Dengue NS1 Antigen Research Articles

Outbreak investigation and containment measures of dengue fever in rural Wardha: A field epidemiological study

Background: Dengue is a common vector-borne disease in countries like India, where it occurs in specific pockets including many in Maharashtra. During July–August 2018, an outbreak of dengue was suspected in a village of Wardha district, following an increase in the number of fever cases from the village, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic/larger outbreak. Objectives: The aim of this study was to find out more cases, source of infection and to recommend necessary actions to control the dengue outbreak. Materials and Methods: This was a cross-sectional epidemiological study, where we used pre-tested, pre-designed epidemiological case sheets obtained from Integrated Disease Surveillance Program (IDSP). A case definition was proposed before beginning the investigation. Line listing, collection of blood samples, distribution of paracetamol tablets to fever cases, and making a spot map were some of the important steps carried out during the investigation. Results: Out of a total of 64 suspected fever cases, 36 cases fulfilled the case definition of dengue, set for the purpose of outbreak investigation. Twenty-three of them got admitted in different hospitals among whom two of them died. Apart from that, four of them were found to be positive for both dengue IgM and NS1 antigen in their blood samples. It was age group of 21–30 years which was mostly affected. Compared to males, the female population suffered more from the illness. House, container, and Breteau index were found to be 0.26, 0.09, and 0.32, respectively. Conclusion: Following the investigation, a detailed report was made, which was shared with the district health authority. The report also contained recommendations for necessary actions to be taken to control this outbreak and to further prevent such outbreaks in future.

Geographical distribution of primary & secondary dengue cases in India - 2017: A cross-sectional multicentric study.

Background & objectives:Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India.Methods:A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases.Results:Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups.Interpretation & conclusions:Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.

Rare magnetic resonance imaging findings in dengue encephalitis

Dengue encephalitis is caused by a nonneurotropic virus of Flaviviridae group. It is a very rare manifestation of dengue fever caused by direct invasion of neural tissue into brain parenchyma. It causes a spectrum of neurologic manifestations such as meningitis, encephalitis, myelitis, and stroke. Here, we discuss a 20-year-old antenatal woman who presented with acute-onset fever and altered sensorium for 1 day. Blood investigations showed mild thrombocytopenia. Magnetic resonance imaging showed characteristic hemorrhagic encephalitis involving bilateral thalami and pons with diffusion restriction. Cerebrospinal fluid for the meningoencephalitic panel was negative. Serology for dengue NS1 antigen and immunoglobulin M antibody were positive. Although considered as a nonneurotropic virus, acute clinical presentation of fever, and altered sensorium apart from herpes and Japanese encephalitis, dengue encephalitis should also be regarded as one of the differentials.

Acute kidney injury, oral mucositis and gastritis as complications of ingestion of papaya leaf juice extract in a patient presenting with dengue fever

The use of crude leaf preparations from Carica papaya for increasing platelet count in patients with dengue fever is a popular self-treatment that is increasingly being observed recently. We report the case of a 62-year-old male who presented to our outpatient department for the evaluation of 4-day fever. In hospital diagnostic testing revealed dengue NS1 antigen enzyme-linked immunosorbent assay was positive, thrombocytopenia (platelet count 66,000/mm3), normal serum creatinine (0.96 mg/dl). Thereafter, since he was told that he was diagnosed to have dengue fever with thrombocytopenia, as per the advice given by a neighbour, he had consumed juice extracted from papaya leaves to 'increase the platelet count.' Six hours after ingestion, he had developed severe mucositis of oral cavity and severe gastritis, vomiting and loose stools. He became drowsy and irritable. Arterial blood gas analysis revealed mild metabolic acidosis, serum creatinine increased to 3.69 mg/dL. He was treated symptomatically with intravenous fluids and was carefully monitored in-hospital. Over the next 2 days, fever subsided, serum creatinine and platelet count became normal and he was discharged in a stable condition. The present case highlights the life-threatening complications that can result with the use of papaya leaf extract in the self-treatment of dengue fever.

Epidemiology and outcomes of dengue in kidney transplant recipients: A 20-year retrospective analysis and comparative literature review.

Kidney transplant (KT) recipients in dengue-endemic areas are at risk of exposure. We investigated the epidemiology and outcomes from dengue in KT recipients at our transplant center and conducted a literature review. We conducted a 20-year retrospective study of KT recipients who were diagnosed with laboratory-confirmed dengue from January 1997 to September 2017 according to the 2009 World Health Organization (WHO) classification. We analyzed clinical characteristics and treatment outcomes. There were 13 (0.7%) dengue cases among 1917 KT recipients with a median age of 39years (interquartile ranges [IQR], 22-46); 54% were males. Cases occurred with a median onset of 24months (IQR, 6-122) after KT. Dengue was diagnosed via dengue NS1 antigen (85%), IgM antibodies (38.5%), or RT-PCR (15.4%). Patients were classified as having dengue without warning sign (30.8%), with warning sign (53.8%), or severe dengue (15.4%). All patients resolved without complications, except one had hemophagocytic lymphohistiocytosis. Ten (76.9%) patients experienced eGFR reduction with a median of 13.7mL/min/1.73m2 (IQR, 8.3-20.5); eight (80%) had a full allograft function recovery. Dengue in KT recipients in endemic areas is uncommon. Although a transient decline in allograft function can occur, the overall clinical and allograft outcomes seem to be favorable.

Dengue Outbreak in Peshawar: Clinical Features and Laboratory Markers of Dengue Virus Infection

BackgroundDengue is a tropical disease caused by dengue virus (DENV). It is one of the most significant arthropod-borne viral infection. ObjectivesThe aim of the current study was to characterize epidemiological, clinical features and laboratory markers of dengue infection during the recent epidemic in Peshawar, KP. MethodsDuring the prospective hospital-based observational study, 2000 dengue suspected cases were serologically examined at Lady Reading Hospital (LRH) Peshawar. Dengue NS1 antigen and Dengue IgG and IgM antibody ELISA tests were conducted for the confirmation of dengue infection. Data regarding the clinical features, platelet count and liver function tests were also recorded for the dengue positive patients. ResultsOut of total samples 415 (21%) cases including 309 (74%) male and 106 (25%) female were detected positive for the dengue infection. In the dengue positive patients, the highest prevalence was observed in the age group of 21–40years with 160 (38%) followed by the age group of 1–20years with 89 (21%) patients. Fever was recorded in 100% of the dengue patients followed by a headache and fatigue in 73% and liver abnormality observed in 70% of the cases. During laboratory examinations IgM antibody was detected in 180 cases, followed by IgG antibody in 87, NS1 antigen in 43, NS1 antigen along with IgG and IgM antibodies in 41 dengue positive cases. Another combine detection of NS1 antigen with IgM antibody, NS1 antigen with IgG antibody and both IgG and IgM antibodies was observed in 21, 21, 22 dengue cases respectively. ConclusionIt was concluded that the dengue infection can be early diagnosed on the basis of described clinical features and with the detection of dengue-specific NS1 antigen along with antibodies such as IgG and IgM.

Sera-epidemiology of Dengue Virus Infection in Clinically Suspected Patients Attended in Dhaka Medical College Hospital During January to December 2016

Introduction: Dengue is now established as one of the most important Arboviral infection in tropical countries. As the epidemic continues worldwide, this Aedes mosquito-transmitted pathogen is considered a major re-emerging tropical disease and significant public health concern. The study was conducted to determine the sero-epidemiology and clinical picture of dengue virus infection among the clinically suspected patients attended in Dhaka Medical College Hospital during January to December 2016.Materials and Methods: The study was carried out on 145 clinically suspected Dengue patients attended in Dhaka Medical College Hospital from January to December 2016 who had fever with temperature >39°C. Blood sample was collected during acute febrile phase of patients and separated sera were tested for NS1 dengue antigen and IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd & IgM antibody by Omega Diagnostics Ltd.).Results: Of the total 145 patients 40 (27.6%) were positive for Dengue NS1 antigen and or IgM antibody test. Of the positive 40 patients, 18 (45%) were positive for NS1, 19 (47.5%) were positive for IgM and 3 (7.5%) were positive for both NS1 and IgM antibody. Major clinical manifestations were fever with arthralgia (79.5%) and retro-orbital pain (50%).Conclusion: Outbreak of Dengue fever is continuing every year and typical presentation of Dengue fever has changed. Arthralgia and retro orbital pain was the most common clinical feature in the present study instead of headache and rash with fever. A large number of suspected dengue cases were negative by Dengue tests for antigen NS1 and IgM antibody which suggests other organisms of similar clinical manifestations are becoming prevalent in Dhaka city.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 111-116

Laboratory diagnosis and molecular tracing of dengue bordline cases in Henan Province, 2017

Objective: To confirm the laboratory diagnosis of dengue bordline cases reported in Henan Province and trace its origin from molecular level in 2017. Methods: The study samples were blood samples (3-5 ml), which came from 8 suspected cases of dengue fever reported in the 2017 direct reporting system of Henan provincial infectious disease monitoring network. Meanwhile, case investigation was conducted according to National dengue fever surveillance programme. Serum were separated from blood samples and tested for Dengue NS1 antigen, IgM & IgG antibodies, and dengue RNA. According to dengue diagnosis criteria, confirmed cases were identified by testing results. Samples carried dengue RNA performed for real-time PCR genotyping and amplification of E gene. Then, the amplicons were sequenced and homological and phylogenetic analyses were constructed. Results: 8 serum samples of suspected dengue cases were collected in Henan Province, 2017. Six of them were diagnosed as dengue confirmed cases. All the dengue confirmed cases belonged to outside imported cases, 5 of them were positive by dengue RNA testing. Genotyping results showed there were 1 DENV1 case, 2 DENV2 cases and 2 DENV3 cases. A DENV2 case and a DENV3 case of this study were traced its origin successfully. The sequence of Pakistan imported DENV2 case belongs to cosmopolitan genotype, which was the most consistent with Pakistan's DENV2 KJ010186 in 2013 (identity 99.0%). The sequence of Malaysia imported DENV3 case belongs to genotype I, which was the most consistent with Singapore's DENV3 KX224276 in 2014(identity 99.0%). Conclusion: The laboratory diagnosis and molecular traceability of dengue cases in Henan Province in 2017 confirmed that all cases were imported and did not cause local epidemics.

NS-1 antigen positive Dengue Infection and molecular characterization of Dengue Viruses in a private Medical College Hospitalin Dhaka, Bangladesh

Introduction: Detection of dengue virus infection as soon as possible is critical for management of dengue virus infected patients. Immuno-chromatographic (ICT) tests are easy, cost effective method for dengue virus antigen detection.The sensitivity and specificity of ICT should compare with a gold standard test like RT-PCR. Aim of this study was to compare two test methods (ICT and RT-PCR), observe dengue serotype and seasonal impact on dengue infection.Methodology & result: The patients of Ibn Sina Medical College Hospital from October 2015 to October 2017 were tested for dengue NS1 antigen by ICT method. Out of 3201 sample tested 32.39% were found positive and 89 of which were re-tested for RT-PCR for comparison. Eighty eight of 89 NS1 positive cases showed positive by RT-PCR method giving an accuracy of 98.87%. Among the RT-PCR positive cases 45 were further analyzed for serotype. DEN-1, DEN-2 or both DEN- 1 and DEN-2 were found in 21, 23 and 1cases respectively. No cases of DEN-3 or DEN-4 were detected.Conclusion: This study showed that easily available and cost effective dengue NS1 antigen detection method (ICT) is as effective as molecular test (RT-PCR). DEN-1 and DEN-2 serotype were prevalent during last few years in Bangladesh. Continuous monitoring of dengue virus serotype is important for prevention and control of sudden epidemic by other serotype. Alert to be more during post monsoon when the peak of dengue virus infection was observed.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.669-673

NEONATAL DENGUE WITH ENTEROCOCCUS SEPSIS

Dengue infection is possible in all the three trimesters of pregnancy and is associated with various maternal and neonatal complications. The occurrence of subclinical infections may lend further confusion to the situation. Here, we report a case of neonatal dengue diagnosed with dengue NS1 antigen positive and IgM positive followed by secondary sepsis with Enterococcus faecium. Case studies like these may contribute to increased awareness of the suspicion of the associated life-threatening infections that can occur with neonatal dengue, their manifestations, and the management, thus improving their outcome.

Epidemiology of Dengue Fever among clinically Suspected Febrile Patients at A Tertiary Care Center in Punjab

ABSTRACT Objective: Dengue has emerged as a major public health concern across the globe in terms of mortality and morbidity. The clinical and epidemiological profile of dengue infection changes from time to time. The study was conducted to determine the prevalence of dengue infection, to study the seasonal variation and the clinical profile in these cases. Methods: A prospective, observational study conducted over a period from April 2015 to March 2016. Patients with acute febrile illness with clinical suspicion of dengue fever admitted in the hospital were included in the study. Serological tests like Dengue IgM and NS1 antigen ELISA were performed to confirm the diagnosis. Serologically confirmed patients of dengue fever were studied for their clinical presentation and lab parameters. Results: From a total 4732 patients tested for dengue viral infection, 1165 (24.6%) tested positive for dengue. The most affected age group was 26-35 years (25.7%) with male predominance. Most dengue cases were seen in the months of August to December 2015. Commonly clinical symptoms and signs were myalgia (72.4%), arthralgia (34.4%), vomiting (50%), abdominal pain (38.6%), hepatomegaly (27.4%) and ascites (10.8%). Lab parameters revealed leukopenia (43%) and thrombocytopenia (93.1%) in most cases. Transaminitis was seen in 84.1% cases. Common complications were shock (4.8%) and encephalopathy (4.8%). Hepatic failure was seen in 3.7% of patients and renal failure in 1.8% of patients. Conclusion: Dengue fever has a very non-specific and variable presentation. Knowledge of local prevalence and recent outbreaks can be very helpful in recognizing the clinical entity. J Microbiol Infect Dis 2018; 8(2):43-48

Frequency of Dengue Hemorrhagic Fever and Dengue Shock Syndrome In Dengue Fever

BACKGROUND: Dengue fever is caused by one of the four dengue virus sero types transmitted by Aedes aegypti mosquito. It was thought to be a disease of tropics but now it's a global health problem. OBJECTIVE: To determine the frequency of dengue hemorrhagic fever and dengue shock syndrome in dengue fever. MATERIALS & METHODS: This cross sectional descriptive study was conducted in medical wards, Hayatabad Medical Complex, Peshawar. All patients of either gender, aged> 14 years and febrile patients with positive dengue IgM or NS1 antigen were included in the study. Patients with respiratory, urinary tract and CNS infection, liver disease, hepatotoxic or bone marrow suppressant drugs and using alcohol were excluded. All cases of dengue fever, with one or more symptoms and positive dengue specific IgM or NS1 antigen were included in the study. After detail history, examination and bio data, patients were looked for Dengue hemorrhagic fever and dengue shock syndrome. Statistical analyses were carried out with SPSS-17. Mean±standard deviation was calculated for continuous variables like age while frequencies and percentages for categorical variables like gender, complications. RESULTS: Among the 161 patients 68% were male and 32% were female. Mean age was 35 ±1.26years. The frequency of Dengue hemorrhagic fever was 12% and Dengue shock syndrome was 5%. CONCLUSION: Infections associated to dengue virus are emerging global health problem. Its most dangerous complications are Dengue hemorrhagic fever and Dengue shock syndrome with Dengue hemorrhagic fever being more common.

Cytokine IL-12, Dengue in children: analysis of a unique relationship

Background: Dengue is a mosquito borne viral infection caused by one of the four serotypes of dengue viruses (DENV1-DENV4). The consequences of DENV infection range from asymptomatic condition, dengue fever (DF), or severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The host immune responses have been considered as the major factor responsible for dengue pathogenesis. In this study, the cytokine IL-12 is reviewed for its utility as potential biomarker of severe dengue disease.Methods: 120 children of paediatric age group with either dengue NS1 antigen or dengue IgM positive were included. Cases were classified as uncomplicated dengue (dengue without warning signs) and complicated dengue (dengue with warning signs and severe dengue). Clinical features and IL-12 (ELISA KIT) levels were analyzed in the study population.Results: Analysis of clinical features among the study groups revealed children with complicated dengue had persistent vomiting (95%), abdominal pain (80%), decreased urine output (50%), bleeding manifestations (83.3%), Hepatomegaly (70%) Haemoconcentration with concurrent thrombocytopenia (93.3%), altered coagulation profile (28.3%), ICU stay (54.7%), leukocytosis (15%), leucopoenia (66.6%) normal leucocytes, (18.4%). Analysis of IL-12 levels revealed children with complicated dengue showed significant elevation compared to controls and uncomplicated dengue.Conclusions: In our study IL-12 levels were significantly higher in complicated dengue patients in comparison with uncomplicated dengue patients as well as normal control population.

Identification of Prevalent Dengue Serotypes by Reverse Transcriptase Polymerase Chain Reaction and Correlation with Severity of Dengue as per the Recent World Health Organization Classification (2009)

Context: A definite link between distinct dengue serotypes and severe clinical manifestations has not been established yet. The WHO classification (2009) of dengue is more competent in diagnosing severe cases compared to traditional (1997) classification. Aims: This study aimed to identify prevalent dengue serotypes and to correlate the severity of dengue with the dengue virus (DENV) serotypes in target population as per the recent WHO classification (2009). Settings and Design: A retrospective comparative observational study was conducted from 1st January 2015 to 31st December 2015. Subjects and Methods: We tested 242 dengue NS-1 antigen ELISA-positive cases for serotyping by dengue reverse transcriptase-polymerase chain reaction (RT-PCR). Severity of each dengue case confirmed by RT-PCR was determined as per the recent WHO classification (2009). Results: On the basis of RT-PCR, dengue infection was confirmed in 135 (55.78%) patients. DEN-3 was the most common serotype found in 71 (52.6%) patients, followed by DEN-2 serotype with 44 (32.6%) patients. Nearly 2.22% cases of DEN-2 and 2.96% cases of DEN-3 serotype were having dengue with warning signs. Severe dengue was found in 2.22% cases of DEN-2 and 5.18% cases of DEN-3 serotypes. Thrombocytopenia, haemorrhagic manifestations and atypical presentations were found most commonly in DEN-3 followed by DEN-2 serotype. Coinfection with more than one serotype was observed in our study, with the most common coinfection pattern being DEN-2 and DEN-3 serotypes. Conclusions: DENV-3 and DENV-2 serotypes are prevalent in the region and are associated with a more serious clinical profile than other serotypes.

PERAN ANTIGEN NS1 DENGUE TERHADAP PENGHITUNGAN TROMBOSIT DAN PENAMPAKAN (MANIFESTASI) KLINIS PENJANGKITAN/PENULARAN (INFEKSI) VIRUS DENGUE

Dengue virus infection has become the major health problem in Indonesia. Dengue haemorrhagic fever is a part of dengue virus infection. 95% of this disease commonly affects children less than 15 years. However, in the last five years the incidence of DHF hasalso increased in adults. In 2008, the case fatality rate of DHF was 0.99% in East Java and 0.47% in Surabaya. The diagnosis of DHFis based on the 1997 WHO criteria. Thrombocytopenia is a haematological abnormality occurring in DHF. There is a hypothesis aboutthe role of non-structural 1 antigen (NS1 antigen) during initial virus replication leading to immunological reaction manifestationin thrombocytopenia. To analyze the role of NS1 antigen dengue to platelet count and clinical manifestations to know the degree ofdengue virus infection. This study used a cross-sectional design. The samples are comprised of 52 patients with dengue fever anddengue haemorrhagic fever grade I until III hospitalized at Tropical Disease Ward, Dr.Soetomo Hospital, and Surabaya. Data wereanalyzed using Mann-Whitney test, t-two sample test (p = 0.05). The result of this study using Mann-Whitney test show no difference between NS1 antigen dengue with the clinical manifestations in dengue virus infection (p = 0.882). Analysis using t-two sample test showed a significant difference between NS1 antigen dengue positive and NS1 antigen dengue negative with a change in platelet count (p = 0.006). Although, the test showed no significant difference between NS1 antigen dengue and the platelet count in dengue virusinfection (p = 0.062). There were found no significant association between NS1 dengue antigen with platelet count and clinicalmanifestations in dengue virus infection.

KETERKAITAN ANTIGEN NS1 INFEKSI VIRUS DENGUE DENGAN SEROTIPE VIRUS DENGUE

Dengue virus infection (DVI) currently is detected by using dengue virus NS1 antigen (NS1 Ag). The sensitivity of NS1 Ag is 27.8%–93.4%,but recent study of Kumarasamy the sensitivity of NS1 Ag is better than the virus isolation and polymerase chain reaction (PCR). This studyis focussed on the evaluation of the validity of Panbio Dengue Early Rapid for the diagnosis of DVI and the NS1 Ag sensitivity associated withdengue virus serotypes. The sera was obtained from 65 DVI patients which diagnosed by the clinicians. The resulted diagnosis was foundby serology tests (positive IgM/IgG antidengue/NS1 Ag ELISA) and 1997 WHO criteria as the gold standard, and which also found 35 nonDVI patients (typhoid fever, HAV, malaria, UTI, tuberculosis and bronchopneumonia). The samples were examined by Panbio Dengue EarlyRapid. PCR was performed on each positive serological test result to determine the dengue virus serotypes. The sensitivity and specificity ofPanbio Dengue Early Rapid was 49.2% and 100%. The PCR results of 65 sera showed positive PCR in 49.2% (positive NS1 Ag was 62.5%).Meanwhile, and negative PCR in 50.8% (positive NS1 Ag was 36.4%). The predominance of serotypes (positive NS1 Ag) were DEN-3 (37.5%),DEN-4 (28.1%), DEN-1 (21.9%) and DEN-2 (12.5%). The Panbio Dengue Early Rapid can be used as early detection of DVI, although itshould be used in conjunction with other dengue serological tests as well. Unfortunately there is still not enough evidence about the NS1 Agsensitivity associated with the dengue virus serotypes.

Diagnosis of Dengue Infection Cases by Serum Lactate Dehydrogenase Profiling Compared to Dengue NS1 Antigen and Anti-dengue IgM Antibody Detection: A Retrospective Study

Diagnosis of Dengue Infection Cases by Serum Lactate Dehydrogenase Profiling Compared to Dengue NS1 Antigen and Anti-dengue IgM Antibody Detection: A Retrospective Study

Concurrent methicillin-resistant Staphylococcus aureus septicemia and pyomyositis in a patient with dengue hemorrhagic fever: a case report

BackgroundConcurrent presence of dengue hemorrhagic fever (DHF), tropical pyomyositis and septicemia due to methicillin-resistant Staphylococcus aureus (MRSA) in a previously healthy person has never been reported. These three conditions even individually are potentially fatal. “Here we describe a case of a patient contracting dengue and developing DHF along with concurrent pyomyositis likely to be due to MRSA, leading to MRSA septicemia with abscesses formed by MRSA”.Case presentationA 44-year old previously healthy Sinhalese man presented on day 3 of the illness with fever, headache, arthralgia and myalgia and watery loose stools. His pulse rate was 76/min, blood pressure was 110/80 mmHg, while cardiovascular, respiratory and abdomen examination findings were unremarkable. The test for the dengue NS1 antigen was positive on the same day. We have diagnosed dengue and started managing him symptomatically as per the current national guidelines. The patient developed DHF with bilateral pleural effusion and ascitis. On the day 5 he developed severe myalgia, tenderness and non pitting edema of lower limbs especially in the thighs. His creatine kinase levels were high and an ultrasound scan confirmed myositis of both thighs. We suspected myositis due to dengue but investigated for possible simultaneous sepsis as well. On day 9 his blood culture became positive for MRSA. Considering the sensitivity of the bacteria intravenous vancomycin and ciprofloxacin was administered for 21 days. He developed a small abscess at the site of the first intravenous access and a large one above the ankle on the left. On day 12 the latter was drained and the pus culture yielded MRSA sensitive to the same antibiotics. The rapid test for dengue IgM was negative initially but later a positive MAC-ELISA test entrenched dengue infection. After improvement he was sent home on day 33 of the illness. He has developed two other abscesses in the proximity of the drained one and they were drained on day 57. The patient recovered.ConclusionsWhen dengue patients develop symptoms and signs of myositis, prompt investigations for pyomyositis and the treatment can save lives.

Seroprevalence of Dengue Infection in a Tertiary Care Hospital in Assam

<p><strong>Background:</strong> Dengue fever (DF) and dengue hemorrhagic fever (DHF) are important arthropod borne viral diseases. Dengue in India has dramatically expanded over the last few decades, with rapidly changing epidemiology. Dengue is emerging as major public health concern in northeast India and spreading with increased morbidity.</p><p><strong>Objective:</strong>This study was carried out to determine the seroprevalence of Dengue infection among patients attending in Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam during the period 2013-2016.</p><p><strong>Methods:</strong> A retrospective study was done from the year 2013 to 2016. A total of 340 serum samples received in the department of microbiology FAAMCH, were tested for the confirmation of suspected cases of dengue. Dengue NS1 antigen and Dengue IgM antibody ELISA tests were performed for the confirmation of dengue cases. We estimated the incidence by applying age, sex and season adjusted dengue positivity.</p><p><strong>Results:</strong> Out of 340 samples tested, 68 were positive either by NS1 antigen or for IgM antibody ELISA tests. These comprised all age groups of both sexes with higher incidence of cases in young males aged 26– 60 years.</p><p><strong>Conclusion:</strong> From this study, it is apparent that dengue surveillance and control should be enhanced by wider use of laboratory testing to confirm dengue as a cause of fever of unknown origin, especially during the local dengue transmission season.</p>

Langmuir-Blodgett Nanoassemblies of the MoS2-Au Composite at the Air-Water Interface for Dengue Detection.

We report Langmuir-Blodgett (LB) films of molybdenum disulphide (MoS2) and gold nanoparticles (AuNP) composite being utilized as a biosensing platform for dengue detection. The LB films of the MoS2-AuNP composite have been transferred from the air-water interface to the indium tin oxide-coated glass substrate under optimized conditions. Further, antibodies specific to dengue NS1 antigen were immobilized onto these LB films. The fabricated immunosensor has been explored for NS1 antigen detection in standard samples as well as in spiked sera samples using electrochemical impedance spectroscopy. The NS1 antigen is present in the blood of infected persons from day one of the onset of clinical symptoms in primary dengue infection. The limit of detection for the standard and the spiked samples is found to be 1.67 and 1.19 ng mL-1, respectively, which is suitable for clinical applications, as NS1 antigen levels in patient's sera range from 0.04 to 2 μg mL-1 in primary infection and from 0.01 to 2 μg mL-1 in secondary infection.