Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK ; Royal Tropical Institute, KIT Biomedical Research, 1105 AZ Amsterdam, The Netherlands.
J Trop Med. 2013;2013:150746. doi: 10.1155/2013/150746. Epub 2013 Jul 9.
Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). We summarized the published literature about the accuracy of diagnostic tests for PKDL. We searched Medline for eligible studies investigating the diagnostic accuracy of any test for PKDL. Study quality was assessed using QUADAS-2. Data were extracted from 21 articles including 43 separate studies. Twenty-seven studies evaluated serological tests (rK39 dipstick, ELISA, DAT, and leishmanin tests), six studies molecular tests, eight microscopy, and two cultures. Only a few of these studies reported a valid estimate of diagnostic accuracy, as most were case-control designs or used a reference standard with low sensitivity. The included studies were very heterogeneous, for example, due to a large variety of reference standards used. Hence, no summary estimates of sensitivity or specificity could be made. We recommend well-designed diagnostic accuracy trials that evaluate, side-by-side, all currently available diagnostics, including clinical symptoms, serological, antigen, molecular, and parasitological tests and possible use of statistical modelling to evaluate diagnostics when there is no suitable gold standard.
由于治疗时间长且毒性大，以及 PKDL 患者可能成为内脏利什曼病 (VL) 的传染源，因此识别皮肤利什曼病 (PKDL) 很重要。我们总结了关于 PKDL 诊断测试准确性的已发表文献。我们在 Medline 上搜索了调查任何用于 PKDL 的测试的诊断准确性的合格研究。使用 QUADAS-2 评估研究质量。从 21 篇文章中提取了数据，其中包括 43 项单独的研究。二十七项研究评估了血清学检测（rK39 试纸条、ELISA、DAT 和利什曼原虫检测），六项研究评估了分子检测，八项研究评估了显微镜检查，两项研究评估了培养。由于大多数研究为病例对照设计或使用敏感性较低的参考标准，因此只有少数研究报告了有效诊断准确性估计值。所纳入的研究非常多样化，例如，由于使用了多种参考标准。因此，无法对敏感性或特异性进行汇总估计。我们建议进行精心设计的诊断准确性试验，并排评估所有当前可用的诊断方法，包括临床症状、血清学、抗原、分子和寄生虫学检测，并在没有合适金标准的情况下使用统计建模来评估诊断方法。
