Diagnostic Options and Challenges for Dengue and Chikungunya Viruses

Table 2

Diagnostic tests for CHIKV infection.

Premise	Diagnostic method	Sample types	Sensitivity (%)	Specificity (%)	Advantages	Disadvantages	References
Detection of virus	Virus isolation (in vivo or in vitro)	Serum, plasma, whole blood, and fresh or FFPE tissues	Variable	100	Highly specific	Technical, laborious; Requires biosafety level 3 containment; May take 1-2 weeks	[1]
Detection of viral antigen	ELISA or immunochromatographic assay (ICA)	Serum and CSF	85 (serum); 80 (CSF)	89 (serum); 87 (CSF)	Early diagnosis	Commercial assays not widely available; Requires biosafety level 3 containment	[16, 17]
Detection of viral nucleic acid	RT-PCR	Serum and dried blood spots	100	Up to 100	Highly sensitive and specific; Rapid turnaround time; Multiplex available	Expensive reagents and specialized equipment	[13, 16, 18–20]
	Real-time RT-PCR		100	Up to 100	Multiplex available	Expensive reagents and specialized equipment
	Isothermal amplification methods (RT-LAMP)		100	95.25	Does not require specialized equipment (i.e., thermocyclers)
Detection of host antibody response	ELISA	Serum; CSF	IgM: 17 (serum); 48 (CSF); IgG: 45 (serum); 63 (CSF)	IgM: 95 (serum); IgG: 53 (serum)	Widely available; Relatively cheaper and easier to perform; Rapid bedside tests are available	Possible cross-reactivity with other alphaviruses; Elevated IgM does not distinguish recent past infection from acute infection	[4, 16, 17, 20–22]
	IFA	Serum	85–97	90–98	Sensitive and specific; Commercially available	Lack the ability to quantify antibodies, are subjective, and require special equipment and training
	PRNT	Serum			Very specific for alphaviruses; gold standard for confirmation of serologic test results	Requires the use of live virus (requires Biosafety level 3 containment)