CHAPTER 4 Laboratory diagnosis WHO（第四章实验室诊断谁）.pdfVIP

Dengue haemorrhagic fever CHAPTER 4 Laboratory diagnosis The two basic methods for establishing a laboratory diagnosis of dengue infection are detection of the virus (e.g. culture) or detection of anti-dengue antibodies (serology). Until recently, detection of the virus implied solely the recovery of the virus by culture; however, current procedures can detect dengue virus RNA and specific dengue virus antigens. Consequently, these procedures are likely to become routine as the necessary reagents and instrumentation become more widely available. An understanding of the kinetics of dengue virus replication and host responses, as well as of the collection and handling of specimens, will help clarify the strengths and weaknesses of the two laboratory methods for diagnosing dengue infection. Kinetics of dengue virus replication and host response By the time a person infected with dengue virus develops fever, the infection is widely disseminated. The virus is found in serum or plasma, in circulating blood cells and in selected tissues, especially those of the immune system, for approximately 2–7 days, roughly corresponding to the period of fever. Dengue virus usually infects the peripheral blood mononuclear cells within a few days of the infective mosquito bite, and the infection rate revealed by antigen staining is usually 1–10 infected cells per 10000 cells. Detectable levels of anti-dengue antibodies appear after several days of fever. Two patterns of immune response are distinguished: primary and secondary (anamnestic) (see Figure 4.1). Persons never previously infected with a flavivirus, nor immunized with a flavivirus vaccine (e.g. yellow fever, Japanese encephalitis, tick-borne encepha- litis), mount