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Diagnostic accuracy of qPCR and microscopy for cutaneous leishmaniasis in rural Ecuador: A Bayesian latent class analysis.
Bezemer, Jacob M; Merckx, Joanna; Freire Paspuel, Byron P; Calvopiña, Manuel; de Vries, Henry J C; Schallig, Henk D F H; Leeflang, Mariska M G; Dendukuri, Nandini.
Afiliação
  • Bezemer JM; Hospital Shell, Fundación Misión Cristiana de Salud, Shell, Pastaza, Ecuador.
  • Merckx J; Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Amsterdam University Medical Centers location Academic Medical Center at the University of Amsterdam, Amsterdam, the Netherlands.
  • Freire Paspuel BP; Amsterdam Institute for infection and Immunity, Infectious Diseases Program, Amsterdam, the Netherlands.
  • Calvopiña M; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
  • de Vries HJC; Department of Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
  • Schallig HDFH; Laboratorios de Investigación, Universidad de las Américas, Quito, Ecuador.
  • Leeflang MMG; Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Dendukuri N; OneHealth Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador.
PLoS Negl Trop Dis ; 17(11): e0011745, 2023 Nov.
Article em En | MEDLINE | ID: mdl-38019756
BACKGROUND: Clinical and laboratory diagnosis of cutaneous leishmaniasis (CL) is hampered by under-ascertainment of direct microscopy. METHODS: This study compared the diagnostic accuracy of qPCR on DNA extracted from filter paper to the accuracy of direct smear slide microscopy in participants presenting with a cutaneous lesion suspected of leishmaniasis to 16 rural healthcare centers in the Ecuadorian Amazon and Pacific regions, from January 2019 to June 2021. We used Bayesian latent class analysis to estimate test sensitivity, specificity, likelihood ratios (LR), and predictive values (PV) with their 95% credible intervals (95%CrI). The impact of sociodemographic and clinical characteristics on predictive values was assessed as a secondary objective. RESULTS: Of 320 initially included participants, paired valid test results were available and included in the diagnostic accuracy analysis for 129 from the Amazon and 185 from the Pacific region. We estimated sensitivity of 68% (95%CrI 49% to 82%) and 73% (95%CrI 73% to 83%) for qPCR, and 51% (95%CrI 36% to 66%) and 76% (95%CrI 65% to 86%) for microscopy in the Amazon and Pacific region, respectively. In the Amazon, with an estimated disease prevalence among participants of 73%, negative PV for qPCR was 54% (95%CrI 5% to 77%) and 44% (95%CrI 4% to 65%) for microscopy. In the Pacific, (prevalence 88%) the negative PV was 34% (95%CrI 3% to 58%) and 37% (95%CrI 3% to 63%). The addition of qPCR parallel to microscopy in the Amazon increases the observed prevalence from 38% to 64% (+26 (95%CrI 19 to 34) percentage points). CONCLUSION: The accuracy of either qPCR on DNA extracted from filter paper or microscopy for CL diagnosis as a stand-alone test seems to be unsatisfactory and region-dependent. We recommend further studies to confirm the clinically relevant increment found in the diagnostic yield due to the addition of qPCR.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Leishmaniose Cutânea / Microscopia Limite: Humans País como assunto: America do sul / Ecuador Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Leishmaniose Cutânea / Microscopia Limite: Humans País como assunto: America do sul / Ecuador Idioma: En Ano de publicação: 2023 Tipo de documento: Article