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.