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Loo LH, Lin RTP, Tee NWS, Ooi EE
Microbiology Laboratory, KK Women's and Children's Hospital, Singapore.
Dengue infection is an important differential diagnosis for undifferentiated fever in Singapore, and rapid diagnosis is essential for clinical management and public health investigation. Most children present early in the course of illness. We examined the usefulness of an in-house real-time RT-PCR protocol versus the use of a rapid serological test to diagnose dengue infection in the acute stage. We also compared 3 commercially-available dengue EIA kits.
Real-time RT-PCR was performed using an in-house protocol, targeted at the 4 dengue serotypes, on the Rotor-Gene RG - 3000 instrument (Corbett Research, Australia). An immunochromatographic kit, Dengue DUO IgM and IgG Rapid Strip Test (DRT) (Panbio Ltd, Australia) was used for routine serology testing. Samples were also tested on two other kits for comparison - Dengue Duo IgM and IgG capture ELISA (Panbio Ltd, Australia) and Dengue Fever Virus ELISA IgM (Focus Technologies Inc, USA).
Out of 180 samples, dengue infection was detected by either DRT serology or RT-PCR in 112 (62.2%), by serology only in 81 (45.0%) and by RT-PCR only in 86 (46.7%). The DRT, Dengue Duo IgM/IgG and Focus IgM EIA kits were comparable in positivity rates, although there were differences in the IgM positive samples detected by the Focus IgM EIA compared with both kits from Panbio. The Panbio kits were able differentiate antibody responses consistent with primary and secondary infections.
In the acute stage of infection, use of both real-time RT-PCR and serology testing would detect substantially more cases of dengue than the use of either test alone. |