Publication:

Optimizing diagnostic cascades: evaluating the sensitivity of NS1 antigen versus antibody serology in a rapidly evolving dengue outbreak

Background Dengue fever, caused by DENV-1-4 serotypes, remains a major public health challenge with clinical manifestations ranging from mild febrile illness to severe complications such as Dengue Hemorrhagic Fever (DHF) and Expanded Dengue Syndrome (EDS). During the devastating 2023-2024 outbreak in Bangladesh, rapid and accurate diagnosis became essential for early intervention. This study evaluated the diagnostic performance of NS1 antigen testing compared with IgM/IgG serology and described the clinico-demographic profile of affected patients.

Methods This prospective observational study was conducted at BIRDEM General Hospital, Dhaka, from June 2023 to February 2024 during the peak dengue epidemic. A total of 292 laboratory-confirmed dengue patients were enrolled. Sociodemographic data, clinical manifestations, and laboratory findings were collected from hospital records following ethical approval. Diagnostic sensitivity of NS1 antigen and antibody serology was compared using SPSS version 26 according to STROBE guidelines.

Results The mean age of participants was 35.63±15.22 years; 54.8% were male and 83.9% were urban residents. Diabetes mellitus was present in 25.7% of cases. NS1 antigen showed the highest positivity rate (82.3%), whereas IgM and IgG positivity were 13% and 9.2%, respectively. Fever (76%), body ache (63.7%), headache (42.1%), and vomiting (41.1%) were common presenting symptoms. Thrombocytopenia (70.9%) and elevated SGPT (50.3%) were frequent laboratory abnormalities. Neuropsychiatric symptoms such as insomnia and irritability were observed in 7.9% of patients.

Conclusions NS1 antigen is a superior early diagnostic marker during dengue outbreaks. Early identification of metabolic comorbidities and hepatic involvement may improve timely management and reduce dengue-related morbidity and mortality in resource-limited settings.