Abstract
BackgroundDirect agglutination test (DAT) as a simple, accurate and reliable method, has been widely used for serodiagnosis of visceral leishmaniasis (VL) during the last three decades. The present study is a systematic review and meta-analysis to evaluate the diagnostic accuracy of DAT for serodiagnosis of human VL.MethodsElectronic databases, including MEDLINE (via PubMed), SCOPUS, Web of Science, SID and Mag Iran (two Persian scientific search engines) were searched from December 2004 to April 2019. We determined the pooled sensitivity and specificity rates of DAT for the diagnosis of human VL, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (ROC) curves parameters across the eligible studies.ResultsOf the 2928 records identified in the mentioned electronic databases and after examining reference lists of articles, 24 articles met inclusion criteria and were enrolled in the systematic review and out of them 20 records qualified for meta-analysis. The pooled sensitivity and specificity rates of DAT was 96% [95% CI, 92–98] and 95% [CI95% 86–99], respectively. The likelihood ratio of a positive test (LR+) was found to be 21 [CI95%, 6.6–66.5] and the likelihood ratio of a negative test (LR−) was found to be 0.04 [(CI95%, 0.02–0.08]. The combined estimate of the diagnostic odds ratio for DAT was high [467 (CI95%, 114–1912]). We found that the summary receiver operating characteristic curve (SROC) is positioned near the upper left corner of the curve and the area under curve (AUC) was 0.98 (95% CI, 0.97 to 0.99).ConclusionReferring to our analysis, we determined that DAT can be considered as a valuable tool for the serodiagnosis of human VL with high sensitivity and specificity. As DAT is a simple, accurate and efficient serological test, it can be recommended for serodiagnosis of human VL particularly in endemic areas.
Highlights
Direct agglutination test (DAT) as a simple, accurate and reliable method, has been widely used for serodiagnosis of visceral leishmaniasis (VL) during the last three decades
Visceral leishmaniasis (VL) is one of the most important neglected tropical diseases that is caused by Leishmania donovani and L. infantum/chagasi in both humans and canines [1,2,3]
Diagnosis and treatment is the first step for elimination of anthroponotic form of VL caused by L.donovani because post kala-azar dermal leishmaniasis (PKDL) cases are potential reservoir hosts in the endemic areas of Indian form of kala-azar, while in Mediterranen form of kala-azar caused by L.infantum/ chagasi, infected canines are potential role as reservoir hosts of the disease [1, 4]
Summary
Direct agglutination test (DAT) as a simple, accurate and reliable method, has been widely used for serodiagnosis of visceral leishmaniasis (VL) during the last three decades. Visceral leishmaniasis (VL) is one of the most important neglected tropical diseases that is caused by Leishmania donovani and L. infantum/chagasi in both humans and canines [1,2,3]. Diagnosis and treatment is the first step for elimination of anthroponotic form of VL caused by L.donovani because post kala-azar dermal leishmaniasis (PKDL) cases are potential reservoir hosts in the endemic areas of Indian form of kala-azar, while in Mediterranen form of kala-azar caused by L.infantum/ chagasi, infected canines are potential role as reservoir hosts of the disease [1, 4].
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