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International Journal of Molecular... Jun 2020The relationship between antiphospholipid antibodies (aPL) and autoimmune haemolytic anaemia (AIHA) has never been systematically addressed. The aim of this study is to... (Meta-Analysis)
Meta-Analysis Review
The relationship between antiphospholipid antibodies (aPL) and autoimmune haemolytic anaemia (AIHA) has never been systematically addressed. The aim of this study is to assess the link between aPL and AIHA in adult systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). This study performed an EMBASE/PubMed search from inception to June 2019 and meta-analysis using Peto's odds ratios. The pooled prevalence (PP) of IgG/IgM anticardiolipin (aCL) and lupus anticoagulant (LA) was greater in AIHA +ve than AIHA -ve patients (34.7% vs. 27.6%, = 0.03; 33.3% vs. 21.8%, < 0.0001; 20.9% vs. 8.3%, = 0.01). The PP of AIHA was greater in: (1) IgG and IgM aCL +ve than -ve patients (21.8% vs. 11.1%, = 0.001 and 18.7% vs. 6.3%, < 0.0001), (2) in SLE related APS than in primary APS patients (22.8% vs. 3.9% < 0.0001), (3) in APS +ve than APS -ve SLE patients (23.2% vs. 8.4%, = 0.01), and (4) in thrombotic APS than non-thrombotic APS/SLE patients (26.8% vs. 10%, = 0.03). The PP of IgG/IgM aCL and LA was greater in DAT +ve than DAT -ve patients (42.4% vs. 12.8%, < 0.0001; 26.2% vs. 12.8%, = 0.03 and 29.2% vs. 15.7%, = 0.004 respectively). It was found that AIHA prevalence is maximal in SLE with aPL/APS, low-moderate in SLE without aPL and minimal in PAPS. Moreover, AIHA is rightly included among the classification criteria for SLE but not for APS/aPL. The significance of an isolated DAT positivity remains unclear in this setting.
Topics: Anemia, Hemolytic, Autoimmune; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Coombs Test; Humans; Lupus Erythematosus, Systemic; Thrombosis
PubMed: 32527000
DOI: 10.3390/ijms21114120 -
Transboundary and Emerging Diseases Sep 2022Bats are the only flying mammalian animals and are distributed worldwide. Bats are well-known hosts of several zoonotic viruses and bacteria, including Leptospira sp.... (Meta-Analysis)
Meta-Analysis
Bats are the only flying mammalian animals and are distributed worldwide. Bats are well-known hosts of several zoonotic viruses and bacteria, including Leptospira sp. Here, we performed a systematic review and a meta-analysis of evidence of Leptospira sp. infection in bats by examining studies published between 1964 and 2021. We reported the frequencies of various species and serogroups on all continents, several species and feeding habits of bats, and different diagnostic tools. Together, 33 papers from all continents with seven to 2077 individuals from one to 31 species were included. Molecular detection was conducted in most studies, followed by MAT (Microscopic Agglutination Test) and isolation and identification. Molecular characterization of Leptospira sp. revealed L. borgpetersenii as the most frequent species. Moreover, 179 positive samples for MAT contained the most likely infecting serogroups described, particularly the Australis serogroup. The percentage of positive tests in isolation and identification ranged between 0% and 0.5%. The highest frequency of Leptospira infection among the continents was observed in Asia, whereas South America had the lowest percentage. Finally, Nycteridae and Rhinonycteridae were the most frequently infected bat families. Our study provides valuable information about the epidemiology of Leptospira sp. infection in bats.
Topics: Agglutination Tests; Animals; Chiroptera; Leptospira; Leptospirosis; Serogroup
PubMed: 35533065
DOI: 10.1111/tbed.14589 -
Comparative Immunology, Microbiology... Apr 2021Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease... (Meta-Analysis)
Meta-Analysis Review
Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1-2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2-0.7%) and 3% (95 %CI, 1-5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1-2 %) was more than males (1%; 95 %CI, 1-2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1-2 % versus 1%, 95 %CI, 0-1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard.
Topics: Animals; Female; Humans; Iran; Leishmaniasis, Visceral; Middle East; Prevalence; Seroepidemiologic Studies
PubMed: 33388595
DOI: 10.1016/j.cimid.2020.101604 -
Heliyon Nov 2022Leptospirosis, a common zoonotic infection in developing countries, usually progresses to severe conditions and poor outcomes when not detected early. Microscopic... (Review)
Review
BACKGROUND
Leptospirosis, a common zoonotic infection in developing countries, usually progresses to severe conditions and poor outcomes when not detected early. Microscopic agglutination test (MAT) and culture are available but are not accessible in all areas and are usually confined to specialized laboratories. There are several available immunochromatographic test kits (ICT) that offer ease of use, access, and affordability, but diagnostic accuracy is not yet well established. In this paper, we aim to review published literature on the use of ICTs for the detection of leptospirosis and evaluate their diagnostic efficiency.
MATERIALS AND METHODS
We systematically searched multiple databases (PubMed, Cochrane Library, and Google Scholar), including gray literature sources for published research articles as of April 13, 2022, on the diagnosis of acute leptospirosis using ICT. We assessed the methodological quality of each article using the revised QUADAS-2.
RESULTS
From a total of 41 articles, 30 (73.2%) were identified as potentially relevant after reviewing the title and abstract and eliminating duplicate articles; then, 22 (53.7%) articles were included after scrutinizing and applying the inclusion/exclusion criteria to the full text. Almost all test kits detect IgM antibodies against the except for one which used IgG as a marker for diagnosis of acute leptospirosis. A wide range of sensitivity (15.8%-100.0%) and specificity (37.3%-100.0%) were recorded. Lipopolysaccharide (LPS)-specific Immunochromatographic Lateral Flow Assay presented the highest sensitivity (∼93-100%) and specificity (∼99.19-100%).
CONCLUSION
Rapid diagnosis of acute leptospirosis is highly warranted; however, available test kits present a wide range of diagnostic accuracy. We found that LPS-specific ICT kit has the highest diagnostic efficiency; however, our analysis was limited by the included studies' heterogeneity in design and reporting; thus, we recommend standardization in the conduct and reporting of diagnostic accuracy of test kits as it is vital to evaluate the reliability of the test kit.
PubMed: 36458294
DOI: 10.1016/j.heliyon.2022.e11829 -
Emerging Microbes & Infections Dec 2023Balancing the potentially serious outcomes of asymptomatic brucellosis and "waiting" for treatment in clinical practice is an urgent issue. Therefore, we assessed the... (Meta-Analysis)
Meta-Analysis
Balancing the potentially serious outcomes of asymptomatic brucellosis and "waiting" for treatment in clinical practice is an urgent issue. Therefore, we assessed the follow-up outcomes and epidemiological characteristics of asymptomatic brucellosis in the absence of treatment to provide evidence-based clinical clues. We searched eight databases in which 3610 studies from 1990 to 2021 were related to the follow-up outcomes of asymptomatic brucellosis. Thirteen studies, involving 107 cases, were finally included. Regarding the follow-up outcomes, we examined the presence or absence of symptoms and decreased serum agglutination test (SAT) titre. During the 0.5-18 months follow-up period, the pooled prevalence of appearing symptomatic was 15.4% (95% CI 2.1%-34.3%), cases that remained asymptomatic were 40.3% (95% CI 16.6%-65.8%), and decreased SAT titre was observed in 36.5% (95% CI 11.6%-66.1%). Subgroup analysis indicated that the pooled prevalence of appearing symptomatic with follow-up times of less than 6 months, 6-12 months, and 12-18 months was 11.5%, 26.4%, and 47.6%, respectively. The student subgroup had a higher prevalence of symptoms (46.6%) than the occupational and family populations. In conclusion, asymptomatic brucellosis has a high likelihood of appearing symptomatic and its severity may be underestimated. Active screening of occupational and family populations should be enhanced, and special attention should be paid to high-titre students for early intervention, if necessary. Additionally, future prospective, long-term, and large-sample follow-up studies are essential.
Topics: Humans; Follow-Up Studies; Brucellosis; Agglutination Tests; Prevalence
PubMed: 36849445
DOI: 10.1080/22221751.2023.2185464 -
The Cochrane Database of Systematic... Jun 2014The diagnosis of visceral leishmaniasis (VL) in patients with fever and a large spleen relies on showing Leishmania parasites in tissue samples and on serological tests.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The diagnosis of visceral leishmaniasis (VL) in patients with fever and a large spleen relies on showing Leishmania parasites in tissue samples and on serological tests. Parasitological techniques are invasive, require sophisticated laboratories, consume time, or lack accuracy. Recently, rapid diagnostic tests that are easy to perform have become available.
OBJECTIVES
To determine the diagnostic accuracy of rapid tests for diagnosing VL in patients with suspected disease presenting at health services in endemic areas.
SEARCH METHODS
We searched MEDLINE, EMBASE, LILACS, CIDG SR, CENTRAL, SCI-expanded, Medion, Arif, CCT, and the WHO trials register on 3 December 2013, without applying language or date limits.
SELECTION CRITERIA
This review includes original, phase III, diagnostic accuracy studies of rapid tests in patients clinically suspected to have VL. As reference standards, we accepted: (1) direct smear or culture of spleen aspirate; (2) composite reference standard based on one or more of the following: parasitology, serology, or response to treatment; and (3) latent class analysis.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed quality of included studies using the QUADAS-2 tool. Discrepancies were resolved by a third author. We carried out a meta-analysis to estimate sensitivity and specificity of rapid tests, using a bivariate normal model with a complementary log-log link function. We analysed each index test separately. As possible sources of heterogeneity, we explored: geographical area, commercial brand of index test, type of reference standard, disease prevalence, study size, and risk of bias (QUADAS-2). We also undertook a sensitivity analysis to assess the influence of imperfect reference standards.
MAIN RESULTS
Twenty-four studies containing information about five index tests (rK39 immunochromatographic test (ICT), KAtex latex agglutination test in urine, FAST agglutination test, rK26 ICT, and rKE16 ICT) recruiting 4271 participants (2605 with VL) were included. We carried out a meta-analysis for the rK39 ICT (including 18 studies; 3622 participants) and the latex agglutination test (six studies; 1374 participants). The results showed considerable heterogeneity. For the rK39 ICT, the overall sensitivity was 91.9% (95% confidence interval (95% CI) 84.8 to 96.5) and the specificity 92.4% (95% CI 85.6 to 96.8). The sensitivity was lower in East Africa (85.3%; 95% CI 74.5 to 93.2) than in the Indian subcontinent (97.0%; 95% CI 90.0 to 99.5). For the latex agglutination test, overall sensitivity was 63.6% (95% CI 40.9 to 85.6) and specificity 92.9% (95% CI 76.7 to 99.2).
AUTHORS' CONCLUSIONS
The rK39 ICT shows high sensitivity and specificity for the diagnosis of visceral leishmaniasis in patients with febrile splenomegaly and no previous history of the disease, but the sensitivity is notably lower in east Africa than in the Indian subcontinent. Other rapid tests lack accuracy, validation, or both.
Topics: Africa, Eastern; Agglutination Tests; Antigens, Protozoan; Asymptomatic Infections; Biomarkers; Chromatography, Affinity; Clinical Trials, Phase III as Topic; Humans; India; Latex Fixation Tests; Leishmaniasis, Visceral; Nepal; Protozoan Proteins; Sensitivity and Specificity
PubMed: 24947503
DOI: 10.1002/14651858.CD009135.pub2 -
PLoS Neglected Tropical Diseases Mar 2024Brucellosis, a widely spread zoonotic disease, poses significant diagnostic challenges due to its non-specific symptoms and underreporting. Timely and accurate diagnosis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Brucellosis, a widely spread zoonotic disease, poses significant diagnostic challenges due to its non-specific symptoms and underreporting. Timely and accurate diagnosis is crucial for effective patient management and public health control. However, a comprehensive comparative review of available diagnostic tests is lacking.
METHODOLOGY/PRINCIPAL FINDINGS
This systematic review addressed the following question: 'What is the accuracy of the available tests to confirm human brucellosis?' Two independent reviewers examined articles published up to January 2023. The review included original studies reporting symptomatic patients with brucellosis suspicion, through any index test, with sensitivity and/or specificity as outcomes. As exclusion criteria were considered: sample size smaller than 10 patients, studies focusing on complicated brucellosis, and those lacking essential information about index or comparator tests. Sensitivity and specificity were assessed, with consideration for the index test, and 'culture' and 'culture and standard tube agglutination test (SAT)' were used as reference standards. Bias assessment and certainty of evidence were carried out using the QUADAS-2 and GRADE tools, respectively. A total of 38 studies reporting diagnostic test performance for human brucellosis were included. However, the evidence available is limited, and significant variability was observed among studies. Regarding the reference test, culture and/or SAT are deemed more appropriate than culture alone. Rose Bengal, IgG/IgM ELISA, and PCR exhibited equally high performances, indicating superior overall diagnostic accuracy, with very low certainty of the evidence.
CONCLUSIONS/SIGNIFICANCE
This systematic review underscores the potential of the Rose Bengal test, IgG/IgM ELISA, and PCR as promising diagnostic tools for brucellosis. However, the successful implementation and recommendations for their use should consider the local context and available resources. The findings highlight the pressing need for standardization, improved reporting, and ongoing advancements in test development to enhance the accuracy and accessibility of brucellosis diagnosis.
Topics: Humans; Rose Bengal; Brucellosis; Sensitivity and Specificity; Immunoglobulin G; Immunoglobulin M
PubMed: 38452046
DOI: 10.1371/journal.pntd.0012030 -
Journal of Equine Veterinary Science Apr 2023Brucellosis, a bacterial infection caused by Brucella spp., is a widespread zoonosis concerning human and animal health. In equines, brucellosis may occur... (Meta-Analysis)
Meta-Analysis Review
Brucellosis, a bacterial infection caused by Brucella spp., is a widespread zoonosis concerning human and animal health. In equines, brucellosis may occur asymptomatically or with clinical signs such as arthritis, bursitis, and tenosynovitis. This study aims to ascertain the overall seroprevalence of equine brucellosis and its related factors, including geographic region, serological detection method, equine's species, gender, age, and body condition. This is because equine brucellosis is a zoonotic infection with significant epidemiological implications. The systematic literature search was conducted from January 1, 1990, to April 1, 2022, in the following electronic databases: Google Scholar, Scopus, Pub Med, Science Direct, Web of Science, Embase, Springer, and ProQuest. Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 49 qualified studies were acquired from several countries. Because Egger's test result and the asymmetry in the funnel plot indicated significant publication bias, the meta-analysis model was corrected using the trim-and-fill method. After correction, the pooled seroprevalence of equine brucellosis was 1.92% (95% CI, 0.67-3.79; estimated by the random effect model). Based on meta-regression analysis, the probable heterogeneity factors may be geographic areas (continents and countries). The brucellosis seroprevalence in equines was the lowest in Europe (0%, 95% CI, 0-0.1) and the highest in Asia (10.03%, 95% CI, 8-12.9). The highest overall estimate of seroprevalence of Brucella infection in equines based on a subset of serological tests was made using the serum agglutination test (10.2%, 95% CI, 7.7-13.4). The combined seroprevalence of brucellosis in donkeys (7.3%, 95% CI, 4.9-9.7) was higher than in other equine species. The overall seroprevalence of brucellosis in female equines was significantly higher than in males (OR = 1.437; 95% CI, 1.025-2.014); despite this, the overall seroprevalence had no significant difference based on other risk factors such as age and body condition. Understanding the epidemiology of this zoonotic infection in equines is critical for one-health integration. In addition, this study's results may be appropriate for controlling and managing equine brucellosis.
Topics: Male; Animals; Horses; Humans; Female; Seroepidemiologic Studies; Brucellosis; Zoonoses; Brucella; Equidae; Horse Diseases
PubMed: 36649828
DOI: 10.1016/j.jevs.2023.104227 -
Journal of Aquatic Animal Health Mar 2017Historically, serological tests for finfish diseases have been underused when compared with their use in terrestrial animal health. For years the nonspecific immune... (Review)
Review
Historically, serological tests for finfish diseases have been underused when compared with their use in terrestrial animal health. For years the nonspecific immune response in fish was judged to make serology unreliable and inferior to the direct measurement of agent analytes. We conducted a systematic review of peer-reviewed publications that reported on the development, validation, or application of serological tests for finfish diseases. A total of 168 articles met the screening criteria; most of them were focused on salmonid pathogens (e.g., Aeromonas spp. and viral hemorrhagic septicemia virus). Before the 1980s, most publications reported the use of agglutination tests, but our review indicates that enzyme-linked immunosorbent assay (ELISA) has more recently become the dominant serological test. The main application of serological tests has been in the assessment of vaccine efficacy, with few applications for surveillance or demonstration of freedom from disease, despite the advantages of serological tests over direct detection at the population level. Nonlethal sampling, low cost, and postinfection persistence of antibodies make serological assays the test of choice in surveillance, especially of valuable broodstock. However, their adoption has been constrained by poor characterization and validation. The number of publications in our review reporting diagnostic sensitivity and specificity of serological tests in finfish was small (n = 7). Foreseeing a wider use of serological tests in the future for diagnostic end purposes, we offer recommendations for mitigating deficiencies in the development and evaluation of serological tests, including optimization, control of nonspecific reactions, informed cutoff points, diagnostic accuracy, and serological baseline studies. Achieving these goals will facilitate greater international recognition of serological testing in programs supporting aquatic animal health. Received March 21, 2016; accepted September 24, 2016.
Topics: Animals; Enzyme-Linked Immunosorbent Assay; Fish Diseases; Fishes; Novirhabdovirus; Sensitivity and Specificity; Serologic Tests
PubMed: 28166451
DOI: 10.1080/08997659.2016.1244577 -
Tropical Animal Health and Production Feb 2018Leptospirosis is a bacterial systemic infection which affects domestic animals and wildlife, as well as humans. Many wild animals act as reservoirs of leptospires.... (Review)
Review
Leptospirosis is a bacterial systemic infection which affects domestic animals and wildlife, as well as humans. Many wild animals act as reservoirs of leptospires. Nevertheless, the real role of wildlife animals as source of infection to livestock and humans, as well as the most important reservoirs and leptospiral strains remains unclear. This systematic review assesses the available data about wildlife and their biomes in Latin America, concerning to leptospiral infection. In addition, we discuss the development of the research on leptospirosis in wildlife in this region. After the application of exclusion criteria, 79 papers were analyzed, comprising 186 species, 122 genus, 53 families, and 19 orders from four classes. Mammals were the most studied class, followed by Amphibian, Reptile, and Aves. The Icterohaemorrhagiae serogroup was predominant in most biomes and many orders. A small number of antigens detected the majority of seroreactive animals of each class, and a smaller panel may be used at microscopic agglutination test. Further studies must always consider edaphoclimatic conditions besides only host class or species, in order to obtain a broader understanding of the wild epidemiological cycle of leptospirosis in the region. In conclusion, direct and indirect evidences demonstrate that leptospirosis is largely widespread among wildlife in all biomes of Latin America. Moreover, more research on the role of wildlife on the epidemiology of leptospirosis and its impact on livestock and public health are required, particularly focusing on direct detection of the agent.
Topics: Animals; Animals, Wild; Ecosystem; Humans; Latin America; Leptospira; Leptospirosis; Livestock; Mammals; Reptiles; Serogroup
PubMed: 28967042
DOI: 10.1007/s11250-017-1429-y