Evaluación del sistema diagnóstico SD Dengue Duo para la detección de la proteína NS1 y los anticuerpos IgM e IgG anti-dengue / Evaluation of the SD Dengue Duo diagnosis system for detection of NS1 protein and IgM and IgG dengue antibodies

Introducción: el sistema comercial SD Dengue Duo (Standard Diagnostics) es una prueba rápida inmunocromatográfica que detecta la proteína NS1 del virus dengue y los anticuerpos anti-dengue IgM e IgG de forma simultánea. Objetivo: evaluar las características funcionales y operacionales del sistema comercial para la detección de los diferentes marcadores virológicos y serológicos. Métodos: se utilizó un panel constituido por 161 muestras de suero, 113 procedentes de pacientes con un diagnóstico clínico y serológico confirmado a cualquiera de los 4 serotipos del virus dengue y 48 negativas. Todas las muestras fueron procesadas por el sistema SD Dengue Duo y por las técnicas Platelia Dengue NS1 Ag, ELISA de captura IgM y el ELISA de inhibición utilizadas como referencia. Resultados: el sistema evaluado mostró una sensibilidad de 57,75 por ciento para la proteína NS1, se observaron falsos negativos en muestras colectadas a partir del quinto día de iniciados los síntomas en casos con infección secundaria. La detección de anticuerpos IgM mostró una sensibilidad de 96,0 por ciento y especificidad de 98,4 por ciento. Se encontró una alta concordancia (95,7 por ciento) al clasificar el tipo de infección. En el estudio global de los 3 marcadores la sensibilidad del sistema se incrementó hasta 100 por ciento. Conclusiones: el SD Dengue Duo es un método simple, rápido, fácil de ejecutar, el cual no requiere de equipamiento adicional; tiene la ventaja de poder ser utilizado para muestras, tanto de fase aguda como en la fase convaleciente y pudiera ser una alternativa para el diagnóstico del dengue en aquellos laboratorios que no cuenten con facilidades para ello.

Introduction: SD Dengue Duo (Standard Diagnosis) commercial kit is an immunochromatographic rapid test that detects NS1 protein and IgG/IgM dengue antibodies simultaneously. Objective: to evaluate the operational and functional characteristics of this system for the detection of virological and serological markers. Methods: sera panel was made up by 161 samples, 113 from patients with clinically and serologically confirmed dengue caused by any of the four dengue virus serotypes and 48 negative samples. All these samples were tested by SD Dengue Duo Kit and by Platelia Dengue NS1 Ag, IgM Capture ELISA and ELISA Inhibition Method used as reference assays. Results: the evaluated kit showed a 57.75 percent sensitivity for the detection of NS1 protein, false negatives were detected in samples collected 5 days or more after fever onset in secondary infection cases. IgM detection showed 96.0 percent sensitivity and 98.4 percent specificity. Furthermore, high agreement (95.7 percent) in classifying dengue infection types (primary or secondary infections) was observed. The global study of the 3 markers, the sensitivity rose to 100 percent. Conclusions: SD Dengue Duo is a simple, easy and rapid assay; it does not require additional equipment, can be used for acute and convalescence serum samples and offers a good alternative for dengue diagnosis in those laboratories where a complete dengue virus diagnosis is difficult to perform.

Association of platelet count and serological markers of dengue infection- importance of NS1 antigen.

Introduction: Dengue is an acute viral infection with potential fatal complications. Specific antibody detection has been the mainstay of diagnosis which is prone for both false positive and false negative reactions. The newer parameter NS1 appears to be highly specific and reliable for diagnosis of dengue infection from the first day of fever. Platelet count is the only accessory test for diagnosis of dengue infection in the peripheral laboratories. Therefore, we tried to evaluate the association of platelet counts against NS1 and IgM/IgG in dengue infections. Materials and Methods: Serum samples from clinically suspected dengue cases were tested for NS1, IgM and IgG by immunochromatography-based test. Platelet counts were obtained for all positive cases and 150 dengue seronegative cases of fever that served as controls. Test results of dengue-specific parameters were compared against platelet counts. The proportions obtained were compared by Standard error of the difference between the proportions (SEP test). Results: Of 2104 samples tested, 320 were positive for one or more dengue parameters. Of the 320, 95 were positive for NS1 only, 161 showed IgM only while 9 showed IgG only. More than one marker was detected in the remaining 55 samples. Thrombocytopenia was more consistently associated whenever NS1 was detected compared to antibody detection (P value <0.001). Conclusions: Inclusion of NS1 in the diagnosis of dengue increases the detection rate significantly. In cases of fever, thrombocytopenia is more consistently found in dengue positive rather than dengue negative subjects. It correlates well when NS1 and IgM are detected simultaneously.

Evaluation of a commercial Dengue NS1 enzyme-linked immunosorbent assay for early diagnosis of dengue infection.

Purpose: Dengue is one of the most serious mosquito-borne viral infections affecting tropical and subtropical countries in the world. Since there is no immunoprophylactic or specific antiviral therapy available, timely and rapid diagnosis plays a vital role in patient management and implementation of control measures. This paper evaluates a commercially available NS1 antigen capture ELISA vis-a-vis SD bioline Dengue NS1 antigen test for early detection of dengue virus. Materials and Methods: To evaluate a commercial NS1 antigen detection kit vis-a-vis SD bioline Dengue NS1 antigen test, a total of 91 clinical samples were tested. Virological investigations with regard to dengue virus, viz. NS1 antigen capture ELISA (Panbio, Australia), SD bioline Dengue NS1 antigen test, RT-PCR and virus isolation were performed. Results: Out of 91 samples, 24 (26%) were positive by NS1 antigen capture ELISA, 15 (16%) by SD bioline Dengue NS1 antigen test and 11(12%) positive by RT-PCR analysis. The RT-PCR-positive samples were further subjected to virus isolation and resulted in three isolates. The results of the Panbio NS1 antigen capture ELISA, SD bioline Dengue NS1 antigen test, RT-PCR and virus isolation were correlated among themselves. Conclusions: The present study comprehensively established the utility of NS1 antigen ELISA in early diagnosis of dengue infection.

Simultaneous detection of dengue NS1 antigen, IgM plus IgG and platelet enumeration during an outbreak

During 2010, there was an increase in dengue virus infections in New Delhi, India compared to 2009. This study was conducted at Sant Parmanand Hospital during this outbreak to determine the utility of a 'Dengue Package', comprising simultaneous detection of dengue non-structural protein 1 [NS1], anti-dengue IgM, anti-dengue IgG and platelet enumeration for early diagnosis, better case management and faster public health response. Blood samples were tested for Dengue NS1, IgM and IgG using the single-step immunochromatigrahic One-step dengue NS1 Ag and IgG/IgM test, while platelets were enumerated with automatic analysers yielding results within 1-2 hours. Of the 1,886 patients screened with the 'Dengue Package', 678 and 1208 were NS1-positive and -negative respectively, in different combinations. In 394 cases, NS1 was exclusively positive while 29 were also IgG positive. In 942 cases NS1, IgM and IgG were negative [triple negative]. The platelet counts in the NS1 positives were lower than the NS1 negatives, mean and standard deviation [SD] 116.8 +/- 70.2 x 109/L: 95% confidence interval [CI] 66.6-74.1 and 167.2 +/- 94.0 x 109/L, P<0.0001. Platelet counts were <20 x 109/L in 20 NS1 antigen-positives and 42 NS1 antigen-negatives. During the 2010 outbreak, swift availability of the 'Dengue Package' assisted patient management, platelet transfusions, implementation of anti-vector measures and public health notifications. Testing for NS1 assisted the diagnosis of an additional 22.4% cases; of these 394 had evidence of primary infection and 29 of secondary infection. The 'Dengue Package' was useful in tackling the rise in suspected cases

The prediction of interferon-alpha therapeutic effect by sequence variation of the HCV hypervariable region 1

Interferon-alpha (IFN-alpha) has been used to treat hepatitis C virus (HCV)-induced hepatitis, but it has been effective in only about half of the treated patients, with recurrence appearing in the other half. As a consequence of the possible complications associated with IFN-alpha and the high cost of treatment, it has become extremely important to select the proper patients for IFN-alpha treatment. In our previous study, we found that the quasispecies in the hypervariable region (HVR) 1 of HCV were various and that a new quasispecies can appear in non-responders and/or lead to deterioration in the patients' condition. The preliminary data we obtained in the process of our previous research led us to believe that the quasispecies of HVR 1 has something to do with the effect of IFN-alpha. Thus, in this investigation, we tried to determine the predictive factors of IFN-alpha therapy. Thirty patients with HCV infection were treated with IFN-alpha. Among them, 15 patients recovered after six months IFN-alpha treatment, but the remaining 15 patients showed no response after six months IFN-alpha treatment. We cloned HVR 1 DNA by reverse transcription-polymerase chain reaction (RT-PCR) and examined the quasispecies of HVR 1. As the quasispecies of HVR 1 in non-responders varied more than in the complete remission group, we concluded that the sequence variation in HVR 1 of HCV can be used to predict the effect of IFN-alpha.