DENG

UE
PRESENTOR:
Nurdeza N. Puntukan
Jay G. Caya
BSMT-4A

Reference:
Laboratory Investigation _Dr Salmah
Idris_Microbiologist_ Hospital Sungai Buloh
(ppt)
https://en.m.wikipedia.org/wiki/Dengue_feve
r

Table of Content
Dengue
Dengue Vector
Mode of Transmission
Serological testing for Dengue
Prevention
Treatment

Objectives:

1.
2.
3.
4.

5.

To be able to know what is:

Dengue
Causative agent
How it is being transmitted
The different test in determining if person
has dengue.
Prevention and treatment.

What is Dengue?

Dengue fever also known asbreakbone

fever, is amosquito-bornetropical disease
caused by thedengue virus.

Dengue vector

The dengue virus is carried and spread by

mosquitoes in the genus Aedes, which
includes a number of mosquito species. Of
these species, the primary vector of the
dengue virus is the speciesAedes aegypti. It
is the principal dengue vector responsible for
dengue transmission and dengue epidemics.
Other mosquito species in the genusAedes
includingAedes albopictus,Aedes
polynesiensis, andAedes scutellaris have a
limited ability to serve as dengue vectors.

Aedes aegypti
Dengue viruses are mainly transmitted by the
bite of infectedAedes aegypti mosquitoes;
an invasive, domestic species with tropical
and subtropical worldwide distribution that
originated in Africa

Aedes Aegypti Life Cycle:

Mode of Transmission

The dengue virus is spread through a

human-to-mosquito-to-human cycle of
transmission Typically, four days after being
bit by an infected Aedes aegyptimosquito,
a person will develop viremia, a condition in
which there is a high level of the dengue
virus in the blood.

Viremia lasts for approximately five days,

but can last as long as twelve days. On the
first day of viremia, the person generally
shows no symptoms of dengue. Five days
after being bit by the infected mosquito, the
person develops symptoms of dengue fever,
which can last for a week or longer

Serological test in
Determining Dengue

Antibody detection- Serology

Viral Isolation
Detection of virus genetic material
Dengue Virus Antigen or protein

Dengue IgM test

IgM capture enzyme-linked immunosorbent
assay (ELISA)
Widely used
IgM titre is higher in primary compared to
secondary infection
Peak at about 2 weeks and undetectable
level by 60 90 days.

Dengue IgM captured

ELISA

Primary Dengue
55% detectable between 4-7 days
100% after day 7

Secondary
78% after day 7

28% of secondary dengue infections were

undiagnosed when IgM was the only test
performed

Indirect IgG ELISA

Primary and secondary dengue

IgG was detected in 100% after day 7 of illness
Recommended if dengue IgM is still negative after
day 7 in secondary dengue

Haemagglutination Inhibition
Test (HI)
Gold standard
Labour intensive and gold standard
Paired samples for interpretation (Acute and
convelescant samples 2 weeks apart)
Research purposes
Differentiate between primary and
secondary dengue infection

Dengue rapid test

Immunochromatography
Qualitative detection of IgM and IgG
Yield is higher when samples were collected
later in the convalescent phase of infection
Good specificity and could be used when
ELISA facilities were not available

False positive
Cross react with
Flavivirus Non-flavivirus malaria, leptospirosis, toxoplasmosis,
syphilis*
Connective Tissue Disorder

Virus Isolation
Definitive test for dengue infection
Lab equipped with tissue culture facilities
Useful only at early phase of illness , blood
collected before day 5 of illness ( before
the formation of Neutralizing antibodies)
During febrile illness

Virus can be isolated from serum, plasma and

leucocytes
Post mortem specimens

Expensive and time consuming (2 weeks

to complete

Virus Isolation

Virus isolation has a poor yield if compared

with molecular test. IT most probably due to
the viability of the virus and the quality of
samples.

Polymerase Chain Reaction

(PCR)
Eg. RT-PCR
Diagnosis of dengue infection in the early
phase (< 5 days of illness)
Sensitivity 100% in the first 5 days of
illness, reduced to 70% by day 6.
Determine dengue serotype

Polymerase Chain Reaction

(PCR)

Limitation
Available in certain facilities and trained
personal
Test is expensive
Specimens requires special storage
temperatures and short transportation , time
between collection and extraction

Use only be considered for in-patients who

present with diagnostic challenges in the
early phase of illness.

Non-structural protein -1
(NS1 Ag)
Highly conserved glycoprotein that seems
to be essential for virus viability
Secretion of the NS1 protein is a hallmark
of flavivirus infecting mammalian cells

Dengue infection, yellow fever and West Nile

High concentration in the sera of dengue

infected patients during the early phase of
the disease.

Detection rate is much better in acute sera

of primary infection (75% - 97.3%) when
compared to acute sera of secondary
infection (60%-70%)

NS1 Antigen

The sensitivity drops from day 4-5 of illness

and usually becomes undetectable in the
convalescence phase.

Treatment for Dengue Fever

There is no specific medicine to treat dengue

infection. If you think you may have dengue
fever, you should use pain relievers with
acetaminophenand avoid medicines with
aspirin, which could worsen bleeding. You
should also rest, drink plenty of fluids, and
see your doctor. If you start to feel worse in
the first 24 hours after your fever goes down,
you should get to a hospital immediately to
be checked for complications.

Prevention
Protect Yourself against Dengue Fever

As yet, there is no effective vaccine against

dengue fever. Therefore, the best prevention is
to avoid being bitten by mosquitoes by paying
attention to the following:

30

Control the Spread of Dengue

Fever

Prevent the patient from being

bitten by mosquitoes.
31

Prevention of
Mosquito Bites
Apply DEET-containing
mosquito-repellents
over exposed parts of
the body and clothes
every 4 to 6 hours.
For DEET products
used by children, its
concentration should
be less than 10%.
32

Prevention of
Mosquito Bites
Your place of
accommodation should
have air-conditioners or
mosquito nets. Otherwise,
hang mosquito screens
around your bed, use
insecticides or coil
incenses to repel
mosquitoes.
33

Elimination of Mosquitoes
The most effective way
to eliminate mosquitoes
is to
keep the environment
clean and to remove
stagnant water so that
mosquitoes cant
breed.

34

Elimination of Mosquitoes
Cover water containers
tightly so that
mosquitoes cant get in
to lay eggs.

35

Elimination of Mosquitoes
Dispose of domestic
wastes properly to
prevent the
accumulation of
stagnant water.
Dispose of empty bottles,
cans and lunchboxes
properly, such as into a
covered bin.
36

Elimination of Mosquitoes
Change water for vases
and aquatic plants at
least once a week,
leaving no water under
the pots or in the
bottom saucers.
Scrub the container
surfaces thoroughly to
37

Elimination of Mosquitoes
Remove or puncture any
dumped tyres to prevent
the accumulation of
stagnant water.

38

Elimination of Mosquitoes

Ditches should be free from blockage.

39

Elimination of Mosquitoes

Fill up uneven ground surfaces to prevent the

accumulation of stagnant water.
40

Elimination of Mosquitoes
Remove stagnant
water immediately if
mosquitoes are found
to be breeding. Use
environmentally
friendly insecticides
such as lavicidal oil if
necessary.
41

Evaluation
1.

2.

3.

4.

5.

What is the causative agent of Dengue

Virus?
What is the gold standard in detecting
Dengue Virus?
What are the antibodies use in detecting
dengue fever?
Why is that patients suspected with
dengue cant take aspirin?
Give at least one way in preventing
dengue.