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Scientific Approach To Dengue Diagnosis

Dengue is an infection caused by any one of the closely related dengue viruses (DEN 1, DEN 2, DEN 3, and DEN 4). The viruses are transmitted to humans by the bite of an infected mosquito, Aedes aegypti. In 1906, Aedes mosquitoes transmitting the dengue was confirmed. The term dengue fever came into use after 1828 when the dengue hemorrhagic fever (DHF) was first reported in Philippines and South America in 1953 and 1981 respectively.

In India, the first outbreak was reported during 1963 in Kolkata. The next major outbreak of dengue/DHF was reported in Delhi and neighboring states in 1996.

The increase in dengue infection is believed to be due to multiple factors like, rapid urbanization, population growth, international travel from endemic areas, and lastly global warming.

Sudden-onset fever, headache (typically behind the eyes), muscle, and joint pains are some of the characteristic symptoms of dengue. Dengue infection results in illness ranging from mild and asymptomatic to life-threatening forms of DHF and dengue shock syndrome (DSS). Thromobocytopenia and drop in hematocrit are characteristic symptoms of DHF and DSS.

Dengue disease testing involves the detection of NS1 antigen and IgM/IgG antibodies. NS1 is a non-structural protein and an early marker for the identification of dengue virus from the first day of the infection. NS1 antigen will be positive till the 5th day of viremia. The IgM antibodies to the dengue virus become detectable by the 5th/ 6th day of fever and remain so till 2-3 months, indicating current or recent infection. The IgG antibodies become detectable in about 2 weeks’ time of fever and remain detectable for life, indicating a past infection.

The common method for detecting dengue virus are RDT (rapid diagnostic testing), ELISA. RDT works on the immunochromatographic principle to detect the presence or absence of antigen and antibody. ELISA is an immunoassay technique to detect and to quantify the concentration of antigen and antibody. The advantages and limitations of both the methods for dengue detection are as follows:

ELISA

RDT

Quantitative test

Qualitative test

Requires a special setup

No special setup required

Requires expertise or skilled manpower

No expertise required

Separate kits required for detecting the NS1 antigen, IgM, and IgG antibodies

Detection of NS1 antigen and IgM, IgG antibodies in single combo card

Results in 90 mins

Results in 15ñ20 minutes

CPC Diagnostics markets dengue detection kits in both ELISA and in RDT format. The advantage of dengue IgG and IGM ELISA kits are the serological detection of antibodies against all four virus types. The sample buffer in the kit contains an IgG/ RF absorbent, which helps in the removal of RF and IgG to avoid interference.  The dengue NS1 ELISA kit detects the dengue virus NS1 antigen in patients suspected of acute DEN V infection. Highest specificity is due to neutralization of HAMA (human anti mouse antibodies) and other heterophilic antibodies.

CPC’s dengue Rapid Cards has been designed to cover the entire spectrum of the infection in order to ensure high sensitivity and specificity. It detects both NS1 and IgG/IgM together. This will help in early diagnosis of dengue from the first day itself. The Rapid Cards high membrane width is critical to identify the bands with ease.

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