A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis
Boelaert, M.; Rijal, S.; Regmi, S.; Singh, R.; Karki, B.; Jacquet, D.; Chappuis, Fçois.; Campino, L.; Desjeux, P.; Le Ray, D.; Koirala, S.; Van der Stuyft, P.
American Journal of Tropical Medicine and Hygiene 70(1): 72-77
2004
ISSN/ISBN: 0002-9637 PMID: 14971701 Document Number: 232315
We compared the validity of pancytopenia, formol-gel test (FGT), indirect fluorescence antibody test (IFAT), direct agglutination test (DAT) and rK39 dipstick test as diagnostic tests 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 was examined for Leishmania donovani. The 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%). The sensitivity estimates obtained by LCA were similar, but specificity estimates were substantially higher (DAT, 93.7 vs. 77.8%; rK39 dipstick test, 93.1 vs. 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.