Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis

BACKGROUND: Typhoid fevers are infections caused by the bacteria Salmonella enterica serovar Typhi (Salmonella Typhi) and Paratyphi A, B and C (Salmonella Paratyphi). Approximately 17.8 million incident cases of typhoid fever occur annually, and incidence is highest in children. The accuracy of curr...

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Autores principales: Arora, Paul, Thorlund, Kristian, Brenner, Darren R., Andrews, Jason R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527309/
https://www.ncbi.nlm.nih.gov/pubmed/31067228
http://dx.doi.org/10.1371/journal.pntd.0007303
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author Arora, Paul
Thorlund, Kristian
Brenner, Darren R.
Andrews, Jason R.
author_facet Arora, Paul
Thorlund, Kristian
Brenner, Darren R.
Andrews, Jason R.
author_sort Arora, Paul
collection PubMed
description BACKGROUND: Typhoid fevers are infections caused by the bacteria Salmonella enterica serovar Typhi (Salmonella Typhi) and Paratyphi A, B and C (Salmonella Paratyphi). Approximately 17.8 million incident cases of typhoid fever occur annually, and incidence is highest in children. The accuracy of current diagnostic tests of typhoid fever is poorly understood. We aimed to determine the comparative accuracy of available tests for the pediatric population. METHODS: We first conducted a systematic literature review to identify studies that compared diagnostic tests for typhoid fever in children (aged ≤15 years) to blood culture results. We applied a Bayesian latent-class extension to a network meta-analysis model. We modelled known diagnostic properties of bone marrow culture and the relationship between bone marrow and blood culture as informative priors in a Bayesian framework. We tested sensitivities for the proportion of negative blood samples that were false as well as bone marrow sensitivity and specificity. RESULTS: We found 510 comparisons from 196 studies and 57 specific to the pediatric population. IgM-based tests outperformed their IgG-based counterparts for ELISA and Typhidot tests. The lateral flow IgG test performed comparatively well with 92% sensitivity (72% to 98% across scenario analyses) and 94% specificity. The most sensitive test of those investigated for the South Asian pediatric population was the Reverse Passive Hemagglutination Assay with 99% sensitivity (98% - 100% across scenario analyses). Adding a Widal slide test to other typhoid diagnostics did not substantially improve diagnostic performance beyond the single test alone, however, a lateral flow-based IgG rapid test combined with the typhoid/paratyphoid (TPT) assay yielded improvements in sensitivity without substantial declines in specificity and was the best performing combination test in this setting. CONCLUSION: In the pediatric population, lateral-flow IgG, TPT and Reverse Passive Hemagglutination tests had high diagnostic accuracy compared to other diagnostics. Combinations of tests may provide a feasible option to increase diagnostic sensitivity. South Asia has the most informed set of data on typhoid diagnostic testing accuracy, and the evidence base in other important regions needs to be expanded.
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spelling pubmed-65273092019-05-31 Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis Arora, Paul Thorlund, Kristian Brenner, Darren R. Andrews, Jason R. PLoS Negl Trop Dis Research Article BACKGROUND: Typhoid fevers are infections caused by the bacteria Salmonella enterica serovar Typhi (Salmonella Typhi) and Paratyphi A, B and C (Salmonella Paratyphi). Approximately 17.8 million incident cases of typhoid fever occur annually, and incidence is highest in children. The accuracy of current diagnostic tests of typhoid fever is poorly understood. We aimed to determine the comparative accuracy of available tests for the pediatric population. METHODS: We first conducted a systematic literature review to identify studies that compared diagnostic tests for typhoid fever in children (aged ≤15 years) to blood culture results. We applied a Bayesian latent-class extension to a network meta-analysis model. We modelled known diagnostic properties of bone marrow culture and the relationship between bone marrow and blood culture as informative priors in a Bayesian framework. We tested sensitivities for the proportion of negative blood samples that were false as well as bone marrow sensitivity and specificity. RESULTS: We found 510 comparisons from 196 studies and 57 specific to the pediatric population. IgM-based tests outperformed their IgG-based counterparts for ELISA and Typhidot tests. The lateral flow IgG test performed comparatively well with 92% sensitivity (72% to 98% across scenario analyses) and 94% specificity. The most sensitive test of those investigated for the South Asian pediatric population was the Reverse Passive Hemagglutination Assay with 99% sensitivity (98% - 100% across scenario analyses). Adding a Widal slide test to other typhoid diagnostics did not substantially improve diagnostic performance beyond the single test alone, however, a lateral flow-based IgG rapid test combined with the typhoid/paratyphoid (TPT) assay yielded improvements in sensitivity without substantial declines in specificity and was the best performing combination test in this setting. CONCLUSION: In the pediatric population, lateral-flow IgG, TPT and Reverse Passive Hemagglutination tests had high diagnostic accuracy compared to other diagnostics. Combinations of tests may provide a feasible option to increase diagnostic sensitivity. South Asia has the most informed set of data on typhoid diagnostic testing accuracy, and the evidence base in other important regions needs to be expanded. Public Library of Science 2019-05-08 /pmc/articles/PMC6527309/ /pubmed/31067228 http://dx.doi.org/10.1371/journal.pntd.0007303 Text en © 2019 Arora et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Arora, Paul
Thorlund, Kristian
Brenner, Darren R.
Andrews, Jason R.
Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis
title Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis
title_full Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis
title_fullStr Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis
title_full_unstemmed Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis
title_short Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis
title_sort comparative accuracy of typhoid diagnostic tools: a bayesian latent-class network analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527309/
https://www.ncbi.nlm.nih.gov/pubmed/31067228
http://dx.doi.org/10.1371/journal.pntd.0007303
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