DENGUE DIAGNOSIS PHASE-BASED ALGORITHM TO OVERCOME CROSS-REACTIVITY AND OPTIMIZE DETECTION
DOI:
https://doi.org/10.64105/sf4d6h80Abstract
Dengue virus (DENV) represents a significant global health threat, resulting in approximately 390 million infections annually. Due to the absence of specific antiviral therapies, precise and prompt diagnosis remains critical for effective clinical management and outbreak control.
This review synthesizes recent evidence on dengue diagnostics, evaluates their clinical utility at various infection stages, and proposes an actionable testing protocol suited for clinical settings.
Relevant studies from 2008 to 2023 were identified in databases including PubMed/MEDLINE and Scopus, with 85 key papers selected on dengue diagnostics. Data were extracted regarding diagnostic performance, optimal timing, and cross-reactivity challenges.
Diagnostic markers emerge at distinct times during infection. Nucleic acid amplification tests (NAATs) demonstrate optimal sensitivity within the first five days. NS1 antigen assays provide rapid results but exhibit reduced reliability in secondary infections. After day five, IgM serology becomes significant, though subject to flavivirus cross-reactivity. Plaque reduction neutralization test (PRNT) remains the gold standard for resolving difficult cases and differentiating virus serotypes.
To diagnose dengue effectively, it is important to use different tests at different stages of the illness. We recommend using NAAT and NS1 tests in the first five days of symptoms, then switching to IgM tests as the patient recovers, and using PRNT for complicated cases. New technologies like multiplex PCR and better point-of-care tests could help improve diagnosis, especially in places with limited resources, such as Pakistan.
Keywords: Dengue diagnosis, NAAT, NS1 antigen, IgM serology, Cross-reactivity, Diagnostic algorithm, Flavivirus
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