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Epic Code LAB848 Dengue Virus Antibody, IgG and IgM, Serum

Important Note

Order as Reference Miscellaneous #LAB848; indicate complete test name when ordering.

Additional Codes

Mayo Test Code: DENGM

Reporting Name

Dengue Virus Ab, IgG and IgM, S

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Clinical Information

Dengue virus (DV) is a globally distributed flavivirus with 4 distinct serotypes (DV-1, -2, -3, -4) and is primarily transmitted by the Aedes aegypti mosquito, which is found throughout the tropical and subtropical regions of over 100 countries. DV poses a significant worldwide public health threat with approximately 2.5 to 3 billion people residing in DV endemic areas, among whom 100 to 200 million individuals will be infected and approximately 30,000 patients will succumb to the disease annually.

 

Following dengue infection, the incubation period varies from 3 to 7 days and, while some infections remain asymptomatic, the majority of individuals will develop classic dengue fever. Symptomatic patients become acutely febrile and present with severe musculoskeletal pain, headache, retro-orbital pain, and a transient macular rash, most often observed in children. Fever defervescence signals disease resolution in most individuals. However, children and young adults remain at increased risk for progression to dengue hemorrhagic fever and dengue shock syndrome, particularly during repeat infection with a new DV serotype.

 

Detection of dengue-specific IgM and IgG-class antibodies remains the most commonly utilized diagnostic method. Seroconversion occurs approximately 3 to 7 days following exposure and, therefore, testing of acute and convalescent sera may be necessary to make the diagnosis. As an adjunct to serologic testing, identification of early DV infection may be made by detection of the DV nonstructural protein 1 (NS1) antigen. NS1 antigenemia is detectable within 24 hours of infection and up to 9 days following symptom onset. The DV NS1 antigen can be detected by ordering DNSAG / Dengue Virus NS1 Antigen, Serum.

Useful For

Aiding in the diagnosis of dengue virus infection

Highlights

Detection of antibodies to dengue virus is suggestive of recent exposure and/or infection with dengue virus.

 

This test should be used for diagnostic purposes only.

Specimen Type

Serum


Specimen Required


Container/Tube: 

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.5 mL


Laboratory Test Directory Note:

COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.

Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  14 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject
Heat-Inactivated specimen Reject

Day(s) Performed

Tuesday

Reference Values

IgG: negative

IgM: negative

Reference values apply to all ages.

Interpretation

The presence of IgG-class antibodies to dengue virus (DV) is consistent with exposure to this virus sometime in the past. By 3 weeks following exposure, nearly all immunocompetent individuals should have developed IgG antibodies to DV.

 

The presence of IgM-class antibodies to DV is consistent with acute-phase infection.

 

IgM antibodies become detectable 3 to 7 days following infection and may remain detectable for up to 6 months or longer following disease resolution.

 

The absence of IgM-class antibodies to DV is consistent with lack of infection. However, specimens collected too soon following exposure may be negative for IgM antibodies to DV. If DV remains suspected, a second specimen, collected approximately 10 to 12 days following exposure should be tested.

Cautions

Test results should be used in conjunction with clinical evaluation, including exposure history and clinical presentation.

 

False-positive results, particularly with the dengue virus (DV) IgG enzyme-linked immunosorbent assay (ELISA), may occur in persons infected with other flaviviruses, including Zika virus, West Nile virus, and St. Louis encephalitis virus. Obtaining a detailed exposure history and further laboratory testing may be necessary to determine the infecting virus.

 

Positive test results may not be valid in persons who have received blood transfusions or other blood products within the last several months.

 

The significance of a negative result in an immunosuppressed patient is unclear.

Clinical Reference

1. Bhatt S, Gething PW, Brady OJ, et al: The global distribution and burden of dengue. Nature. 2013 Apr 25;496:504-507. doi: 10.1038/nature12060

2. Dengue--an infectious disease of staggering proportions. Lancet. 2013 Jun 22;381(9884):2136 doi: 10.1016/S0140-6736(13)61423-3

3. Rigau-Perez JG, Clark GG, Gubler DJ, et al: Dengue and dengue haemorrhagic fever. Lancet. 1998 Sep 19;352:971-977

4. Tang KF, Ooi EE: Diagnosis of dengue: an update. Expert Rev Anti Infect. Ther 2012 Aug;10:895-907 doi: 10.1586/eri.12.76

5. Guzman MG, Kouri G: Dengue diagnosis, advances and challenges. Int J Infect Dis. 2004 Mar;8:69-80

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)

Method Description

Dengue virus IgM:

In this enzyme-linked immunosorbent assay (ELISA), samples and controls are diluted in sample dilution buffer and incubated in microtiter wells coated with antihuman IgM antibodies. This incubation is followed by incubation with dengue-derived recombinant antigens (DENRA) and normal cell antigen (NCA) separately. After incubation and washing, the wells are treated with a DEN-specific monoclonal antibody labeled with horseradish peroxidase (HRP). After a second incubation and washing step, the wells are incubated with tetramethylbenzidine (TMB) substrate. Acid stop is added and absorbance at 450 nm is read. Ratio of absorbencies of the DENRA and the control antigen wells determine whether the result is positive or negative.(Package insert: InBiOS DENV Detect IgM CAPTURE ELISA. InBios International, Inc; Revision 10/1/2015)

 

Dengue virus IgG:

In this ELISA assay, controls and diluted samples are incubated in microtiter wells coated with monoclonal antibody bound to DENRA. After incubation and washing, wells are treated with IgG antibody labeled with HRP. After a second incubation and washing, wells are incubated with TMB substrate. Acid stop is added and absorbance at 450 nm is measured. Ratio of the absorbencies of the DENRA and the control wells determines whether a result is positive or negative.(Package insert: InBiOS DENV Detect IgG ELISA. InBios International, Inc; Revision 2/18/2015)

Report Available

Same day/1 to 7 days

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

IgM-86790

IgG-86790

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DENGM Dengue Virus Ab, IgG and IgM, S 87546-8

 

Result ID Test Result Name Result LOINC Value
DENG Dengue Virus Ab, IgG, S 29661-6
DENM Dengue Virus Ab, IgM, S 29663-2
DNABI Dengue Ab Interpretation 69048-7

Profile Information

Test ID Reporting Name Available Separately Always Performed
DENG Dengue Virus Ab, IgG, S No Yes
DENM Dengue Virus Ab, IgM, S No Yes
DNABI Dengue Ab Interpretation No Yes

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.