Simultaneous detection of IgM antibodies against dengue and chikungunya: Coinfection or cross-reactivity?

Abstract

Background: Dengue and chikungunya sharing same mosquito vector are two most important arboviruses circulating in northern India including Delhi and are responsible for frequent outbreaks. Antigen and antibodies detection ELISA kits are the major tool to diagnose these viral illnesses, and are sometimes associated with cross–reactivity, giving a false picture of coinfection, although simultaneous harboring of both the viruses is not uncommon. Various studies have reported coinfection up to 25% from the same region. Procedure: This study was conducted in the Department of Microbiology, Maulana Azad Medical College, New Delhi, during the month of September 2016 which included 200 blood samples from clinically suspected cases attending Medicine OPD of associated Lok Nayak Hospital, New Delhi. Diagnosis of dengue and chikungunya was made using NS-1 antigen and IgM MAC ELISA for dengue and IgM MAC ELISA for chikungunya as per manufacturer's instructions. Results: Out of 200 suspected cases, 34 (17%) were positive for dengue serology, 77 (38.5%) were positive for chikungunya serology, and 29.9% of positive chikungunya cases were simultaneously affected with dengue. This higher percentage of coinfection might be because of cross-reactivity of the ELISA kits. Discussion: India being a hyperendemic region for dengue and chikungunya, frequent outbreaks are quite common. Circulation of both the virus and huge susceptible population are the major causes for frequent outbreaks. Restricting our attention to diagnose one of them is not sufficient, and coinfection further complicates the illness. Conclusion: Simultaneous diagnosis of dengue and chikungunya is need of time to diagnose dual infection and prevent complications by starting supportive treatment well in time. Molecular technique if ever possible should be employed whenever the coinfection number is higher than expected to rule out cross-reactivity.

Analysis of a Routinely Used Commercial Anti-Chikungunya IgM ELISA Reveals Cross-Reactivities with Dengue in Brazil: A New Challenge for Differential Diagnosis?

“…Although both are associated with poor quality of life, evidence for more severe diseases in DENV/CHIKV co-infected individuals is poorly understood and controversial. According to Abhishek and Chakravarti, the co-infection further worsens the condition [ 50 ]. However, for Silva et al, there is no exacerbation of clinical signs [ 1 ].…”

Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017

“…In addition, IgM diagnostic assays for dengue virus infection can cross-react between other flaviviruses, such as yellow fever and Zika, distorting data. [40][41][42] There is a need for a major breakthrough in the dengue field to allow developing countries the ability to diagnose their patients with utmost confidence. Nevertheless, the PAHO diagnostic system is effective overall, where most cases were correctly diagnosed, confirmed by the available diagnostic methods most of the time in six of our nine study years.…”

Circulating Dengue Serotypes in Central Delhi during 2015 Outbreak

“…18 Moreover, dengue and chikungunya co-infection is not so uncommon. 19 Mortality associated with dengue and chikungunya co-infection has also been reported. 20 Since Aedes mosquito is a common vector for both dengue and chikungunya, there is always a high possibility of transmitting the infection simultaneously.…”