Aiding in the diagnosis of central nervous system infection caused by dengue virus
Detection of dengue virus nucleic acid in cerebrospinal fluid (CSF) is suggestive of recent exposure or acute central nervous system infection with dengue virus.
The presence of dengue virus nucleic acid in CSF or serum can be used as a marker for acute-phase infection.
Patients with a history of symptoms for more than 1 week may be negative by molecular tests (ie, real-time PCR) and may require serologic testing to confirm the diagnosis of dengue virus infection.
See Mosquito-borne Disease Laboratory Testing in Special Instructions.
Real-Time Polymerase Chain Reaction (PCR)
Dengue fever
Break Bone Fever
Flavivirus
Mosquito-borne infection
Arbovirus
See Mosquito-borne Disease Laboratory Testing in Special Instructions.
CSF
The presence of dengue virus nucleic acid in cerebrospinal fluid (CSF) or serum (as detected by molecular assays [This test or DENGS / Dengue Virus, Molecular Detection, PCR, Serum] overlaps with the presence of dengue virus nonstructural protein 1 (NS1) antigen (DNSAG / Dengue Virus NS1 Antigen, Serum). Patients with a history of symptoms for more than 1 week may be negative by molecular tests (ie, real-time PCR) and may require serologic testing (DENVP / Dengue Virus Antibody/Antigen Panel, Serum) to confirm the diagnosis of dengue virus infection.
Supplies: Sarstedt 5 mL Aliquot Tube (T914)
Preferred: 12 x 75-mm screw cap vial
Acceptable: Sterile screw cap vial
Container/Tube: Sterile vial
Specimen Volume: 0.5 mL
Collection Instructions: Do not centrifuge.
If not ordering electronically, complete, print, and send a Microbiology Test Request (T244)with the specimen.
Heat-inactivated specimen | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
CSF | Refrigerated (preferred) | 7 days | |
Frozen | 7 days |
Aiding in the diagnosis of central nervous system infection caused by dengue virus
See Mosquito-borne Disease Laboratory Testing in Special Instructions.
Dengue virus (DV) is a globally distributed flavivirus with 4 distinct serotypes (DV-1, -2, -3, -4) and is primarily transmitted by the Aedes aegypti mosquito, found throughout the tropical and subtropical regions of over 100 countries. DV poses a significant worldwide public health threat with approximately 2.5 to 3 billion people residing in DV endemic areas, among whom 100 to 200 million individuals will be infected and approximately 30,000 patients will succumb to the disease, annually.
Following dengue infection, the incubation period varies from 3 to 7 days and while some infections remain asymptomatic, the majority of individuals will develop classic dengue fever. Symptomatic patients become acutely febrile and present with severe musculoskeletal pain, headache, retro-orbital pain, and a transient macular rash, most often observed in children. Fever defervescence signals disease resolution in most individuals. However, children and young adults remain at increased risk for progression to dengue hemorrhagic fever and dengue shock syndrome, particularly during repeat infection with a new DV serotype.
Detection of DV nucleic acid in cerebrospinal fluid (CSF) is a marker for central nervous system infection caused by this virus. Importantly, the period of time that the virus can be detected in serum and CSF is brief and, therefore, molecular testing should be performed within the first week following onset of symptoms. After this time, serologic testing is the preferred method for diagnosis of DV infection.
Negative
Positive:
The detection of dengue virus nucleic acid in cerebrospinal fluid (CSF) is consistent with acute-phase infection of the central nervous system.
Dengue virus nucleic acid may be detectable during the first 1 to 7 days following the onset of symptoms.
Negative:
The absence of dengue nucleic acid in CSF is consistent with the lack of acute-phase infection.
Dengue virus nucleic acid may not be detected if the CSF specimen is collected immediately following dengue virus infection (<24-48 hours) and is rarely detectable following 7 days of symptoms.
Results should be used in conjunction with clinical presentation and exposure history.
Negative dengue virus (DV) PCR results may occur if the specimen was collected more than 7 days following symptom onset. Serologic testing for the presence of IgM and IgG antibodies to DV is recommended in such cases.
Assay Inclusivity:
The Altona RealStar Dengue virus RT-PCR assay was tested using control strains of each of the four dengue serotypes, and was able to detect serotypes 1, 2, 3 and 4.
Accuracy:
A commercial panel (SeraCare) of known positive samples for dengue virus serotypes 1, 2, 3, and 4 was tested. Each member of the panel was tested in triplicate, and all replicates were positive by the Altona RealStar Dengue assay.
Thirty analyte-negative CSF samples were spiked (1:10 dilution) with plasma samples collected in South America during an outbreak of dengue virus and determined to be positive for the virus. Of the 30 spiked CSF samples, 29 (97%) were positive by the Altona RealStar Dengue RT-PCR assay.
Limit of Detection:
The limit of detection (LoD) in CSF was determined to be the following:
Dengue serotype 1: 1.4 genomic targets/mcL (700 genomic targets/mL)
Dengue serotype 2: 2 genomic targets/mcL (1000 genomic targets/mL)
Dengue serotype 3: 1.6 genomic targets/mcL (800 genomic targets/mL)
Dengue serotype 4: 1.3 genomic targets/mcL (650 genomic targets/mL)
Reference Range (Analytical Specificity):
20 CSF samples collected for non-infectious diseases testing (eg, chemistry) were analyzed by the Altona RealStar Dengue RT-PCR assay and all 20 were negative.
A cross-reactivity panel of bacteria (n=12), viruses (n=15), and parasites (n=2) was tested, and all were negative by the Altona Dengue RT-PCR assay.
1. Bhatt S, Gething PW, Brady OJ, et al: The global distribution and burden of dengue. Nature 2013;496:504-507
2. Dengue--an infectious disease of staggering proportions. Lancet 2013 Jun 22;381(9884):2136
3. Rigau-Perez JG, Clark GG, Gubler DJ, et al: Dengue and dengue haemorrhagic fever. Lancet 1998;352:971-977
4. Tang KF, Ooi EE: Diagnosis of dengue: an update. Expert Rev Anti Infect Ther 2012;10:895-907
5. Guzman MG, Kouri G: Dengue diagnosis, advances and challenges. Int J Infect Dis 2004;8:69-80
The Altona Real Star (ARS) DENV is a qualitative, reverse transcription-PCR (RT-PCR) assay targeting the 3' UTR polyprotein gene. The assay includes a heterologous amplification system (internal control) to identify possible RT-PCR inhibition and to confirm the integrity of the reagents of the kit. Specimens are run on the LightCycler 480 following nucleic acid extraction using the NucliSENS EasyMag (BioMerieux). Real-time RT-PCR technology utilizes reverse-transcriptase (RT) reaction to convert RNA into complementary DNA (cDNA), PCR for the amplification of specific target sequences and target specific probes for the detection of the amplified DNA. The probes are labelled with fluorescent reporter and quencher dyes. Probes specific for DENV RNA are labelled with the fluorophore FAM. The probe specific for the Internal Control (IC) is labeled with the fluorophore JOE. Using probes linked to distinguishable dyes enables the parallel detection of DENV specific RNA and the internal control in corresponding detector channels of the real-time PCR instrument.(Package insert: RealStar Dengue RT-PCR Kit 2.0. Altona Diagnostics, Hamburg. 01/2017)
Tuesday, Thursday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
87798
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
DENGC | Dengue Virus, PCR, CSF | 77958-7 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
606371 | Dengue Virus, PCR, CSF | 77958-7 |