A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis

被引:113
作者
Boelaert, M
Rijal, S
Regmi, S
Singh, R
Karki, B
Jacquet, D
Chappuis, F
Campino, L
Desjeux, P
Le Ray, D
Koirala, S
Van Der Stuyft, P
机构
[1] Inst Trop Med Prince Leopold, Dept Publ Hlth, B-2000 Antwerp, Belgium
[2] Inst Trop Med Prince Leopold, Dept Parasitol, B-2000 Antwerp, Belgium
[3] BP Koirala Inst Hlth Sci, Dept Med, Dharan, Nepal
[4] BP Koirala Inst Hlth Sci, Dept Pediat, Dharan, Nepal
[5] BP Koirala Inst Hlth Sci, Dept Microbiol, Dharan, Nepal
[6] Univ Hosp Geneva, Dept Community Med, Geneva, Switzerland
[7] Inst Higiene & Med Trop, Unidade Leishmanioses, Lisbon, Portugal
[8] WHO, CH-1211 Geneva, Switzerland
关键词
D O I
10.4269/ajtmh.2004.70.72
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
We compared the validity of pancytopenia, the formol-gel test (FGT), the indirect fluorescence antibody test (IFAT), the direct agglutination test (DAT), and the rK39 dipstick test as diagnostic criteria for visceral leishmaniasis (VL) in Nepal. Between September 2000 and January 2002, 310 clinical suspects had a bone marrow aspirate, and if negative, a spleen aspirate smear examined for Leishmania donovani. Sensitivity and specificity of all tests were determined compared with parasitology and by latent class analysis (LCA). Compared with parasitology, the sensitivities of the other tests were as follows: pancytopenia = 16.3% (95% confidence interval [CI] = 11.3-22.5%), FGT = 39.9% (95% CI = 32.7-47.4%), IFAT = 28.4% (95% CI = 22.0-35.5%), DAT = 95.1% (95% CI = 90.8-97.7%), and the rK39 dipstick test = 87.4% (95% CI = 81.7-91.9%). Sensitivity estimates obtained by LCA were similar, but specificity estimates were substantially higher (DAT = 93.7% versus 77.8%; rK39 dipstick test 93.1% versus 77.0%). The DAT or the rK39 dipstick test can replace parasitology as the basis of a decision to treat VL in Nepalese peripheral health services.
引用
收藏
页码:72 / 77
页数:6
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