title: Prospective evaluation and comparison of the direct agglutination test and an rK39-antigen-based dipstick test for the diagnosis of suspected kala-azar in Nepal.
abstract: The diagnosis of visceral leishmaniasis (kala-azar) remains difficult in rural endemic areas and practical and reliable tests are badly needed. Two serological tests, the Direct Agglutination Test (DAT) and an rK39-antigen-based dipstick test, were compared to parasitological diagnosis in a group of 184 patients presenting at a tertiary care centre in south-eastern Nepal with a history of fever > or = 14 days and splenomegaly; 139 patients had a parasitologically proven kala-azar and 45 patients had a negative parasitological work-up. The rK39 dipstick showed a sensitivity of 97% and a specificity of 71%. The DAT was up to 99% sensitive with a low cut-off titre (1:400) but its specificity did not exceed 82% even with a high cut-off titre (1:51 200). Both tests could be used for screening suspect patients in endemic areas. However, their use as confirmatory tests should be restricted to situations where the proportion of kala-azar among clinical suspect patients is high. The rK39 dipstick is cheaper and easier to use than the DAT and could be used widely provided that both its performance and production remain stable.
authors.affiliation: Department of Community Medicine, Geneva University Hospital, Geneva, Switzerland. francois.chappuis@hcuge.ch
authors.forename: F
authors.initials: F
authors.lastname: Chappuis
authors.forename: S
authors.initials: S
authors.lastname: Rijal
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Acharya
authors.forename: B M S
authors.initials: BM
authors.lastname: Karki
authors.forename: M L
authors.initials: ML
authors.lastname: Das
authors.forename: P A
authors.initials: PA
authors.lastname: Bovier
authors.forename: P
authors.initials: P
authors.lastname: Desjeux
authors.forename: D
authors.initials: D
authors.lastname: Le Ray
authors.forename: S
authors.initials: S
authors.lastname: Koirala
authors.forename: L
authors.initials: L
authors.lastname: Loutan
mesh_terms: D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood; D000953:Antigens, Protozoan / Q000276:immunology; D005260:Female; D006386:Hemagglutination Tests / Q000379:methods; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015800:Protozoan Proteins / Q000276:immunology; D012372:ROC Curve; D011934:Reagent Strips; D011994:Recombinant Proteins / Q000276:immunology; D012423:Rural Health; D012680:Sensitivity and Specificity
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D015800:Protozoan Proteins; D011934:Reagent Strips; D011994:Recombinant Proteins; C079253:K39 antigen, Leishmania