Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study.
BACKGROUND:Diagnostic guidelines for Visceral Leishmaniasis (VL) in the East African region are complex. Patients meeting the VL clinical case definition should be tested by rK39 rapid diagnostic test (RDT) followed by the Direct Agglutination Test (DAT) or tissue aspiration if RDT-negative. Otherwi...
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ftdoajarticles:oai:doaj.org/article:72dd53563d2641a2828c44016929f11e 2023-05-15T15:13:36+02:00 Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. Ermias Diro Lutgarde Lynen Mahlet Assefa Yegnasew Takele Bewketu Mengesha Emebet Adem Rezika Mohammed Robert Kimutai Asrat Hailu Marleen Boelaert Johan van Griensven 2015-05-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0003738 https://doaj.org/article/72dd53563d2641a2828c44016929f11e EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC4428797?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0003738 https://doaj.org/article/72dd53563d2641a2828c44016929f11e PLoS Neglected Tropical Diseases, Vol 9, Iss 5, p e0003738 (2015) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2015 ftdoajarticles https://doi.org/10.1371/journal.pntd.0003738 2022-12-31T14:15:41Z BACKGROUND:Diagnostic guidelines for Visceral Leishmaniasis (VL) in the East African region are complex. Patients meeting the VL clinical case definition should be tested by rK39 rapid diagnostic test (RDT) followed by the Direct Agglutination Test (DAT) or tissue aspiration if RDT-negative. Otherwise, RDT-positive patients should be started on VL treatment. We evaluated how this guideline is adhered to by assessing the routine clinical practice in a university hospital in North-West Ethiopia. METHODS:Retrospective record analysis was done for all patients who had an rK39-RDT done at University of Gondar (UoG) Hospital between June 2012 and June 2013. We described the diagnostic work-up performed and the proportion initiated on VL treatment by test result. RESULTS/FINDINGS:From a total of 928 patients tested, 308 (33.2%) were rK39 RDT-positive. Spleen or bone marrow aspiration was done for 237 (77.2%) RDT-positive patients. Of these, 165 were confirmed parasitologically, yielding a positive predictive value of 69.6%. Only 126 (20.3%) of the 620 patients with a negative rK39 test underwent further testing by tissue aspiration, of which 22 (17.5%) were also parasitology positive. HIV test results were available for 570 (61.4%) patients and 36 (6.3%) were HIV-infected. Of the 187 parasitologically confirmed patients, 182 (97.3%) were started on VL treatment. CONCLUSIONS/DISCUSSION:A negative rK39 test was often not followed by further testing and a positive rK39 test result was followed by tissue aspiration in three out of four cases. Further research is required to understand why the diagnostic work-up did not comply with the guidelines, including evaluating adherence to the VL clinical case definition and quality of rK39-RDT testing. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 9 5 e0003738 |
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Directory of Open Access Journals: DOAJ Articles |
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English |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Ermias Diro Lutgarde Lynen Mahlet Assefa Yegnasew Takele Bewketu Mengesha Emebet Adem Rezika Mohammed Robert Kimutai Asrat Hailu Marleen Boelaert Johan van Griensven Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND:Diagnostic guidelines for Visceral Leishmaniasis (VL) in the East African region are complex. Patients meeting the VL clinical case definition should be tested by rK39 rapid diagnostic test (RDT) followed by the Direct Agglutination Test (DAT) or tissue aspiration if RDT-negative. Otherwise, RDT-positive patients should be started on VL treatment. We evaluated how this guideline is adhered to by assessing the routine clinical practice in a university hospital in North-West Ethiopia. METHODS:Retrospective record analysis was done for all patients who had an rK39-RDT done at University of Gondar (UoG) Hospital between June 2012 and June 2013. We described the diagnostic work-up performed and the proportion initiated on VL treatment by test result. RESULTS/FINDINGS:From a total of 928 patients tested, 308 (33.2%) were rK39 RDT-positive. Spleen or bone marrow aspiration was done for 237 (77.2%) RDT-positive patients. Of these, 165 were confirmed parasitologically, yielding a positive predictive value of 69.6%. Only 126 (20.3%) of the 620 patients with a negative rK39 test underwent further testing by tissue aspiration, of which 22 (17.5%) were also parasitology positive. HIV test results were available for 570 (61.4%) patients and 36 (6.3%) were HIV-infected. Of the 187 parasitologically confirmed patients, 182 (97.3%) were started on VL treatment. CONCLUSIONS/DISCUSSION:A negative rK39 test was often not followed by further testing and a positive rK39 test result was followed by tissue aspiration in three out of four cases. Further research is required to understand why the diagnostic work-up did not comply with the guidelines, including evaluating adherence to the VL clinical case definition and quality of rK39-RDT testing. |
format |
Article in Journal/Newspaper |
author |
Ermias Diro Lutgarde Lynen Mahlet Assefa Yegnasew Takele Bewketu Mengesha Emebet Adem Rezika Mohammed Robert Kimutai Asrat Hailu Marleen Boelaert Johan van Griensven |
author_facet |
Ermias Diro Lutgarde Lynen Mahlet Assefa Yegnasew Takele Bewketu Mengesha Emebet Adem Rezika Mohammed Robert Kimutai Asrat Hailu Marleen Boelaert Johan van Griensven |
author_sort |
Ermias Diro |
title |
Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. |
title_short |
Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. |
title_full |
Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. |
title_fullStr |
Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. |
title_full_unstemmed |
Impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in Ethiopia: a retrospective study. |
title_sort |
impact of the use of a rapid diagnostic test for visceral leishmaniasis on clinical practice in ethiopia: a retrospective study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2015 |
url |
https://doi.org/10.1371/journal.pntd.0003738 https://doaj.org/article/72dd53563d2641a2828c44016929f11e |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 9, Iss 5, p e0003738 (2015) |
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http://europepmc.org/articles/PMC4428797?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0003738 https://doaj.org/article/72dd53563d2641a2828c44016929f11e |
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https://doi.org/10.1371/journal.pntd.0003738 |
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PLOS Neglected Tropical Diseases |
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