Evaluation of Diagnostic Tests for Visceral Leishmaniasis in Iran: A Meta-Analysis

Year 2019, Volume: 09 Issue: 01, 16 - 22, 15.03.2019

Azar Najafi Entezar Abbasi Somar Kourosh Sayehmiri Hamidreza Majidiani Asad Mirzaei

https://doi.org/10.5799/jmid.537150

Cited By: 1

Abstract

Objective: There exist various diagnostic tests to detect
visceral leishmaniasis, but the most efficient ones have not been demonstrated
yet. Herein, we evaluated the accuracy of these diagnostic tests in Iran.

Methodology: English and Persian database searching was done from
1993 to 2016. According to heterogeneity of the studies, estimations of the
study were pooled by random-effects model. Totally, twenty investigations were
eligible for current review with 2115 patients as pooled sample size.

Results:
The
overall pooled estimate of sensitivity and specificity for all diagnostic tests
were 0.92 ([95% CI = 0.90–0.95]) and 0.92 ([95% CI = 0.89–0.94]), respectively.
Also, the separate sensitivity and specificity of each test were as follow:
PCR: 1.00 ([95% CI = 0.99–1.01]) and 0.37 ([95% CI = 0.25–0.49]); DAT: 0.93
([95% CI = 0.89–0.96]) and 0.92 ([95% CI = 0.89–0.94]); ELISA: 0.78 ([95% CI =
0.47–1.09]) and 1.00 ([95% CI = 0.99–1.01]) as well as IFA: 0.50 ([95% CI =
0.29–0.72]) and 0.96 ([95% CI = 0.95–0.97]).

Conclusions: The specificity and sensitivity of PCR and DAT
as molecular and serological tests, respectively, are remarkable to detect
visceral leishmaniasis; hence, it is highly recommended to simultaneously
employ these diagnostic tests for this widespread infection. J Microbiol Infect Dis 2019; 9(1): 16-22

Keywords

Visceral Leishmaniasis, sensitivity, specificity, diagnostic tests, L. infantum, Iran

References

• 1. Chappuis F, Sundar S, Hailu A, et al, Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nature Rev Microbiol 2007; 5(11):873-882. 2. Motazedian M, Fakhar,M, Motazedian,MH, Hatam, G, Mikaeili F. A urine-based polymerase chain reaction method for the diagnosis of visceral leishmaniasis in immunocompetent patients. Diagn Microbiol Infect Dis 2008; 60(2): 151-154. 3. Badirzadeh A, Mohebali M, Ghasemian M, et al., Cutaneous and post kala-azar dermal leishmaniasis caused by Leishmania infantum in endemic areas of visceral leishmaniasis, northwestern Iran 2002-2011. Pathog Glob Health 2013; 107(4): 194-197. 4. Rakhshanpour A, Mohebali M, Akhondi B, Rahimi MT, Rokni MB. Serological Survey and Associated Risk Factors of Visceral Leish-maniasis in Qom Province, Central Iran. Iran J Public Health 2014; 43(1): 50-55. 5. Abai MR, Oshaghi MA, Tajedin L, Rassi Y, Akhavan A. Geographical distribution and ecological features of the great gerbil subspecies in the main zoonotic cutaneous leishmaniasis foci in Iran. Asian Pac J Trop Biomed 2010; 3(10): 800-803. 6. Mniouil, M, Fellah H, Amarir F, et al, Epidemiological characteristics of visceral leishmaniasis in Morocco (1990–2014): an update. Acta Trop 2017; 170: 169-177. 7. Alborzi A, Pouladfar GR, Aelami MH. Visceral leishmaniasis; literature review and Iranian experience. Iran J Clin Infect Dis 2007; 2(2): 99-108. 8. Mohebali M. Visceral leishmaniasis in Iran: review of the epidemiological and clinical features. Iran J Parasitol 2013; 8(3):348-358. 9. Mohebali M, Hajjaran H, Hamzavi Y, et al, Epidemiological aspects of canine visceral leishmaniosis in the Islamic Republic of Iran. Vet Parasitol 2005; 129(3):243-251. 10. Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 2004; 27(5): 305-318. 11. Fakhar M, E. Ahmad Pour, An Overview of theLaboratory Diagnostic Procedures of Visceral Leishmaniasis (Kala-Azar). Med Lab J 2013; 7(1): 45-54. 12. Khademvatan S, Mazloumi A, Fallah E, Jasem Saki. Detection of Leishmania infantum antigen in urinary samples by KAtex and comparison with serological methods. Ofogh-e-Danesh, Med J Gonabad Univ Med Sci 2011; 17: 6-20. 13. Davood R, Hejazi H, Ghasemi M. Evaluation and Comparison serological methods indirect immunofluorescence (IFAT) and direct agglutination (DAT) using standard antigen in the diagnosis of visceral leishmaniasis. Med J Mazandaran Univ Med Sci 2005; 15(49): 1-8. 14. Sakkas H, Constantina G, Levidiotou S. Laboratory diagnosis of human visceral leishmaniasis. J Vector Borne Dis 2016; 53(1): 8-16. 15. Baratloo A, Hosseini M, Negida A, El Ashal G. Part 1: Simple Definition and Calculation of Accuracy, Sensitivity and Specificity. Emerg (Tehran) 2015; 3(2): 48-49. 16. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6(7): e1000097. 17. Zijlstra E, Ali MS, El-hassam AM, et al, Kala-azar: a comparative study of parasitological methods and the direct agglutination test in diagnosis. Trans R Soc Trop Med Hyg 1992; 86(5): 505-507. 18. Soleimanzadeh G, Edrissian GH, Movahhed-Danes AM, Nadim A. Epidemiological aspects of kala-azar in Meshkin-Shahr, Iran: human infection. Bull World Health Organ 1993; 71(6): 759762. 19. Mohammadiha A, Haghighi A, Mohebali M, et al, Canine visceral leishmaniasis: a comparative study of real-time PCR, conventional PCR, and direct agglutination on sera for the detection of Leishmania infantum infection. Vet Parasitol 2013. 192 (1): 83-90. 20. Pandey K, Pandey BD, Mallik AK, et al. Diagnosis of visceral leishmaniasis by polymerase chain reaction of DNA extracted from Giemsa's solution-stained slides. J Parasitol Res 2010; 107(3):727-730. 21. moadab A, Alborzi A, Behbahani A, Shahyan jahromi F, Motazedian M. The early diagnosis of visceral leishmaniasis using peripheral blood and polymerase chain reaction. Sci J Hamdan Univ Med Sci 2003;16-21. 22. Silva ES, Schoone GJ, Gontijo CMF, Brazil RP, Pacheco RS, Schallig HDFH. Application of direct agglutination test (DAT) and fast agglutination screening test (FAST) for sero-diagnosis of visceral leishmaniasis in endemic area of Minas Gerais, Brazil. Kinetoplastid Biol Dis 2005; 4:4. 23. Chappuis F, Rijal S,Soto A, Menten J, Boelaert MA. Meta-analysis of the diagnostic performance of the direct agglutination test and rK39 dipstick for visceral leishmaniasis. BMJ 2006; 333(7571):723. 24. Gavgani ASM, Mohite H, Edrissian GH, Mohebali M, Davies CR. Domestic dog ownership in Iran is a risk factor for human infection with Leishmania infantum. Am J Trop Med Hyg 2002; 67(5):511-515. 25. Mohammadi-Ghalehbin B, Hatam GR, Sarkari B, et al. A Leishmania infantum FML-ELISA for the detection of symptomatic and asymptomatic canine visceral leishmaniasis in an endemic area of Iran. Iran J immunol 2011; 8(4):244-250. 26. Mahami M, Mohebali M, Keshavarz H, Zareei Z. Comparison of direct agglutination test (DAT),indirect immunofluorescent antibody(IFAT)and Elisa in diagnosis of visceral Leishmaniasis.2008. 27. Imani M, Dehkharghani AD, Ghelman M, Mohammadloo M. Molecular technique for detection of Leishmania infantum isolates in Iran. Trop Parasitol 2014; 4(1):35-37. 28. Babakhan L, Mohebali M, Akhoundi B, Edrissian GH, Keshavarz H. Rapid detection of Leishmania infantum infection in dogs: a comparative study using fast agglutination screening test (FAST) and direct agglutination test (DAT) in Iran. J Parasitol Res 2009; 105(3):717720. 29. Akhoundi B, Mohebali M, Babakhan L, et al. Rapid detection of human Leishmania infantum infection: A comparative field study using the fast agglutination screening test and the direct agglutination test. Travel Med Infect Dis. 2010; 8(5):305-310.