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Meta-Analysis
. 2024 Mar 7;18(3):e0012030.
doi: 10.1371/journal.pntd.0012030. eCollection 2024 Mar.

Diagnosis of human brucellosis: Systematic review and meta-analysis

Mariana Lourenço Freire  1 , Tália Santana Machado de Assis  1   2 , Sarah Nascimento Silva  1 , Gláucia Cota  1
Affiliations
Meta-Analysis

Diagnosis of human brucellosis: Systematic review and meta-analysis

Mariana Lourenço Freire et al. PLoS Negl Trop Dis. .

Abstract

Background: Brucellosis, a widely spread zoonotic disease, poses significant diagnostic challenges due to its non-specific symptoms and underreporting. Timely and accurate diagnosis is crucial for effective patient management and public health control. However, a comprehensive comparative review of available diagnostic tests is lacking.

Methodology/principal findings: This systematic review addressed the following question: 'What is the accuracy of the available tests to confirm human brucellosis?' Two independent reviewers examined articles published up to January 2023. The review included original studies reporting symptomatic patients with brucellosis suspicion, through any index test, with sensitivity and/or specificity as outcomes. As exclusion criteria were considered: sample size smaller than 10 patients, studies focusing on complicated brucellosis, and those lacking essential information about index or comparator tests. Sensitivity and specificity were assessed, with consideration for the index test, and 'culture' and 'culture and standard tube agglutination test (SAT)' were used as reference standards. Bias assessment and certainty of evidence were carried out using the QUADAS-2 and GRADE tools, respectively. A total of 38 studies reporting diagnostic test performance for human brucellosis were included. However, the evidence available is limited, and significant variability was observed among studies. Regarding the reference test, culture and/or SAT are deemed more appropriate than culture alone. Rose Bengal, IgG/IgM ELISA, and PCR exhibited equally high performances, indicating superior overall diagnostic accuracy, with very low certainty of the evidence.

Conclusions/significance: This systematic review underscores the potential of the Rose Bengal test, IgG/IgM ELISA, and PCR as promising diagnostic tools for brucellosis. However, the successful implementation and recommendations for their use should consider the local context and available resources. The findings highlight the pressing need for standardization, improved reporting, and ongoing advancements in test development to enhance the accuracy and accessibility of brucellosis diagnosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram illustrating the study selection process according to PRISMA.
Fig 2
Fig 2. Rose Bengal’s sensitivity and specificity for human brucellosis diagnosis considering culture and/or SAT as the reference test.
Fig 3
Fig 3. ELISA’s sensitivity and specificity for human brucellosis diagnosis considering culture and/or SAT as reference test.
Fig 4
Fig 4. Immunochromatography’s sensitivity for human brucellosis diagnosis using culture combined with the SAT as a reference test.
Fig 5
Fig 5. Coombs tests’ sensitivity and specificity for human brucellosis diagnosis using culture combined with the SAT as a reference test.
Fig 6
Fig 6. Qualitative PCR’s sensitivity and specificity for human brucellosis diagnosis considering culture and/or SAT as reference test.
Fig 7
Fig 7. Risk of bias assessment by the Quadas-2 tool for diagnostic accuracy studies.
See this image and copyright information in PMC

References

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