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Correspondence

Indian Pediatr 2015;52: 906-907

The Dilemma of Reactive NS1 Antigen Test in Dengue Fever


Sriram Pothapregada,

Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Email: psriram_ped@yahoo.co.in
 

     


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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