Confusion Prevails Over Effective Diagnostic Test For Dengue Virus
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06 October 2010
Even as around three dozen more suspected dengue cases, including around 12 in government hospitals, were reported in the city on Tuesday, confusion prevailed over the diagnostic test for confirmation of the disease.
While the Trauma Centre, medicine ward and the paediatrics emergency ward of Chhatrapati Shahuji Maharaj Medical University (CSMMU) was overburdened with the patients, several sharing beds and even lying on stretcher, government health officials remained in denial mode saying that only 10 cases and that too suspected ones have been reported in the last 24 hours.
On the other hand, the platelets crisis continued with people making beeline for the blood component for transfusion and very few coming for blood donation. Among new cases include three CSMMU students. Death of a suspected dengue patient, Sachin, 25, an employee of Nirman Nigam was also reported but authorities did not confirm it. Sachin was under–treatment in a private hospital.
Director general health, Dr P C Ram said that as per government of India guidelines, only those cases in which dengue has been confirmed by polymerase chain reaction (PCR) test can be considered as a dengue patient, but doctors (both government and private) said World Health Organisation (WHO) also approves Enzyme Linked ImmunoSorbent Assay (ELISA) test for rapid diagnosis of dengue.
The facility of PCR test is available only in CSMMU and SGPGIMS in the government sector and in a few private hospitals. In the government sector, PCR is available for Rs 230–Rs 300 and is free for below poverty line patients. The ELISA test is free in government hospitals since most of the victims are from poor category, labs at CSMMU and SGPGIMS are working overnight.
Government ‘officially’ recognises only PCR test but doctors in government hospital said that they also take ELISA test into cognizance as PCR facility is limited in the city. Significantly, while suspected dengue cases are on the rise, the only testing facility for government hospitals is available in the health directorate. The blood samples of suspected cases from various government hospitals in the city are sent to health directorate for confirmation. As a result, there is a long queue of samples waiting for confirmation test. This is leading to delay in management of dengue patients.
"The need is to have more PCR labs in the state and equip hospitals in every district at least with Elisa facility and trained staff in dengue management, said a government doctor.
Dr A K Shukla, chief medical officer, Lucknow, blames private pathologies for causing panic. The platelets count can also decrease in other diseases other than dengue, he added.
Dr V S Nigam, officiating director, communicable diseases, said that PCR facility is very costly which poor cannot bear. Hence, he added, we also consider ELISA reports for treatment.
Dr P K Gupta, president pathologist association, said, "It’s true that PCR is more accurate than ELISA but we also need to take into account the demographic and economic profile of our state before taking decisions.
Pathologist Dr Pragat Gupta said, "Rapid chromatography test can also deliver results in short time and at a very low cost in comparison to other tests.
"The rush for platelets is huge, over 200 units per day, as doctors are recommending transfusion even if the platelets count is one lakh or 50,000. Excess or unnecessary transfusion can cause complications, said Dr Tulika Chandra, in charge, Blood Bank, CSMMU. "The platelets transfusion is required only in case of internal bleeding or platelets count dips below 20,000, she said.
Platelet is a component of blood. It prevents bleeding and helps in formation of clot. Normal platelets count in human body is between 1.5 lakh and 4 lakh.
PCR Test | Molecular test. It can detect dengue even in the early stages. Most accurate and sensitive. Investment cost to establish the lab and equipment between Rs 4 crore and Rs 5 crore. Cost of the test in private hospitals is Rs 5,000 and above. Result in a day.
ELISA Test | Less accurate than PCR but investment cost of facility around Rs 2 lakh and cost of testing in private Rs 2,000 and above. Can deliver results in few hours.
Rapid Chromatographic Test | Less accurate and reliable but handy. Can deliver results in few minutes. Cost in private centres between Rs 600 and Rs 1200.
Platelets Count Test | Cost between Rs 100 ans Rs 200. It’s a blood test to find the concentration of platelets in the blood. It’s not a confirmatory test but useful if patient has other symptoms of dengue. But there are several virus which can cause similar symptoms with reduction in platelets count in blood. Hence, it is used more to monitor the status of the patient once dengue is confirmed.