From: Clinical and Laboratory Diagnosis of Dengue Virus Infection

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From: Clinical and Laboratory Diagnosis of Dengue Virus Infection Figure 2. Timeline of dengue biomarker appearance in patients experiencing primary and secondary infection. In primary infection (top panel), both nonstructural protein 1 (NS1) and virus can be detected from the onset of disease, with immunoglobulin M (IgM) appearing around day 3 of illness and immunoglobulin G (IgG) appearing toward the end of the acute period. Secondary infections (bottom panel) are characterized by the presence of IgG early in the acute phase of disease and a shorter duration of NS1 and virus detection. Note onset of severe dengue (dengue hemorrhagic fever [DHF]/dengue shock syndrome [DSS]), primarily in secondary infections and at a time when virus and NS1 levels are falling. From: Clinical and Laboratory Diagnosis of Dengue Virus Infection J Infect Dis. 2017;215(suppl_2):S89-S95. doi:10.1093/infdis/jiw649 J Infect Dis | © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

From: Clinical and Laboratory Diagnosis of Dengue Virus Infection Figure 3. Diagnostic algorithm for laboratory confirmation of dengue virus infection. Polymerase chain reaction (PCR) or nonstructural protein 1 (NS1) positivity in either acute (S1) or convalescent (S2) clinical samples confirms current dengue infection. Seroconversion of S1 to S2 as measured by immunoglobulin M (IgM) enzyme-linked immunosorbent assay confirms acute dengue infection. The presence of immunoglobulin G (IgG) in acute laboratory-confirmed dengue indicates a probable secondary dengue infection. The presence of IgM in a single sample indicates a presumptive or recent dengue infection. While negative IgM with IgG seroconversion between S1 and S2 indicates an acute flavivirus infection, the presence of IgG in S1 and S2 indicates a past flavivirus infection. Adapted from Jaenisch et al [40]. From: Clinical and Laboratory Diagnosis of Dengue Virus Infection J Infect Dis. 2017;215(suppl_2):S89-S95. doi:10.1093/infdis/jiw649 J Infect Dis | © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

From: Clinical and Laboratory Diagnosis of Dengue Virus Infection Figure 1. Classification of dengue disease progression. Criteria for dengue disease progression with and without warning signs are listed, as are the symptoms that define severe dengue. Adapted from World Health Organization guidelines [16]. Abbreviations: +ve, positive; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CNS, central nervous system; DSS, dengue shock syndrome; HCT, Hematocrit. From: Clinical and Laboratory Diagnosis of Dengue Virus Infection J Infect Dis. 2017;215(suppl_2):S89-S95. doi:10.1093/infdis/jiw649 J Infect Dis | © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.