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Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 21 / No. 1 / Published : 2014-01

TOC : 16, and page :82 - 89

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Original Article :

The diagnostic value of anti dengue iga and anti dengue igm/igg in dengue virus infection)

Author :

  1. Resna*1
  2. Aryati*2
  3. Puspa Wardhani*3
  4. Erwin Triyono*4
  1. Departemen/Instalasi Patologi Klinik Universitas Airlangga/RSUD Dr. Soetomo Surabaya.
  2. Dosen Fakultas Kedokteran
  3. Dosen Fakultas Kedokteran
  4. 2 Departemen/Instalasi Ilmu Penyakit Dalam Universitas Airlangga/RSUD Dr Soetomo Surabaya

Abstract :

The clinical manifestations of dengue virus infection are varied and thus a specific diagnostic examination is required. Usually antidengue IgM is often used, but the presence in the circulation is 3−8 months long. NS1 is sensitive in the detection of primary infection, whereas IgG is more better used in secondary infection. The examination of anti-dengue IgA as a new marker is estimated to be able to detect the acute primary and secondary infection, however the diagnostic value of anti-dengue IgA is not much well known for the Indonesian population. This study was done at the Tropical Infectious Disease Ward of Dr. Soetomo Hospital, Surabaya during February – April 2013. The samples consisted of 37 sera from patients infected by dengue virus and 37 sera from those non one (dengue virus infection patients). The NS1 serum, anti-dengue IgM and anti dengue IgG were examined by ELISA and anti-dengue IgA was examined by an indirect immunochromatography method using Assure@ Dengue IgA Rapid Test (MP Biomedicals Asia Pacific Pte Ltd). The diagnostic value was analyzed by 2x2 table with a confidence interval of (CI) 95%. The used gold standards were from the 1997th WHO criteria and one of the positive dengue serological tests by ELISA (NS1/anti dengue IgM/anti dengue IgG). AUC and anti-dengue IgA cut-off were determined by ROC curve. The Diagnostic value of anti-dengue IgA showed a sensitivity and specificity of 83.8% (67.3 to 93.2) and 81.1% (64.3 to 91.4). A positive predictive value of 81.6% (65.1 to 91.7) and a negative predictive value of 83.3% (66.5 to 93.0) was found. The positive likelihood ratio was 4.4 times (2.2 to 8.8) and negative likelihood ratio of only 0.2 times (0.09 to 0.42). The best cut off value of 0.2 was shown by the area under the curve of 83.5%. Based on this study, the diagnostic value of anti-dengue IgA had a good validity for the diagnosis of dengue virus infection. Manifestasi klinis infeksi virus dengue beragam dan diperlukan pemeriksaan diagnostik yang khusus. Anti dengue IgM digunakan sebagai petanda infeksi akut primer, tetapi tetap berada di edaran darah antara 3−8 bulan. NS1 peka dalam mendeteksi infeksi primer, sedangkan IgG lebih baik digunakan untuk infeksi sekunder. Pemeriksaan anti dengue IgA sebagai petanda baru ditengarai dapat mendeteksi tingkat akut infeksi primer dan sekunder, tetapi belum banyak diketahui nilai diagnostik IgA anti dengue di masyarakat Indonesia. Penelitian dilakukan di Ruang Tropik Infeksi Penyakit Dalam RSUD Dr. Soetomo Surabaya antara bulan Februari−April 2013. Sampel penelitian terdiri dari 37 serum pasien infeksi virus dengue dan 37 infeksi nonvirus dengue. Serum yang diperiksa ialah NS1, IgM dan anti dengue IgG dengan metode ELISA, kemudian anti dengue IgA diperiksa menurut metode indirek imunokromatografi menggunakan Assure@ Dengue IgA Rapid Test (MP Biomedicals Asia Pasific Pte Ltd). Nilai diagnostik anti dengue IgA dianalisis menggunakan tabel 2x2 dengan selang kepercayaan 95%. Bakuan emas yang dipakai adalah menurut patokan WHO 1997 dan salah satu uji serologis dengue dengan ELISA positif (anti dengue NS1/IgM /IgG). AUC dan cut off anti dengue IgA ditentukan dengan kurva ROC. Nilai diagnostik anti dengue IgA menunjukkan kepekaan dan kekhasan 83,8% (67,3-93,2) dan 81,1% (64,3-91,4). Nilai ramal positif 81,6% (65,1-91,7) serta nilai ramal negatif 83,3% (66,5-93,0). Angka banding kemungkinan positif sebesar 4,4 kali (2,2-8,8) dan yang kemungkinan negatif hanya 0,2 kali (0,09-0,42). Nilai cut off paling baik 0,2 dengan daerah bawah lengkung sebesar 83,5%. Nilai diagnostik anti dengue IgA bervaliditas yang baik untuk penetapan diagnosis infeksi virus dengue

Keyword :

Dengue virus infection, anti-dengue IgA, diagnostic value, the ROC curve, AUC,

References :

  1. Soegijanto S., (2006). Bahaya yang mengintai endemisitas DBD di Indonesia. Dalam: Soegijanto S,. hal 25-41 : University Press
  2. aryati, (2012). distribusi serotipe dengue di surabaya tahun 2012. 41-4 : IJCP


Archive Article

Cover Media Content

Volume : 21 / No. : 1 / Pub. : 2014-01
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