Evaluating a rapid molecular assay in a mobile laboratory for improved diagnosis of dengue in Bangladesh.

Objectives: Dengue emerged as a significant health threat in endemic regions in recent years. However, inconsistent diagnostic accuracy in sequential dengue infections necessitate improved testing methods to ensure effective management of dengue cases. Here, we evaluated a portable, rapid, and sensitive molecular assay-reverse transcriptase recombinase polymerase amplification assay (RT-RAA)-utilizing a mobile suitcase laboratory to detect infections in suspected dengue cases in Bangladesh.

Methods: A total of 364 suspected patients with dengue were enrolled in the study. Dengue cases were confirmed by a positive result from any of the four tests: non-structural protein 1 (NS1) rapid diagnostic test (RDT), immunoglobulin (Ig) M RDT, quantitative reverse transcriptive-polymerase chain reaction (RT-PCR), and RT-RAA assay. IgG RDT was performed to differentiate between primary and secondary dengue infections.

Results: Of 364 suspected cases, 320 were confirmed dengue cases, with 55.94% classified as primary and 44.06% as secondary infections. Laboratory results showed comparable positivity rates between RT-RAA (78.8%) and NS1 RDT (77.1%) in primary dengue, followed by quantitative RT-PCR (57.5%) and IgM RDT (12.8%). RT-RAA demonstrated superior positivity rates in secondary dengue (76.6%), surpassing RT-PCR (60.3%), NS1 RDT (27%), and IgM RDT (24.8%). Combining RT-RAA with NS1 RDT detected infections in 89.95% primary and 81.56% secondary dengue.

Conclusions: The findings suggest that complementing RT-RAA with NS1 RDT could significantly improve dengue detection rate, particularly, for secondary infections.