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PLoS Neglected Tropical Diseases Aug 2016Dengue fever is a ubiquitous arboviral infection in tropical and sub-tropical regions, whose incidence has increased over recent decades. In the absence of a rapid point... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dengue fever is a ubiquitous arboviral infection in tropical and sub-tropical regions, whose incidence has increased over recent decades. In the absence of a rapid point of care test, the clinical diagnosis of dengue is complex. The World Health Organisation has outlined diagnostic criteria for making the diagnosis of dengue infection, which includes the use of the tourniquet test (TT).
PURPOSE
To assess the quality of the evidence supporting the use of the TT and perform a diagnostic accuracy meta-analysis comparing the TT to antibody response measured by ELISA.
DATA SOURCES
A comprehensive literature search was conducted in the following databases to April, 2016: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, BIOSIS, Web of Science, SCOPUS.
STUDY SELECTION
Studies comparing the diagnostic accuracy of the tourniquet test with ELISA for the diagnosis of dengue were included.
DATA EXTRACTION
Two independent authors extracted data using a standardized form.
DATA SYNTHESIS
A total of 16 studies with 28,739 participants were included in the meta-analysis. Pooled sensitivity for dengue diagnosis by TT was 58% (95% Confidence Interval (CI), 43%-71%) and the specificity was 71% (95% CI, 60%-80%). In the subgroup analysis sensitivity for non-severe dengue diagnosis was 55% (95% CI, 52%-59%) and the specificity was 63% (95% CI, 60%-66%), whilst sensitivity for dengue hemorrhagic fever diagnosis was 62% (95% CI, 53%-71%) and the specificity was 60% (95% CI, 48%-70%). Receiver-operator characteristics demonstrated a test accuracy (AUC) of 0.70 (95% CI, 0.66-0.74).
CONCLUSION
The tourniquet test is widely used in resource poor settings despite currently available evidence demonstrating only a marginal benefit in making a diagnosis of dengue infection alone.
REGISTRATION
The protocol for this systematic review was registered at
PROSPERO
CRD42015020323.
Topics: Dengue; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Humans; Sensitivity and Specificity; Tourniquets
PubMed: 27486661
DOI: 10.1371/journal.pntd.0004888 -
Medicine Nov 2023Anti-mitochondrial antibodies (AMA) and the M2 subtype are considered serological hallmarks in the diagnosis of primary biliary cholangitis (PBC). However, these... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Anti-mitochondrial antibodies (AMA) and the M2 subtype are considered serological hallmarks in the diagnosis of primary biliary cholangitis (PBC). However, these autoantibodies may be undetectable in some patients. This meta-analysis aimed to evaluate the diagnostic accuracy of serum AMA and M2 for PBC.
METHODS
We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant studies. Pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were calculated using a random-effects model. We also constructed hierarchical summary receiver operating characteristic curves and calculated the area under the curve values.
RESULTS
Our meta-analysis included 28 studies, of which 24 examined the diagnostic accuracy of AMA for PBC. Pooled sensitivity and specificity of AMA were 84% (95% confidence intervals [CI] 77-90%) and 98% (96-99%), respectively. Pooled LR+, LR-, and DOR were 42.2 (22.1-80.5), 0.16 (0.11-0.24), and 262 (114-601), respectively. Sixteen studies explored the diagnostic value of the M2 subtype, demonstrating pooled sensitivity and specificity of 89% (81-94%) and 96% (93-98%), respectively. Pooled LR+, LR-, and DOR were 20.3 (8.0-51.1), 0.12 (0.05-0.26), and 169 (41-706), respectively. The hierarchical summary receiver operating characteristic curves for both of serum AMA and M2 subtype lie closer to the upper left corner of the plot with area under the curve values of 0.98 (95% CI = 0.96-0.99) and 0.98 (95% CI = 0.96-0.99) respectively.
CONCLUSION
This meta-analysis provides evidence affirming the utility of AMA and M2 as sensitive and specific serological hallmarks that can facilitate early screening and diagnosis of PBC.
Topics: Humans; Liver Cirrhosis, Biliary; Mitochondria; Autoantibodies; Sensitivity and Specificity; ROC Curve
PubMed: 37960792
DOI: 10.1097/MD.0000000000036039 -
Alimentary Pharmacology & Therapeutics Mar 2022There is growing support for a biopsy avoidant approach to diagnose coeliac disease in both children and adults, using a serological diagnosis instead. (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is growing support for a biopsy avoidant approach to diagnose coeliac disease in both children and adults, using a serological diagnosis instead.
AIMS
To assess the diagnostic accuracy of serological tests for coeliac disease in adults and children.
METHODS
Seven electronic databases were searched between January 1990 and August 2020. Eligible diagnostic studies evaluated the accuracy of serological tests for coeliac disease against duodenal biopsy. Risk of bias assessment was performed using QUADAS-2. Bivariate random-effects meta-analyses were used to estimate serology sensitivity and specificity at the most commonly reported thresholds.
RESULTS
113 studies (n = 28,338) were included, all in secondary care populations. A subset of studies were included in meta-analyses due to variations in diagnostic thresholds. Summary sensitivity and specificity of immunoglobulin A (IgA) anti-tissue transglutaminase were 90.7% (95% confidence interval: 87.3%, 93.2%) and 87.4% (84.4%, 90.0%) in adults (5 studies) and 97.7% (91.0%, 99.4%) and 70.2% (39.3%, 89.6%) in children (6 studies); and of IgA endomysial antibodies were 88.0% (75.2%, 94.7%) and 99.6% (92.3%, 100%) in adults (5 studies) and 94.5% (88.9%, 97.3%) and 93.8% (85.2%, 97.5%) in children (5 studies).
CONCLUSIONS
Anti-tissue transglutaminase sensitivity appears to be sufficient to rule out coeliac disease in children. The high specificity of endomysial antibody in adults supports its use to rule in coeliac disease. This evidence underpins the current development of clinical guidelines for a serological diagnosis of coeliac disease. Studies in primary care are needed to evaluate serological testing strategies in this setting.
Topics: Adult; Autoantibodies; Celiac Disease; Child; Humans; Immunoglobulin A; Protein Glutamine gamma Glutamyltransferase 2; Sensitivity and Specificity; Serologic Tests; Transglutaminases
PubMed: 35043426
DOI: 10.1111/apt.16729 -
The Journal of Hospital Infection Feb 2021Healthcare workers (HCWs) represent a high-risk population for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). (Meta-Analysis)
Meta-Analysis
BACKGROUND
Healthcare workers (HCWs) represent a high-risk population for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
AIM
To determine the seroprevalence of SARS-CoV-2 antibodies among HCWs, and identify the factors associated with this seroprevalence.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were applied for this systematic review and meta-analysis. Databases including PubMed/MEDLINE and preprint services (medRχiv and bioRχiv) were searched from inception to 24 August 2020.
FINDINGS
Forty-nine studies including 127,480 HCWs met the inclusion criteria. The estimated overall seroprevalence of SARS-CoV-2 antibodies among HCWs was 8.7% (95% confidence interval 6.7-10.9%). Seroprevalence was higher in studies conducted in North America (12.7%) compared with those conducted in Europe (8.5%), Africa (8.2) and Asia (4%). Meta-regression showed that increased sensitivity of antibody tests was associated with increased seroprevalence. The following factors were associated with seropositivity: male gender; Black, Asian and Hispanic HCWs; work in a coronavirus disease 2019 (COVID-19) unit; patient-related work; front-line HCWs; healthcare assistants; shortage of personal protective equipment; self-reported belief of previous SARS-CoV-2 infection; previous positive polymerase chain reaction test; and household contact with suspected or confirmed cases of COVID-19.
CONCLUSION
The seroprevalence of SARS-CoV-2 antibodies among HCWs is high. Excellent adherence to infection prevention and control measures; sufficient and adequate personal protective equipment; and early recognition, identification and isolation of HCWs infected with SARS-CoV-2 are imperative to decrease the risk of SARS-CoV-2 infection.
Topics: Adult; Africa; Antibodies, Viral; Asia; COVID-19; COVID-19 Serological Testing; Europe; Female; Guideline Adherence; Health Personnel; Humans; Infectious Disease Transmission, Patient-to-Professional; Male; Middle Aged; North America; Personal Protective Equipment; Risk Factors; SARS-CoV-2; Self Report; Sensitivity and Specificity; Seroepidemiologic Studies
PubMed: 33212126
DOI: 10.1016/j.jhin.2020.11.008 -
Clinical Infectious Diseases : An... Jun 2020We reviewed relevant syphilis diagnostic literature and conducted a meta-analysis to address the question, "What is the sensitivity and specificity of the Syphilis... (Meta-Analysis)
Meta-Analysis
We reviewed relevant syphilis diagnostic literature and conducted a meta-analysis to address the question, "What is the sensitivity and specificity of the Syphilis Health Check, a rapid qualitative test for the detection of human antibodies to Treponema pallidum." The Syphilis Health Check is the only rapid syphilis test currently cleared by the Food and Drug Administration (FDA). We conducted a systematic review and a meta-analysis using Bayesian bivariate random-effects and fixed-effect models to create pooled estimates of sensitivity and specificity of the Syphilis Health Check. We identified 5 test evaluations published in the literature and 10 studies submitted to the FDA and for a Clinical Laboratory Improvement Amendments waiver application. The pooled sensitivity (95% CI) from the laboratory evaluations (n = 5) was 98.5% (92.1-100%), while pooled specificity was 95.9% (81.5-100.0%). The pooled sensitivity for prospective studies (n = 10) was 87.7% ( 71.8-97.2%), while pooled specificity was 96.7% (91.9-99.2%). Using nontreponemal supplemental testing, the sensitivity improved to a pooled sensitivity of 97.0% (94.8-98.6%). The Syphilis Health Check may provide accurate detection of treponemal antibody.
Topics: Antibodies, Bacterial; Bayes Theorem; Humans; Point-of-Care Systems; Prospective Studies; Sensitivity and Specificity; Syphilis; Syphilis Serodiagnosis; Treponema pallidum
PubMed: 32578863
DOI: 10.1093/cid/ciaa350 -
Anais Da Academia Brasileira de Ciencias 2018The objective of the study was to conduct a systematic review to synthesize the current evidence on the accuracy of IgM and IgA to early diagnosis the dengue virus. The... (Meta-Analysis)
Meta-Analysis Review
The objective of the study was to conduct a systematic review to synthesize the current evidence on the accuracy of IgM and IgA to early diagnosis the dengue virus. The review protocol was registered at PROSPERO (CRD 42015024808). We searched for studies in the following electronic database from 1990 to January 2018. The search identified 3507 studies. Five studies were included for quantitative analysis. Three studies included evaluations of salivary IgM provided a sensitivity of 86% and specificity of 93%. Two studies included evaluating of IgA salivary showed a combined sensitivity of 69% and a combined specificity of 98%. Despite the results found and the low methodological quality of the studies included in the meta-analysis it is still soon to claim that IgA is better than IgM to diagnosis Dengue.
Topics: Antibodies, Viral; Antibody Specificity; Biomarkers; Dengue; Dengue Virus; Early Diagnosis; Humans; Immunoglobulin A, Secretory; Immunoglobulin M; Polymerase Chain Reaction; Risk Factors; Saliva; Sensitivity and Specificity
PubMed: 29947679
DOI: 10.1590/0001-3765201820170989 -
Revista Chilena de Infectologia :... Oct 2011Candidemia is a disease with high morbidity and mortality especially in critical care patients. Early diagnosis enables early treatment. (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Candidemia is a disease with high morbidity and mortality especially in critical care patients. Early diagnosis enables early treatment.
OBJECTIVES
To conduct a systematic review of the literature in order to establish the best laboratory tests for the diagnosis of candidemia in critical patients.
MATERIALS AND METHODS
We conducted a systematic review of available literature in PubMed. Serological studies were subjected to meta-analysis in metadisk-Beta 1.1.1.
RESULTS
4 studies of 1286 reviewed were included. Three were about serological tests and one about molecular testing (RT-PCR). The sensitivity and specificity for RT-PCR, antibody testing and antigen and antibody tests were 87% and 100%, 47.5% and 82.6%, 96% and 81%, respectively. Diagnostic Odds Ratio of antigenemia was 1.51 (95% CI = 0,032-70,964, p = 0.001).
CONCLUSIONS
RT-PCR has better diagnostic performance, measuring antigenemia plus antibodies improves sensitivity, specificity, LR + and LR-- . There is insufficient evidence to support this.
Topics: Antibodies, Fungal; Antigens, Fungal; Candida; Candidemia; Critical Illness; Cross Infection; Humans; Intensive Care Units; Real-Time Polymerase Chain Reaction; Sensitivity and Specificity
PubMed: 22051618
DOI: No ID Found -
The Brazilian Journal of Infectious... 2017The diagnosis of progressive disseminated histoplasmosis is often a challenge to clinicians, especially due to the low sensitivity and long turnaround time of the... (Review)
Review
The diagnosis of progressive disseminated histoplasmosis is often a challenge to clinicians, especially due to the low sensitivity and long turnaround time of the classic diagnostic methods. In recent years, studies involving a variety of non-culture-based diagnostic tests have been published in the literature. We performed a systematic review by selecting studies evaluating non-culture-based diagnostic methods for progressive disseminated histoplasmosis. We searched for articles evaluating detection of antibody, antigens, as well as DNA-based diagnostic methods. A comprehensive PUBMED, Web of Science, and Cochrane Library search was performed between the years 1956 and 2016. Case reports, review articles, non-human models and series involving less than 10 patients were excluded. We found 278 articles and after initial review 18 articles were included: (12) involved antigen detection methods, (4) molecular methods, and (2) antibody detection methods. Here we demonstrate that the pursuit of new technologies is ultimately required for the early and accurate diagnosis of disseminated histoplasmosis. In particular, urinary antigen detection was the most accurate tool when compared with other diagnostic techniques.
Topics: Histoplasmosis; Humans; Immunoenzyme Techniques; Polymerase Chain Reaction; Sensitivity and Specificity; Serologic Tests
PubMed: 27875685
DOI: 10.1016/j.bjid.2016.09.012 -
Thorax Oct 2007Conventional diagnostic tests for tuberculosis have several limitations and are often unhelpful in establishing the diagnosis of extrapulmonary tuberculosis. Although... (Meta-Analysis)
Meta-Analysis Review
Conventional diagnostic tests for tuberculosis have several limitations and are often unhelpful in establishing the diagnosis of extrapulmonary tuberculosis. Although commercial serological antibody based tests are available, their usefulness in the diagnosis of extrapulmonary tuberculosis is unknown. A systematic review was conducted to assess the accuracy of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. In a comprehensive search, 21 studies that reported data on sensitivity and specificity for extrapulmonary tuberculosis were identified. These studies evaluated seven different commercial tests, with Anda-TB IgG accounting for 48% of the studies. The results showed that (1) all commercial tests provided highly variable estimates of sensitivity (range 0.00-1.00) and specificity (range 0.59-1.00) for all extrapulmonary sites combined; (2) the Anda-TB IgG kit showed highly variable sensitivity (range 0.26-1.00) and specificity (range 0.59-1.00) for all extrapulmonary sites combined; (3) for all tests combined, sensitivity estimates for both lymph node tuberculosis (range 0.23-1.00) and pleural tuberculosis (range 0.26-0.59) were poor and inconsistent; and (4) there were no data to determine the accuracy of the tests in children or in patients with HIV infection, the two groups for which the test would be most useful. At present, commercial antibody detection tests for extrapulmonary tuberculosis have no role in clinical care or case detection.
Topics: Antigens, Bacterial; Area Under Curve; Enzyme-Linked Immunosorbent Assay; Humans; Immunoglobulins; Sensitivity and Specificity; Serologic Tests; Tuberculosis
PubMed: 17675320
DOI: 10.1136/thx.2006.075754 -
Pathogens (Basel, Switzerland) May 2021is the zoonotic parasite responsible for toxoplasmosis in warm-blooded vertebrates. This systematic review compares and evaluates the available knowledge on... (Review)
Review
is the zoonotic parasite responsible for toxoplasmosis in warm-blooded vertebrates. This systematic review compares and evaluates the available knowledge on enzyme-linked immunosorbent assays (ELISAs), their components, and performance in detecting antibodies in animals. Four databases were searched for published scientific studies on and ELISA, and 57 articles were included. Overall, indirect (95%) and in-house (67%) ELISAs were the most used types of test among the studies examined, but the 'ID Screen Toxoplasmosis Indirect Multi-species' was common among commercially available tests. Varying diagnostic performance (sensitivity and specificity) and Kappa agreements were observed depending on the type of sample (serum, meat juice, milk), antigen (native, recombinant, chimeric) and antibody-binding reagents used. Combinations of recombinant and chimeric antigens resulted in better performance than native or single recombinant antigens. Protein A/G appeared to be useful in detecting IgG antibodies in a wide range of animal species due to its non-species-specific binding. One study reported cross-reactivity, with and spp. This is the first systematic review to descriptively compare ELISAs for the detection of antibodies across different animal species.
PubMed: 34063342
DOI: 10.3390/pathogens10050605