|Year : 2017 | Volume
| Issue : 1 | Page : 49-51
Grishma Vijaykumar Kulkarni
Department of Microbiology, MaxCure Hospital, Hyderabad, Telangana, India
|Date of Web Publication||19-Dec-2016|
Grishma Vijaykumar Kulkarni
MaxCure Hospital, No. 5-9-22, Secretariat Road, Hyderabad - 500 063, Telangana
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
Dengue is an acute mosquito-borne viral febrile illness endemic to the Indian subcontinent. , It is caused by four distinct viruses, Types 1-4 that are closely related antigenically.  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. ,
| Materials and methods|| |
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|| |
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].
| Discussion|| |
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. ,,,,,
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. ,
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.  In the present study, ELISA was not performed whereas the North Indian study revealed 90.1% agreement between the immunochromatography and NS1 capture ELISA. 
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.  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.  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.  Better sensitivity of IgM capture assay compared to the rapid test is known. 
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. 
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.  Immunoblot for the differentiation of dengue serotypes 1-4 had displayed the overall sensitivity and specificity of 89.4% and 96.%, respectively.  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. 
| Conclusion|| |
DF is an endemic in the most tropical and subtropical areas worldwide.  It is a life-threatening illness which warrants early diagnosis and treatment.  Rapid kits detecting NS1, IgM, and IgG help in the management of the patient.  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
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]