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Rapid diagnostic tests for dengue virus infection in febrile Cambodian children: diagnostic accuracy and incorporation into diagnostic algorithms.

Carter MJ, Emary KR, Moore CE, Parry CM, Sona S, Putchhat H, Reaksmey S, Chanpheaktra N, Stoesser N, Dobson AD, Day NP, Kumar V, Blacksell SD - PLoS Negl Trop Dis (2015)

Bottom Line: Clinical and laboratory variables, and DENV RDT results were recorded at admission.Sensitivity was 58%, and specificity 85% for RDT NS1 and IgM combined.Variables associated with diagnosis of DENV infection were not associated with critical care admission (70 children, 21%) or mortality (19 children, 6%).

View Article: PubMed Central - PubMed

Affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Institute of Child Health, University College London, London, United Kingdom.

ABSTRACT

Background: Dengue virus (DENV) infection is prevalent across tropical regions and may cause severe disease. Early diagnosis may improve supportive care. We prospectively assessed the Standard Diagnostics (Korea) BIOLINE Dengue Duo DENV rapid diagnostic test (RDT) to NS1 antigen and anti-DENV IgM (NS1 and IgM) in children in Cambodia, with the aim of improving the diagnosis of DENV infection.

Methodology and principal findings: We enrolled children admitted to hospital with non-localised febrile illnesses during the 5-month DENV transmission season. Clinical and laboratory variables, and DENV RDT results were recorded at admission. Children had blood culture and serological and molecular tests for common local pathogens, including reference laboratory DENV NS1 antigen and IgM assays. 337 children were admitted with non-localised febrile illness over 5 months. 71 (21%) had DENV infection (reference assay positive). Sensitivity was 58%, and specificity 85% for RDT NS1 and IgM combined. Conditional inference framework analysis showed the additional value of platelet and white cell counts for diagnosis of DENV infection. Variables associated with diagnosis of DENV infection were not associated with critical care admission (70 children, 21%) or mortality (19 children, 6%). Known causes of mortality were melioidosis (4), other sepsis (5), and malignancy (1). 22 (27%) children with a positive DENV RDT had a treatable other infection.

Conclusions: The DENV RDT had low sensitivity for the diagnosis of DENV infection. The high co-prevalence of infections in our cohort indicates the need for a broad microbiological assessment of non-localised febrile illness in these children.

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Related in: MedlinePlus

Conditional inference tree for the prediction of reference diagnosis of DENV infection using clinical diagnostics, laboratory parameters and DENV RDT results with an association (p<0.05) with reference diagnosis of DENV infection (DENV RDT, platelet levels, white cell levels, hepatomegaly).
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pntd.0003424.g004: Conditional inference tree for the prediction of reference diagnosis of DENV infection using clinical diagnostics, laboratory parameters and DENV RDT results with an association (p<0.05) with reference diagnosis of DENV infection (DENV RDT, platelet levels, white cell levels, hepatomegaly).

Mentions: Combining clinical, laboratory and DENV RDT covariates created five classifications (four, if node 6 [hepatomegaly] is combined) for likelihood of reference assay positive DENV infection (Fig. 4). Children with a positive DENV RDT result and platelet count ≤313 x109/mm3 had the highest probability (error rate of 37.1%), particularly if they showed hepatomegaly (error rate 31.9%). Alternatively children with a negative DENV RDT, and white cell count >7.4 x109/mm3 had a low likelihood (error rate 4.8%). Other classifications showed intermediate likelihood.


Rapid diagnostic tests for dengue virus infection in febrile Cambodian children: diagnostic accuracy and incorporation into diagnostic algorithms.

Carter MJ, Emary KR, Moore CE, Parry CM, Sona S, Putchhat H, Reaksmey S, Chanpheaktra N, Stoesser N, Dobson AD, Day NP, Kumar V, Blacksell SD - PLoS Negl Trop Dis (2015)

Conditional inference tree for the prediction of reference diagnosis of DENV infection using clinical diagnostics, laboratory parameters and DENV RDT results with an association (p<0.05) with reference diagnosis of DENV infection (DENV RDT, platelet levels, white cell levels, hepatomegaly).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4340051&req=5

pntd.0003424.g004: Conditional inference tree for the prediction of reference diagnosis of DENV infection using clinical diagnostics, laboratory parameters and DENV RDT results with an association (p<0.05) with reference diagnosis of DENV infection (DENV RDT, platelet levels, white cell levels, hepatomegaly).
Mentions: Combining clinical, laboratory and DENV RDT covariates created five classifications (four, if node 6 [hepatomegaly] is combined) for likelihood of reference assay positive DENV infection (Fig. 4). Children with a positive DENV RDT result and platelet count ≤313 x109/mm3 had the highest probability (error rate of 37.1%), particularly if they showed hepatomegaly (error rate 31.9%). Alternatively children with a negative DENV RDT, and white cell count >7.4 x109/mm3 had a low likelihood (error rate 4.8%). Other classifications showed intermediate likelihood.

Bottom Line: Clinical and laboratory variables, and DENV RDT results were recorded at admission.Sensitivity was 58%, and specificity 85% for RDT NS1 and IgM combined.Variables associated with diagnosis of DENV infection were not associated with critical care admission (70 children, 21%) or mortality (19 children, 6%).

View Article: PubMed Central - PubMed

Affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Institute of Child Health, University College London, London, United Kingdom.

ABSTRACT

Background: Dengue virus (DENV) infection is prevalent across tropical regions and may cause severe disease. Early diagnosis may improve supportive care. We prospectively assessed the Standard Diagnostics (Korea) BIOLINE Dengue Duo DENV rapid diagnostic test (RDT) to NS1 antigen and anti-DENV IgM (NS1 and IgM) in children in Cambodia, with the aim of improving the diagnosis of DENV infection.

Methodology and principal findings: We enrolled children admitted to hospital with non-localised febrile illnesses during the 5-month DENV transmission season. Clinical and laboratory variables, and DENV RDT results were recorded at admission. Children had blood culture and serological and molecular tests for common local pathogens, including reference laboratory DENV NS1 antigen and IgM assays. 337 children were admitted with non-localised febrile illness over 5 months. 71 (21%) had DENV infection (reference assay positive). Sensitivity was 58%, and specificity 85% for RDT NS1 and IgM combined. Conditional inference framework analysis showed the additional value of platelet and white cell counts for diagnosis of DENV infection. Variables associated with diagnosis of DENV infection were not associated with critical care admission (70 children, 21%) or mortality (19 children, 6%). Known causes of mortality were melioidosis (4), other sepsis (5), and malignancy (1). 22 (27%) children with a positive DENV RDT had a treatable other infection.

Conclusions: The DENV RDT had low sensitivity for the diagnosis of DENV infection. The high co-prevalence of infections in our cohort indicates the need for a broad microbiological assessment of non-localised febrile illness in these children.

Show MeSH
Related in: MedlinePlus