|
| Premise of test | Method | Sample types | Sensitivity (%) | Specificity (%) | Advantages | Disadvantages | References |
|
| Detection of virus | Virus isolation | Serum, plasma, whole blood, and fresh or FFPE tissues | 71.5–84.2 (mosquito inoculation);
40.5 (cell line-based) | 100 | Greatest specificity
Allows for further characterization of isolate | Technical, laborious
Variable sensitivity
Narrow window of detection (viremic period) | [3, 9, 10] |
|
| Detection of viral antigen | NS1 detection via ELISA | Serum, urine, and CSF | 54.2–93.4 (serum);
73.9–76.9 (urine)
50 (CSF, if neurological symptoms) | 71–80 (serum);
100 (CSF, if neurological symptoms) | Early diagnosis
Rapid tests available | Does not differentiate between serotypes
Lower sensitivity in secondary infections | [11–13] |
|
|
Detection of viral nucleic acid | RT-PCR | Serum, plasma, whole blood, fresh or FFPE tissues, urine, and saliva | 48.4–98.2 | 100 | Rapid turnaround time
Multiplex available (can identify all serotypes from single sample; less potential for contamination) | Expensive reagents and specialized equipment |
[3, 9, 14] |
| Real-time RT-PCR | 58.9–100 | 100 |
| Isothermal amplification methods (NASBA, LAMP) |
98.5 |
100 |
Does not require specialized equipment (i.e., thermocyclers) | |
|
|
Detection of host antibody response | MAC-ELISA |
Serum | 61.5–99 | 79.9–97.8 | Detection of IgM is considered diagnostic | Cross-reactivity among serotypes (not serotype-specific) and with other flaviviruses (false-positives) |
[3, 9, 14, 15] |
| IgG ELISA | | | Can distinguish primary from secondary infection using paired sera | Later diagnosis (need postconvalescent sample) |
| IgM/IgG ratio | | | Distinguishes between primary from secondary infection | Later diagnosis |
| IgA | Serum and saliva | 93 (serum);
70–92 (saliva) | 88 (serum);
97 (saliva) | Option for testing saliva (easier sample to obtain)
Better sensitivity and specificity in secondary infection | Lower sensitivity in primary infection |
|
