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 Table of Contents  
BRIEF COMMUNICATION
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 49-51

Childhood dengue


Department of Microbiology, MaxCure Hospital, Hyderabad, Telangana, India

Date of Web Publication19-Dec-2016

Correspondence Address:
Grishma Vijaykumar Kulkarni
MaxCure Hospital, No. 5-9-22, Secretariat Road, Hyderabad - 500 063, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.196067

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  Abstract 

Dengue is a vector borne disease, known for its serious life threatening complications. It is endemic in India. Early diagnosis of dengue virus is important and can be established with the easily available laboratory tests. Rapid tests detecting NS1, IgM, and IgG identify the cases at earlier stage, thus reducing the morbidity and the mortality due to dengue haemorrhagic fever(DHF) and dengue shock syndrome (DSS).

Keywords: Children, dengue, rapid test


How to cite this article:
Kulkarni GV. Childhood dengue. CHRISMED J Health Res 2017;4:49-51

How to cite this URL:
Kulkarni GV. Childhood dengue. CHRISMED J Health Res [serial online] 2017 [cited 2019 Oct 19];4:49-51. Available from: http://www.cjhr.org/text.asp?2017/4/1/49/196067


  Introduction Top


Dengue is an acute mosquito-borne viral febrile illness endemic to the Indian subcontinent. [1],[2] It is caused by four distinct viruses, Types 1-4 that are closely related antigenically. [3] Primary dengue may represent as a nonspecific illness or dengue fever (DF). Secondary infection with the serotype different from causing the primary may lead to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Diagnosis of all these entities is usually done by the rapid tests or ELISA encompassing nonstructural protein 1 (NS1), IgM, and IgG. [1],[4]


  Materials and methods Top


This retrospective study was conducted at Lotus Children's Hospital, Hyderabad (Telangana, India), from September 1, 2014, to March 31, 2015. A total of 187 children with the age range <1 year to >15 years

were included in the study. Serum samples from all the patients presenting to the hospital with dengue-like illness were collected in this evaluation. These samples were tested by the rapid immunochromatography dengue day 1 test (J.Mitra Ltd., India). Moreover, the results were noted.


  Results Top


Of the 187,124 (66.31%) were males and 63 (33.68%) were female, respectively. The age- and sex-wise distribution of the children included in the study is represented in [Table 1]. Only 54 (28.87%) children showed the positive results with the rapid tests. Of them, only 49 (90.74%) children displayed the strong positivity for a single dengue marker as showcased in [Table 2]. Majority of them infected with dengue fall in 1-5 years and >5-10 years age category.

Double positivity for the infection markers was shown by five (9.25%) children as presented in [Table 3]. None of them was reactive for all the three markers.

In the positive group, weak reactivity was seen in the four children (7.4%) [Table 4].
Table 1: Age and sex distribution of the study group

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Table 2: Distribution of dengue markers

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Table 3: Double positivity of dengue markers

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Table 4: Weak positivity of dengue markers

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  Discussion Top


Dengue is a life-threatening illness, common in tropics and subtropics. Dengue is a notifiable disease in India. Although the dengue serotype 2 is the most prevalent serotype over 50 years, the serotypes 3 and 4 have appeared in some of the epidemics. [5],[6],[7],[8],[9],[10]

In the clinical practice, the diagnosis of dengue is done by the detection of NS1, IgM, and IgG which can be detected from 0 to 7 days, 5 days to 3 months, and 10 days to several months or probably lifelong, respectively. [11],[12]

As this study was a retrospective evaluation, the details of the patient were not available and hence the serological markers could not be related to the clinical data.

In our study, dengue infection markers were detected by the dengue day 1 rapid immunochromatography test. As per the South Indian study, the sensitivity, specificity, positive predictive value, and negative predictive value for IgM were 81.8%, 75%, 61%, and 89.6%, respectively, whereas for IgG, it was 87.5%, 66.6%, 72.9%, and 83.9%, respectively. [1] In the present study, ELISA was not performed whereas the North Indian study revealed 90.1% agreement between the immunochromatography and NS1 capture ELISA. [5]

In this study, the convalescent sera were not collected but as per the another school of thought, the performance of the rapid devices improved for the acute and convalescent sera and ultimately the accuracy of the diagnosis. [1] As per the present study, out of 187, 49 children were positive for the dengue markers, out of which 31 (63%), 6 (12.24%), and 12 (24.48%) showed reactivity for the isolated NS1, IgM, and IgG, respectively. Only five displayed the dual positivity for the dengue markers. As per New Delhi study, 26% were positive for NS1 by Panbio NS1 early ELISA kit and 15% by standard deviation (SD) lateral flow test whereas only 6 and 7 samples showed the positivity for IgM and IgG, respectively. It also stated that only five showed the double reactivity for IgM and IgG bands. All the negative samples were not confirmed by the ELISA in the present study whereas the North Indian analysis revealed nine dengue negative cases by SD NS1 antigen lateral flow test were positive by dengue early ELISA test. [2] Similar results are reported by the different analysis. On the contrary, the same comparative study revealed 94.26% concordance among two ELISA and one rapid tests. [5] Better sensitivity of IgM capture assay compared to the rapid test is known. [1]

In the present study, four children showed the weak positivity for the dengue infection markers (four for IgM and one each for NS1 and IgG). Other than dengue, similar observations of showing a faint colored band in comparison with the strong control band for diagnosis of pregnancy-associated malaria is reported. In this case, the test result was a true positive though false positive results are reported by the rapid tests in conditions like pregnancy causing a diagnostic dilemma. [13]

In the present study, RNA polymerase chain reaction (PCR), immunoblot for the serotype differentiation, and virus isolation by the culture were not performed. Although the virus isolation considered as the gold standard for the laboratory diagnosis of the acute dengue virus infection, it is expensive and takes at least 6-10 days for virus in the cell culture. Virus isolation gave the overall positive isolation rate of 27.27% with reverse transcription PCR positive samples as per New Delhi study. [2] Immunoblot for the differentiation of dengue serotypes 1-4 had displayed the overall sensitivity and specificity of 89.4% and 96.%, respectively. [4] It also stated that the sensitivity for the serotypes 1 and 2 was 94% whereas for the serotypes 3 and 4, it was 100%. In addition to this, the specificity for all the serotypes was 100% except 3 (80%). It could be because of a high degree of homology among B domains of the serotypes 1 and 3. A German-based study reported a sensitivity of 94% for the detection of RNA by TaqMan PCR. [14]


  Conclusion Top


DF is an endemic in the most tropical and subtropical areas worldwide. [14] It is a life-threatening illness which warrants early diagnosis and treatment. [5] Rapid kits detecting NS1, IgM, and IgG help in the management of the patient. [5] Although ELISA, PCR, and immunoblot show higher sensitivity and specificity in comparison with the rapid immunochromatographic test, rapid tests are suitable for regular use in any modest laboratory or primary health care for the early diagnosis of the viral infection and prevention of the complications such as DHF and DSS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Moorthy M, Chandy S, Selvaraj K, Abraham AM. Evaluation of a rapid immunochromatographic device for the detection of IgM and IgG antibodies to dengue viruses (DENV) in a tertiary care hospital in South India. Indian J Med Microbiol 2009;27:254-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Shrivastava A, Dash PK, Tripathi NK, Sahni AK, Gopalan N, Lakshmana Rao PV. Evaluation of a commercial dengue NS1 enzyme-linked immunosorbent assay for early diagnosis of dengue infection. Indian J Med Microbiol 2011;29:51-5.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Chaturvedi UC, Shrivastava R. Dengue haemorrhagic fever: A global challenge. Indian J Med Microbiol 2004;22:5-6.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Ludolfs D, Schilling S, Altenschmidt J, Schmitz H. Serological differentiation of infections with dengue virus serotypes 1 to 4 by using recombinant antigens. J Clin Microbiol 2002;40:4317-20.  Back to cited text no. 4
    
5.
Stephen S, Charles MV, Anitharaj V, Deepa C, Umadevi S. Early dengue diagnosis by nonstructural protein 1 antigen detection: Rapid immunochromotography versus two the enzyme-linked immunosorbent assay kits. Indian J Pathol Microbiol 2014;57:81-4.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India. Indian J Med Res 2012;136:373-90.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Arya SC, Agarwal N, Parikh SC, Agarwal S. Simultaneous detection of dengue NS1 Antigen, IgM plus IgG and platelet enumeration during an outbreak. Sultan Qaboos Univ Med J 2011;11:470-6.  Back to cited text no. 7
    
8.
Datta S, Wattal C. Dengue NS1 antigen detection: A useful tool in early diagnosis of dengue virus infection. Indian J Med Microbiol 2010;28:107-10.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Singh MP, Majumdar M, Singh G, Goyal K, Preet K, Sarwal A, et al. NS1 antigen as an early diagnostic marker in dengue: Report from India. Diagn Microbiol Infect Dis 2010;68:50-4.  Back to cited text no. 9
    
10.
Padbidri VS, Wairagkar NS, Joshi GD, Umarani UB, Risbud AR, Gaikwad DL, et al. A serological survey of arboviral diseases among the human population of the Andaman and Nicobar Islands, India. Southeast Asian J Trop Med Public Health 2002;33:794-800.  Back to cited text no. 10
    
11.
Bhattacharya N, Mukherjee H, Naskar R, Talukdar S, Das G, Pramanik N, et al. Serological diagnosis of dengue in laboratory practice in Kolkata. Indian J Med Microbiol 2014;32:277-80.  Back to cited text no. 11
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12.
Peeling RW, Artsob H, Pelegrino JL, Buchy P, Cardosa MJ, Devi S, et al. Evaluation of diagnostic tests: Dengue. Nat Rev Microbiol 2010;8 12 Suppl:S30-8.  Back to cited text no. 12
    
13.
Mohapatra S, Deb M, Samantaray JC, Ghosh A. Weak positive band by immunochromatographic test in pregnancy-associated malaria: A diagnostic dilemma. Indian J Med Microbiol 2013;31:418-9.  Back to cited text no. 13
[PUBMED]  Medknow Journal  
14.
Laue T, Emmerich P, Schmitz H. Detection of dengue virus RNA in patients after primary or secondary dengue infection by using the TaqMan automated amplification system. J Clin Microbiol 1999;37:2543-7.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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