Pathology Queensland, Townsville QLD, Australia.
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
J Med Microbiol. 2024 May;73(5). doi: 10.1099/jmm.0.001833.
Dengue is an important arboviral infection of considerable public health significance. It occurs in a wide global belt within a variety of tropical regions. The timely laboratory diagnosis of Dengue infection is critical to inform both clinical management and an appropriate public health response. Vaccination against Dengue virus is being introduced in some areas. Appropriate diagnostic strategies will vary between laboratories depending on the available resources and skills. Diagnostic methods available include viral culture, the serological detection of Dengue-specific antibodies in using enzyme immunoassays (EIAs), microsphere immunoassays, haemagglutination inhibition or in lateral flow point of care tests. The results of antibody tests may be influenced by prior vaccination and exposure to other flaviviruses. The detection of non-structural protein 1 in serum (NS1) has improved the early diagnosis of Dengue and is available in point-of-care assays in addition to EIAs. Direct detection of viral RNA from blood by PCR is more sensitive than NS1 antigen detection but requires molecular skills and resources. An increasing variety of isothermal nucleic acid detection methods are in development. Timing of specimen collection and choice of test is critical to optimize diagnostic accuracy. Metagenomics and the direct detection by sequencing of viral RNA from blood offers the ability to rapidly type isolates for epidemiologic purposes. The impact of vaccination on immune response must be recognized as it will impact test interpretation and diagnostic algorithms.
登革热是一种具有重要公共卫生意义的重要虫媒病毒感染。它发生在全球广泛的热带地区。及时进行登革热感染的实验室诊断对于指导临床管理和采取适当的公共卫生应对措施至关重要。一些地区正在引入针对登革热病毒的疫苗接种。根据可用资源和技能，不同实验室之间的诊断策略会有所不同。可用的诊断方法包括病毒培养、酶联免疫吸附试验（EIA）中检测登革热特异性抗体、微球免疫分析、血凝抑制或侧向流动即时检测。抗体检测的结果可能受到先前接种疫苗和接触其他黄病毒的影响。血清中非结构蛋白 1（NS1）的检测提高了登革热的早期诊断，除了 EIA 外，还可在即时检测中使用。通过 PCR 直接从血液中检测病毒 RNA 比 NS1 抗原检测更灵敏，但需要分子技能和资源。越来越多种类的等温核酸检测方法正在开发中。标本采集的时间和检测方法的选择对于优化诊断准确性至关重要。宏基因组学和直接从血液中测序检测病毒 RNA 能够快速对分离株进行分型，以用于流行病学目的。疫苗接种对免疫反应的影响必须得到认识，因为它将影响测试解释和诊断算法。
