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Dx Challenge at BTGH, questionsFrom: Terrence.Jones@ncal.kaiperm.orgTue Oct 31 06:44:00 1995
Dengue, unlikely a dx as it is, may fit these clinical parameters, though usually assoc. with other s/s's as well (headache/cutaneous changes/myalgia/ nausea/vomiting/evidence of infection in community). May use subtype viral serotesting or PCR for Dx. (4 subtypes when lastchecked) PCR -- oligonucleotide complimentary DNA primers can detect flavivirus RNA rapidly (3 hours) in acute infection (Arch Virol 134: 29-37 (1994); and J Med Virol 44: 54-8 (1994)). SEROTESTING for antiviral antibodies is, as you'd predict, less useful in ACUTE infection diagnosis. Techniques include traditional HI (hemagglutinin- inhibition), and a more recently described DEIA (dot enzyme-immunoassay). {This, as was mentioned, is also a problem in the dx of acute Hep C, as antibodies take time to show up}. However Dengue is a bit unusual, in that its more severe presentation (hemorrhagic fever), is usually secondary to RE-infection. Here, the DEIA may be useful in its ability to pick up RE-infxn on initial screening (rather than having to wait for traditional sero-conver- sion (acute & conv. titres)). (see Bull WHO 69: 741-5 (1991)). Tjones/KSF
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