Table 2.

Diagnostic tests for CHIKV infection.

Premise	Diagnostic method	Sample types	Sensitivity (%)	Specificity (%)	Advantages	Disadvantages	References
Detection of virus	Virus isolation (in vivo or in vitro)	Serum, plasma, whole blood, and fresh or FFPE tissues	Variable	100	Highly specific	Technical, laborious   Requires biosafety level 3 containment   May take 1-2 weeks	[1]
Detection of viral antigen	ELISA or immunochromatographic assay (ICA)	Serum and CSF	85 (serum)   80 (CSF)	89 (serum)   87 (CSF)	Early diagnosis	Commercial assays not widely available   Requires biosafety level 3 containment	[16, 17]
Detection of viral nucleic acid	RT-PCR	Serum and dried blood spots	100	Up to 100	Highly sensitive and specific   Rapid turnaround time   Multiplex available	Expensive reagents and specialized equipment	[13, 16, 18–20]
	Real-time RT-PCR		100	Up to 100	Multiplex available	Expensive reagents and specialized equipment
	Isothermal amplification methods (RT-LAMP)		100	95.25	Does not require specialized equipment (i.e., thermocyclers)
Detection of host antibody response	ELISA	Serum   CSF	IgM: 17 (serum); 48 (CSF)   IgG: 45 (serum); 63 (CSF)	IgM: 95 (serum)   IgG: 53 (serum)	Widely available   Relatively cheaper and easier to perform   Rapid bedside tests are available	Possible cross-reactivity with other alphaviruses   Elevated IgM does not distinguish recent past infection from acute infection	[4, 16, 17, 20–22]
	IFA	Serum	85–97	90–98	Sensitive and specific   Commercially available	Lack the ability to quantify antibodies, are subjective, and require special equipment and training
	PRNT	Serum			Very specific for alphaviruses; gold standard for confirmation of serologic test results	Requires the use of live virus (requires Biosafety level 3 containment)