What are the best diagnostic tests for diagnosing bacterial arthritis of a native joint?

Aims This study aimed to answer two questions: what are the best diagnostic methods for diagnosing bacterial arthritis of a native joint?; and what are the most commonly used definitions for bacterial arthritis of a native joint? Methods We performed a search of PubMed, Embase, and Cochrane libraries for relevant studies published between January 1980 and April 2020. Of 3,209 identified studies, we included 27 after full screening. Sensitivity, specificity, area under the curve, and Youden index of diagnostic tests were extracted from included studies. We grouped test characteristics per diagnostic modality. We extracted the definitions used to establish a definitive diagnosis of bacterial arthritis of a native joint per study. Results Overall, 28 unique diagnostic tests for diagnosing bacterial arthritis of a native joint were identified. The following five tests were deemed most useful: serum ESR (sensitivity: 34% to 100%, specificity: 23% to 93%), serum CRP (sensitivity: 58% to 100%, specificity: 0% to 96%), serum procalcitonin (sensitivity: 0% to 100%, specificity: 68% to 100%), the proportion of synovial polymorphonuclear cells (sensitivity: 42% to 100%, specificity: 54% to 94%), and the gram stain of synovial fluid (sensitivity: 27% to 81%, specificity: 99% to 100%). Conclusion Diagnostic methods with relatively high sensitivities, such as serum CRP, ESR, and synovial polymorphonuclear cells, are useful for screening. Diagnostic methods with a relatively high specificity, such as serum procalcitonin and synovial fluid gram stain, are useful for establishing a diagnosis of bacterial arthritis. This review helps to interpret the value of various diagnostic tests for diagnosing bacterial arthritis of a native joint in clinical practice. Cite this article: Bone Joint J 2021;103-B(12):1745–1753.

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A comparative evaluation of three methods for the rapid diagnosis of cryptococcal meningitis (CM) among HIV-infected patients in Northern Malawi

Malawi Medical Journal ◽

10.4314/mmj.v32i1.2 ◽

2020 ◽

Vol 32 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Master Chisale

Keyword(s):

Diagnostic Tests ◽

Target Population ◽

Rapid Diagnosis ◽

Lateral Flow ◽

Lateral Flow Assay ◽

Diagnostic Methods ◽

Gram Stain ◽

Cross Sectional ◽

Timely Initiation ◽

India Ink

IntroductionCryptococcal meningitis (CM) is the most common systemic fungal infection in patients with HIV infection. Rapid diagnosis and timely initiation of antifungal therapy are key to reducing mortality rate associated with CM. This study aims to evaluate the ability of four different diagnostic tests (Gram stain, India ink, and two types of commercial lateral flow assay [LFA]) to identify CM-positive patients and to compare the sensitivity and specificity of these tests.MethodsThis was a prospective cross-sectional study on diagnostic tests accuracy conducted in Northern Malawi. The target population was HIV-infected adult patients presenting with features of meningitis. Four types of diagnostic tests were conducted: India ink, Gram stain, and two types of commercial lateral flow assay (LFA) (Immy, Inc., OK, USA and Dynamiker Biotechnology (Tianjin) Co., Ltd), Singapore). Culture was conducted as the reference standard.ResultsA total of 265 samples were collected. The rate of positive CM detection ranged from 6.4% (using India ink) to 14.3% (using LFA). India ink exhibited the lowest sensitivity of 54.8% (95% confidence interval [CI]: 36.0%–72.7%), followed by Gram stain (61.3%; 95% CI: 42.2%–78.2%). The Dynamiker LFA exhibited the highest sensitivity of 100.0% (95% CI: 90.0%–100.0%) but a lower specificity (97.0%; 93.9%–98.8%) compared to the Immy LFA (98.3%; 95% CI: 95.7%–99.5%). ConclusionLFA diagnostic methods have the potential to double the detection rate of CM-positive patients in resource-limited countries such as Malawi. As such, LFAs should be considered to become the main diagnostic tests used for CM diagnostics in these countries. Our data indicate that LFAs may be the best method for diagnosing CM and exhibits the highest diagnostic accuracy as it has shown that it outperforms cell culture, the current gold standard.

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Combination of Synovial Fluid IL-4 and Polymorphonuclear Cell Percentage Improves the Diagnostic Accuracy of Chronic Periprosthetic Joint Infection

10.21203/rs.3.rs-749524/v1 ◽

2021 ◽

Author(s):

Jiaxing Huang ◽

Jiawei wang ◽

Lei lei Qin ◽

Bo Zhu ◽

Sizheng Zhu ◽

...

Keyword(s):

Synovial Fluid ◽

Diagnostic Accuracy ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Diagnostic Value ◽

Polymorphonuclear Cells ◽

Polymorphonuclear Cell ◽

Cell Percentage ◽

Serum Crp

Abstract Background: Synovial fluid biomarkers have been confirmed with promising diagnostic value for chronic periprosthetic joint infection (PJI), even there was still no “gold standard”. Interleukin-4 (IL-4) and polymorphonuclear cells (neutrophil) count in synovial fluid play a crucial role in mediating local inflammation of bacterial infections and therefore could be valuable biomarkers for PJI. Methods: The purpose of this study was to investigate the diagnostic capacity of synovial fluid IL4 (SF-IL4) and polymorphonuclear cell percentage(SF-PMN%) for chronic PJI. According to the 2013 Musculoskeletal Infections Society(MSIS 2013) criteria, chronic PJI is defined as occurred more than 6 weeks after the primary arthroplasty. A total of 110 patients who scheduled to undergo revision arthroplasty from January 2019 to October 2020 were enrolled. 11 patients were eliminated by exclusion criteria. 43 of 99 patients were classified as infected and 56 as not infected. In all patients, SF-IL4 and SF-PMN% were measured in synovial fluid, serum CRP, ESR levels were measured preoperatively. The area under the curve(AUC) for each biomarker was analyzed, the diagnostic value and optimal cutoff values were calculated. Results: The demographic data was not statistically different. The SF-IL4 and SF-PMN% showed a great diagnostic accuracy of chronic PJI from aseptic failure patients with AUC of 0.97(95% confidence interval (CI), 0.92-0.99) and 0.89(95%CI, 0.82-0.95) separately, which was higher than the serum ESR (0.72), and serum CRP (0.83). We set 1.7 pg/mL and 75% as the optimal cut-off values of SF-IL4 and SF-PMN% individually. Combination of SF-IL4 and SF-PMN% improved the diagnostic ability for chronic PJI with a specificity of 97.0%, and 96.0% accuracy.Conclusion: Synovial fluid IL-4 was a valuable biomarker for chronic PJI detection. Combination of SF-IL4 and SF-PMN% provided higher specificity and accuracy when met the cut-off values of 1.7 pg/mL and 75% simultaneously.

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Chronic Wasting Disease Options of Surveillance in Carpathian Cervids: from the Identification of Characteristic Microscopic Pathologic Changes to Prionic Seeded Conversion and Amplification Assays

Revista de Chimie ◽

10.37358/rc.20.3.8022 ◽

2001 ◽

Vol 71 (3) ◽

pp. 480-486

Author(s):

Florica Barbuceanu ◽

Stelian Baraitareanu ◽

Stefania-Felicia Barbuceanu ◽

Gabriel Predoi

Keyword(s):

Enzyme Immunoassay ◽

Diagnostic Tests ◽

Chronic Wasting Disease ◽

Rapid Diagnostic Tests ◽

Diagnostic Methods ◽

Wasting Disease ◽

Western Immunoblotting ◽

Negative Results ◽

Antigen Capture ◽

Confirmatory Tests

This paper describes the current diagnostic methods of Chronic Wasting Disease (CWD) in cervides used between 2013 and 2017 in Romania. The active surveillance of CWD involves the targeted groups screening by using rapid diagnostic tests (e.g., antigen capture enzyme immunoassay). If the first test does not provide certain negative results, then the confirmatory methods have been used, i.e. histopathology, immunohistochemistry and Western immunoblotting. These tests did not lead to the detection of CWD prions (PrPCWD) in Romania. This may be due to the absence or insufficient quantity of PrPCWD in samples, below the threshold of confirmatory tests.

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Enteric Fever Diagnosis: Current Challenges and Future Directions

Pathogens ◽

10.3390/pathogens10040410 ◽

2021 ◽

Vol 10 (4) ◽

pp. 410

Author(s):

Durga P. Neupane ◽

Hari P. Dulal ◽

Jeongmin Song

Keyword(s):

Diagnostic Tests ◽

Enteric Fever ◽

Asymptomatic Carrier ◽

Diagnostic Methods ◽

Effective Control ◽

Future Directions ◽

Clinical Presentations ◽

Global Spread ◽

Life Threatening ◽

Pros And Cons

Enteric fever is a life-threatening systemic febrile disease caused by Salmonella enterica serovars Typhi and Paratyphi (S. Typhi and S. Paratyphi). Unfortunately, the burden of the disease remains high primarily due to the global spread of various drug-resistant Salmonella strains despite continuous advancement in the field. An accurate diagnosis is critical for effective control of the disease. However, enteric fever diagnosis based on clinical presentations is challenging due to overlapping symptoms with other febrile illnesses that are also prevalent in endemic areas. Current laboratory tests display suboptimal sensitivity and specificity, and no diagnostic methods are available for identifying asymptomatic carriers. Several research programs have employed systemic approaches to identify more specific biomarkers for early detection and asymptomatic carrier detection. This review discusses the pros and cons of currently available diagnostic tests for enteric fever, the advancement of research toward improved diagnostic tests, and the challenges of discovering new ideal biomarkers and tests.

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Tick-borne zoonoses and commonly used diagnostic methods in human and veterinary medicine

Parasitology Research ◽

10.1007/s00436-020-07033-3 ◽

2021 ◽

Author(s):

Andrea Springer ◽

Antje Glass ◽

Julia Probst ◽

Christina Strube

Keyword(s):

Veterinary Medicine ◽

Diagnostic Tests ◽

One Health ◽

Animal Health ◽

Diagnostic Techniques ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Zoonotic Pathogens ◽

Health Concept ◽

The One

AbstractAround the world, human health and animal health are closely linked in terms of the One Health concept by ticks acting as vectors for zoonotic pathogens. Animals do not only maintain tick cycles but can either be clinically affected by the same tick-borne pathogens as humans and/or play a role as reservoirs or sentinel pathogen hosts. However, the relevance of different tick-borne diseases (TBDs) may vary in human vs. veterinary medicine, which is consequently reflected by the availability of human vs. veterinary diagnostic tests. Yet, as TBDs gain importance in both fields and rare zoonotic pathogens, such as Babesia spp., are increasingly identified as causes of human disease, a One Health approach regarding development of new diagnostic tools may lead to synergistic benefits. This review gives an overview on zoonotic protozoan, bacterial and viral tick-borne pathogens worldwide, discusses commonly used diagnostic techniques for TBDs, and compares commercial availability of diagnostic tests for humans vs. domestic animals, using Germany as an example, with the aim of highlighting existing gaps and opportunities for collaboration in a One Health framework.

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Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

Journal of the American Academy of Audiology ◽

10.1055/s-0040-1718931 ◽

2020 ◽

Author(s):

Luma Cordeiro Rodrigues ◽

Silvia Ferrite ◽

Ana Paula Corona

Keyword(s):

Hearing Loss ◽

High Specificity ◽

Hearing Screening ◽

Youden Index ◽

Hearing Level ◽

Predictive Values ◽

Auditory Thresholds ◽

The Mean ◽

Low Sensitivity ◽

Sensitivity Specificity

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

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Arthritis and Diagnostics in Lyme Disease

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6010018 ◽

2021 ◽

Vol 6 (1) ◽

pp. 18

Author(s):

Javier A. Quintero ◽

Raluchukwu Attah ◽

Reena Khianey ◽

Eugenio Capitle ◽

Steven E. Schutzer

Keyword(s):

Lyme Disease ◽

Borrelia Burgdorferi ◽

Diagnostic Tests ◽

Laboratory Tests ◽

Diagnostic Methods ◽

Lyme Arthritis ◽

Differential Diagnoses ◽

Antibody Testing ◽

Active Infection ◽

Indirect Measure

The diagnosis of Lyme disease, caused by Borrelia burgdorferi, is clinical but frequently supported by laboratory tests. Lyme arthritis is now less frequently seen than at the time of its discovery. However, it still occurs, and it is important to recognize this, the differential diagnoses, and how laboratory tests can be useful and their limitations. The most frequently used diagnostic tests are antibody based. However, antibody testing still suffers from many drawbacks and is only an indirect measure of exposure. In contrast, evolving direct diagnostic methods can indicate active infection.

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Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313212 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1296-1300 ◽

Cited By ~ 3

Author(s):

Fahriye Groen-Hakan ◽

Laura Eurelings ◽

Aniki Rothova ◽

Jan van Laar

Keyword(s):

Diagnostic Tests ◽

Medical Center ◽

Age At Onset ◽

Diagnostic Value ◽

Youden Index ◽

First Episode ◽

Operating Characteristics ◽

Non Invasive ◽

Erasmus Medical ◽

Uveitis Attack

Background/aimsThe diagnostic properties of conventional diagnostic tests (ACE and chest radiography) for sarcoidosis-associated uveitis are not ideal. The diagnostic value of lymphopaenia for sarcoidosis-associated uveitis is investigated.MethodsA retrospective study of 191 consecutive patients with a first uveitis episode visiting the ophthalmology department (Erasmus Medical Center, Rotterdam, The Netherlands). Receiver operating characteristics (ROC) analysis was performed and compared with known ROC values from literature of conventional diagnostic tests for sarcoidosis-associated uveitis. An ideal cut-off was determined for lymphopaenia by calculation of the highest Youden index.ResultsOut of all patients with first uveitis attack, 32/191 or 17% were subsequently diagnosed with biopsy-proven or radiological diagnosis of sarcoidosis. Lymphopaenia (<1.5×109/L) was significantly more often observed in patients with sarcoidosis-associated uveitis compared with patients with non-sarcoidosis-associated uveitis (p<0.05). The sensitivity and specificity of lymphopaenia was 75 % and 77 %, respectively. The optimal cut-off for lymphopaenia for diagnosing sarcoidosis-associated uveitis was 1.47 ×109/L. Lymphopaenia resulted in a 12.0 (95% CI 4.7 to 30.5 fold risk for having sarcoidosis, corrected for sex, race and age at onset of uveitis in patients with a first uveitis attack.ConclusionLymphopaenia is a non-invasive and useful marker for diagnosing sarcoidosis-associated uveitis.

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Development of a multiplex and sensitive lateral flow immunoassay for the diagnosis of periprosthetic joint infection

Scientific Reports ◽

10.1038/s41598-019-52051-6 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Tsung-Ting Tsai ◽

Tse-Hao Huang ◽

Natalie Yi-Ju Ho ◽

Yu-Pei Chen ◽

Chung-An Chen ◽

...

Keyword(s):

Synovial Fluid ◽

Clinical Diagnosis ◽

Periprosthetic Joint Infection ◽

Diagnostic Tests ◽

Joint Infection ◽

Lateral Flow ◽

Rapid Response ◽

Detection Sensitivity ◽

Lateral Flow Immunoassay ◽

Enzyme Linked Immunosorbent Assay

Abstract The diagnosis of periprosthetic joint infection (PJI) remains a challenge. However, recent studies showed that synovial fluid biomarkers have demonstrated greater diagnostic accuracy than the currently used PJI diagnostic tests. In many diagnostic tests, combining several biomarkers into panels is critical for improving diagnostic efficiency, enhancing the diagnostic precision for specific diseases, and reducing cost. In this study, we prove that combining alpha-defensin and C-reactive protein (CRP) as biomarkers possesses the potential to provide accurate PJI diagnosis. To further verify the result, we developed a multi-target lateral flow immunoassay strip (msLFIA) with staking pad design to obtain on-site rapid response for clinical diagnosis of PJI. A total of 10 synovial fluid samples were tested using the msLFIA, and the results showed that the combined measurements of synovial fluid alpha-defensin and CRP levels were consistent with those obtained from a commercial enzyme-linked immunosorbent assay kit. In addition, we developed a multi-target lateral flow immunoassay strip (msLFIA) with staking pad design to obtain on-site rapid response for clinical diagnosis of PJI, which the multi-target design is used to increase specificity and the stacking pad design is to enhance detection sensitivity. As a result, the turnaround time of the highly sensitive test can be limited from several hours to 20 min. We expect that the developed msLFIA possesses the potential for routine monitoring of PJI as a convenient, low-cost, rapid and easy to use detection device for PJI.

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Sensitivity and Specificity of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Children with Rheumatic Heart Disease

Paediatrica Indonesiana ◽

10.14238/pi31.9-10.1991.233-44 ◽

2019 ◽

Vol 31 (9-10) ◽

pp. 233-44 ◽

Cited By ~ 4

Author(s):

Sudigdo Sastroasmoro ◽

Bambang Madiyono ◽

Ismet N. Oesman

Keyword(s):

Heart Disease ◽

Left Ventricular Hypertrophy ◽

Confidence Interval ◽

Rheumatic Heart Disease ◽

Ventricular Hypertrophy ◽

Pediatric Patients ◽

High Specificity ◽

Left Ventricular ◽

Diagnostic Modality ◽

Rheumatic Heart

Electrocardiographic criteria for left ventricular hypertrophy (L VH) were examined in 84 unselected pediatric patients with rheumatic heart disease. There were 47 male and 3 7 female patients, ranging in age from 6 to 19 years. Electrocardiographic L VH was detected m 41 patients (48.8%), i.e. in 55.3% (26/47) of boys and in 36.6% (15/41) of girls. Echocardiographically determined L VH was present in 42 cases (50%) if left ventricular mass (L VM) was indexed for height, or 47 cases (56%) if L VM was indexed for body surface area (BSA). The overall sensitivity of height-indexed electrocardiographic diagnosis of LVH was 71.4% (95% confidence interval= 57.7% to 85.1%), while its sensitivity was 73.8% (95% confidence interval= 60.0% to 87.0%). For BSA indexed echocardiographic LVH, the sensitivity was 68.1% (95% confidence interval = 54.8 to 81.4%) and the specificity was 75.7% (95% confidence interval = 61.9% to 89.5%). When sex-adjustment was examined, there was no increase of sensitivity of electrocardiographic LVH. Sensitivity of the electrocardiogram for LVH increased when age-adjustment was examined with 13 years of age as a cut-off point, both for height indexed and BSA-indexed echocardiographic LVH. Reasons/or the difference between these findings and the findings in adult patients (remarkably low sensitivity and very high specificity of ECG L VH) were discussed. Electrocardiogram was a moderate diagnostic modality in the detection of L VH in our pediatric patients with rheumatic heart disease. Sex did not influence the sensitivity of ECG L VH, but older age group tended to increase its sensitivity.

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