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DETECTION OF CHIKUNGUNYA VIRUS RNA IN ORAL FLUID AND URINE: AN ALTERNATIVE APPROACH TO DIAGNOSIS?
Alternative title
Detecção do RNA do vírus Chikungunya em fluido oral e urina: uma abordagem alternativa para o diagnóstico?Author
Affilliation
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Yale School of Public Health. Yale University. New Haven, Estados Unidos.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Yale School of Public Health. Yale University. New Haven, Estados Unidos.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil.
Abstract
Objetivo(s): To evaluate whether oral fluid (OF) and urine can be used as alternative samples to serum to diagnose chikungunya virus (CHIKV) infection by qRT-PCR. Material e Métodos: Serum, OF (collected with a rayon-tipped swab in the sublingual region), and urine samples used in the evaluation were obtained from patients enrolled in a prospective surveillance study to detect arbovirus infection among cases of acute febrile illness (≤7 days of symptom onset). The studied samples belonged to three groups of patients with laboratory evidence of chikungunya: patients with qRT-PCR positive for CHIKV in acute-phase sera (n=19); with CHIKV IgM seroconversion between
paired sera (n=12); and with CHIKV IgM detection in acute-phase sera (n=20). The last two groups were negative for CHIKV by qRT-PCR in acute-phase serum. As controls, we used sera, OF, and urine from patients with other acute febrile illnesses (n=28) and from patients with RT-PCR-confirmed dengue (n=16). All samples underwent RNA extraction (Maxwell®, Promega, Madison, USA), followed by CHIKV qRT-PCR (CDC-TRIOPLEX). CHIKV IgM antibodies were investigated using IgM ELISA kits (InBios, Seattle, USA). Resultados e Conclusão: Of the 19 patients with qRT-PCR positive for CHIKV in sera, 9 (47.4%) and one (5.2%) were also positive by qRT-PCR in OF and urine, respectively. Of the 12 patients with
evidence of CHIKV infection solely based on CHIKV IgM seroconversion, 2 (16.7%) were positive for CHIKV by qRT-PCR in OF, and none in urine. None of the 20 patients belonging to the group with CHIKV IgM antibodies in acute-phase sera were positive for CHIKV by qRT-PCR in OF and urine. None of the samples from the control groups were positive (specificity: 100%).Although the CHIKV qRT-PCR in OF was positive in some patients with CHIKV IgM seroconversion who were negative by qRT-PCR in sera, the qRT-PCR sensitivity in OF was about 50% among patients who had a positive CHIKV qRT-PCR in serum. Thus, while OF may be useful as an alternative non-invasive specimen to diagnose acute
chikungunya, a negative result cannot rule out an infection. The frequency at which acute-phase urine showed detectable levels of CHIKV RNA in patients with detectable CHIKV RNA in sera was too low to suggest the use of urine as an alternative acute-phase sample. Further research is needed to evaluate whether OF and urine collected later in the disease course may be helpful in diagnosing chikungunya.
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