A meta-analysis of the diagnostic performance of the direct agglutination test and rK39 dipstick for visceral leishmaniasis.
OBJECTIVE
To compare the performance of the direct agglutination test and rK39 dipstick for the diagnosis of visceral leishmaniasis.


METHODS
Medline, citation tracking, January 1986 to December 2004. Selection criteria Original studies evaluating the direct agglutination test or the rK39 dipstick with clinical visceral leishmaniasis as target condition; adequate reference classification; and absolute numbers of true positive, true negative, false positive, and false negative observations available or derivable from the data presented.


RESULTS
30 studies evaluating the direct agglutination test and 13 studies evaluating the rK39 dipstick met the inclusion criteria. The combined sensitivity estimates of the direct agglutination test and the rK39 dipstick were 94.8% (95% confidence interval 92.7% to 96.4%) and 93.9% (87.7% to 97.1%), respectively. Sensitivity seemed higher and more homogenous in the studies carried out in South Asia. Specificity estimates were influenced by the type of controls. In phase III studies carried out on patients with clinically suspected disease, the estimated specificity of the direct agglutination test was 85.9% (72.3% to 93.4%) and of the rK39 dipstick was 90.6% (66.8% to 97.9%).


CONCLUSIONS
The diagnostic performance of the direct agglutination test and the rK39 dipstick for visceral leishmaniasis is good to excellent and seem comparable.
Chappuis
François
F
Geneva University Hospitals, Travel and Migration Medicine Unit, rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. francois.chappuis@hcuge.ch
Rijal
Suman
S
Soto
Alonso
A
Menten
Joris
J
Boelaert
Marleen
M
D000372:Agglutination Tests / Q000379:methods / Q000592:standards; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods / Q000592:standards; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D012680:Sensitivity and Specificity