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Dengue Virus Testing

Dengue Virus NS1 Antigen                   

Test Code 92942                                                 

Dengue Fever Antibodies (IgG, IgM) and NS1 Antigen Panel

Test Code 93192

 

Question 1. What is the global and U.S. importance of dengue virus?

Dengue virus is a flavivirus transmitted to humans by Aedes mosquitoes. An estimated 50-100 million infections occur annually throughout the world. Dengue virus primarily affects persons living in or traveling to tropical areas. Nearly all dengue cases reported in the 48 continental states were acquired elsewhere by travelers or immigrants, with sporadic cases reported along the southern U.S. border (eg, in Arizona, Texas, Florida) and in Hawaii.

Symptoms of dengue infection can range from mild febrile illness to bleeding (dengue hemorrhagic fever) or hypotension (dengue shock syndrome) with potentially high mortality. It is important to diagnose dengue promptly, since other tropical infections can produce similar patterns of illness and may require different treatment.

Question 2. What is the dengue NS1 antigen?

Dengue nonstructural protein 1 (NS1) is an antigen produced in abundance by the replicating dengue virus as early as the first day of symptoms and as late as day 18 of symptoms.1 NS1 can be detected in the blood sooner than IgM, which cannot be reliably detected until days 6 to 10.1

Question 3. What is the advantage of detecting dengue NS1 antigen instead of dengue antibodies?

Detection of NS1 antigen allows an accurate diagnosis of current infection within the first week of illness (ie, during the febrile phase). Detection of IgM antibody, on the other hand, indicates possible current infection or recent infection (within the past 2 to 3 months).1 An acute and convalescent specimen is thus required to diagnose current infection. Additionally, the NS1 antigen is specific to dengue, whereas the antibody may cross react with other flaviviruses such as West Nile virus, St. Louis and Japanese encephalitis viruses, and yellow fever virus.1

Question 4. What are the specimen collection requirements for NS1 antigen testing?

Specimen collection requirements are the same as for the antibody test (ie, 1 mL of room-temperature serum). However, only 1 specimen collection is needed; ie, acute and convalescent specimens are not needed to make the diagnosis.

Question 5. Is there a panel available to diagnose acute dengue infection?

Yes. The Dengue Fever Antibodies (IgG, IgM) and NS1 Antigen Panel (test code 93192) includes NS1 antigen and IgM and IgG antibody tests. The panel may be helpful for diagnosing dengue in certain patients. Diagnostic sensitivity during early dengue infection is higher when NS1 is combined with IgM—a significant number of patients will have measurable NS1 but no measurable IgM or IgG during the first week of illness.2,3

Table

NS1 antigen may be ordered separately (test code 92942). An additional test, Dengue Virus RNA PCR (test code 43400), may also be useful to detect acute infection in the first five days of illness.

Question 6. How are dengue infections treated?

There is no specific antiviral therapy currently available to treat dengue infection. Treatment is supportive, based on observation of hemorrhagic and circulatory abnormalities and laboratory test results (eg, electrolytes, platelets and hemoglobin).

References

  1. Centers for Disease Control and Prevention. Dengue: Laboratory guidance and diagnostic testing. http://www.cdc.gov/dengue/clinicalLab/laboratory.html. Updated September 27, 2012. Accessed August 11, 2015.
  2. Kassim FM, Izati MN, TgRogayah TA, et al. Use of dengue NS1 antigen for early diagnosis of dengue virus infection. Southeast Asian J Trop Med Public Health. 2011;42:562-569.
  3. Huhtamo E, Hasu E, Uzcategui NY, et al. Early diagnosis of dengue in travelers: comparison of a novel real-time PCR, NS1 antigen detection and serology. J Clin Virol 2010;47:49-53.
This FAQ is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.
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Effective 02/03/2016 to present