adult dengue presentations. The two basic methods for establishing a laboratory diagnosis of dengue infection are. There are 2 main methods for dengue infection diagnosis.
Annex 1 laboratory and clinical diagnosis of dengue fever. Clinical and laboratory diagnosis of dengue virus infection. These laboratories have been classified with biosafety levels bsl ranging from 1 to 4 by the world health organization. Since the last major pandemic in 1998, epidemics have recurred in much of the area. After the onset of illness, the virus can be detected in serum, plasma, circulating blood cells and other tissues for 45 days. There are four characterised serotypes of dengue virus, designated denv1 to 4. Laboratory methods precise laboratory diagnosis of dengue infection is important not. It is transmitted via the bite of infected female aedes aegypti mosquito. Health workers should be informed of the appropriate procedures for collecting specimens. Clinical features and pitfalls in the laboratory diagnosis of. Current available techniques can be separated in three categories.
Dengue fever, dengue haemorrhagic fever and dengue shock syndrome are distinct clinical forms of an infection that is caused by dengue virus, a member of the flaviviridae family. Laboratory diagnostics must be tailored to a specific laboratory environment, the objectives of clinical needs and the availability of clinical specimens. The diagnosis and treatment of dengue and dengue hemorrhagic fever are guided by the symptoms and findings that the patient presents, and cannot depend on laboratory confirmation, since routine tests cannot confirm dengue with the speed required for patients in critical condition. Alternating decision trees for early diagnosis of dengue fever. In very technical terms, this is done by antigendetection elisa or pr pcr during the acute phase of the disease or by igm elisa or paired serology during the recovery phase of dengue fever. Localization of dengue virus in naturally infected human tissues, by immunohistochemistry and in situ hybridization. In practice, however, often only one blood sample is available from febrile travellers returning from dengue endemic areas. Dengue guidelines for diagnosis, treatment, prevention and. Insights from phase iii dengue vaccine efficacy trials. Definitive methods used in laboratories for the diagnosis of dengue fever include viral isolation, viral rna detection, igmigg antibody detection. Introduction dengue is the most rapidly spreading mosquito borne viral disease in the world.
A commercial dengue ns1 antigencapture elisa was evaluated to demonstrate its potential application for early laboratory diagnosis of acute dengue virus infection. Early diagnosis of dengue disease severity in a resource. Laboratory surveillance is essential so that differential diagnosis could be performed between dengue fever and other acute febrile diseases, due to clinical. For patients with suspected dengue virus disease, naats are the preferred method of laboratory diagnosis.
Dengue ns1 antigen detection is useful for the diagnosis of acute dengue infections up to 07 days of symptoms but not recommended after 7 days. Speed and accuracy of diagnosis must be balanced against test cost and availability. It is imperative that accurate and speedy diagnosis of the infection is delivered so that it can be differentiated from other diseases including rubella, leptospirosis as well as other flavivirus infections 4 guzman mg, kouri g. Since no protective vaccine or specific treatments are available for dengue fever dengue hemorrhagic fever dhf, accurate diagnosis is critical for the early initiation of specific preventive health measures to curtail epidemic spread and reduce. Accurate and efficient diagnosis of dengue is important for clinical care, surveillance support, pathogenesis studies, and vaccine research. Dengue, laboratory test, diagnosis, assay introduction dengue, an arthropodborne disease is a major health concern especially in the tropics and subtropics. Dengue virus ns1 antigen was detected in 199 of 2 acute serum samples from patients with laboratory confirmation of acute dengue virus infection but none of the 354 healthy blood. Viral hemorrhagic fever diagnostics clinical infectious. Pdf clinical and laboratory diagnosis of dengue virus. Wc 528 the world health organization welcomes requests for permission to reproduce or translate its publications, in part or in full.
Laboratory diagnosis 37 contamination, exposure to ambient temperatures for up to 7 days while in transit will not signi. Clinical and laboratory diagnosis of dengue virus infection oxford. Its laboratory diagnosis, with special emphasis on igm detection who regional office for southeast asia. Feb 16, 2018 certain laboratory tests can detect evidence of the dengue viruses, but test results usually come back too late to help direct treatment decisions. To evaluate the diagnostic value of positive dengue antibody. Confirmed diagnosis of dengue infection requires lab tests. Virus detection and serological conversion have been the main targets of diagnostic assessment for many years, however crossreactivity of antibody responses among the flaviviruses has been a confounding issue in providing a differential diagnosis. The highly conserved ns1 glycoprotein can be detected in patient serum at the onset of clinical symptoms in both primary and secondary infections see figure 2. The diagnosis of dengue virus infections is not based on clinical symptoms though, due to the symptoms of dengue being similar to those of many other diseases 16,17.
Given that dengue virus infection elicits such a broad range of clinical symptoms, early and accurate laboratory diagnosis is essential for appropriate patient management. Laboratory diagnosis of malaria requires the identification of the parasite or its antigens products in the patients blood. The clinical laboratory findings of dengue fever include low levels of white blood cells leukopenia and platelets thrombocytopenia and, often, an elevated level of the enzyme serum aminotransferase the diagnosis of dengue fever is usually confirmed in the laboratory by serologic tests on blood samples from the patient. Laboratory diagnosis is also important for case confirmation. We have developed and trained an alternating decision tree with boosting and compared its performance with c4. Evaluation of a commercial dengue ns1 antigencapture elisa. These tests look for fragments of dengue genetic material or proteins in the patients blood, or grow the virus in specialized cell cultures. Dengue virus is a member of the flaviviridae family, along with yellow fever, west nile, japanese encephalitis and tickborne encephalitis tbe viruses. Guidelines for diagnosis, treatment, prevention and control. Laboratory diagnosis methods for confirming dengue virus infection may involve. Thus, a rapid and accurate dengue diagnosis is of paramount importance for effective control of dengue outbreaks 8. A guide to utilization of the microbiology laboratory for. Any fever not settling down after three or four days should invite further tests like a blood count, a routine urine and chest xray.
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