Skip to main content
Download PDF

Performance of the nonstructural 1 Antigen Rapid Test for detecting all four DENV serotypes in clinical specimens from Bangkok, Thailand

Virology Journal volume 19, Article number: 169 (2022) Cite this article

A Correction to this article was published on 10 November 2023

This article has been updated

Abstract

Background:

Dengue is an arboviral disease that has a large effect on public health in subtropical and tropical countries. Rapid and accurate detection of dengue infection is necessary for diagnosis and disease management. We previously developed highly sensitive immunochromatographic devices, the TKK 1st and TKK 2nd kits, based on dengue virus (DENV) nonstructural protein 1 detection. However, these TKK kits were evaluated mainly using DENV type 2 clinical specimens collected in Bangladesh, and further validation using clinical specimens of other serotypes was needed.

Methods:

In the present study, one of the TKK kits, TKK 2nd, was evaluated using 10 DENV-1, 10 DENV-2, 4 DENV-3, 16 DENV-4, and 10 zika virus-infected clinical specimens collected in Bangkok, Thailand.

Results:

The TKK 2nd kit successfully detected all four DENV serotypes in patient serum specimens and did not show any cross-reactivities against zika virus serum specimens. The IgM and/or IgG anti-DENV antibodies were detected in seven serum specimens, but did not seem to affect the results of antigen detection in the TKK 2nd kit.

Conclusion:

The results showed that the TKK 2nd kit successfully detected all four DENV serotypes in clinical specimens and confirmed the potential of the kit for dengue diagnosis in endemic countries.

Background

Dengue is a mosquito-borne viral infection. The symptoms vary from an acute undifferentiated febrile illness to the much more severe dengue shock syndrome which is found in a small number of patients with a heterotypic dengue virus (DENV) infection in endemic areas of tropical and subtropical regions [1, 2]. DENV infection impacts global human health due to the distribution of its main mosquito vector, Aedes aegypti [3], and human travel. DENV belongs to the genus Flavivirus, family Flaviviridae. DENV is an enveloped virus containing a single-stranded RNA, approximately 10.6 kb in length. DENV genomic RNA encodes three structural proteins (capsid (C), pre-membrane/membrane (prM/M), and envelope (E) proteins) and seven nonstructural (NS) proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5) [4]. Based on antigenic differences, DENVs were divided into four serotypes, DENV-1, DENV-2, DENV-3, and DENV-4, each of which elicits only limited cross-protective immunity [4,5,6].

Nonstructural protein 1 (NS1) is a 48-kDa glycoprotein produced by all flaviviruses and is secreted from infected mammalian cells since the early phases of infection [7]. The NS1 protein was found in serum from the first day after the onset of clinical signs up to 9 days later. Furthermore, the viral NS1 protein can be detected even after defervescence, when viral nucleic acid is no longer detected [8]. NS1 levels during the acute phase correlate with the levels of viremia and disease severity [9,10,11]. Several studies have suggested that NS1 is a key mediator of the pathogenesis of flaviviruses and a representative biomarker for detection in the early phase of infection [12,13,14].

Immunochromatographic tests (ICTs) were developed for the detection of DENV NS1 antigen in approximately 10–15 min without specialized equipment or specialized personnel. An ideal rapid diagnostic test (RDT) has to reliably detect the infection, should be sensitive, specific, user-friendly, rapid and robust, equipment-free, and can be delivered to the field or hospitals for epidemiological studies with limited instruments [15]. However, the sensitivity and specificity or advantages and limitations of the test vary widely depending on the timing of specimen collection and various other factors in endemic areas [9, 16]. Recently, several commercial NS1 RDTs showed differing efficacies in the detection of different serotypes of DENV [17, 18]. We have previously reported the novel ICTs of DENV NS1 detection, the TKK 1st and TKK 2nd kits, and evaluated their efficiency in DENV clinical isolates and patient serum specimens in Bangladesh. The results showed higher efficiency and specificity of both of these kits for detection of DENV-1 genotype V, DENV-2 genotype Cosmopolitan, and DENV-3 genotype I than commercial ICT kits. However, we failed to evaluate these ICTs for DENV-4, which was not endemic in Bangladesh [19]. It would also be better to examine the kit in Thailand, where multiple DENV serotypes and genotypes co-circulate in the same area. In the present study, the aim was to evaluate one of the two TKK kits, the TKK 2nd kit, in Thailand, since the TKK 2nd kit showed slightly higher sensitivity than the TKK 1st kit [19]. We report here that, the TKK 2nd kit was found to show high levels of efficiency and specificity in clinical specimens of all four serotypes of DENV, which were collected and confirmed in the Hospital for Tropical Diseases, Bangkok, Thailand.

Methods

The protocol of the present study was reviewed and approved by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand under Ethical approval number TMEC 19–051. The present study was exempt from obtaining participants’ consent since only leftover specimens were used after anonymization. Serum specimens were obtained from anonymous DENV and zika virus (ZIKV)-positive patients who presented to the Hospital for Tropical Diseases during 2017–2020. The clinical serum specimens were separated and stored at − 80 °C until analysis.

Viral RNA was extracted from 70 µL of clinical serum specimens using a QIAamp viral RNA mini kit (Qiagen, Hilden, Germany) according to the manufacturer’s instructions. The viral RNA was eluted in 60 µL of nuclease-free water and stored at − 80 °C until analysis. The viral load data were measured by One-step SYBR Green I-based quantitative reverse transcriptase PCR (qRT-PCR) specific to DENV or ZIKV using previously described primer pairs and protocols [20, 21].For DENV-positive specimens, the viral load was expressed as plaque forming units per milliliter (PFU/mL) using serially diluted laboratory strains of DENV with known infectious titers as a standard curve. The extracted DENV RNA was also used for determination of DENV serotype using a commercial dengue subtyping multiplex kit (Genesig, Chandler’s Ford, UK) according to the manufacturer’s instructions.

A total of 30 µL of patient serum specimens was mixed with 60 µL of dilution buffer of the TKK 2nd kit. The chromatographic stick was soaked in the mixture and incubated for 15 min at room temperature. The test band intensities were measured using a chromatogram reader (Hamamatsu photonics, model C10066-10). Bands with an intensity > 15 milli-absorbance units (mAbs) were visible by eye. The presence of anti-DENV IgM and IgG antibodies was detected using the SD-Bioline Duo kit (NS1Ag + IgG/IgM, The Alere Medical) according to the manufacturer’s instructions.

Results

Forty RT-PCR confirmed DENV-positive serum specimens were obtained from the Hospital for Tropical Diseases during 2017–2020; there were 10 DENV-1, 10 DENV-2, 4 DENV-3, and 16 DENV-4 specimens. As negative controls, 10 ZIKV-positive serum specimens were used. The viral loads of DENV-positive specimens ranged from 1.34 × 103 to 3.99 × 106 PFU/mL, with a median of 3.70 × 105 PFU/mL in all DENV-positive specimens. The median viral load of DENV-1-positive specimens was the highest among the four serotypes, followed by DENV-2, DENV-3, and DENV-4, in that order. The descriptive analysis comparing RDT results for DENV detection is shown in Table 1. The color intensity ranged from 30 to 1000.7 mAbs, with a median of 706.6 mAbs. The median color intensity of DENV-4 specimens was the highest among the four serotypes, followed by DENV-2, DENV-1, and DENV-3, in that order. The NS1 rapid antigen detection TKK 2nd kit was positive in all these 40 DENV-positive serum specimens. The kit was negative in all 10 ZIKV-positive specimens. Therefore, the TKK 2nd kit exhibited 100% sensitivity, including serum specimens with a Ct value greater than 30 and five serum specimens with viral load less than 1 × 104 PFU/mL. Including, there were seven serum specimens with IgM and/or IgG anti-DENV antibodies that were also positive with the TKK 2nd kit. There were weak negative correlations between Ct value and color intensity (mAbs) in DENV-1, DENV-2, and DENV-4. In contrast, DENV-3 showed stronger negative correlation but none of them reached statistical significance (Table 1; Fig. 1). Specimen ID numbers, DENV serotype, genotype, and other data are shown in Additional file 1. It should be noted that the TKK 2nd kit showed much higher color intensity than the SD Bioline RDT in 6 DENV-4 specimens (Additional file 1). Schematic illustrations and photographs of the TKK 2nd kits used in the present study are shown in Additional file 2.

Moreover, specimens from 6 additional DENV-positive participants with a range of different time points during the infection were tested. Results showed that the TKK2nd kit could detect DENV NS1 protein in serum specimens from clinical signs until defervescence in most of the participants (Additional file 3).

Table 1 Descriptive analysis of the TKK 2nd kit for detection of DENV-positive clinical serum specimens
Full size table
Fig. 1
figure 1

The DENV and ZIKV patient serum specimens from the Hospital for Tropical Diseases, Bangkok, Thailand, collected during 2017–2020, were used in the present study. The y-axis indicates color intensity quantified as milli-absorbance (mAbs) units using an immunochromatogram reader. Results obtained from the TKK 2nd kit for all four DENV serotypes and ZIKV-positive specimens are shown. The green, blue, orange, purple, and black circles represent the DENV-1, 2, 3, 4, and ZIKV-positive serum specimens, respectively, with the median and interquartile range of color intensity (mAbs) (a). The dotted lines indicate linear regression of the correlation between Ct values and color intensity of the TKK 2nd kit (b). The grid line at 15 mAbs on the y-axis is set as the cut-off value of the TKK 2nd kit. Each of the data points represents the result of a single kit.

Full size image

Discussion

DENV is widespread in tropical and subtropical regions, and quick and simple detection methods would be beneficial for immediate responses in the early phase of dengue infection. High accuracy and efficiency for detection of all four DENV serotypes are important in dengue diagnosis. Although molecular detection of viral genomes using RT-PCR methods is the gold standard due to its highly sensitive and specific detection of the viruses, this technique requires expensive equipment and experienced personnel [13, 22]. So far, several NS1 antigen RDTs for DENV detection have been developed and released for early clinical diagnosis in hospitals and the field. High levels of sensitivity and specificity are essential for commercial RDTs [9, 16, 23]. In the present study, the sensitivity of the TKK 2nd kit for DENV NS1 detection in PCR-confirmed positive sera was investigated in recent dengue patients in Bangkok, Thailand, where all four serotypes co-circulate. This TKK 2nd kit demonstrated reasonable overall agreement with RT-PCR results for these specimens. In addition, the TKK 2nd kit did not show any cross-reaction with serum specimens of ZIKA patients, confirming our previous results of laboratory strains of ZIKA [19]. Furthermore, the TKK 2nd kit needs less serum volume than several commercial RDTs, which is another benefit for diagnosis in pediatric cases.

In addition, the TKK 2nd kit was sensitive enough in both primary and secondary DENV infections, since the presence of anti-DENV antibodies did not seem to affect the result of antigen detection of the TKK 2nd kit (Additional file 1). In contrast, several studies reported that the commercial NS1 RDTs produced false-negative results and low sensitivity in DENV secondary infections, and that antibodies against DENV NS1 in the patient specimens affected the results of their commercial RDTs, including a recently evaluated RDT in Thailand that showed 5 false-negative results [17, 24,25,26,27,28]. Thus, patients’ antibodies may eclipse the affinity of RDT antibodies by recognizing NS1 protein at the same epitope, leading to negative results [28,29,30]. However, ICT false-negative results may be caused by low levels of viremia and NS1 antigenemia during secondary infections [25, 31]. Therefore, the sensitivity and specificity of RDT in clinical specimens indicate the probability and capability of diagnostics [32].

Dengue is caused by four serotypes of DENV. Therefore, the commercial NS1 antigen test should detect all four DENV serotypes. The TKK 2nd kit was able to detect these clinical specimens of all four serotypes of DENV, whereas previous RDT NS1 detection showed false-negative results due to amino acid variations of NS1 and secondary infections by DENV-2 strains [33,34,35]. Although DENV-2 was a predominant serotype in Malaysia in 2018, low sensitivity of DENV-2 by commercial RDT evaluation was recently reported [36]. On the other hand, the present study showed the ability of the TKK 2nd kit to detect both Cosmopolitan and Asian I genotypes of DENV-2.

Moreover, the TKK 2nd kit detected more efficiently for DENV-2 and DENV-4 than other serotypes (Fig. 1b). In contrast, the SD BIOLINE Dengue NS1 antigen kit was reported to show sensitivities less than 80% when compared with a newly developed serotyping NS1 ELISA system using DENV-2 and DENV-4 patient specimens in Thailand [37, 38]. Previous evaluations of both the commercial and newly developed RDT NS1 detection systems showed false-negative results and various levels of sensitivity [17, 24, 39,40,41]. A low level of NS1 protein in sera from DENV-3 and DENV-4 infections was reported, and the frequency of viremia of these serotypes was significantly lower than of other serotype infections [42,43,44]. Despite these findings, the present study showed that the TKK 2nd kit was able to detect DENV infections with low levels of viremia in DENV-3 and DENV-4 cases (Fig. 1b).

Previous studies reported low sensitivity of a commercial ICT NS1 Ag test for detection of DENV-4 in serum specimens collected in Brazil, Thailand, Vietnam, and Malaysia [43, 45,46,47,48,49]. These studies suggest that lower sensitivity to DENV-4 than to the other three serotypes might be caused by monoclonal antibodies of commercial RDT which failed to capture epitopes of DENV-4 NS1 protein. Therefore, the present study showed further benefit of the TKK 2nd kit for detecting DENV-4 that previously dominated in Thailand and has emerged in Laos. Anti-DENV antibody detection of either IgM or IgG would further increase the capability of dengue diagnosis [25, 50].

Our previous study reported performance of the TKK 1st and 2nd kits to detect NS1 proteins in clinical DENV isolates and patient serum specimens in Bangladesh and neither kit displayed any cross-reaction with other flaviviruses [19]. Consequently, the present study showed the performance of the TKK 2nd kit in native NS1 proteins in clinical serum specimens in Bangkok, Thailand, where all four DENV serotypes currently co-circulate. Therefore, the present study confirmed the efficiency of the TKK 2nd kit for detecting all four DENV serotypes distributed in Southeast Asia and Asia. Because DENV-3 was detected at very low prevalence during the sample collection period of the present study, we were able to evaluate only a small number of DENV-3 positive serum specimens. Nevertheless, this study exhibited that the TKK2nd kit could detect both genotypes I and III of DENV-3 currently circulating in Bangkok, Thailand. Moreover, these results showed the improvement of the RDT for detection of all four DENV serotypes in clinical specimens. Such an ICT can be an effective RDT device for DENV detection that could be clinically useful in endemic countries. Although our results showed moderate levels of correlation between the levels of color intensities of the TKK2nd kit and viral load, the color intensity merely indicated NS1 antigenemia and did not directly refer to the viremia levels in clinical serum specimens [19]. Nevertheless, numerous studies reported that DENV NS1-related disease status and serum NS1 levels showed significant differences between fatal and non-fatal cases [9,10,11, 13, 51]. Therefore, semi-quantitative NS1 level detection by the TKK 2nd kit (Fig. 1b) may be used for monitoring or screening patients who might develop severe dengue symptom. However, further study is needed to evaluate this possibility.

There were DENV false-positive results in SARS-CoV-2 patients by antibody detection kits, which raised the possibility of cross-reactivity between DENV and SARS-CoV-2 [52, 53]. The effects of SARS-CoV-2 antigens and antibodies should also be carefully investigated using the TKK 2nd kit in the future.

Conclusion

The ICT TKK 2nd kit, which has sufficient sensitivity and specificity for detection of DENV NS1 in the present study, would be valuable for rapid detection and management of all four serotypes of DENV in endemic areas.

Data availability

All data and materials used and/or analyzed during this study are included in this published article and its Additional files.

Change history

Abbreviations

DENV:

Dengue virus

ICT:

Immunochromatographic test

NS1:

Nonstructural protein 1

mAbs:

Milli-absorbance

RDT:

Rapid diagnostic test

References

  1. World Health Organization (WHO). Global strategy for dengue prevention and control 2012–2020. Geneva: World Health Organization; 2012. ISBN 978 92 4 150 403 4.

    Google Scholar 

  2. Alvarez M, Rodriguez-Roche R, Bernardo L, Vazquez S, Morier L, Gonzalez D, Castro O, Kouri G, Halstead SB, Guzman MG. Dengue hemorrhagic Fever caused by sequential dengue 1–3 virus infections over a long time interval: Havana epidemic, 2001–2002. Am J Trop Med Hyg. 2006;75:1113–7.

    Article  PubMed  Google Scholar 

  3. Messina JP, Brady OJ, Golding N, Kraemer MUG, Wint GRW, Ray SE, Pigott DM, Shearer FM, Johnson K, Earl L, et al. The current and future global distribution and population at risk of dengue. Nat Microbiol. 2019;4:1508–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Perera R, Kuhn RJ. Structural proteomics of dengue virus. Curr Opin Microbiol. 2008;11:369–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, Hunsperger E, Kroeger A, Margolis HS, Martinez E, et al. Dengue: a continuing global threat. Nat Rev Microbiol. 2010;8:7–16.

    Article  Google Scholar 

  6. World Health Organization (WHO). Dengue guidelines for diagnosis, treatment, prevention and control: new edition. Geneva: World Health Organization; 2009. ISBN 978924154787 1.

  7. Alcon-LePoder S, Sivard P, Drouet MT, Talarmin A, Rice C, Flamand M. Secretion of flaviviral non-structural protein NS1: from diagnosis to pathogenesis. In: Novartis Found Symp. 2006;277:233 – 47.

  8. Paranavitane SA, Gomes L, Kamaladasa A, Adikari TN, Wickramasinghe N, Jeewandara C, Shyamali NL, Ogg GS, Malavige GN. Dengue NS1 antigen as a marker of severe clinical disease. BMC Infect Dis. 2014;14:570.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Peeling RW, Artsob H, Pelegrino JL, Buchy P, Cardosa MJ, Devi S, Enria DA, Farrar J, Gubler DJ, Guzman MG, et al. Evaluation of diagnostic tests: dengue. Nat Rev Microbiol. 2010;8:30-8.

    Google Scholar 

  10. Alcon S, Talarmin A, Debruyne M, Falconar A, Deubel V, Flamand M. Enzyme-linked immunosorbent assay specific to Dengue virus type 1 nonstructural protein NS1 reveals circulation of the antigen in the blood during the acute phase of disease in patients experiencing primary or secondary infections. J Clin Microbiol. 2002;40:376–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Thomas L, Najioullah F, Verlaeten O, Martial J, Brichler S, Kaidomar S, Moravie V, Cabie A, Cesaire R. Relationship between nonstructural protein 1 detection and plasma virus load in Dengue patients. Am J Trop Med Hyg. 2010;83:696–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sirisena N, Noordeen F, Fernando L. NS1 lasts longer than the dengue virus nucleic acid in the clinically suspected patients with dengue fever and dengue haemorrhagic fever. Virusdisease. 2017;28:341–4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Libraty DH, Young PR, Pickering D, Endy TP, Kalayanarooj S, Green S, Vaughn DW, Nisalak A, Ennis FA, Rothman AL. High circulating levels of the dengue virus nonstructural protein NS1 early in dengue illness correlate with the development of dengue hemorrhagic fever. J Infect Dis. 2002;186:1165–8.

    Article  CAS  PubMed  Google Scholar 

  14. Chuansumrit A, Chaiyaratana W, Pongthanapisith V, Tangnararatchakit K, Lertwongrath S, Yoksan S. The use of dengue nonstructural protein 1 antigen for the early diagnosis during the febrile stage in patients with dengue infection. Pediatr Infect Dis J. 2008;27:43–8.

    Article  PubMed  Google Scholar 

  15. Wilder-Smith A, Renhorn KE, Tissera H, Abu Bakar S, Alphey L, Kittayapong P, Lindsay S, Logan J, Hatz C, Reiter P, et al. DengueTools: innovative tools and strategies for the surveillance and control of dengue. Glob Health Action. 2012;5.

  16. Chaterji S, Allen JC Jr, Chow A, Leo YS, Ooi EE. Evaluation of the NS1 rapid test and the WHO dengue classification schemes for use as bedside diagnosis of acute dengue fever in adults. Am J Trop Med Hyg. 2011;84:224–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liu LT, Chen CH, Tsai CY, Lin PC, Hsu MC, Huang BY, Wang YH, Tsai JJ. Evaluation of rapid diagnostic tests to detect dengue virus infections in Taiwan. PLoS ONE. 2020;15:e0239710.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lee H, Ryu JH, Park HS, Park KH, Bae H, Yun S, Choi AR, Cho SY, Park C, Lee DG, et al. Comparison of Six Commercial Diagnostic Tests for the Detection of Dengue Virus Non-Structural-1 Antigen and IgM/IgG Antibodies. Ann Lab Med. 2019;39:566–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Suzuki K, Nakayama EE, Saito A, Egawa A, Sato T, Phadungsombat J, Rahim R, Hasan A, Iwamoto H, Rahman M, Shioda T. Evaluation of novel rapid detection kits for dengue virus NS1 antigen in Dhaka, Bangladesh, in 2017. Virol J. 2019;16:102.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Shu PY, Chang SF, Kuo YC, Yueh YY, Chien LJ, Sue CL, Lin TH, Huang JH. Development of group- and serotype-specific one-step SYBR green I-based real-time reverse transcription-PCR assay for dengue virus. J Clin Microbiol. 2003;41:2408–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lanciotti RS, Kosoy OL, Laven JJ, Velez JO, Lambert AJ, Johnson AJ, Stanfield SM, Duffy MR. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis. 2008;14:1232–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hunsperger EA, Sharp TM, Lalita P, Tikomaidraubuta K, Cardoso YR, Naivalu T, Khan AS, Marfel M, Hancock WT, Tomashek KM, Margolis HS. Use of a Rapid Test for Diagnosis of Dengue during Suspected Dengue Outbreaks in Resource-Limited Regions. J Clin Microbiol. 2016;54:2090–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Mat Jusoh TNA, Shueb RH. Performance Evaluation of Commercial Dengue Diagnostic Tests for Early Detection of Dengue in Clinical Samples. J Trop Med. 2017;2017:4687182.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pal S, Dauner AL, Mitra I, Forshey BM, Garcia P, Morrison AC, Halsey ES, Kochel TJ, Wu SJ. Evaluation of dengue NS1 antigen rapid tests and ELISA kits using clinical samples. PLoS ONE. 2014;9:e113411.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Teoh BT, Sam SS, Tan KK, Johari J, Abd-Jamil J, Hooi PS, AbuBakar S. The Use of NS1 Rapid Diagnostic Test and qRT-PCR to Complement IgM ELISA for Improved Dengue Diagnosis from Single Specimen. Sci Rep. 2016;6:27663.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lim JK, Chanthavanich P, Limkittikul K, Lee JS, Sirivichayakul C, Lee KS, Lim SK, Yoon IK, Hattasingh W. Clinical and epidemiologic characteristics associated with dengue fever in 2011–2016 in Bang Phae district, Ratchaburi province, Thailand. PLoS Negl Trop Dis. 2021;15:e0009513.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wongsawat E, Avirutnan P, Kim YW, Suputtamongkol Y. Performance of Two Commercial Dengue NS1 Rapid Tests for the Diagnosis of Adult Patients with Dengue Infection. Siriraj Med J. 2020;72:74–48.

    Article  Google Scholar 

  28. Blessmann J, Winkelmann Y, Keoviengkhone L, Sopraseuth V, Kann S, Hansen J, El Halas H, Emmerich P, Schmidt-Chanasit J, Schmitz H, et al. Assessment of diagnostic and analytic performance of the SD Bioline Dengue Duo test for dengue virus (DENV) infections in an endemic area (Savannakhet province, Lao People’s Democratic Republic). PLoS ONE. 2020;15:e0230337.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hang VT, Nguyet NM, Trung DT, Tricou V, Yoksan S, Dung NM, Van Ngoc T, Hien TT, Farrar J, Wills B, Simmons CP. Diagnostic accuracy of NS1 ELISA and lateral flow rapid tests for dengue sensitivity, specificity and relationship to viraemia and antibody responses. PLoS Negl Trop Dis. 2009;3:e360.

    Article  PubMed  Google Scholar 

  30. Muller DA, Depelsenaire AC, Young PR. Clinical and Laboratory Diagnosis of Dengue Virus Infection. J Infect Dis. 2017;215:89–95.

    Article  Google Scholar 

  31. Tricou V, Minh NN, Farrar J, Tran HT, Simmons CP. Kinetics of viremia and NS1 antigenemia are shaped by immune status and virus serotype in adults with dengue. PLoS Negl Trop Dis. 2011;5:e1309.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Labrique AB, Pan WK. Diagnostic tests: understanding results, assessing utility, and predicting performance. Am J Ophthalmol. 2010;149:878–81 e872.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yu L, Wen Y, Xiang M, Hong W, Zhao L, Zhang F. The Limitation of Rapid Tests for DENV2 Infection in Host with Unique Immune Status: Low NS1 Antigenemia and Deficient Antibody Responses. Virol Sin. 2020;35:478–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Watanabe S, Tan KH, Rathore AP, Rozen-Gagnon K, Shuai W, Ruedl C, Vasudevan SG. The magnitude of dengue virus NS1 protein secretion is strain dependent and does not correlate with severe pathologies in the mouse infection model. J Virol. 2012;86:5508–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Felix AC, Romano CM, Centrone Cde C, Rodrigues CL, Villas-Boas L, Araujo ES, de Matos AM, Carvalho KI, Martelli CM, Kallas EG, et al. Low sensitivity of NS1 protein tests evidenced during a dengue type 2 virus outbreak in Santos, Brazil, in 2010. Clin Vaccine Immunol. 2012;19:1972–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Ngim CF, Husain SMT, Hassan SS, Dhanoa A, Ahmad SAA, Mariapun J, Wan Ismail WF, Botross Henien NP, Jahan NK, Pong LY, et al. Rapid testing requires clinical evaluation for accurate diagnosis of dengue disease: A passive surveillance study in Southern Malaysia. PLoS Negl Trop Dis. 2021;15:e0009445.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Wongsawat E, Suputtamongkol Y, Assanasaen S, Silpasakorn S, Avirutnan P, Puttikhunt C, Angkasekwinai N, Yamasmith E, Prommool T, Niwattayakul K. Performance of a New Microfluidic Dengue NS1 Immuno-magnetic Agglutination Assay for the Rapid Diagnosis of Dengue Infection in Adults. Am J Trop Med Hyg. 2021;105:771–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Prommool T, Sethanant P, Phaenthaisong N, Tangthawornchaikul N, Songjaeng A, Avirutnan P, Mairiang D, Luangaram P, Srisawat C, Kasinrerk W, et al. High performance dengue virus antigen-based serotyping-NS1-ELISA (plus): A simple alternative approach to identify dengue virus serotypes in acute dengue specimens. PLoS Negl Trop Dis. 2021;15:e0009065.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Bessoff K, Delorey M, Sun W, Hunsperger E. Comparison of two commercially available dengue virus (DENV) NS1 capture enzyme-linked immunosorbent assays using a single clinical sample for diagnosis of acute DENV infection. Clin Vaccine Immunol. 2008;15:1513–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Alejo-Cancho I, Navero-Castillejos J, Peiro-Mestres A, Albarracin R, Barrachina J, Navarro A, Gonzalo V, Pastor V, Munoz J, Martinez MJ. Evaluation of a novel microfluidic immuno-magnetic agglutination assay method for detection of dengue virus NS1 antigen. PLoS Negl Trop Dis. 2020;14:e0008082.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Poltep K, Nakayama EE, Sasaki T, Kurosu T, Takashima Y, Phadungsombat J, Kosoltanapiwat N, Hanboonkunupakarn B, Suwanpakdee S, Imad HA, et al: Development of a Dengue Virus Serotype-Specific Non-Structural Protein 1 Capture Immunochromatography Method. Sensors (Basel) 2021, 21.

  42. Duyen HT, Ngoc TV, Ha do T, Hang VT, Kieu NT, Young PR, Farrar JJ, Simmons CP, Wolbers M, Wills BA. Kinetics of plasma viremia and soluble nonstructural protein 1 concentrations in dengue: differential effects according to serotype and immune status. J Infect Dis. 2011;203:1292–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Shan X, Wang X, Yuan Q, Zheng Y, Zhang H, Wu Y, Yang J. Evaluation of the diagnostic accuracy of nonstructural protein 1 Ag-based tests for dengue virus in Asian population: a meta-analysis. BMC Infect Dis. 2015;15:360.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Allonso D, Meneses MD, Fernandes CA, Ferreira DF, Mohana-Borges R. Assessing positivity and circulating levels of NS1 in samples from a 2012 dengue outbreak in Rio de Janeiro, Brazil. PLoS ONE. 2014;9:e113634.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Acosta PO, Granja F, Meneses CA, Nascimento IA, Sousa DD, Lima Junior WP, Naveca FG. False-negative dengue cases in Roraima, Brazil: an approach regarding the high number of negative results by NS1 ag kits. Rev Inst Med Trop Sao Paulo. 2014;56:447–50.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Colombo TE, Vedovello D, Araki CS, Cogo-Moreira H, dos Santos IN, Reis AF, Costa FR, Cruz LE, Casagrande L, Regatieri LJ, et al. Dengue-4 false negative results by Panbio(R) Dengue Early ELISA assay in Brazil. J Clin Virol. 2013;58:710–2.

    Article  PubMed  Google Scholar 

  47. Sea VR, Cruz AC, Gurgel RQ, Nunes BT, Silva EV, Dolabella SS, dos Santos RL. Underreporting of Dengue-4 in Brazil due to low sensitivity of the NS1 Ag test in routine control programs. PLoS ONE. 2013;8:e64056.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Hermann LL, Thaisomboonsuk B, Poolpanichupatam Y, Jarman RG, Kalayanarooj S, Nisalak A, Yoon IK, Fernandez S. Evaluation of a dengue NS1 antigen detection assay sensitivity and specificity for the diagnosis of acute dengue virus infection. PLoS Negl Trop Dis. 2014;8:e3193.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Fry SR, Meyer M, Semple MG, Simmons CP, Sekaran SD, Huang JX, McElnea C, Huang CY, Valks A, Young PR, Cooper MA. The diagnostic sensitivity of dengue rapid test assays is significantly enhanced by using a combined antigen and antibody testing approach. PLoS Negl Trop Dis. 2011;5:e1199.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Yow KS, Aik J, Tan EY, Ng LC, Lai YL. Rapid diagnostic tests for the detection of recent dengue infections: An evaluation of six kits on clinical specimens. PLoS ONE. 2021;16:e0249602.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Nunes PCG, Nogueira RMR, Heringer M, Chouin-Carneiro T, Damasceno Dos Santos Rodrigues C, de Filippis AMB, Lima M, Dos Santos FB: NS1 Antigenemia and Viraemia Load: Potential Markers of Progression to Dengue Fatal Outcome? Viruses 2018, 10.

  52. Lustig Y, Keler S, Kolodny R, Ben-Tal N, Atias-Varon D, Shlush E, Gerlic M, Munitz A, Doolman R, Asraf K, et al. Potential Antigenic Cross-reactivity Between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Dengue Viruses. Clin Infect Dis. 2021;73:e2444–9.

    Article  CAS  PubMed  Google Scholar 

  53. Yan G, Lee CK, Lam LTM, Yan B, Chua YX, Lim AYN, Phang KF, Kew GS, Teng H, Ngai CH, et al. Covert COVID-19 and false-positive dengue serology in Singapore. Lancet Infect Dis. 2020;20:536.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Chatnapa Duangdee and Jantawan Satayarak for providing clinical specimens and acknowledge all patients, physicians, nurses, and laboratory technicians at the Hospital for Tropical Diseases and the staff of the Faculty of Tropical Medicine, staff of the Office of Research Services (ORS), and the Department of Microbiology and Immunology, Mahidol University, Bangkok, Thailand, for their support. This study was also supported by the Osaka University ASEAN campus project.

Funding

This research was funded by the Japan Agency for Medical Research and Development under grant numbers JP19fm0108003, 20wm0225010h0101, and 21wm0225010h0102.

Author information

Authors and Affiliations

  1. Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi road, Ratchathewi, 10400, Bangkok, Thailand

    Kanaporn Poltep, Nathamon Kosoltanapiwat & Pornsawan Leaungwutiwong

  2. Mahidol-Osaka Center for Infectious Diseases (MOCID), Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi road, Ratchathewi, 10400, Bangkok, Thailand

    Kanaporn Poltep, Juthamas Phadungsombat, Emi E. Nakayama & Tatsuo Shioda

  3. The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals (MoZWE), Faculty of Veterinary Science, Mahidol University, 999 Phutthamonthon Sai 4 Road, 73170, Phutthamonthon, Nakhonpathom, Thailand

    Kanaporn Poltep, Witthawat Wiriyarat, Sarin Suwanpakdee & Phirom Prompiram

  4. Center for Infectious Disease Education and Research (CiDER), Department of Viral Infections, Research Institute for Microbial Diseases (RIMD), Osaka University, 3-1, Yamada-oka, 565-0871, Suita, Osaka, Japan

    Juthamas Phadungsombat, Emi E. Nakayama & Tatsuo Shioda

  5. Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi road, Ratchathewi, 10400, Bangkok, Thailand

    Borimas Hanboonkunupakarn

  6. POCT Business Unit, TANAKA Kikinzoku Kogyo K.K, 2-73, 254-0076, Shinmachi, Hiratsuka, Kanagawa, Japan

    Keita Suzuki & Hisahiko Iwamoto

Authors
  1. Kanaporn Poltep
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juthamas Phadungsombat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathamon Kosoltanapiwat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Borimas Hanboonkunupakarn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Witthawat Wiriyarat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarin Suwanpakdee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Phirom Prompiram
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Emi E. Nakayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keita Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hisahiko Iwamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tatsuo Shioda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Pornsawan Leaungwutiwong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KP: performed analysis, interpreted the data, and prepared the draft of the manuscript. JP: performed analysis and substantively revised the manuscript. NK, WW, SS, and PP: substantively revised the manuscript. KS and HI: supplied the ICT devices and substantively revised the manuscript. BH: resources and substantively revised the manuscript. EEN: methodology, substantively revised the manuscript, and funding acquisition. TS: conceptualization, methodology, substantively revised the manuscript, and funding acquisition. PL: conceptualization and substantively revised the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Tatsuo Shioda or Pornsawan Leaungwutiwong.

Ethics declarations

Ethics approval and consent to participate

The protocol of this study was reviewed and approved by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (TMEC 19–051). This study was exempt from patient consent since only leftover specimens were used after anonymization.

Consent for publication

Not applicable.

Competing interests

Keita Suzuki and Hisahiko Iwamoto were employed by TANAKA Kikinzoku Kogyo, which developed and donated the immunochromatographic devices for evaluation. TANAKA Kikinzoku Kogyo had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

Supplementary Material 3

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poltep, K., Phadungsombat, J., Kosoltanapiwat, N. et al. Performance of the nonstructural 1 Antigen Rapid Test for detecting all four DENV serotypes in clinical specimens from Bangkok, Thailand. Virol J 19, 169 (2022). https://doi.org/10.1186/s12985-022-01904-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12985-022-01904-0

Keywords:

Virology Journal

ISSN: 1743-422X