Dengue in the Early Febrile Phase: Viremia and Antibody Responses

Abstract

A multicenter effort was begun in 1994 to characterize the pathophysiology of dengue using a study design that minimized patient selection bias by offering enrollment to all children with undifferentiated fever for <72 h. In the first year, 189 children were enrolled (age range, 8 months to 14 years). Thirty-two percent of these children had dengue infections (60 volunteers). The percentage of children with a secondary dengue infection was 93%, with only 4 (7%) having a primary dengue infection. The virus isolation rate from the plasma of children with dengue was 98%. Viremia correlated highly with temperature. All four dengue virus serotypes were isolated at both study sites. This study demonstrates that all four serotypes of dengue virus can cause dengue hemorrhagic fever, that all dengue patients as defined by serology experience viremia during the febrile phase, and that as fever subsides, so does viremia.

Utility of a Commercial Nonstructural Protein 1 Antigen Capture Kit as a Dengue Virus Diagnostic Tool

“…Reverse transcriptase PCR (RT-PCR) has been widely adopted as an alternative to viral isolation for the diagnosis of acute infection, but PCR is technically intensive and expensive, and sensitivity varies from 80 to 90% based on primer sets (4,14). An IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) is useful primarily for diagnosing dengue infection in the late acute or early convalescent phase of the illness but is often insensitive for early-acute-phase infections (19). For the period between days 3 and 5 post-onset of illness, there is no available diagnostic test that is adequately sensitive.…”

Evaluación de la utilidad de la prueba rápida de casete por inmunocromatografía para el diagnóstico de dengue en una región endémica colombiana

“…La relación entre la sensibilidad de esta prueba y el tiempo de enfermedad, observada en el presente estudio, coincide con los resultados de otros trabajos en los que se han evaluado diferentes pruebas serológicas (22,(24)(25)(26). En general, se ha descrito que la sensibilidad de la detección de IgM por cualquier método es muy baja en los primeros días de enfermedad (25,26).…”

“…En general, se ha descrito que la sensibilidad de la detección de IgM por cualquier método es muy baja en los primeros días de enfermedad (25,26).…”

“…Estos resultados podrían explicarse por la aparición simultánea de ambas clases de anticuerpos, respuesta inmunológica que suele ocurrir con la mejoría clínica en las infecciones secundarias del dengue, propias de las zonas endémicas (25,26).…”

Dengue Virus Immunoglobulin M Detection in a Reference Laboratory Setting during the 2010 Dengue Virus Outbreak on Caribbean Islands

“…DV infections are also an important medical concern outside the tropics and subtropics, where cases in travelers returning from areas of endemicity have been well documented (1,6,19,20,26,31,36). Measurement of DV immunoglobulin M (IgM) is an important laboratory tool for identifying individuals with recent DV infection; DV IgM develops within 5 days of symptom onset and then wanes to undetectable levels within a few months (10,11,16,17,34).Although reports (4,13,15,23,24,32,33) have described the role of DV IgM detection by hospital, medical center, and public health laboratories in conjunction with regional DV outbreaks, little information is available on DV IgM detection in a reference laboratory setting during an outbreak. As part of a large commercial reference laboratory system, our laboratory performs DV antibody testing on specimens submitted from across the United States, as well as from outside the United States.…”