Systematic Review into Diagnostics for Post-Kala-Azar Dermal Leishmaniasis (PKDL)

Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). We summarized the published literature about the accuracy of diagnostic tests for PKDL. We searched Medline for eligible studies investigating the diagnostic accuracy of any test for PKDL. Study quality was assessed using QUADAS-2. Data were extracted from 21 articles including 43 separate studies. Twenty-seven studies evaluated serological tests (rK39 dipstick, ELISA, DAT, and leishmanin tests), six studies molecular tests, eight microscopy, and two cultures. Only a few of these studies reported a valid estimate of diagnostic accuracy, as most were case-control designs or used a reference standard with low sensitivity. The included studies were very heterogeneous, for example, due to a large variety of reference standards used. Hence, no summary estimates of sensitivity or specificity could be made. We recommend well-designed diagnostic accuracy trials that evaluate, side-by-side, all currently available diagnostics, including clinical symptoms, serological, antigen, molecular, and parasitological tests and possible use of statistical modelling to evaluate diagnostics when there is no suitable gold standard.

Download Full-text

Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms

Cadernos de Saúde Pública ◽

10.1590/0102-311x00069921 ◽

2022 ◽

Vol 38 (1) ◽

Author(s):

Caroline Nespolo de David ◽

Fernanda Hammes Varela ◽

Ivaine Tais Sauthier Sartor ◽

Márcia Polese-Bonatto ◽

Ingrid Rodrigues Fernandes ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Clinical Symptoms ◽

Point Of Care ◽

Rapid Test ◽

Lateral Flow Immunoassay ◽

Optimal Time ◽

Rt Pcr ◽

Serological Tests ◽

Over Time

Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants’ status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.

Download Full-text

Chapter 10: Diagnosis

Tick-borne encephalitis - The Book ◽

10.33442/978-981-14-0914-1_10 ◽

2019 ◽

Cited By ~ 1

Author(s):

Gerhard Dobler

Keyword(s):

Cerebrospinal Fluid ◽

Viral Encephalitis ◽

Clinical Symptoms ◽

Serological Tests ◽

Specific Antibodies ◽

Cross Reactions ◽

Neuro Imaging ◽

Tbev Infection

• TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from oth-er forms of viral encephalitis or other diseases. • Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. • Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detec-tion of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. • During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. • Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either Infection with other flaviviruses or with other flavivirus vaccines.

Download Full-text

Chapter 10: Diagnosis

Tick-borne encephalitis - The Book ◽

10.33442/26613980_10-3 ◽

2020 ◽

Keyword(s):

Cerebrospinal Fluid ◽

Viral Encephalitis ◽

Clinical Symptoms ◽

Serological Tests ◽

Specific Antibodies ◽

Cross Reactions ◽

Neuro Imaging ◽

Tbev Infection

TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from other forms of viral encephalitis or other diseases. Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detection of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either infection with other flaviviruses or with other flavivirus vaccines.

Download Full-text

Validity of a Serological Diagnostic Kit for SARS-CoV-2 Available in Iran

Archives of Iranian Medicine ◽

10.34172/aim.2020.75 ◽

2020 ◽

Vol 23 (9) ◽

pp. 629-632

Author(s):

Hamid Reza Shamsollahi ◽

Mostafa Amini ◽

Shaban Alizadeh ◽

Saharnaz Nedjat ◽

Ali Akbari-Sari ◽

...

Keyword(s):

Diagnostic Techniques ◽

Effective Control ◽

Molecular Technique ◽

Size Estimation ◽

Medical Sciences ◽

Serological Tests ◽

Standard Case ◽

Epidemic Size ◽

Low Sensitivity ◽

Negative Controls

Background: The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic broke out in December 2019 and is now characterized as a pandemic. Effective control of this infectious disease requires access to diagnostic techniques, for both case finding and epidemic size estimation. The molecular technique is routinely used worldwide. Although it is the "standard" case detection and management method, it has its own shortcomings. Thus, some easy-to-use rapid serological tests have been developed. Methods: One hundred and fourteen positive RT-PCR-diagnosed patients were tested by VivaDiag Kit, a brand of rapid serological kits available in hospitals affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. Frozen serum specimens taken from healthy people in summer and fall 2019 were also tested as negative controls. Results: Test sensitivity was 47.9% (95% confidence interval [CI]: 38.8-56.9) for IgM and 47.0% (95% CI: 38.0–56.0) for IgG. There was no difference between IgG and IgM seropositivity except in one case. Specificity was calculated as 99.0% (95% CI: 96.4–99.9) for IgM and of 100.0% (95% CI: 0.98.2–100.0) for IgG. Sensitivity was higher in men and older participants. Conclusion: This test can be used for epidemiological investigations, especially for the estimation of the level of infection in the community, after it is properly corrected for sensitivity and specificity. The low sensitivity could be attributed to the technical limitations of the kit or low levels of antibodies after infection. The different sensitivity in age and sex groups supports the hypothesis that different people show different immune responses to this virus.

Download Full-text

Etiology and clinical features of epididymo-orchitis: A single-center study in Tehran, Iran

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200218115400 ◽

2020 ◽

Vol 20 ◽

Cited By ~ 1

Author(s):

Sara Abolghasemi ◽

Mohammad Alizadeh ◽

Ali Hashemi ◽

Shabnam Tehrani

Keyword(s):

Chlamydia Trachomatis ◽

Clinical Symptoms ◽

Urine Culture ◽

Clinical Manifestations ◽

Urinary Frequency ◽

Serological Tests ◽

Duration Of Symptoms ◽

Two Samples ◽

History Of ◽

Tract Infections

Introduction: Epididymo-orchitis is a common urological disease among men. Little is known about the clinical and epidemiological aspects of the disease in Iran. Thus, the present study was aimed to investigate the etiology, clinical sequelae and risk factors of patients with epididymo-orchitis in Tehran, Iran. Materials and Methods: Patients presenting with epididymo-orchitis were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, molecular and serological tests were undertaken to look for Chlamydia trachomatis, Neisseria gonorrhoeae, Brucella spp., Mycoplasma spp, and other bacteria. Results: Fifty patients with epididymo-orchitis were evaluated according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The mean age of the patients was 53 years. Fever, dysuria, pain in the flanks, urinary frequency and discharges occurred in 58.0%, 50.0%, 50.0%, 28.0% and 6.0%, respectively. Bacterial pathogen was identified in 26% (13/50) of patients by urine culture. Escherichia coli was the etiological agent in 11/13 patients (84.6%). Two out of 50 patients (4.0%) were also positive for Chlamydia trachomatis. Two samples were serologically positive for Brucella spp. High Mean age, fever, urinary frequency, history of the underlying disease and history of urinary tract infections were found to have a significant association with the positive bacteriologic urine culture (P<0.05). Conclusions: The most common clinical manifestations were fever, dysuria, and abdominal pain. E. coli and C. trachomatis were the major causative agents. Use of a set of diagnostic approaches including clinical symptoms, urine culture and more precise techniques such as PCR should be taken into consideration for the definitive diagnosis.

Download Full-text

The Peguero-Lo Presti criteria has the highest diagnostic accuracy for the diagnosis of left ventricular hypertrophy in the elderly

European Heart Journal ◽

10.1093/ehjci/ehaa946.3230 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.A.M Tavares ◽

N Samesima ◽

L.A Hajjar ◽

L.C Godoy ◽

E.M.P Hirano ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Diagnostic Accuracy ◽

Ventricular Hypertrophy ◽

The Elderly ◽

Left Ventricular ◽

Accuracy Score ◽

Increased Sensitivity ◽

Low Sensitivity ◽

Ecg Criteria ◽

Improved Accuracy

Abstract Background Left Ventricular Hypertrophy (LVH) is an independent predictor of mortality and cardiovascular morbidity and the 12-lead ECG is recommended as a universal screening for patients with hypertension. However, the ECG has low sensitivity and there is limited data in patients 70 years or older. The recently published Peguero-Lo Presti (PLP) criteria had improved accuracy compared with other ECG criteria but with very few patients with age ≥70 years included. Purpose To compare the accuracy of the PLP criteria versus the traditional ECG criteria for detecting LVH in patients ≥70 years. Methods Retrospective single-center study. Patients were included if they were 70 years or older and underwent an ECG and echocardiogram (gold standard) less than 180 days apart from jan/2017 to mar/2018. Patients with left or right bundle branch block, non-sinus rhythm or ventricular paced rhythm were excluded. All tracings were independently reviewed by two cardiologists, blinded to the echocardiogram. The PLP criteria was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL), and Romhilt-Estes 4 and 5 (RE) criteria. LVH was defined as a left ventricular mass index >115 g/m2 in males and >95 g/m2 in females, according to the echocardiogram. McNemar's test, F1 score, and the area under the Receiver Operating Characteristic curves (AUC) were used to compare the diagnostic performance of the tests Results A total of 592 patients were included (mean age 77.5 years, SD: 5.9; 50.8% were women). The PLP criteria had increased sensitivity compared with both the SL and CV criteria (p<0.0001 for both comparisons) and RE5 (p=0.042). PLP also had better specificity than the RE4 criteria (p<0.0001) and the highest F1 accuracy score (Table 1). The AUC of the PLP was significantly higher than the AUC of the CV and RE criteria (0.70 vs 0.66 vs 0.64, respectively, p<0.05) and numerically higher than the SL criteria (AUC=0.67, p=0.311, Figure 1). Conclusion Compared to the traditional ECG criteria for LVH, the PLP criteria had the highest diagnostic accuracy in elderly patients. Figure 1. AUC of the ECG criteira Funding Acknowledgement Type of funding source: None

Download Full-text

381 Role of CT scans of abdomen and pelvis in management of patients with immunotherapy-induced colitis

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0381 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A406-A406

Author(s):

Juan Ibarra Rovira ◽

Raghunandan Vikram ◽

Selvi Thirumurthi ◽

Bulent Yilmaz ◽

Heather Lin ◽

...

Keyword(s):

Negative Predictive Value ◽

Clinical Diagnosis ◽

Predictive Value ◽

Clinical Symptoms ◽

Cytotoxic T Lymphocyte ◽

Checkpoint Inhibitors ◽

Ct Scans ◽

Wall Thickening ◽

Low Sensitivity ◽

Sensitivity Specificity

BackgroundColitis is one of the most common immune-related adverse event in patients who receive immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Although radiographic changes are reported on computed tomography such as mild diffuse bowel thickening or segmental colitis, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well studied.MethodsCT scans of the abdomen and pelvis of 34 patients on immunotherapy with a clinical diagnosis of immunotherapy induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (control) were enrolled in this retrospective study. Segments of the colon (rectum, sigmoid, descending, transverse, ascending and cecum) were assessed independently by two fellowship trained abdominal imaging specialists with 7 and 13 years‘ experience who were blinded to the clinical diagnosis. Each segment was assessed for mucosal enhancement, wall thickening, distension, peri-serosal fat stranding. Any disagreements were resolved in consensus. The degree of distension and the spurious assignment of wall thickening were the most common causes for disagreement. The presence of any of the signs was considered as radiographic evidence of colitis.ResultsCT evidence of colitis was seen in 16 of 34 patients with symptoms of colitis. 7 of 19 patients who did not have symptoms of colitis showed signs of colitis on CT. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for colitis on CT is 47%, 63.2%, 69.5% and 40%, respectively.ConclusionsCT has a low sensitivity, specificity and negative predictive value for the diagnosis of immunotherapy-induced colitis. CT has no role in the diagnosis of patients suspected of having uncomplicated immune-related colitis and should not be used routinely for management.Trial RegistrationThis protocol is not registered on clinicaltrials.gov.Ethics ApprovalThis protocol was IRB approved on: 11/16/2015 - IRB 4 Chair Designee FWA #: 00000363 OHRP IRB Registration Number: IRB 4 IRB00005015ConsentThis protocol utilizes an IRB approved waiver of consent.

Download Full-text

Diagnosis and Treatment Algorythm in Lyme Neuroborreliosis

Acta Medica Marisiensis ◽

10.1515/amma-2015-0125 ◽

2016 ◽

Vol 62 (1) ◽

pp. 121-127

Author(s):

Brîndușa Țilea ◽

Rodica Bălașa ◽

Andrea Fodor ◽

Țilea Ioan

Keyword(s):

Borrelia Burgdorferi ◽

Bacterial Species ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Lyme Neuroborreliosis ◽

Early Administration ◽

Serological Tests ◽

Initiation Of Therapy ◽

Low Sensitivity ◽

Third Generation Cephalosporins

AbstractLyme neuroborreliosis is an infection of the nervous system caused by spirochetes of the Borrelia burgdorferi sensulato group. Neurological clinical manifestations usually present a steady evolution and are different in patients from Europe compared to those from America, possibly due to vector agents and different bacterial species. Various diagnostic markers were studied in consideration of a clear or possible diagnosis of the disease, because evolution and complications depend on early diagnosis and initiation of therapy. The isolation of the bacterium is difficult, microscopic examination and the bacterial dezoxiribonucleic acid amplification shows low sensitivity. However, the diagnosis of Lyme neuroborreliosis is mainly based on serological methods that have a satisfactory sensitivity and specificity. A correct diagnosis can be performed by strictly respecting clinical guidelines and protocols and carefully interpreting the serological tests. The presence of anti-borrelia burgdorferi antibodies in the cerebrospinal fluid with evidence of intrathecal antibody production is the gold standard diagnosis of Lyme neuroborreliosis. Early administration of antibiotic treatment (third generation cephalosporins, cyclins, aminopenicillins) can produce the remission of neurological symptoms, the eradication of spirochetes in acute phase of the disease, thus avoiding the development of the chronic disease.

Download Full-text

Previremic Identification of Ebola or Marburg Virus Infection Using Integrated Host-Transcriptome and Viral Genome Detection

mBio ◽

10.1128/mbio.01157-20 ◽

2020 ◽

Vol 11 (3) ◽

Author(s):

Emily Speranza ◽

Ignacio Caballero ◽

Anna N. Honko ◽

Joshua C. Johnson ◽

J. Kyle Bohannon ◽

...

Keyword(s):

Host Response ◽

Nonhuman Primates ◽

Ebola Virus ◽

Clinical Symptoms ◽

Infectious Agent ◽

Marburg Virus ◽

Viral Rna ◽

Molecular Tests ◽

Early Replication ◽

Host Infection

ABSTRACT Outbreaks of filoviruses, such as those caused by the Ebola (EBOV) and Marburg (MARV) virus, are difficult to detect and control. The initial clinical symptoms of these diseases are nonspecific and can mimic other endemic pathogens. This makes confident diagnosis based on clinical symptoms alone impossible. Molecular diagnostics for these diseases that rely on the detection of viral RNA in the blood are only effective after significant disease progression. As an approach to identify these infections earlier in the disease course, we tested the effectiveness of viral RNA detection combined with an assessment of sentinel host mRNAs that are upregulated following filovirus infection. RNAseq analysis of EBOV-infected nonhuman primates identified host RNAs that are upregulated at early stages of infection. NanoString probes that recognized these host-response RNAs were combined with probes that recognized viral RNA and were used to classify viral infection both prior to viremia and postviremia. This approach was highly successful at identifying samples from nonhuman primate subjects and correctly distinguished the causative agent in a previremic stage in 10 EBOV and 5 MARV samples. This work suggests that unified host response/viral fingerprint assays can enable diagnosis of disease earlier than testing for viral nucleic acid alone, which could decrease transmission events and increase therapeutic effectiveness. IMPORTANCE Current molecular tests that identify infection with high-consequence viruses such as Ebola virus and Marburg virus are based on the detection of virus material in the blood. These viruses do not undergo significant early replication in the blood and, instead, replicate in organs such as the liver and spleen. Thus, virus begins to accumulate in the blood only after significant replication has already occurred in those organs, making viremia an indicator of infection only after initial stages have become established. Here, we show that a multianalyte assay can correctly identify the infectious agent in nonhuman primates (NHPs) prior to viremia through tracking host infection response transcripts. This illustrates that a single-tube, sample-to-answer format assay could be used to advance the time at which the type of infection can be determined and thereby improve outcomes.

Download Full-text

Occurrence of infectious laringotracheitis on farms in Vojvodina

Veterinarski glasnik ◽

10.2298/vetgl0302031o ◽

2003 ◽

Vol 57 (1-2) ◽

pp. 31-35

Author(s):

Dusan Orlic ◽

Milos Kapetanov ◽

Mira Kovacevic ◽

Maja Velhner ◽

Dragica Stojanovic

Keyword(s):

Hydrogen Peroxide ◽

Egg Production ◽

Clinical Observation ◽

Virus Isolation ◽

Clinical Symptoms ◽

Serological Tests

For over 10 years infectious laringotracheitis has occurred rarely in Vojvodina. In such situations morbidity was 40% and mortality was 16%. Drop in egg production was over 30% and after 4 weeks egg production returned to normal. After the disappearance of clinical symptoms and after 30 days of quarantine and disinfection of eggs with formaldehyde and 5% hydrogen peroxide there was no appearance of the disease in hatched chickens. Clinical observation and pathohistology results are valuable proof for diagnosis of ILT. Diagnosis of ILT should be confirmed by virus isolation or applying serological tests such as ELISA on sera from diseased chickens.

Download Full-text