Haider N, Khan S U, Islam A, Osmani M G, Rahman M Z, Epstein J H, Daszak P, Zeidner N S
Center for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Section for Epidemiology, National Veterinary Institute, Technical University of Denmark, Copenhagen, Denmark.
Transbound Emerg Dis. 2017 Aug;64(4):1329-1333. doi: 10.1111/tbed.12502. Epub 2016 Apr 8.
As in most low-income countries, adequate laboratory facilities are not available in Bangladesh to assist veterinarians in diagnosing animal diseases. We aimed to determine the efficiency of veterinary diagnoses for two common ruminant diseases in Bangladesh: Peste des petits ruminants (PPR) and foot-and-mouth disease (FMD). We conducted the study from May 2009 to August 2010 in three government veterinary hospitals where veterinarians collected samples from sick livestock and recorded the presumptive diagnosis on the basis of clinical presentations. Samples were tested for PPR and FMD using real-time RT-PCR. We estimated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the presumptive diagnoses when compared to laboratory tests. We tested 539 goats for PPR and 340 cattle and goats for FMD. Our results indicate that the veterinarians' presumptive diagnoses were different from laboratory findings for both PPR (P < 0.05) and FMD (P < 0.05). The overall sensitivity of the presumptive clinical diagnoses was 54% (95% CI: 47-61%) while specificity was 81% (95% CI: 78-84%) compared to real-time RT-PCR tests. The kappa value obtained in our validation process for PPR (kappa: 0.25) and FMD (kappa 0.36) indicated a poor performance of the presumptive diagnoses. Most of the animals (93%) were treated with antibiotics. Our findings indicate that veterinarians can detect animals not infected with FMD or PPR but miss the true cases. The clinical competency of these veterinarians needs to be improved and access to laboratory diagnostic facilities could help veterinarians to improve the diagnostics and outcomes. The rational use of antibiotics by veterinarians in animals must be ensured.
与大多数低收入国家一样，孟加拉国没有足够的实验室设施来协助兽医诊断动物疾病。我们旨在确定孟加拉国两种常见反刍动物疾病的兽医诊断效率：小反刍兽疫（PPR）和口蹄疫（FMD）。我们于2009年5月至2010年8月在三家政府兽医医院开展了这项研究，兽医从患病牲畜身上采集样本，并根据临床表现记录初步诊断结果。使用实时逆转录聚合酶链反应（RT-PCR）对样本进行PPR和FMD检测。与实验室检测相比，我们估计了初步诊断的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。我们对539只山羊进行了PPR检测，对340头牛和山羊进行了FMD检测。我们的结果表明，兽医的初步诊断与PPR（P < 0.05）和FMD（P < 0.05）的实验室检测结果均不同。与实时RT-PCR检测相比，初步临床诊断的总体敏感性为54%（95%置信区间：47-61%），而特异性为81%（95%置信区间：78-84%）。我们在PPR（kappa值：0.25）和FMD（kappa值0.36）验证过程中获得的kappa值表明初步诊断表现不佳。大多数动物（93%）接受了抗生素治疗。我们的研究结果表明，兽医能够检测出未感染FMD或PPR的动物，但会遗漏真正的病例。这些兽医的临床能力需要提高，获得实验室诊断设施有助于兽医改善诊断和治疗结果。必须确保兽医合理使用动物抗生素。
