Accuracy of clinical criteria and an immunochromatographic strip test for dengue diagnosis in a DENV-4 epidemic

BMC Infectious Diseases

Research Article

Rita Maria Ribeiro Nogueira¹  Flavia Barreto dos Santos¹  Regina Paiva Daumas²  Sonia Regina Lambert Passos³  Sibelle Nogueira Buonora³  Yara Hahr Marques Hökerberg³  Diana Neves Rodrigues de Oliveira³  Fernanda Moisés Quintela³  Cleber Nascimento do Carmo⁴ 

[1] Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil;Germano Sinval Faria Teaching Primary Care Center, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil;Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil;National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil;

关键词: Dengue;    Accuracy;    Sensitivity;    Specificity;    Diagnosis;    Point-of-care systems;    NS1;   

DOI  :  10.1186/s12879-016-1368-7

 received in 2015-08-19, accepted in 2016-01-22,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundEarly diagnosis of dengue infection is important for decision-making and timely implementation of therapeutic measures. Although rapid NS1 assays have been used for dengue diagnosis since 2008, their performance in DENV-4 cases has not yet been fully assessed.MethodsWe evaluated the accuracy of NS1 Bioeasy™ immunochromatographic strip test and of three clinical criteria for dengue diagnosis. Patients presenting at an emergency care center within 72 h of an acute febrile illness during the 2013 DENV-4 epidemic in Rio de Janeiro were consecutively enrolled for clinical and laboratory evaluation. We classified patients as suspected dengue or not according to three clinical criteria: WHO 2009, WHO 1997, and INI-FIOCRUZ. Dengue diagnosis was defined by RNA detection using RT-PCR and the negative cases were negative for all dengue serotypes and also Platelia™ NS1 ELISA. We obtained accuracy indices for NS1 Bioeasy™ alone and in combination with the clinical criteria.ResultsRT-PCR for DENV-4 was positive in 148 out of 325 patients. Positive likelihood ratio, sensitivity, and specificity of NS1 Bioeasy™ with WHO 2009, WHO 1997, and INI-FIOCRUZ criteria were 22.6 (95 % CI 7.2–70.6), 40.6 % (95 % CI 32.3–49.3), and 98.2 % (95 % CI 94.9–99.6); 18.3 (95 % CI 6.8–49.2), 44.2 (95 % CI 35.8–52.9), 97.6 (95 % CI 94.0–99.3); 26.2 (95 % CI 6.5–106.5), 29.7 (95 % CI 22.4–37.8), 98.9 (95 % CI 96.0–99.9), respectively. WHO 1997 clinical criteria presented high sensitivity to rule out disease, but extremely low specificity. INI-FIOCRUZ had moderate sensitivity and specificity, and could target a group to a more specific test.ConclusionsAlthough the large rates of false negative results using NS1 Bioeasy™ rapid test advise against its use for triaging (rule out) purposes in DENV-4 epidemics, it could be used as a confirmatory tool in a bedside algorithm.

【 授权许可】

CC BY   
© Buonora et al. 2016