A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos
Leptospirosis is a globally important cause of acute febrile illness, and a common cause of non-malarial fever in Asia, Africa, and Latin America. Simple rapid diagnostic tests (RDTs) are needed to enable health-care workers, particularly in low resource settings, to diagnose leptospirosis early and...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
American Society of Tropical Medicine and Hygiene
2018
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| _version_ | 1826275319789649920 |
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| author | Dittrich, S Boudthasavong, L Keokhamhoung, D Phuklia, W Craig, S Tulsiani, S Burns, M Weier, S Dance, D Davong, V Vongsouvath, M Mayxay, M Phetsouvanh, R Newton, P Woods, K |
| author_facet | Dittrich, S Boudthasavong, L Keokhamhoung, D Phuklia, W Craig, S Tulsiani, S Burns, M Weier, S Dance, D Davong, V Vongsouvath, M Mayxay, M Phetsouvanh, R Newton, P Woods, K |
| author_sort | Dittrich, S |
| collection | OXFORD |
| description | Leptospirosis is a globally important cause of acute febrile illness, and a common cause of non-malarial fever in Asia, Africa, and Latin America. Simple rapid diagnostic tests (RDTs) are needed to enable health-care workers, particularly in low resource settings, to diagnose leptospirosis early and give timely targeted treatment. This study compared four commercially available RDTs to detect human IgM against Leptospira spp. in a head-to-head prospective evaluation in Mahosot Hospital, Lao PDR. Patients with an acute febrile illness consistent with leptospirosis (N = 695) were included in the study during the 2014 rainy season. Samples were tested with four RDTs: ("Test-it" [Life Assay, South Africa; N = 418]; "Leptorapide" [Linnodee, Northern Ireland; N = 492]; "Dual Path Platform" [DPP] [Chembio; N = 530]; and "SD-IgM" [Standard Diagnostics, South Korea; N = 481]). Diagnostic performance characteristics were calculated and compared with a composite reference standard combining PCR (rrs), microscopic agglutination tests (MATs), and culture. Of all patients investigated, 39/695 (5.6%) were positive by culture, PCR, or MAT. The sensitivity and specificity of the RDTs ranged greatly from 17.9% to 63.6% and 62.1% to 96.8%, respectively. None of the investigated RDTs reached a sensitivity or specificity of > 90% for detecting Leptospira infections on admission. In conclusion, our investigation highlights the challenges associated with Leptospira diagnostics, particularly in populations with multiple exposures. These findings emphasize the need for extensive prospective evaluations in multiple endemic settings to establish the value of rapid tools for diagnosing fevers to allow targeted antibiotics. |
| first_indexed | 2024-03-06T22:56:55Z |
| format | Journal article |
| id | oxford-uuid:60b86254-e10d-4bb7-aa93-858450f0a15b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:56:55Z |
| publishDate | 2018 |
| publisher | American Society of Tropical Medicine and Hygiene |
| record_format | dspace |
| spelling | oxford-uuid:60b86254-e10d-4bb7-aa93-858450f0a15b2022-03-26T17:55:05ZA prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in LaosJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:60b86254-e10d-4bb7-aa93-858450f0a15bEnglishSymplectic Elements at OxfordAmerican Society of Tropical Medicine and Hygiene2018Dittrich, SBoudthasavong, LKeokhamhoung, DPhuklia, WCraig, STulsiani, SBurns, MWeier, SDance, DDavong, VVongsouvath, MMayxay, MPhetsouvanh, RNewton, PWoods, KLeptospirosis is a globally important cause of acute febrile illness, and a common cause of non-malarial fever in Asia, Africa, and Latin America. Simple rapid diagnostic tests (RDTs) are needed to enable health-care workers, particularly in low resource settings, to diagnose leptospirosis early and give timely targeted treatment. This study compared four commercially available RDTs to detect human IgM against Leptospira spp. in a head-to-head prospective evaluation in Mahosot Hospital, Lao PDR. Patients with an acute febrile illness consistent with leptospirosis (N = 695) were included in the study during the 2014 rainy season. Samples were tested with four RDTs: ("Test-it" [Life Assay, South Africa; N = 418]; "Leptorapide" [Linnodee, Northern Ireland; N = 492]; "Dual Path Platform" [DPP] [Chembio; N = 530]; and "SD-IgM" [Standard Diagnostics, South Korea; N = 481]). Diagnostic performance characteristics were calculated and compared with a composite reference standard combining PCR (rrs), microscopic agglutination tests (MATs), and culture. Of all patients investigated, 39/695 (5.6%) were positive by culture, PCR, or MAT. The sensitivity and specificity of the RDTs ranged greatly from 17.9% to 63.6% and 62.1% to 96.8%, respectively. None of the investigated RDTs reached a sensitivity or specificity of > 90% for detecting Leptospira infections on admission. In conclusion, our investigation highlights the challenges associated with Leptospira diagnostics, particularly in populations with multiple exposures. These findings emphasize the need for extensive prospective evaluations in multiple endemic settings to establish the value of rapid tools for diagnosing fevers to allow targeted antibiotics. |
| spellingShingle | Dittrich, S Boudthasavong, L Keokhamhoung, D Phuklia, W Craig, S Tulsiani, S Burns, M Weier, S Dance, D Davong, V Vongsouvath, M Mayxay, M Phetsouvanh, R Newton, P Woods, K A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos |
| title | A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos |
| title_full | A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos |
| title_fullStr | A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos |
| title_full_unstemmed | A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos |
| title_short | A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos |
| title_sort | prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in laos |
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