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Clinical and Diagnostic Laboratory Immunology, March 2003, p. 317-322, Vol. 10, No. 2
1071-412X/03/$08.00+0     DOI: 10.1128/CDLI.10.2.317-322.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Diagnosis of Dengue Virus Infection by Detection of Specific Immunoglobulin M (IgM) and IgA Antibodies in Serum and Saliva

Angel Balmaseda,1 María G. Guzmán,2* Samantha Hammond,3 Guillermo Robleto,4 Carolina Flores,5 Yolanda Téllez,1 Elsa Videa,1 Saira Saborio,1 Leonel Pérez,1 Erick Sandoval,1 Yoryelin Rodriguez,1 and Eva Harris3

National Center for Diagnosis and Reference, Ministry of Health,1 Francisco Buitrago Health Center, Managua,5 Regional Health Center, Granada, Nicaragua,4 Pedro Kouri Institute of Tropical Medicine, Havana, Cuba,2 Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California 94720-73603

Received 17 May 2002/ Returned for modification 13 August 2002/ Accepted 16 November 2002

To evaluate alternative approaches to the serological diagnosis of dengue virus (DEN) infection, the detection of DEN-specific immunoglobulin M (IgM) and IgA antibodies in serum and saliva specimens was assessed in 147 patients with symptoms of DEN infection seen at the Ministry of Health in Nicaragua. Seventy-two serum samples were determined to be positive for anti-DEN antibodies by IgM capture enzyme-linked immunosorbent assay, the routine diagnostic procedure. Serum and saliva specimens were obtained from 50 healthy adults as additional controls. IgM was detected in the saliva of 65 of the 72 serum IgM-positive cases, 6 of the 75 serum IgM-negative cases, and none of the control group, resulting in a sensitivity of 90.3% and a specificity of 92.0% and demonstrating that salivary IgM is a useful diagnostic marker for DEN infection. Detection of IgA in serum may be another feasible alternative for the diagnosis of DEN infection, with serum IgA found in 68 (94.4%) of the IgM-positive cases. In contrast, detection of IgA in saliva was not found to be a useful tool for DEN diagnosis in the present study. Further studies of the kinetics of antibody detection in another set of 151 paired acute- and convalescent-phase serum samples showed that DEN-specific IgA antibodies were detected in more acute-phase samples than were IgM antibodies. Thus, we conclude that DEN-specific IgA in serum is a potential diagnostic target. Furthermore, given that saliva is a readily obtainable, noninvasive specimen, detection of DEN-specific salivary IgM should be considered a useful, cheaper diagnostic modality with similar sensitivity and specificity to IgM detection in serum.

* Corresponding author. Mailing address: Pedro Kouri Tropical Medicine Institute, Box 601, Marianao 13, Havana, Cuba. Phone: 53-7-202-0450. Fax: 53-7-204-6051. E-mail: lupe{at}ipk.sld.cu.

Clinical and Diagnostic Laboratory Immunology, March 2003, p. 317-322, Vol. 10, No. 2
1071-412X/03/$08.00+0     DOI: 10.1128/CDLI.10.2.317-322.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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