Role of IgM/ IgG Ratio in Distinguishing Primary and Secondary Dengue Viral Infections: A Cross-Sectional Study

Charu Kalra; Garima Mittal; Priyanka Gupta; Rajiv Kumar Agarwal; Sohaib Ahmad

doi:10.7759/cureus.66714

Role of IgM/ IgG Ratio in Distinguishing Primary and Secondary Dengue Viral Infections: A Cross-Sectional Study

Cureus. 2024 Aug 12;16(8):e66714. doi: 10.7759/cureus.66714. eCollection 2024 Aug.

Authors

Charu Kalra¹, Garima Mittal², Priyanka Gupta³, Rajiv Kumar Agarwal², Sohaib Ahmad⁴

Affiliations

¹ Microbilogy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND.
² Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND.
³ Microbiology, Gautam Buddha Chikitsa Mahavidyalaya, Subharti University, Dehradun, IND.
⁴ Internal Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND.

Abstract

Objectives In recent years, Uttarakhand, a state in North India has become one of the prime spots for tourism all over the world. Thereby, a tremendous increase in the epidemics of dengue infection has been observed recently. Secondary dengue causes more severe disease in comparison with primary, thus to differentiate the two is very crucial. We aim to find out the cut-off values of the IgM:IgG ratio for early detection of secondary dengue which could further help clinicians to prevent the complications. Methods A cross-sectional study was conducted over one year involving around 936 suspected cases of dengue. Samples were tested using the commercially available capture enzyme linked Immunosorbent assay (ELISA) method for IgM and IgG. Real-time and nested polymerase chain reaction (PCR) tests were also done to find out the prevalent serotype. IgM:IgG ratio was evaluated by using receiver operating characteristic curve analysis for the differentiation of primary and secondary dengue. Results Among the total 91 serologically confirmed dengue patients, forty-seven (51.6%) were found to be primary, and forty-four (48.4%) were secondary dengue infections with male preponderance. Using the WHO diagnostic criteria, patients with dengue fever (DF) without warning signs added up to 51.6%, with warning signs 42.9% and severe dengue 5.5% of the total cases. The cut-off ratio of IgM:IgG ratio = 1.59 found the best discrimination between primary and secondary infection. Forty out of ninety-one (44%) patients exhibited ratios of > 1.59 whereas the rest fifty-one (56%) exhibited ratios of < 1.59. Dengue virus - 2 (DENV- 2) was found to be the most prevalent serotype. Conclusion Our study recommends the cut-off values for IgM:IgG ratio as 1.59. Therefore it is hoped that this will guide the clinicians to early distinguish between primary and secondary dengue. Furthermore, it can reduce morbidity and mortality because of dengue infections in the future.

Keywords: elisa; igm :igg ratio; pcr; primary dengue; secondary dengue.