11/10/2016

DengueWorkup:ApproachConsiderations,CompleteBloodCellCount,MetabolicPanelandLiverEnzymes

DengueWorkup
Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Michael
Stuart Bronze, MD more...

Updated: Oct 05, 2015

Serum Studies
Serum specimens should be sent to the laboratory for serodiagnosis,
PCR, and viral isolation. Because the signs and symptoms of dengue
fever are nonspecic, attempting laboratory conrmation 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.
The IgM capture enzyme-linked immunosorbent assay (MAC-ELISA)
has become the most widely used serologic assay for dengue. Other
tests are also used, however, including the following:
Complement xation (CF)
Neutralization test (NT)
Hemagglutination inhibition (HI)
IgG ELISA
NS1 strip test [57]
Draw serum specimens for diagnosis as soon as possible after the
onset of illness or hospitalization and at the time of death or
discharge from the hospital. Immediately place specimens on wet ice
and send to the laboratory. Obtain a second (ie, convalescent) blood
sample for convalescent-phase serologic testing 7-21 days after the
acute-phase serum specimen was drawn. Ideally, draw the
convalescent-phase serum specimen 10 days after the acute-phase
specimen.
A European study found that if only a single serum sample is
available, a single positive result on enzyme-linked ELISA (PanBio
IgM or IgG) has a high rate of false positivity and should be conrmed
using a second, more specic diagnostic technique. In the absence
of further testing, platelet and white blood cell counts can be
diagnostically helpful, because the combination of thrombocytopenia
and leukopenia is present in 40.4% of conrmed cases but in only
6.1% of false-positive cases.[58, 59]

http://emedicine.medscape.com/article/215840workup#c11

1/1