Rapid diagnostic tests for visceral leishmaniasis

Boelaert, Marleen; Chappuis, François; Menten, Joris; Griensven, Johan van; Sunyoto, Temmy; Rijal, Suman

doi:10.1002/14651858.cd009135

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…Some studies reported the number of excluded patients explicitly , but for other studies, we could not determine if or how many clinical suspects who could not unequivocally classified as diseased or not were excluded. Another explanation is the strict criteria for selecting studies in the meta‐analysis following the predefined protocol .…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of predefined selection rules , we included 16 studies in the meta‐analysis: six from the Indian subcontinent, eight from Eastern Africa, and one each from Latin America and the Mediterranean. As geographic region has been shown to be an important determinant, we incorporate the effects of geographic region in the analysis using meta‐regression techniques and limit the current analysis to the regions from where more than a single study was available, that is, the Indian subcontinent and Eastern Africa.…”

Section: Motivating Examplementioning

confidence: 99%

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Bayesian meta‐analysis of diagnostic tests allowing for imperfect reference standards

Menten

Boelaert

Lesaffre

2013

Statistics in Medicine

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There is an increasing interest in meta-analyses of rapid diagnostic tests (RDTs) for infectious diseases. To avoid spectrum bias, these meta-analyses should focus on phase IV studies performed in the target population. For many infectious diseases, these target populations attend primary health care centers in resource-constrained settings where it is difficult to perform gold standard diagnostic tests. As a consequence, phase IV diagnostic studies often use imperfect reference standards, which may result in biased meta-analyses of the diagnostic accuracy of novel RDTs. We extend the standard bivariate model for the meta-analysis of diagnostic studies to correct for differing and imperfect reference standards in the primary studies and to accommodate data from studies that try to overcome the absence of a true gold standard through the use of latent class analysis. Using Bayesian methods, improved estimates of sensitivity and specificity are possible, especially when prior information is available on the diagnostic accuracy of the reference test. In this analysis, the deviance information criterion can be used to detect conflicts between the prior information and observed data. When applying the model to a dataset of the diagnostic accuracy of an RDT for visceral leishmaniasis, the standard meta-analytic methods appeared to underestimate the specificity of the RDT.

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Section: Discussionmentioning

confidence: 99%

Section: Motivating Examplementioning

confidence: 99%

Bayesian meta‐analysis of diagnostic tests allowing for imperfect reference standards

Menten

Boelaert

Lesaffre

2013

Statistics in Medicine

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A general framework for comparative Bayesian meta-analysis of diagnostic studies

Menten

Lesaffre

2015

BMC Med Res Methodol

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BackgroundSelecting the most effective diagnostic method is essential for patient management and public health interventions. This requires evidence of the relative performance of alternative tests or diagnostic algorithms. Consequently, there is a need for diagnostic test accuracy meta-analyses allowing the comparison of the accuracy of two or more competing tests. The meta-analyses are however complicated by the paucity of studies that directly compare the performance of diagnostic tests. A second complication is that the diagnostic accuracy of the tests is usually determined through the comparison of the index test results with those of a reference standard. These reference standards are presumed to be perfect, i.e. allowing the classification of diseased and non-diseased subjects without error. In practice, this assumption is however rarely valid and most reference standards show false positive or false negative results. When an imperfect reference standard is used, the estimated accuracy of the tests of interest may be biased, as well as the comparisons between these tests.MethodsWe propose a model that allows for the comparison of the accuracy of two diagnostic tests using direct (head-to-head) comparisons as well as indirect comparisons through a third test. In addition, the model allows and corrects for imperfect reference tests. The model is inspired by mixed-treatment comparison meta-analyses that have been developed for the meta-analysis of randomized controlled trials. As the model is estimated using Bayesian methods, it can incorporate prior knowledge on the diagnostic accuracy of the reference tests used.ResultsWe show the bias that can result from using inappropriate methods in the meta-analysis of diagnostic tests and how our method provides more correct estimates of the difference in diagnostic accuracy between two tests. As an illustration, we apply this model to a dataset on visceral leishmaniasis diagnostic tests, comparing the accuracy of the RK39 dipstick with that of the direct agglutination test.ConclusionsOur proposed meta-analytic model can improve the comparison of the diagnostic accuracy of competing tests in a systematic review. This is however only true if the studies and especially information on the reference tests used are sufficiently detailed. More specifically, the type and exact procedures used as reference tests are needed, including any cut-offs used and the number of subjects excluded from full reference test assessment. If this information is lacking, it may be better to limit the meta-analysis to direct comparisons.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-015-0061-7) contains supplementary material, which is available to authorized users.

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Visceral Leishmaniasis: Epidemiology, Diagnosis, and Treatment Regimens in Different Geographical Areas with a Focus on Pediatrics

et al. 2022

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Visceral Leishmaniasis (VL) is a vector-borne disease caused by an intracellular protozoa of the genus Leishmania that can be lethal if not treated. VL is caused by Leishmania donovani in Asia and in Eastern Africa, where the pathogens’ reservoir is represented by humans, and by Leishmania infantum in Latin America and in the Mediterranean area, where VL is a zoonotic disease and dog is the main reservoir. A part of the infected individuals become symptomatic, with irregular fever, splenomegaly, anemia or pancytopenia, and weakness, whereas others are asymptomatic. VL treatment has made progress in the last decades with the use of new drugs such as liposomal amphotericin B, and with new therapeutic regimens including monotherapy or a combination of drugs, aiming at shorter treatment duration and avoiding the development of resistance. However, the same treatment protocol may not be effective all over the world, due to differences in the infecting Leishmania species, so depending on the geographical area. This narrative review presents a comprehensive description of the clinical picture of VL, especially in children, the diagnostic approach, and some insight into the most used pharmacological therapies available worldwide.

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Rapid diagnostic tests for visceral leishmaniasis

Cited by 3 publications

References 37 publications

Bayesian meta‐analysis of diagnostic tests allowing for imperfect reference standards

Bayesian meta‐analysis of diagnostic tests allowing for imperfect reference standards

A general framework for comparative Bayesian meta-analysis of diagnostic studies

Visceral Leishmaniasis: Epidemiology, Diagnosis, and Treatment Regimens in Different Geographical Areas with a Focus on Pediatrics

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