Accuracy of dengue clinical diagnosis with and without NS1 antigen rapid test: Comparison between human and Bayesian network model decision

Abstract

Differentiating dengue patients from other acute febrile illness patients is a great challenge among physicians. Several dengue diagnosis methods are recommended by WHO. The application of specific laboratory tests is still limited due to high cost, lack of equipment, and uncertain validity. Therefore, clinical diagnosis remains a common practice especially in resource limited settings. Bayesian networks have been shown to be a useful tool for diagnostic decision support. This study aimed to construct Bayesian network models using basic demographic, clinical, and laboratory profiles of acute febrile illness patients to diagnose dengue. Data of 397 acute undifferentiated febrile illness patients who visited the fever clinic of the Bangkok Hospital for Tropical Diseases, Thailand, were used for model construction and validation. The two best final models were selected: one with and one without NS1 rapid test result. The diagnostic accuracy of the models was compared with that of physicians on the same set of patients. The Bayesian network models provided good diagnostic accuracy of dengue infection, with ROC AUC of 0.80 and 0.75 for models with and without NS1 rapid test result, respectively. The models had approximately 80% specificity and 70% sensitivity, similar to the diagnostic accuracy of the hospital’s fellows in infectious disease. Including information on NS1 rapid test improved the specificity, but reduced the sensitivity, both in model and physician diagnoses. The Bayesian network model developed in this study could be useful to assist physicians in diagnosing dengue, particularly in regions where experienced physicians and laboratory confirmation tests are limited.

MCP-1 LEVELS AND ATYPICAL LYMPHOCYTES IN EARLY FEVER OF DENGUE VIRUS INFECTION WITH NON-STRUCTURAL PROTEIN 1 (NS-1) ANTIGEN TEST IN dr DARSONO HOSPITAL, PACITAN

“…Therefore, clinical information of patients must be considered along with the NS1 test result. 39 Dengue fever is a disease that is difficult to treat at the clinical level, mostly because of the late manifestation of severe disease in some patients. 36 Early in the acute febrile period of the disease, dengue fever presents with the same clinical symptoms as primary dengue.…”

“…This is an observational analytical study with a cross-sectional design to determine the MCP-1 level in dengue infection patients with 1st until the 4th day of fever and the presence of a typical lymphocytes. Dengue infection was determined by rapid tests NS1 positive or negative and MCP-1 levels were measured using by ELISA sandwich method.MCP-1 level of sixty patients dengue infection NS-1 rapid positive or negative with 2nd until 4rt fever were significantly higher than healthy subjects (420.263 ± 158,496 vs 29, 475 ± 23.443;p=0.000), but there was no significant difference in subjects with DF, DHF or DSS (436,47 ± 225,59 vs 422,77 ± 170,55 vs 448,50 ± 117,39; p =0.844). A typically lymphocytes differs significantly in healthy subjects than subjects infected with DENV an average of 2% (p= 0,000).…”

“…Kadar MCP-1 pada serum/ plasma diukur menggunakan metode ELISA sandwich. Subyek penelitian terdiri 50 pasien infeksi dengue dengan NS-1 rapid tes positif dengan demam hari kedua sampai hari keempat memiliki kadar MCP-1 lebih tinggi dibandingkan subyek sehat (420.263 ± 158,496 vs 29, 475 ± 23.443;p=0.000), dan tidak ada perbedaan bermakna kadar MCP-1 subyek dengan DF, DHF dan DSS (436,47 ± 225,59 vs 422,77 ± 170,55 vs 448,50 ± 117,39; p =0.844). Limfosit plasma biru berbeda bermakna pada subyek sehat dengan subyek terinfeksi DENV rata-rata 2% (p= 0,000).…”

A fully automated sample-to-answer PCR system for easy and sensitive detection of dengue virus in human serum and mosquitos

“…Currently, commercially available NS1 immunological test products are rapid and do not require trained personnel to detect DENV in both human and mosquitos [39]. However, they are reported as less sensitive than ELISA and may cross react with other flaviviruses [11][12][13]. Moreover, their sensitivities were relatively low on days 1 and 2 and after day 5 postsymptomatic onset in human, compared to that seen with the RT-PCR methods [40].…”

“…Early, accurate and rapid diagnosis of dengue is critical for confirmation of clinically suspected cases to ensure timely management of severe dengue disease [10]. A number of NS1 rapid diagnostic tests are commercially available to easily detect NS1 antigen, but they are not sensitive or specific enough [11][12][13]. During the acute phase of the illness when viremia levels are high, the viral RNA or soluble antigens can be easily detected [14].…”