What is the role of serum studies in the diagnosis of dengue?

Updated: May 03, 2019
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Serum specimens should be sent to the laboratory for serodiagnosis, PCR, and viral isolation. Because the signs and symptoms of dengue fever are nonspecific, attempting laboratory confirmation of dengue infection is important. Serodiagnosis is made based on a rise in antibody titer in paired specimens obtained during the acute stage and during convalescence. Results vary depending on whether the infection is primary or secondary.

Early in the illness (≤5 days after symptom onset), laboratory confirmation can be made from a single acute-phase serum specimen by detecting dengue virus genomic sequences with RT-PCR or DENV nonstructural protein 1 (NS1) antigen via immunoassay. Later in the illness, IgM anti-DENV can be detected with ELISA. The CDC currently recommends that, within the first week of illness, diagnostic testing should include a test for dengue virus (RT-PCR or NS1) and IgM anti-DENV. For patients seen more than one week after fever onset, IgM anti-DENV, such as the MAC-ELISA, is more useful, although NS1 may still be positive up to 12 days after fever onset.


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