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The detection of anti-dengue virus IgM in urine in participants enrolled in an acute febrile illness study in Puerto Rico.

PLoS Neglected Tropical Diseases. 2020;14(1):e0007971 DOI 10.1371/journal.pntd.0007971


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Journal Title: PLoS Neglected Tropical Diseases

ISSN: 1935-2727 (Print); 1935-2735 (Online)

Publisher: Public Library of Science (PLoS)

LCC Subject Category: Medicine: Internal medicine: Special situations and conditions: Arctic medicine. Tropical medicine | Medicine: Public aspects of medicine

Country of publisher: United States

Language of fulltext: English

Full-text formats available: PDF, HTML, XML



Elba Caraballo

B Katherine Poole-Smith

Kay M Tomashek

Brenda Torres-Velasquez

Luisa I Alvarado

Olga D Lorenzi

Carmen Ramos

Jessica Carrión

Elizabeth Hunsperger


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Time From Submission to Publication: 23 weeks


Abstract | Full Text

BACKGROUND:Dengue is an important arboviral disease with about 100 million dengue cases per year, of which, ~5% result in severe disease. Clinical differentiation of dengue from other acute febrile illnesses (AFI) is difficult, and diagnostic blood tests are costly. We evaluated the utility of anti-DENV IgM in urine to identify dengue cases among AFI patients enrolled in a clinical study. METHODS:Between May 2012-March 2013, 1538 study participants with fever for ≤7 days were enrolled, a medical history was obtained, and serum and urine specimens were collected. Serum was tested for DENV RNA and anti-DENV IgM. Urine was tested for anti-DENV IgM, and its sensitivity and specificity to detect sera laboratory-positive dengue cases were calculated. We evaluated if urine anti-DENV IgM positivity early (≤5 days post-illness onset [DPO]) and late (6-14 DPO) in the clinical course was associated with dengue severity. RESULTS:Urine anti-DENV IgM sensitivity and specificity were 47.4% and 98.5%, respectively, when compared with serum anti-DENV IgM ELISA results, and 29.7% and 91.1% when compared with serum rRT-PCR results. There was no correlation between urine anti-DENV IgM positivity and patient sex or pre-existing chronic disease. Early in the clinical course, a significantly higher proportion of those who developed dengue with warning signs had anti-DENV IgM in their urine when compared to those without warning signs (20.4% vs. 4.3%). There was no difference in the proportion with urine anti-DENV IgM positivity between severity groups late in the clinical course. CONCLUSION:While detection of urine anti-DENV IgM lacked adequate diagnostic sensitivity, it is a highly specific marker for laboratory-positive dengue, and its presence early in the clinical course may distinguish those with more severe disease. Further assessment of urine anti-DENV IgM by DPO is warranted to determine its utility as an early diagnostic (and possibly prognostic) marker for dengue.