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Free Content Evaluation of a urinary antigen-based latex agglutination test in the diagnosis of kala-azar in eastern Nepal

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Summary Background 

We evaluated the diagnostic accuracy as well as the reproducibility of the urine latex agglutination test ‘KAtex’ in the diagnosis of kala-azar in patients recruited at a tertiary care centre in Dharan, Nepal, between November 2000 and January 2002. Methods 

All patients presenting with fever of 2 weeks or more and splenomegaly were consecutively enrolled. Bone marrow and – if negative – spleen aspirates were examined for Leishmania donovani. Serum and urine samples were taken in duplicate for the Direct Agglutination Test (DAT) and KAtex. The reference laboratory determined sensitivity and specificity of KAtex. Reproducibility between both laboratories was assessed. Results 

KAtex was performed on urine from 155 parasitologically confirmed kala-azar and 77 non-kala-azar cases (parasitology and DAT-negative). KAtex showed a sensitivity of 47.7% (74/155, 95% CI: 39.7–55.9) and a specificity of 98.7% (76/77, 95% CI: 93.0–100.0). Reproducibility of KAtex showed a kappa of 0.684 (P < 0.001, n = 232). Conclusion 

KAtex evaluation showed high specificity, low sensitivity and moderate reproducibility. A urine test for kala-azar could become a real breakthrough in kala-azar management if its reproducibility and sensitivity could be further improved.

Keywords: Nepal; diagnostic accuracy; sensitivity and specificity; urine antigen detection test; visceral leishmaniasis

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2004.01251.x

Affiliations: 1:  B.P. Koirala Institute of Health Sciences, Dharan, Nepal 2:  Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium 3:  Liverpool School of Tropical Medicine, Liverpool, UK 4:  Geneva University Hospital, Geneva, Switzerland 5:  Disease Control, Prevention and Eradication, World Health Organization, Geneva, Switzerland

Publication date: June 1, 2004

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