00001), but not significantly

better than rRT-PCR alone (P=0.5). This was also true for the combination of IgM+NS-1+rRT-PCR (93%), which was significantly better than NS-1 antigen or IgM antibody detection alone (P<0.00001), but not better than rRT-PCR alone (P=0.2). The combination of NS-1+rRT-PCR was significantly more sensitive than NS-1 antigen detection alone (P<0.00001), but was not significantly better than rRT-PCR alone (P=0.2). NS-1+IgM was significantly more sensitive than IgM antibody alone (P<0.0001), but not significantly better than NS-1 antigen detection alone (P=0.1). Combining tests resulted in a fall in specificity. selleck kinase inhibitor Combining rRT-PCR with IgM antibody alone or with IgM antibody and NS-1 antigen resulted in a specificity of 83%, whereas combining NS-1 antigen with rRT-PCR or IgM antibody, the specificities were 96% and 88% respectively. An accurate and rapid method for the diagnosis of dengue virus infection would facilitate optimal patient management. In resource-poor settings, diagnosis based on clinical features is the norm but, as shown in the current study, clinical

diagnosis of dengue using WHO criteria is non-specific: only 72/162 (44%) of patients meeting the clinical case definition in the current study had laboratory confirmed dengue infection. Twenty six patients (16%) meeting the dengue clinical case definition had an alternative, and antibiotic-treatable, cause for their illness. Unfortunately, Selleck Panobinostat for a definitive laboratory diagnosis of dengue using current Y-27632 2HCl techniques often a combination of tests are required.22 In spite of this, many clinical laboratories continue to rely on a single assay to confirm dengue infection, which, as we have demonstrated, may lead to diagnostic inaccuracy. Additionally, many currently available rapid immunochromatographic tests (ICT), used in the

field for clinical decision-making, suffer from poor performance characteristics.19 Antigen or molecular-based assays are attractive options for rapid diagnosis of dengue infection because they can potentially detect infection before an antibody response develops. Indeed, detection of dengue NS-1 antigen by ELISA allowed detection of infection prior to sero-conversion and could be detected in serum from the first day after onset of fever up to day nine of fever.23 Shu et al. confirmed the ability of PCR to detect dengue virus RNA between day one and day seven of fever.11 In the current study, NS-1 antigen and acute IgM antibody detection did not detect the majority of confirmed dengue cases. The positive predictive value (PPV) for NS-1 antigen detection was excellent (100%) but the negative predictive value (NPV) was poor at 73%, resulting in many patients with confirmed dengue being missed if the test were to be used alone.