Differentiating secondary from primary dengue using IgG to IgM ratio in early dengue: an observational hospital based clinico-serological study from North India
Differentiating secondary from primary dengue using IgG to IgM ratio in early dengue: an observational hospital based clinico-serological study from North India
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DOI：
10.1186/s12879-016-2053-6
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发表时间：
2016-11-28
影响因子：
3.7
通讯作者：
Changal, Qayum Hamid
中科院分区：
文献类型：
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作者：
Changal, Khalid Hamid;Raina, Ab Hameed;Changal, Qayum Hamid
背景：继发性登革热比原发性登革热引起更严重的疾病。在早期，区分这两者是很重要的。我们试图找出两者之间重要的临床和实验室差异，以便早期鉴别。方法：对114例经逆转录聚合酶链反应（RT - PCR）确诊的患者进行分析。在发病第2天检测IgM和IgG指标，计算IgG/IgM比值。采用一步免疫层析法将患者分为原发性和继发性登革热。还研究了患者的特征。结果：60.5%的患者以血清1型登革热最为常见。继发性登革热76例，占66.7%。继发性登革热病例平均体温较高（101.56 +/- 1.55 vs 100.79 +/- 1.25， F度，p 0.015），血小板计数较低（50.51 +/- 38.91 vs 100.45 +/- 38.66, x10 (3)/micl, p < 0.0001），登革出血热/登革休克综合征的比例显著较高（38.2% vs. 2.6%, p < 0.0001）。早期发现NS1和PCR是较好的诊断方法，后期发现IgM是较好的诊断方法。IgG/IgM比值为1.10，对登革热继发性与原发性鉴别的敏感性为100%，特异性为97.4%，准确率为67.5%。结论：在临床早期，IgG/IgM比值对两者的鉴别具有重要意义。我们发现>= 1.10的比值是最好的分割值。
Background: Secondary dengue causes more severe disease than the primary. Early on, it is important to differentiate the two. We tried to find important clinical and laboratory differences between the two for the purpose of early differentiation.Methods: One hundred fourteen patients confirmed on reverse transcriptase-polymerase chain reaction (RT PCR) were studied. On day 2 of illness IgM and IgG indices were studied for calculation of IgG/IgM ratio. A one-step immunochromatographic assay was used for classification of patients into primary and secondary dengue. Patient characteristics were also studied.Results: Dengue serotype 1 was the most common found in 60.5% patients. 66.7% (76 patients) had secondary dengue. Secondary dengue cases had a higher mean temperature (101.56 +/- 1.55 vs. 100.79 +/- 1.25, degrees F, p 0.015), lower platelet counts (50.51 +/- 38.91 vs. 100.45 +/- 38.66, x 10(3)/micl, p < 0.0001) and a significantly higher percentage of Dengue hemorrhagic fever/Dengue shock syndrome (38.2% vs. 2.6%, p < 0.0001). In early phase of dengue NS1 and PCR were found to be better tests for diagnosis and later IgM is better. The IgG/IgM ratio of = 1.10 had a sensitivity of 100%, specificity of 97.4% and accuracy of 67.5% in differentiating secondary from primary dengue.Conclusion: Early on in the clinical course, IgG/IgM ratio can play an important role to differentiate the two. We found the ratio of >= 1.10 to be the best cut off for the same.