NPJD is guarantor of the paper. The study was funded by the Wellcome Trust of Great Britain (London, UK) (grant no. B9RPYY0) and the London School of Hygiene & Tropical Selleckchem BKM120 Medicine (London, UK) (MSc summer projects funding no. 491863). None declared. Ethical approval for this study was obtained from the Bangladesh Medical Research Council Ethics Committee, the London

School of Hygiene & Tropical Medicine Ethics Committee (UK) and the Oxford Tropical Research Ethics Committee (OXTREC). The authors thank the attending physicians and other hospital staff from the six medical colleges for recruiting patients into the study. The authors also thank the laboratory technicians at Mahidol–Oxford Tropical Medicine Research Unit (Bangkok, Thailand), in particular Sayan Langla and Tippawan Anantarat, for assisting with www.selleckchem.com/products/azd-1208.html the indirect haemagglutination assays. “
“Dengue virus is the most important arboviral disease in humans,

with an estimated 100 million cases of dengue fever (DF) and several hundred thousand cases of dengue haemorrhagic fever (DHF) each year.1 Cases of DF and DHF were increasingly reported in nine countries within the South East Asia region between 1985 and 2006, with Thailand reporting the highest number of cases in the region until 2003.2 In South East Asia, adults with dengue virus infection usually present with an acute, undifferentiated, febrile illness.3, 4, 5, 6 and 7 Previous reports have documented the difficulty in clinically differentiating dengue from other causes of fever, including leptospirosis8 and scrub typhus.5 Given this difficulty, and the fact that delayed antimicrobial treatment for such infections may result in increased mortality, reliable and rapid dengue confirmatory tests are needed. Additionally, rapid confirmation of dengue infection would facilitate improved monitoring of confirmed cases for development of complications such as shock or haemorrhage.9 Accurate laboratory confirmation not of dengue infection involves a combination of tests depending on timing of infection. During the acute phase of infection, virus

culture, nucleic acid detection (RT-PCR)10, 11 and 12 or antigen detection (for example, by NS-1 antigen ELISA13, 14 and 15) may be used for diagnosis. Serology is also used to confirm infection and distinguish primary and secondary infections by determining the differences between IgM and IgG antibody response and is currently more widely used as one of the laboratory diagnostic methods.16 There are a variety of serological methods described, including ELISA and haemagglutination inhibition (HI) tests, some of which are commercially available.17 and 18 However, serological diagnosis of dengue infection requires paired serum specimens, resulting in retrospective, rather than rapid and clinically useful, confirmation of infection.