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FALSE-NEGATIVE DENGUE CASES

September 24, 2014

Dear Editor, we would like to discuss on the recent publication on false-negative dengue cases1Acosta PO, Granja F, Meneses CA, Nascimento IA, Sousa DD, Lima Júnior WP, et al. False-negative dengue cases in Roraima, Brazil: an approach regarding the high number of negative results by NS1 Ag kits. Rev Inst Med Trop Sao Paulo. 2014;56:447-50.. ACOSTA et al. 1Acosta PO, Granja F, Meneses CA, Nascimento IA, Sousa DD, Lima Júnior WP, et al. False-negative dengue cases in Roraima, Brazil: an approach regarding the high number of negative results by NS1 Ag kits. Rev Inst Med Trop Sao Paulo. 2014;56:447-50. reported that "Health care providers should therefore be aware of samples tested negative by NS1 antigen assays, especially when clinical symptoms and other laboratory data results show evidence of dengue infection". In fact, the problem of false-negative in dengue diagnosis is an important issue for discussion. First, the problem of the NS1 assay in dengue diagnosis is noted worldwide2Stephen S, Charles MV, Anitharaj V, Deepa C, Umadevi S. Early dengue diagnosis by nonstructural protein 1 antigen detection: rapid immunochromotography versus two the enzyme-linked immunosorbent assay kits. Indian J Pathol Microbiol. 2014;57:81-4.. Combining with other immunological test is suggested for improvement of diagnostic accuracy2Stephen S, Charles MV, Anitharaj V, Deepa C, Umadevi S. Early dengue diagnosis by nonstructural protein 1 antigen detection: rapid immunochromotography versus two the enzyme-linked immunosorbent assay kits. Indian J Pathol Microbiol. 2014;57:81-4.. Also, it should be noted that the diagnosis of dengue in many tropical countries is usually a presumptive diagnosis without the laboratory confirmation3Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8:841-5.. This implies that there can be both false-positive and false-negative of dengue diagnosis. Sometimes, other arboviral infection such as Chikungunya virus infection can have the similar clinical feature to dengue and mis-diagnosed as dengue. In addition, there can be more than one arboviral infection in a case (such as co-infection between dengue and Mayaro virus infection)4Zuchi N, Heinen LB, Santos MA, Pereira FC, Slhessarenko RD. Molecular detection of Mayaro virus during a dengue outbreak in the state of Mato Grosso, Central-West Brazil. Mem Inst Oswaldo Cruz. 2014;109:820-3.. Nevertheless, the definitive diagnosis is more useful for epidemiological purpose than therapeutic purpose. The symptomatic and supportive treatment is usually the basic effective management for the patient with dengue and other similar arboviral infections.

REFERENCES

  • 1
    Acosta PO, Granja F, Meneses CA, Nascimento IA, Sousa DD, Lima Júnior WP, et al. False-negative dengue cases in Roraima, Brazil: an approach regarding the high number of negative results by NS1 Ag kits. Rev Inst Med Trop Sao Paulo. 2014;56:447-50.
  • 2
    Stephen S, Charles MV, Anitharaj V, Deepa C, Umadevi S. Early dengue diagnosis by nonstructural protein 1 antigen detection: rapid immunochromotography versus two the enzyme-linked immunosorbent assay kits. Indian J Pathol Microbiol. 2014;57:81-4.
  • 3
    Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8:841-5.
  • 4
    Zuchi N, Heinen LB, Santos MA, Pereira FC, Slhessarenko RD. Molecular detection of Mayaro virus during a dengue outbreak in the state of Mato Grosso, Central-West Brazil. Mem Inst Oswaldo Cruz. 2014;109:820-3.

Publication Dates

  • Publication in this collection
    Mar-Apr 2015
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