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. 2016 Oct 4:44:32.
doi: 10.1186/s41182-016-0031-8. eCollection 2016.

Latent class evaluation of three serological tests for the diagnosis of human brucellosis in Bangladesh

A K M A Rahman  1 , C Saegerman  2 , D Berkvens  3
Affiliations

Latent class evaluation of three serological tests for the diagnosis of human brucellosis in Bangladesh

A K M A Rahman et al. Trop Med Health. .

Abstract

Background: A Bayesian latent class evaluation was used to estimate the true prevalence of brucellosis in livestock farmers and patients with prolonged pyrexia (PP) and to validate three conditionally dependent serological tests: indirect ELISA (iELISA), Rose Bengal Test (RBT), and standard tube agglutination (STAT). A total of 335 sera from livestock farmers and 300 sera from PP patients were investigated.

Results: The true prevalence of brucellosis in livestock farmers and PP patients was estimated to be 1.1 % (95 % credibility interval (CrI) 0.1-2.8) and 1.7 % (95 % CrI 0.2-4.1), respectively. Specificities of all tests investigated were higher than 97.8 % (95 % CrI 96.1-99.9). The sensitivities varied from 68.1 % (95 % CrI 54.5-80.7) to 80.6 % (95 % CrI 63.6-93.8). The negative predictive value of all the three tests in both populations was very high and more than 99.5 % (95 % CrI 98.6-99.9). The positive predictive value (PPV) of all three tests varied from 27.9 % (95 % CrI 3.6-62.0) to 36.3 % (95 % CrI 5.6-70.5) in livestock farmers and 39.8 % (95 % CrI 6.0-75.2) to 42.7 % (95 % CrI 6.4-83.2) in patients with PP. The highest PPV were 36.3 % for iELISA and 42.7 % for RBT in livestock farmers and pyrexic patients, respectively.

Conclusions: In such a low prevalence scenario, serology alone does not help in diagnosis and thereby therapeutic decision-making. Applying a second test with high specificity and/or testing patients having history of exposure with known risk factors and/or testing patients having some clinical signs and symptoms of brucellosis may increase the positive predictive value of the serologic tests.

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