Diagnosing dengue at the point-of-care: utility of a rapid combined diagnostic kit in Singapore.
Autor: | Gan VC; Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore., Tan LK; Environmental Health Institute, National Environment Agency, Singapore, Singapore., Lye DC; Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Pok KY; Environmental Health Institute, National Environment Agency, Singapore, Singapore., Mok SQ; Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore., Chua RC; Environmental Health Institute, National Environment Agency, Singapore, Singapore., Leo YS; Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Ng LC; Environmental Health Institute, National Environment Agency, Singapore, Singapore; School of Biological Sciences, Nanyang Technological University, Singapore, Singapore. |
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Jazyk: | angličtina |
Zdroj: | PloS one [PLoS One] 2014 Mar 19; Vol. 9 (3), pp. e90037. Date of Electronic Publication: 2014 Mar 19 (Print Publication: 2014). |
DOI: | 10.1371/journal.pone.0090037 |
Abstrakt: | WHO recommendations for dengue diagnosis require laboratory facilities. Antibody-based rapid diagnostic tests (RDTs) have performed poorly, and clinical diagnosis remains the mainstay in dengue-endemic countries. We evaluated a combination antigen-antibody RDT for point-of-care testing in a high-prevalence setting. In this prospective cohort study, adults were enrolled from a tertiary infectious disease centre for evaluation of undifferentiated febrile illness from October 2011 to May 2012. SD Bioline Dengue Duo was evaluated at point-of-care against a WHO-based reference standard of viral isolation, RT-PCR, NS1-, IgM-, and IgG-ELISA. 246 adults were enrolled (median age 34 years, range 18-69), of which 197 could be confirmed definitively as either dengue or non-dengue. DENV-2 was the predominant serotype (79.5%) and the ratio of primary to secondary cases was 1∶1.1. There were no test failures and minimal interobserver variation with a Fleiss' kappa of 0.983 (95% CI 0.827-1.00). Overall sensitivity and specificity were 93.9% (95% CI 88.8-96.8%) and 92.0% (95% CI 81.2-96.9%) respectively. Using WHO clinical criteria alone for diagnosis had similar sensitivities (95.9%, 95% CI 91.4-98.1%) and lower specificities (20.0%, 95% CI 11.2-33.0%). No significant difference in performance was found when testing early versus late presenters, primary versus secondary cases, or DENV-1 versus DENV-2 infections. The use of a combination RDT fulfills WHO ASSURED criteria for point-of-care testing and can enhance dengue diagnosis in an endemic setting. This has the potential to markedly improve clinical management of dengue in the field. |
Databáze: | MEDLINE |
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