Abstract
Objective: The immunochromatographic rapid tests facilitate the early diagnosis of dengue by providing evidence of the presence of virus specific proteins (antigens/ antibody) in human blood. Many products for rapid dengue diagnosis are available in the market; the performance of few selected products was evaluated and compared with enzyme linked immuno sorbent assays (ELISA). Methods: Sera from a large number of patients (n=184) admitted to National Institute of Blood Diseases & Bone Marrow Transplantation (NIBD) were used to determine the efficiency of non-structural (NS) 1, IgA, IgG and IgM based rapid test devices for dengue diagnosis. Results: The dengue NS1 antigen based device was least efficient while among the antibody based devices the dengue IgA rapid test (RDT) was comparatively better (specificity: 80.95%; sensitivity: 85.21%). This device could detect both primary and secondary dengue infection and was found to be the most sensitive device at all point of sample collection. Conclusion: The dengue IgA RDT could be a cost effective and efficient rapid test device for timely dengue diagnosis at all levels of healthcare settings.
Highlights
Of 142 dengue positive samples, 97 samples were considered as secondary infection and 45 samples were dengue primary infection
Sensitivity and specificity of dengue immunochromatographic tests versus reference dengue tests: The sensitivities and specificities of three rapid test (RDT) against the reference tests i.e. dengue IgM/IgG RDT (IgG) RDT showed 63.38% (IgM)-cap enzyme linked immuno sorbent assays (ELISA) and IgG-cap ELISA are presented in Table-II
The dengue NS1 antigen based RDT showed 64.08% (91/142) sensitivity compared to 72.54% (103/142) by Den IgM/IgG RT
Summary
In the past few decades dengue has become a global health problem infecting millions of individuals annually.[1,2,3] Since its first report in 1994 from the metropolitan city of Karachi dengue virus infection has become one of the expected causes of morbidity and mortality in Pakistan.[4,5] All four serotypes of dengue virus (DENV-1 to DENV-4) are currently circulating and become endemic in Pakistan with highest incidences reported during post monsoon period each year.[6]. The primary and secondary dengue infections are diagnosed by the detection of either IgM or IgG or both in patient’s serum.[8] These anti-dengue antibodies appear late in serum i.e. after 5-6 days of infection so NS 1 protein is detected in routine diagnosis during this period. Serological tests for dengue NS1 antigen, dengue IgA, dengue IgG/ IgM antibodies were carried out to demonstrate the potential application of these kits in early laboratory diagnosis of dengue infection with the special emphasis on utility of dengue IgA RDT as one of the new dengue diagnostic markers.[12] The results were compared with more specific and sensitive gold standard methods of dengue diagnosis i.e. IgG and IgM capture ELISAs
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