Utility of the Rose Bengal Test as a Point-of-Care Test for Human Brucellosis in Endemic African Settings: A Systematic Review

Abstract

In endemic African areas, such as Tanzania, Brucella spp. cause human febrile illnesses, which often go unrecognized and misdiagnosed, resulting in delayed diagnosis, underdiagnosis, and underreporting. Although rapid and affordable point-of-care tests, such as the Rose Bengal test (RBT), are available, acceptance and adoption of these tests at the national level are hindered by a lack of local diagnostic performance data. To address this need, evidence on the diagnostic performance of RBT as a human brucellosis point-of-care test was reviewed. The review was initially focused on studies conducted in Tanzania but was later extended to worldwide because few relevant studies from Tanzania were identified. Databases including Web of Science, Embase, MEDLINE, and World Health Organization Global Index Medicus were searched for studies assessing the diagnostic performance of RBT (sensitivity and specificity) for detection of human brucellosis, in comparison to the reference standard culture. Sixteen eligible studies were identified and reviewed following screening. The diagnostic sensitivity (DSe) and specificity (DSp) of RBT compared to culture as the gold standard were 87.5% and 100%, respectively, in studies that used suitable “true positive” and “true negative” patient comparison groups and were considered to be of high scientific quality. Diagnostic DSe and DSp of RBT compared to culture in studies that also used suitable “true positive” and “true negative” patient comparison groups but were considered to be of moderate scientific quality varied from 92.5% to 100% and 94.3 to 99.9%, respectively. The good diagnostic performance of RBT combined with its simplicity, quickness, and affordability makes RBT an ideal (or close to) stand-alone point-of-care test for early clinical diagnosis and management of human brucellosis and nonmalarial fevers in small and understaffed health facilities and laboratories in endemic areas in Africa and elsewhere.

Epidemiological study of human brucellosis among febrile patients in Erbil-Kurdistan region, Iraq

“…Based on culture results, RBT showed high sensitivity, specificity, and negative predictive value, while the positive predictive value was low (77.5%) which increases false-positive cases. We recommend in endemic areas where the isolation of Brucella or ELISA are difficult to apply, that RBT could be an accepted test for brucellosis diagnosis, taking into consideration the compatibility of clinical features when the clinician interprets the positive results, this suggestion is in agreement with recent studies [46,47].…”

Seroprevalence of brucellosis and Q fever infections amongst pastoralists and their cattle herds in Sokoto State, Nigeria

“…The use of the Rose Bengal Plate Test (RBT) and Competitive Enzyme-Linked Immunosorbent Assay (cELISA) for the diagnosis of brucellosis [15,16] has been earlier reported. The sensitivity and specificity of RBT for diagnosis of brucellosis were 95.8% and 100% in cattle [17], and 87.5% and 100% in humans [18,19], respectively. For the cELISA, the sensitivity and specificity were 97.1% and 100% in cattle [20], respectively.…”

Knowledge, Attitudes, and Practices Regarding Brucellosis among Parents in Aseer Region, Southwestern Saudi Arabia

“…Brucellosis is endemic in most developing countries and manifests as a febrile illness that is sometimes indistinguishable from malaria or typhoid fever; hence, it may not be recognized in clinical and laboratory settings [9][10][11]. It is quite prevalent in Middle Eastern [12] and east African countries [13].…”