Use of saliva for early dengue diagnosis

Grace Yap, Bijon Kumar Sil, Lee-Ching Ng, Grace Yap, Bijon Kumar Sil, Lee-Ching Ng

Abstract

Background: The necessity of a venous blood collection in all dengue diagnostic assays and the high cost of tests that are available for testing during the viraemic period hinder early detection of dengue cases and thus could delay cluster management. This study reports the utility of saliva in an assay that detects dengue virus (DENV)-specific immunoglobulin A (Ig A) early in the phase of a dengue infection.

Methods and findings: Using an antigen capture anti-DENV IgA (ACA) ELISA technique, we tested saliva samples collected from dengue-confirmed patients. The sensitivity within 3 days from fever onset was over 36% in primary dengue infections. The performance is markedly better in secondary infections, with 100% sensitivity reported in saliva samples from day 1 after fever onset. Serum and salivary IgA levels showed good correlation (Pearson's r = 0.69, p<0.001). Specificity was found to be 97%.

Conclusion: Our findings suggest that this technique would be very useful in dengue endemic regions, where the majority of dengue cases are secondary. The ACA-ELISA is easy to perform, cost effective, and especially useful in laboratories without sophisticated equipment. Our findings established the usefulness and reliability of saliva for early dengue diagnosis.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Sensitivity of ACA-ELISA assay compared…
Figure 1. Sensitivity of ACA-ELISA assay compared with Capture IgM ELISA.
Overall sensitivity of ACA-ELISA in saliva and sera and Capture-IgM ELISA in sera indicated the reliability of ACA-ELISA (saliva) in picking up 7 times more DENV patients compared to Capture-IgM ELISA (sera) in the first 3 d after fever onset. The error bars showed 1 standard of deviation of the proportion for each value.
Figure 2. Sensitivity of ACA-ELISA and Capture-IgM…
Figure 2. Sensitivity of ACA-ELISA and Capture-IgM ELISA in primary and secondary dengue.
Data showed the excellent sensitivity of ACA-ELISA among secondary cases. The ACA-ELISA was less sensitive in primary DENV cases (A), when compared to secondary cases (B), but was notably more sensitive than IgM Capture ELISA. The error bars showed 1 standard of deviation of the proportion for each value.

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