Dengue disease diagnosis: A puzzle to be solved

Dengue is an infection caused by dengue virus and is the most
important arthropod transmitted viral disease in the world,
causing near 100 million cases and 50 000 fatalities each year.
Health authorities believe that these numbers will grow in
coming years. In Colombia, almost 600 municipalities are in
regions with Aedes aegypti circulation, and the presence of four
dengue serotypes has been demonstrated. Despite the increasing
knowledge about disease pathogenesis and the dengue virus,
some technical or scientific difficulties with diagnosing dengue
remain, negatively affecting both public health surveillance
and the appropriate attention to patients in health settings and
hospitals. This paper reviews the principles and developments
of the current diagnostic techniques for dengue, pointing out
the difficulties with making accurate dengue diagnoses and case
confirmations in public health and specialized laboratories. The
principles and limitations of MAC-ELISA, IgG serology, viral
NS1 detection and viral isolation by cell culture are presented.
In addition, the review of immunochromatography techniques
(rapid diagnostic tests) that have been put forward to help the
point-of-care diagnosis is proposed. This paper is intended to
bring forward some points of view about the issues related to
dengue diagnosis and contribute to improve the discussion
surrounding the strategies and techniques needed for reducing
the impact of the disease and favoring its control.