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Indian Pediatr 2015;52: 906-907 |
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The Dilemma of Reactive NS1 Antigen Test in
Dengue Fever
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Sriram Pothapregada,
Department of Pediatrics, Indira Gandhi Medical College
and Research Institute, Puducherry, India.
Email: [email protected]
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Dengue NS1 antigen test assays are very useful in the
diagnosis of dengue fever with good sensitivity and specificity during
the first week of illness [1]. There has been wide spread use of Dengue
ELISA NS1 antigen test. In an outbreak setting, NS1 antigen may not
necessarily be an indicator for severe dengue infection or of need for
hospitalization. Since 2012, Puducherry has experienced an unprecedented
rise in dengue fever cases. We confirmed the diagnosis of dengue fever
either by ELISA-based NS1 antigen test or dengue serology for IgM and
IgG antibodies. Among 261 diagnosed cases of Dengue fever, NS1 antigen
was positive in 217 cases (56.4%); 44 cases (31.4%) were negative for
NS1 antigen assay and positive for IgM MAC ELISA. Among the children who
were positive only for NS1 antigen, non-severe dengue infection was the
most common mode of presentation.
During epidemics, we witness traumatized and panic-
struck parents putting unnecessary pressure for hospitalization. It
results in burning of hospital resources with non-severe dengue
infection. The reactive NS1 antigen rapid diagnostic test for dengue
results in stress and unnecessary paranoia among parents. The natural
history of dengue infection and pointers such as warning signs for
severe dengue infection has been well characterized in the Revised World
Health Organization Dengue fever Guidelines 2011 [2,3]. The parents can
be easily taught to identify these symptoms and bring the child to
medical attention should the need arise. Hence, the real need of the
hour is to remove the dilemma among clinicians, improve the primary
health care services and referral services. Pediatricians have an
important role to play in not only recognizing the symptoms and signs
of severe dengue infection but also to counsel and educate the parents
about the warning signs, home care and when to visit hospital during an
epidemic. The role of rapid diagnostic tests like NS1antigen in dengue
fever during an epidemic should be probably be limited to serve
epidemiological purposes and should not be criteria for hospital
admissions.
References
1. Datta W, Wattal C. Dengue NS1 antigen detection
test: A useful tool in early diagnosis of dengue virus infection. Indian
J Med Microbiol. 2010; 28:107-10.
2. World Health Organization. Dengue Haemorrhagic
fever: Diagnosis, Treatment, Prevention and Control. 2nd edn. Geneva:
World Health Organization, 2011.
3. Balasubramanian S, Ramachandran B, Amperayani S.
Dengue viral infection in children- A perspective. Arch Dis Child. 2012;
97:907-12.
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