Dengue -IgM (ELISA)

Bacterial/ Viral

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No Fasting Required

Details

Detects Immunoglobulin M (IgM) antibodies produced in response to a recent dengue virus infection

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Dengue - IgM (ELISA) Test Information Guide

Why is it done?
- Detection of Acute Dengue Infection: IgM antibodies are produced during the primary immune response to dengue virus and indicate an acute or recent infection
- Clinical Suspicion of Dengue: Ordered when patients present with symptoms suggestive of dengue fever such as fever, headache, muscle pain, joint pain, rash, and bleeding manifestations
- Epidemiological Context: Performed in patients living in or recently traveled to dengue-endemic regions during active transmission periods
- Timing of Testing: Most useful when performed 3-5 days after onset of symptoms when IgM antibody levels are highest; can detect infection up to 3-6 months after initial infection
- Differentiation from Other Febrile Illnesses: Helps distinguish dengue from other tropical febrile illnesses like malaria, typhoid, and other arboviruses
Normal Range
- Negative Result: Absence of dengue-specific IgM antibodies, typically reported as <0.9 Index or <1.0 cutoff value depending on laboratory standards
- Positive Result: Presence of dengue-specific IgM antibodies, typically reported as ≥0.9 Index or ≥1.0 cutoff value or as a qualitative positive result
- Borderline/Equivocal Result: Values close to the cutoff (typically 0.8-1.1 Index) requiring repeat testing after 3-5 days for confirmation
- Units of Measurement: Index value (optical density ratio) or dilution titer depending on methodology; some laboratories use qualitative descriptors (Negative/Positive)
- Clinical Significance: Negative results indicate absence of acute dengue infection or testing performed too early in the disease course; positive results strongly suggest acute dengue infection
Interpretation
- IgM Positive (≥0.9 Index or ≥1.0 Cutoff): Indicates acute dengue infection, likely within the last 3-6 months; most reliable between days 3-14 of illness onset
- IgM Negative (<0.9 Index or <1.0 Cutoff): May indicate absence of dengue infection, testing performed too early (<3 days), or past infection that has resolved with clearance of IgM antibodies
- IgM Positive + IgG Negative (Primary Dengue): Indicates first-time dengue infection; patient may be at higher risk for severe dengue in secondary infection
- IgM Positive + IgG Positive (Secondary Dengue): Indicates reinfection with a different dengue serotype; carries increased risk of dengue hemorrhagic fever or dengue shock syndrome
- Factors Affecting Reliability: Sensitivity varies (80-96%) depending on timing; cross-reactivity with other flaviviruses (Zika, West Nile virus) may cause false positives; immunosuppression may reduce antibody production; recent blood transfusions may contain dengue antibodies
- Early Phase Testing (Days 1-2): May be negative even with dengue infection; NS1 antigen or RT-PCR may be more useful for early diagnosis
- Clinical Correlation Essential: Results must be interpreted with clinical presentation, epidemiological exposure, and other diagnostic findings
Associated Organs
- Primary Organ Systems Involved: Immune system (lymphocytes producing IgM antibodies), vascular system (endothelial dysfunction and increased permeability)
- Dengue Fever (Classic Dengue): Self-limited febrile illness with sudden onset fever, headache, myalgia, arthralgia, and rash; presents with systemic inflammation
- Dengue Hemorrhagic Fever (DHF): Severe form with hemorrhagic manifestations including thrombocytopenia, platelet dysfunction, coagulopathy, and spontaneous bleeding (gum bleeding, petechiae, gastrointestinal bleeding)
- Dengue Shock Syndrome (DSS): Life-threatening condition characterized by capillary leakage causing plasma loss, shock, organ dysfunction, and high mortality; affects cardiovascular system, liver, kidneys, and lungs
- Hepatic Involvement: Elevated liver enzymes (AST, ALT), hepatomegaly, and in severe cases acute hepatic necrosis
- Hematologic Manifestations: Thrombocytopenia, leukopenia, hemoconcentration, and disseminated intravascular coagulation (DIC) in severe cases
- Neurological Complications: Encephalitis, meningitis, Guillain-Barré syndrome, and acute disseminated encephalomyelitis in rare cases
- Renal Complications: Acute kidney injury from hypovolemia, sepsis, or direct viral injury
- Cardiac Involvement: Myocarditis, arrhythmias, and circulatory collapse in severe dengue
Follow-up Tests
- Dengue IgG ELISA: Confirms acute dengue and determines if it is primary or secondary infection; helps identify past immunity; should be performed simultaneously with or after IgM testing
- Dengue NS1 Antigen Detection: Useful for early diagnosis (within first 5 days of illness); can be positive when IgM is still negative; indicates active viral replication
- Dengue RT-PCR/Viral Culture: Gold standard for dengue diagnosis; identifies specific dengue serotype; most sensitive during acute viremia phase (first 3-5 days); recommended if early diagnosis needed or IgM results are equivocal
- Repeat IgM Testing: If initial test is negative but clinical suspicion remains high, repeat testing after 3-5 days as IgM may take time to develop; borderline results warrant confirmation testing
- Complete Blood Count (CBC): Assess for thrombocytopenia, leukopenia, hemoconcentration; critical in monitoring for dengue hemorrhagic fever; serial measurements recommended every 24 hours in severe cases
- Coagulation Profile: PT, aPTT, fibrinogen levels to evaluate for coagulopathy and DIC in severe dengue; important for hemorrhagic manifestations
- Liver Function Tests (LFTs): Assess hepatic involvement including AST, ALT, bilirubin, and albumin; elevated transaminases are common in dengue
- Renal Function Tests: Creatinine and urea levels; monitor for acute kidney injury in severe dengue or dengue shock syndrome
- Hematocrit/Hemoglobin: Serial measurements to detect hemoconcentration (>20% rise) suggesting plasma leakage and progression to DHF/DSS
- Imaging Studies: Ultrasound or CT scan to assess for pleural effusion, ascites, gallbladder wall thickening, and other signs of plasma leakage in severe cases
- Testing for Other Arboviruses: Zika, West Nile virus, chikungunya serology if dengue IgM positive but clinical presentation atypical or co-circulation of multiple viruses
Fasting Required?
- Fasting Status: No
- Patient Preparation: Fasting is not required; patient can eat and drink normally before blood collection; test can be performed at any time of day
- Fluid Intake: Patient should maintain normal fluid intake; adequate hydration is beneficial, especially in dengue patients
- Medications: No medications need to be avoided prior to testing; continue regular medications as prescribed unless specifically instructed by physician
- Sample Collection: Blood sample (serum) is collected by venipuncture into a serum separator tube; typically 5 mL of blood is required; no special handling needed beyond standard laboratory protocols
- Optimal Timing: Best results when collected 3-14 days after symptom onset for maximum IgM antibody levels; should be collected as soon as dengue is suspected
- Special Considerations: Patient should inform healthcare provider of any recent vaccinations (dengue vaccine or other vaccines) as they may affect results; inform of any recent blood transfusions as this can affect antibody interpretation

How our test process works!