Value of Routine Dengue Diagnostic Tests in Urine and Saliva Specimens

Abstract

BackgroundDengue laboratory diagnosis is essentially based on detection of the virus, its components or antibodies directed against the virus in blood samples. Blood, however, may be difficult to draw in some patients, especially in children, and sampling during outbreak investigations or epidemiological studies may face logistical challenges or limited compliance to invasive procedures from subjects. The aim of this study was to assess the possibility of using saliva and urine samples instead of blood for dengue diagnosis.Methodology/Principal FindingsSerial plasma, urine and saliva samples were collected at several time-points between the day of admission to hospital until three months after the onset of fever in children with confirmed dengue disease. Quantitative RT-PCR, NS1 antigen capture and ELISA serology for anti-DENV antibody (IgG, IgM and IgA) detection were performed in parallel on the three body fluids. RT-PCR and NS1 tests demonstrated an overall sensitivity of 85.4%/63.4%, 41.6%/14.5% and 39%/28.3%, in plasma, urine and saliva specimens, respectively. When urine and saliva samples were collected at the same time-points and tested concurrently, the diagnostic sensitivity of RNA and NS1 detection assays was 69.1% and 34.4%, respectively. IgG/IgA detection assays had an overall sensitivity of 54.4%/37.4%, 38.5%/26.8% and 52.9%/28.6% in plasma, urine and saliva specimens, respectively. IgM were detected in 38.1% and 36% of the plasma and saliva samples but never in urine.ConclusionsAlthough the performances of the different diagnostic methods were not as good in saliva and urine as in plasma specimens, the results obtained by qRT-PCR and by anti-DENV antibody ELISA could well justify the use of these two body fluids to detect dengue infection in situations when the collection of blood specimens is not possible.

Advantage of urine based molecular diagnosis of Zika virus

“…Diagnosis of other viral infections in urine and saliva samples has been reported for human immunodeficiency virus (HIV), Hepatitis A, B, and C, and rubella [14][15][16][17][18][19][20], and more recently in other flaviviruses, West-Nile virus (WNV) [21][22][23] and Dengue (DENV) serotypes -1, -2, -3, and -4 [24][25][26][27][28][29][30][31][32][33][34][35]. WNV can be detected longer in urine than serum [21] and can be isolated from urine [22,23].…”

“…WNV can be detected longer in urine than serum [21] and can be isolated from urine [22,23]. Some studies also suggest that like WNV, DENV can be detected for a longer time in urine than saliva or serum [25,29,31,32].…”

Field-deployable viral diagnostics using CRISPR-Cas13

“…Many viruses are shed in urine or saliva, including ZIKV and DENV, and sampling is not invasive(2, 7). To detect viral nucleic acid directly from bodily fluids via SHERLOCK, we developed HUDSON, a method to lyse viral particles and inactivate the high levels of RNases found in bodily fluids using heat and chemical reduction (Figs.…”

“…DENV was detected directly from 8 of 8 patient serum samples (Fig. 2E) and 3 of 3 patient saliva samples tested (Fig 2F), with a total turnaround time < 1 hour from saliva despite lower viral titers than in serum (7). We directly detected DENV with a colorimetric readout using lateral flow strips (Fig.…”

Point of sampling detection of Zika virus within a multiplexed kit capable of detecting dengue and chikungunya

“…Thus, urine and saliva samples for Zika detection are preferred over blood because of higher viral titers and prolonged presence of virus [11, 12]. Even though blood samples are shown to have higher viral loads for chikungunya and dengue, urine and saliva samples can still be used to diagnose these diseases, especially desirable for their easy collection and handling [13, 14]. …”