A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos

S Dittrich; L Boutthasavong; D Keokhamhoung; W Phuklia; Scott B Craig; S M Tulsiani; M A Burns; S L Weier; D A B Dance; V Davong; M Vongsouvath; M Mayxay; R Phetsouvanh; P N Newton; K Woods

doi:10.4269/ajtmh.17-0702

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A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos

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A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos

S Dittrich, L Boutthasavong, D Keokhamhoung, W Phuklia, Scott B Craig, S M Tulsiani, M A Burns, S L Weier, D A B Dance, V Davong, …

American Journal of Tropical Medicine and Hygiene, Vol.98(4), pp.1056-1060

2018

DOI: https://doi.org/10.4269/ajtmh.17-0702

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Abstract

Leptospirosis is a globally important cause of acute febrile illness, and a commoncause of non-malarial fever in Asia, Africa, and Latin America. Simple rapid diagnostic tests (RDTs) are needed to enable health-care workers, particularly in low resource settings, to diagnose leptospirosis early and give timely targeted treatment. This study compared fourcommercially availableRDTs to detecthuman IgMagainst Leptospira spp. in a head-to-head prospective evaluation in Mahosot Hospital, Lao PDR. Patients with an acute febrile illness consistent with leptospirosis (N = 695) were included in the study during the 2014 rainy season. Samples were tested with four RDTs: ("Test-it" [Life Assay, Cape Town, South Africa; N = 418]; "Leptorapide" [Linnodee, Ballyclare, Northern Ireland; N = 492]; "Dual Path Platform" [DPP] [Chembio, Medford, NY; N = 530]; and "SD-IgM" [Standard Diagnostics, Yongin, South Korea; N = 481]). Diagnostic performance characteristics were calculated and compared with a composite reference standard combining polymerase chain reaction (PCR) (rrs), microscopic agglutination tests (MATs), and culture.Of all patients investigated, 39/695 (5.6%) were positive by culture, PCR, orMAT. The sensitivity and specificity of theRDTs ranged greatly from17.9%to 63.6%and 62.1%to 96.8%, respectively. None of the investigatedRDTs reached a sensitivity or specificity of >90%for detecting Leptospira infections on admission. In conclusion, our investigation highlights the challenges associated with Leptospira diagnostics, particularly in populations with multiple exposures. These findings emphasize the need for extensive prospective evaluations in multiple endemic settings to establish the value of rapid tools for diagnosing fevers to allow targeting of antibiotics. © 2018 by The American Society of Tropical Medicine and Hygiene.

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Title: A prospective hospital study to evaluate the diagnostic accuracy of rapid diagnostic tests for the early detection of leptospirosis in Laos
Authors: S Dittrich (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
L Boutthasavong (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
D Keokhamhoung (Author) - University of Oxford, United Kingdom
W Phuklia (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
Scott B Craig (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
S M Tulsiani (Author) - Queensland Health Forensic and Scientific Service
M A Burns (Author) - Queensland Health Forensic and Scientific Service
S L Weier (Author) - Queensland University of Technology
D A B Dance (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
V Davong (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
M Vongsouvath (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
M Mayxay (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
R Phetsouvanh (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
P N Newton (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
K Woods (Author) - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Laos
Publication details: American Journal of Tropical Medicine and Hygiene, Vol.98(4), pp.1056-1060
Publisher: American Society of Tropical Medicine and Hygiene
Date published: 2018
DOI: 10.4269/ajtmh.17-0702
ISSN: 0002-9637
Copyright note: Copyright © The American Society of Tropical Medicine and Hygiene [open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Organisation Unit: School of Science and Engineering - Legacy; University of the Sunshine Coast, Queensland
Language: English
Record Identifier: 99451487202621
Output Type: Journal article

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