Dengue NS1 Antigen Research Articles

Enhancing blood safety: the utility of NS-1 antigen capture ELISA for detecting acute dengue infections among blood donors during peak transmission periods and the potential to curtail dengue spread

Background: Dengue fever is a viral disease transmitted by mosquitoes and affects millions of people worldwide. It can also be transmitted through blood transfusions, particularly during peak transmission periods. Methods: This was a cross sectional study which was conducted over a two-month period (June 2022 to July 2022) at a tertiary hospital blood bank. A total of 180 nonrepetitive serum samples were collected from voluntary blood donors and analyzed using the dengue NS-1 Ag Microlisa ELISA kit. Results: Among the 180 samples two samples tested positive for the dengue virus NS-1 antigen using the NS-1 antigen capture ELISA, indicating a prevalence of acute dengue virus infection among blood donors during the peak transmission period of 1.2% (2/180). Conclusions: The use of NS-1 antigen testing was shown to be useful for dengue virus detection. Routine screening of blood donors for dengue virus is not universally implemented in many countries, partly due to the lack of sensitive and specific screening tests. However, the use of serological tests, such as ELISA for dengue antibodies or NS-1 antigen, can effectively detect dengue virus in blood donors. Interventions made during peak transmission periods can help in curtailing the spread of dengue infections.

Dengue-induced Guillain–Barre syndrome: a case series

BackgroundDengue virus is an RNA virus that is associated with a myriad of neurological manifestations. Less than 5% of patients develop neuromuscular complications. Guillain–Barre syndrome (GBS) is an uncommon neurological sequelae of dengue fever. Studies have shown acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) to be the most common variants associated with dengue fever in Asian countries. Very few cases have been reported from Pakistan to date.Case presentationWe present four adult patients with dengue-associated GBS. The time interval between onset of symptoms of dengue fever and development of lower limb weakness in all patients was between 6 and 20 days. Dengue was diagnosed based on either serology or dengue NS1 antigen testing. Acute inflammatory demyelinating polyneuropathy (AIDP) (n = 1), AMAN (n = 1), and AMSAN (n = 2) variants were identified. One patient had a coexisting myopathy which has not been previously reported. All patients showed good recovery after treatment with plasmapheresis or intravenous immunoglobulins.ConclusionsOur case series is valuable in contributing to the limited pool of reported cases of dengue fever complicated by GBS. Early detection of new onset symmetrical limb weakness during or after a dengue infection is imperative for early treatment and to limit disability.

Role of Sonography in the Assessment of Dengue Fever with Serological Correlation

Objective: To assess ultrasound findings and their correlation with hematological parameters in patients with serologically confirmed Dengue Fever (DF).Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Medicine of Pak Emirates Military Hospital (PEMH), Rawalpindi, Pakistan from April 2022 to July 2022.Methods: All participants in this study were serologically confirmed to have dengue disease. Each participant underwent chest, abdomen, and pelvis ultrasound examinations and a complete blood count (CBC). Both descriptive and analytic factors were analyzed statistically. Chi-Square / Fisher exact tests were employed to determine the connection between variables. A p-value less than (0.05) was statistically significant.Results: 166 individuals with Dengue NS-1 antigen positive with a mean age of 35.77±11.13 years were included in this research. The mean duration of symptoms at the time of admission was 7.32± 1.86 days, and the average duration of hospital stay was 6.69± 2.01 days. Edema of the gallbladder wall was noticed in 67 (40.36%) of patients, whereas hepatomegaly was observed in 82 (49.39%). Ascites in 49 (29.51%), Pleural effusion in 48 (28.91%), and splenomegaly in 37 (22.28%). The average count of megakaryocytes was 97.09± 43.10. Significantly more sonographic anomalies were identified in patients younger than 36 years of age.Conclusion: Ultrasound helps in early detection of leaky phase and complications in serologically confirmed patients with Dengue Fever who need prompt medical care.
 How to cite this: Rashid A, Fakhr A, Azeem AR, Arshad AR, Ahmed W, Ahmed Y. Role of Sonography in the Assessment of Dengue Fever with Serological Correlation. Life and Science. 2023; 4(4): 410-414. doi: http://doi.org/10.37185/LnS.1.1.390

Prospective study to compare results of FIA (fluorescent immunoassay) test with gold standard ELISA test in Dengue NS1 patients admitted in a tertiary care hospital

PurposeThe objective of this study was to compare the performance of STANDARD F Dengue NS1 Ag FIA SD Biosensor and ELISA for diagnosis of dengue in patients admitted in a tertiary care hospital. The results of the FIA test were compared with ELISA test, the gold standard in terms of sensitivity, specificity, positive predictive value, negative predictive value. MethodsTotal 19,890 patients suffering from acute febrile illness suspecting dengue were screened for dengue NS1 antigen by rapid immunochromatography test during the period of one year and six months from June 2020 to November 2021. Out of them, a total of 300 blood samples were selected by simple random sampling method for the study. The blood samples were collected and subjected to dengue NS1 ELISA and FIA test according to the kit literature. ResultsOut of total 300 samples, 67.67% (203) patients were positive for dengue NS1 antigen by FIA test. Total 200 patients (66.67%) were positive for dengue NS1 antigen by ELISA and (190) 63.33% were positive for dengue NS1 antigen by rapid ICT.It was also seen that there was an inverse relation between the Cutoff Index (COI) value of FIA and the platelet count of the dengue NS1 positive patients. ConclusionWe conclude that the results of Dengue NS1 Microwell ELISA test and Dengue NS1 FIA test are almost equivalent in relation to sensitivity, specificity, positive predictive value, and negative predictive value.FIA gives rapid test results, thus is time saving and can be routinely used. The COI value can also give a relative idea about the severity of the disease.

Outbreak investigation of Dengue like fever in rural area of Rajasthan

During October 2020, suddenly many cases were reported with Dengue like Illness in Sahawa village, Rajasthan. Blood samples collected from 68 patients were tested for Dengue NS1 antigen and IgM antibodies for Dengue, Chikungunya, Scrub typhus, Leptospira and Brucella by ELISA, Dengue, Chikungunya and Zika viral RNA by multiplex Polymerase Chain Reaction (PCR), 41.17% samples were positive for Dengue; 25% were positive by Dengue PCR, 17.64% for NS1 Ag,14.70% for IgM ELISA, 20.58% were positive for antibodies either for Scrub typhus (4.41%), Leptospira (7.35%) or Brucella (10.29%). Dengue was seen in 41.17% cases and other etiological agents in 20.58% cases.

An Unusual Dual Coinfection of Dengue Fever and COVID-19 in India

ABSTRACT Rationale—Our article reaffirms challenges associated with diagnosing COVID-19 in areas hyperendemic for tropical infections with overlapping presentations such as dengue. Patient Concerns—A 47-year-old male healthcare provider, previously diagnosed with COVID-19 infection five months prior, presented with fever, dry cough, and generalized weakness for three days. He had completed vaccination for COVID-19 two weeks prior to his illness and was on medications for diabetes and hypertension. Additionally, he had a history of COVID infection which followed a mild course five months prior to the current symptoms. Diagnosis—Investigations revealed a positive test on COVID-19 real-time polymerase chain reaction (RTPCR) as well as for dengue NS1 antigen, while his anti–severe acute respiratory syndrome (SARS) IgG antibodies were measured at 38 × 103 AU/ml (Normal—<12.0). Outcome—The patient was treated with supportive therapy and monitored with daily platelet counts which normalized on the fifth day of treatment. Thus, the known potential for repeat dengue infections and the possibility for repeat SARS-CoV-2 infections add further complications and must be incorporated into triage and hospital protocols.

Is the Dengue NS1 Antigen test a credible indicator for clinical decision-making?

Is the Dengue NS1 Antigen test a credible indicator for clinical decision-making?

Antibody and memory B cell responses to the dengue virus NS1 antigen in individuals with varying severity of past infection.

To further understand the role of NS1-specific antibodies (Abs) in disease pathogenesis, we compared neutralizing antibody levels (Nabs), NS1-Ab levels, IgG antibody subclass profiles and NS1-specific memory B-cell responses (Bmems) in individuals, with varying severity of past dengue. Nabs (Neut50 titres) were assessed using the Foci Reduction Neutralization Test (FRNT) and in-house ELISAs were used to assess NS1-Abs and NS1-Ab subclasses for all four DENV serotypes in individuals with past DF (n = 22), those with past DHF (n = 14) and seronegative (SN) individuals (n = 7). B-cell ELISpot assays were used to assess NS1-specific Bmem responses. 15/22 (68.18%) individuals with past DF and 9/14 (64.29%) individuals with past DHF had heterotypic infections. Neut50 titres were found to be significantly higher for DENV1 than DENV2 (p = 0.0006) and DENV4 (p = 0.0127), in those with past DHF, whereas there was no significant difference seen in titres for different DENV serotypes in those with past DF. Overall NS1-Ab to all serotypes and NS1-specific IgG1 responses for DENV1, 2 and 4 serotypes were significantly higher in those with past DHF than individuals with past DF. Those with past DHF also had higher IgG1 than IgG3 for DENV1 and DENV3, whereas no differences were seen in those with past DF. Over 50% of those with past DF or DHF had NS1-specific Bmem responses to >2 DENV serotypes. There was no difference in the frequency of Bmem responses to any of the DENV serotypes between individuals with past DF and DHF. Although the frequency of Bmem responses to DENV1 correlated with DENV1-specific NS1-Abs levels (Spearman r = 0.35, p = 0.02), there was no correlation with other DENV serotypes. We found that those with past DF had broadly cross-reactive Nabs, while those with past DHF had higher NS1-Ab responses possibly with a different functionality profile than those with past DF. Therefore, it would be important to further evaluate the functionality of NS1-specific antibody and Bmem responses to find out the type of antibody repertoire that is associated with protection against severe disease.

Epidemiological and demographic characteristics of dengue at a tertiary care center in Kutch region during the year 2019

Dengue is the most rapidly spreading mosquito borne viral disease of mankind, with a 30 fold increase in global incidence over the last five decades. It is a major public health concern throughout the tropical and subtropical regions of the world. The present study was conducted with objective to study epidemiological and demographic characteristics of dengue infection during the year 2019 in Kutch region, Gujarat, India.The study was carried out from January 2019 to December 2019 at Department of Microbiology, Gujarat Adani Institute of Medical Sciences, G.K. General Hospital, Bhuj. The patients having suspected dengue fever was based on standard criteria like presentation of febrile illness of 2-7 days duration were included in this study.A total of 1509 blood samples were collected during study period and serologically tested for dengue NS1 antigen and IgM antibody by capture ELISA testing method. Total 1509 blood samples were tested by ELISA for NS1 antigen and/or IgM antibody as per the protocols and personal, demographic and clinical details of each patient was recorded. Out of 1509 cases 761 tested positive for dengue. Amongst all positive cases 533(47%) were tested positive for NS1 antigen which helped in early diagnosis of dengue. Rise of dengue cases started after the month of October and falls down by the end of December. Analysis of this data revealed that age group 00-10 years had maximum dengue cases. Male cases 418(55%) were more than females 343(45%). Dengue cases were high in urban area.The present study reported that dengue mainly affected children, males and urban population. Perennial occurrence with seasonal increase during monsoon and post monsoon moths was reported. Effective implementation of vector control measures through efforts toward vector breeding source reduction and with the use of personal prophylactic measures against mosquito bites will help in reducing the dengue prevalence in the community.

SEROPREVALENCE OF DENGUE IN A TERTIARY CARE HOSPITAL: CROSS SECTIONAL STUDY

Background: Dengue is endemic and an important emerging public health problem in India. Dengue illness is major concern causing increased morbidity and mortality. Disease burden is highly variable between different places within a country. This study was conducted to determine the age wise seroprevalence of dengue and seasonal variation of dengue infection in tertiary care hospital in Mumbai. Materials And Methods: The present cross sectional study was conducted from January 2021 to March 2022 for a period of 15 months. Total 1550 serum samples were collected from suspected dengue cases. All the samples were subjected to ELISA for detection of dengue NS1 antigen and IgM antibody. Results: Out of 1550 suspected dengue patients 187 (12.06%) were seropositive for NS1antigen or IgM antibody or both NS1 antigen & IgM antibody. Of 187 seropositive dengue cases 121 (64.71%) were male and 66 (35.29%) were female. The maximum dengue cases (31.55%) were from 31-40 years age group, followed by 21-30 (23.52%) years. Most dengue positive cases were seen in monsoon period. The monsoon peak was observed in September (22.00%) followed by August (17.11%). However, in May (dry season) few cases were reported. Conclusion: Dengue illness is a major public health concern. With early diagnosis and treatment, morbidity and mortality can be reduced. Knowledge of prior infection is also very important if vaccination strategy by WHO is implemented in future. Maximum cases were observed in monsoon period but dengue cases were seen throughout the year. Hence continuous surveillance of cases is required for early diagnosis and treatment, to know the prevalence throughout the year, for vector control measures & administration of dengue vaccine as per WHO strategy if implemented in future in our country

Performance evaluation of a rapid dengue NS1 antigen lateral flow immunoassay test with reference to dengue NS1 antigen-capture ELISA

BackgroundDengue, ranked as one of the most critical viral diseases, requires rapid, accurate, and early diagnosis for better patient care. ObjectivesThis study pertains to the development and clinical validation of an in house easy to do, affordable kit for the detection of dengue NS1 antigen based on lateral flow immunoassay in serum samples of patients. Study DesignClinically uncharacterized serum specimens were obtained and analyzed using the developed NS1 detection kit and compared against the ELISA results. ResultsThe performance of the kit was evaluated with both positive and negative patients’ serum samples for NS1 antigen and found to be highly specific and sensitive. An overall sensitivity of 92.16 % and specificity of 97.25 % were recorded. Kit stability tests were also carried out and the performance of the kit was found to be similar to real time tests. ConclusionThe results indicate that the developed NS1 detection kit has good reliability with comparable performance to ELISA results.

Dengue Burden and Circulation of Dengue-2 Serotype Among Children Along With Clinical Profiling in Uttarakhand, India: A Cross-Sectional Study From 2018 to 2020.

The multiple serotypes of the dengue virus (DENV) are always a major public concern for dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). This study aimed to analyse the demographic characteristics and circulating serotypes of dengue among the paediatric age group. One hundred forty-one clinically suspected children were enrolled in the study from 2018 to 2020 in a tertiary care hospital in Uttarakhand, India. Central tendency, frequency, and One-Way ANOVA were measured for continuous and categorical data. The Shapiro-Wilks test was used to calculate the normality assumption. Dengue NS1 Ag, IgM, and IgG antibodies ELISA were performed, and NS1-positive samples were further tested for molecular studies. From one hundred forty-one suspected cases, 100 (70.92%) came positive for dengue NS1 antigen, 18 (12.76%), and three (2.12%) came positive for IgM and IgG antibodies respectively. Rest 20 (14.18%) samples came negative for dengue. Fever with chills (97.5%), headache (89%), and arthralgia (82%) were the most common clinical features. Molecular studies showed the dengue serotype-2 (DEN-2) was found in most cases, followed by the dengue-3 serotype (DEN-3). This is the preliminary study as the authors' best knowledge which demonstrate the burden of dengue in children with prevalent serotypes for consecutive three yearsin Uttarakhand. This study identifies that the serotype-2 (DEN-2) of the dengue virus was the primary cause of infection in children at the tertiary care hospital in northern India. These results will help further to understand the nature of the disease so that improved patient care management will imply. Further molecular studies on large sample sizes during the endemic would be helpful to gain knowledge of the actual load of the disease and the genetic characteristics of the virus.

Acute acalculous cholecystitis in a patient with dengue fever: A case report

and importance: Although dengue fever classically presents with fever, headache, retro-orbital pain, myalgia, arthralgia, and vomiting, it can have unusual manifestations like acalculous cholecystitis. The study highlights the importance of atypical presentations of dengue fever in suspecting dengue earlier, especially during outbreaks. Herein, we report a case of a 29 years old female who presented with fever for 5 days which was associated with headache, body ache, vomiting, and abdominal pain in the right hypochondriac region. Lab results came positive for dengue NS1 antigen, and ultrasonography showed features suggestive of acalculous cholecystitis. She was managed conservatively after which her symptoms resolved gradually. Acute acalculous cholecystitis in dengue could be due to increased vascular permeability leading to edematous thickening of the gall bladder wall. It should be suspected if a patient presents with fever, right upper quadrant pain, abnormal liver function tests, and thickened gall bladder wall without stones on abdominal ultrasonography. Acute acalculous cholecystitis is an atypical presentation of dengue fever. Awareness of atypical presentations of dengue helps in identifying dengue earlier and preventing complications.

Pattern of Aedes aegypti and Aedes albopictus Associated with Human Exposure to Dengue Virus in Kinshasa, the Democratic Republic of the Congo.

Dengue is a worldwide public health concern. The current study assessed the extent of human exposure to the dengue virus in relation to the distribution pattern of Aedes aegypti and Ae. albopictus in Kinshasa. Cross-sectional surveys were carried out in 2021 and 2022. The baseline entomological survey involved 19 municipalities using a grid cell sampling approach. All containers holding water were inspected for the presence of larvae in each grid. The collected larvae were kept in an insectary until the adult emergence for morphological identification. Four hundred febrile patients attending the hospital were screened for the presence of dengue antibodies (IgG, IgM) and NS1 antigen using a rapid diagnostic test (RDT) Biosynex®. Residences of positive cases were geo-referenced. We evaluated 1850 grid cells, of which 19.5% were positive for Aedes larvae. The positive grid cells were identified in the Ndjili (44.0%), Mont Ngafula (32.0%) and Ngaliema (26.0%), and Limete (32.0%) municipalities. The Ae. aegypti (11.2%) predominated in the northwestern, and Ae. albopictus (9.1%) appeared in the high vegetation coverage areas. Of 61 (15.3%) participants exposed to dengue, 8.3% presented acute dengue. Young, (6-17 years), male, and Mont Amba district participants were most exposed to dengue. In conclusion, dengue occurrence in Kinshasa overlaps somewhat the geographical and ecological distributions of Ae. aegypti and Ae. albopictus. Both species are not homogenously distributed, likely due to environmental factors. These findings can assist the targeted control activities.

Dengue Encephalopathy or Japanese Encephalitis? Co-Infection or Serologic Cross- Reactivity?

Dengue infection has a wide clinical spectrum ranging from asymptomatic presentation to life-threatening severe dengue with multiorgan failure, and increasingly recognized neurological presentation in the past decade. Japanese encephalitis on the other hand is another common mosquitoes-borne flavivirus infection endemic in Southeast Asia, which share some similar clinical features. We report a case of a 38-year-old male patient who presented to us with complaints of fever and acute encephalitis syndrome with positive dengue NS1 antigen, and positive cerebrospinal fluid serologies for both dengue and JE immunoglobulins. Magnetic Resonance Imaging findings were suggestive of encephalitic changes. Co-infection and serology cross-reactivity of these two flaviviruses is not uncommon in countries where both dengue and Japanese encephalitis are endemic, and thus, the treating clinician should have a high index of suspicion if clinical and serological evidence are present whilst treating the patient.

Laporan Kasus : Neonatal Dengue

Background : Dengue fever in late pregnancy puts the fetus at great risk because fewer maternal-specific antibodies cross the placenta, leading to a high probability of neonatal dengue infection. We followed a patient in the pediatric health department of the Bali Mandara Hospital. 
 Case Persentation : A 9-day-old baby boy complained of fever for 3 days up to a temperature of 39℃; the fever rose up and fell, but the fever did not go down to normal temperature. On physical examination, the baby was found to be less active, crying enough, suction reflex (+), pulse 135x/minute, breathing: 44 x/minute, temperature: 38.8 (axillary), SpO2: 93%, jaundice (+), lower extremities: warm acral (+), left petechiae (+), CRT <2'', jaundice skin of Kramer 2-3. Laboratory test result’s showed the platelets (69.000), hematocrit(52.2), positive dengue NS1 antigen, and positive dengue IgG and IgM. The patient was diagnosed with neonatal dengue and admitted to Perinatology. Optimal management is needed to treat neonatal dengue.
 Conclussion : It is Importance to know the transmission of dengue infection to infants, especially in endemic areas. Considering the complication that may occur, early recognition of dengue will significantly reduce infant mortality. Careful monitoring and proper laboratory tests can lead to a smooth recovery.
 Key word : Neonatal dengue, Platelets, Placenta

The characteristics of bacteremia among patients with acute febrile illness requiring hospitalization in Indonesia.

Blood culturing remains the "gold standard" for bloodstream infection (BSI) diagnosis, but the method is inaccessible to many developing countries due to high costs and insufficient resources. To better understand the utility of blood cultures among patients in Indonesia, a country where blood cultures are not routinely performed, we evaluated data from a previous cohort study that included blood cultures for all participants. An acute febrile illness study was conducted from July 2013 to June 2016 at eight major hospitals in seven provincial capitals in Indonesia. All participants presented with a fever, and two-sided aerobic blood cultures were performed within 48 hours of hospital admission. Positive cultures were further assessed for antimicrobial resistance (AMR) patterns. Specimens from participants with negative culture results were screened by advanced molecular and serological methods for evidence of causal pathogens. Blood cultures were performed for 1,459 of 1,464 participants, and the 70.6% (1,030) participants that were negative by dengue NS1 antigen test were included in further analysis. Bacteremia was observed in 8.9% (92) participants, with the most frequent pathogens being Salmonella enterica serovar Typhi (41) and Paratyphi A (10), Escherichia coli (14), and Staphylococcus aureus (10). Two S. Paratyphi A cases had evidence of AMR, and several E. coli cases were multidrug resistant (42.9%, 6/14) or monoresistant (14.3%, 2/14). Culture contamination was observed in 3.6% (37) cases. Molecular and serological assays identified etiological agents in participants having negative cultures, with 23.1% to 90% of cases being missed by blood cultures. Blood cultures are a valuable diagnostic tool for hospitalized patients presenting with fever. In Indonesia, pre-screening patients for the most common viral infections, such as dengue, influenza, and chikungunya viruses, would maximize the benefit to the patient while also conserving resources. Blood cultures should also be supplemented with advanced laboratory tests when available.

Sensitivity and specificity of DPP® Fever Panel II Asia in the diagnosis of malaria, dengue and melioidosis.

IntroductionRapid diagnostic tests (RDTs) that can facilitate the diagnosis of a panel of tropical infectious diseases are critically needed. The ‘DPP® Fever Panel II Asia’ is a multiplex lateral flow immunoassay comprising of antigen and IgM panels for the diagnosis of pathogens that commonly cause febrile illness in Southeast Asia.AimTo evaluate sensitivity and specificity of DPP® Fever Panel II for malaria, dengue and melioidosis.MethodologyWe conducted a cohort-based case-control study. Both cases and controls were derived from a prospective observational study of patients presenting with community-acquired infections and sepsis in northeast Thailand (Ubon-sepsis). We included 143 and 98 patients diagnosed with malaria or dengue based on a positive PCR assay and 177 patients with melioidosis based on a culture positive for Burkholderia pseudomallei. Controls included 200 patients who were blood culture positive for Staphylococcus aureus, Escherichia coli or Klebsiella pneumoniae, and cases of the other diseases. Serum samples collected from all patients within 24 hours of admission were stored and tested using the DPP® Fever Panel II Asia antigen and IgM multiplex assays. We selected cutoff values for each individual assay corresponding to a specificity of ≥95%. When assessing diagnostic tests in combination, results were considered positive if either individual test was positive.ResultsWithin the DPP® Fever Panel II antigen assay, a combination of pLDH and HRPII for malaria had a sensitivity of 91% and a specificity of 97%. The combination of dengue NS1 antigen and dengue antibody tests had a sensitivity of 61% and a specificity of 91%. The B. pseudomallei CPS antigen test had a sensitivity of 27% and a specificity of 97%. An odds ratio of 2.34 (95% CI 1.16-4.72, p=0.02) was observed for the association between positivity of CPS and mortality among melioidosis patients.ConclusionThe performance of the DPP® Fever Panel II Asia for diagnosis of malaria was high and that for dengue and melioidosis was relatively limited. For all three diseases, performance was comparable with other established RDTs. The potential operational advantages of a multiplex and quantitative point of care assay are substantial and warrant further investigation.

A study on the role of lepidopterism in seasonal fever outbreaks

1. To screen subjects with clinical features resembling viral fevers for specific IgE antibodies against tiger moth toxin. 2. To assess the role of tiger moths in producing features resembling viral fevers in humans. This hospital-based, cross-sectional analytical study was conducted from March 2015 to March 2016 in a tertiary hospital in North Kerala. The sample population included patients who had clinical manifestations suggestive of viral fevers and presented to the outpatient departments of Family Medicine, Internal Medicine, or Emergency Medicine and satisfied the inclusion criteria. After collecting the informed consent, the blood sample needed for the study was collected simultaneously with the blood collected for other tests ordered by the consulting doctor. No extra needle insertion was needed for the study. A total of 234 samples were examined for the presence of moth-toxin-specific IgE antibodies. Data were analysed using SPSS 17.0. Graphs were produced using Microsoft Excel. Categorical variables were expressed as frequencies with percentages and analysed using Chi-square test/Fisher's exact test. Incidence/prevalence was also expressed in percentages with confidence interval. The continuous variable was expressed as mean with standard deviation or median with inter-quartile range. For all tests, a probability value (p value) < 0.05 was considered as statistically significant. Among the 234 subjects who were screened in the 13-month period, 44 subjects (18.8%) tested positive for moth-toxin IgE, of which 28 were males and 16 were females. The maximum percentage of samples with positive moth-toxin IgE antibodies was detected during the months of March, June, July, November, December, and January. Out of the 44 subjects who had positive moth-toxin IgE antibodies, 24 tested positive for Dengue fever (of which eight were positive for the Dengue NS1 antigen, 11 were positive for the Dengue IgM antibody, and five were positive for both Dengue NS1 antigen and Dengue IgM antibody), two tested positive for Leptospira IgM antibody, two tested positive for Rickettsial antibody, and three had a positive Widal test. It was found that association of moth-toxin IgE with all the presenting symptoms of subjects analysed in this study was not statistically significant, except for lymphadenopathy. Skin rashes of different morphologies were seen in the study group. 20.5% (n = 9) of the subjects who tested positive for moth-toxin IgE had skin rashes. A majority of these weffigurere erythematous and maculopapular rashes, with incidence of 44% (n = 4) and 33% (n = 3), respectively. 1. A seasonal variation is evident in the incidence of cases with positive moth-toxin IgE. 2. There is no significant age/sex preference for moth-toxin IgE positivity. 3. Subjects who tested positive for moth-toxin IgE also had positive serological tests for other infectious causes of fever, including Dengue fever, Leptospirosis, Enteric fever, and Rickettsial fever. The role of tiger moth exposure in producing fever and related symptoms hence needs to be studied further. 4. It was observed that moth-toxin IgE had significant association with lymphadenopathy. This should be investigated in further studies. 5. Even though the role of lepidopterism in seasonal fever epidemics is not clear, primary care physicians should be more aware of such entities which can present with a wide range of manifestations.

Differential Leukocyte and Platelet Counts as Early Diagnostic Indicators in Acute Dengue Infection

Introduction: Dengue is an epidemic in Pakistan. Proper monitoring of dengue cases is necessary for its early diagnosis and prevention, especially in developing countries with limited resources. Our study aims to use some hematological parameters as Early Diagnostic Indicators in Acute Dengue Infection which can help reduce mortality and morbidity.&#x0D; Materials and Methods: Dengue NS1 Antigen test was used to identify 119 Dengue Patients over August-October, 2019. Hematological data from such patients was collected and analysed.&#x0D; Results: In our study thrombocytopenia was prominent with sensitivity based on gender distribution being 86% for males and 76% for females. According to age, distribution thrombocytopenia had a sensitivity of up to 81% in the younger age group and 80% in the older age group.&#x0D; The other prominent findings in younger age groups were lymphopenia, neutropenia, and monocytopenia with a sensitivity of 55%, 43%, and 24% respectively. Lymphopenia and neutropenia had similar sensitivity across the two genders, whereas monocytopenia had higher sensitivity among females of 27% as opposed to males of 12%.&#x0D; Eosinopenia did not differ as much among the two age groups i.e. 18% in young and 19% in older patients and across the two genders i.e. 56% in males and 60% in females.&#x0D; The sensitivity of lymphocytosis in older patients is 21% which was also significant.&#x0D; Conclusions: The Differential Leukocyte Count and Platelets Count can help as an early indicator of acute dengue infection in resource-limited areas. This can help in early diagnosis and prompt treatment thus reducing complications.