Pucken Valerie-Beau, Knubben-Schweizer Gabriela, Döpfer Dörte, Groll Andreas, Hafner-Marx Angela, Hörmansdorfer Stefan, Sauter-Louis Carola, Straubinger Reinhard K, Zimmermann Pia, Hartnack Sonja
Clinic for Ruminants with Ambulatory and Herd Health Services, Centre for Clinical Veterinary Medicine, LMU Munich, Oberschleißheim, Germany.
Food Animal Production Medicine, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, United States of America.
PLoS One. 2017 Jun 22;12(6):e0179847. doi: 10.1371/journal.pone.0179847. eCollection 2017.
Germany has been officially free of bovine tuberculosis since 1996. However, in the last years there has been an increase of bovine tuberculosis cases, particularly in the southern part of Germany, in the Allgäu region. As a consequence a one-time tuberculosis surveillance program was revisited with different premortal and postmortal tests. The aim of this paper was to estimate diagnostic sensitivities and specificities of the different tests used within this surveillance program. In the absence of a perfect test with 100% sensitivity and 100% specificity, thus in the absence of a gold standard, a Bayesian latent class approach with two different datasets was performed. The first dataset included 389 animals, tested with single intra-dermal comparative cervical tuberculin (SICCT) test, PCR and pathology; the second dataset contained 175 animals, tested with single intra-dermal cervical tuberculin (SICT) test, Bovigam® assay, pathology and culture. Two-way conditional dependencies were considered within the models. Additionally, inter-laboratory agreement (five officially approved laboratories) of the Bovigam® assay was assessed with Cohen's kappa test (21 blood samples). The results are given in posterior means and 95% credibility intervals. The specificities of the SICT test, SICCT test, PCR and pathology ranged between 75.8% [68.8-82.2%] and 99.0% [96.8-100%]. The Bovigam® assay stood out with a very low specificity (6.9% [3.6-11.1%]), though it had the highest sensitivity (95.7% [91.3-99.2%]). The sensitivities of the SICCT test, PCR, SICT test, pathology and culture varied from 57.8% [48.0-67.6%] to 88.9% [65.5-99.7%]. The prevalences were 19.8% [14.6-26.5%] (three-test dataset) and 7.7% [4.2-12.3%] (four-test dataset). Among all pairwise comparisons the highest agreement was 0.62 [0.15-1]). In conclusion, the specificity of the Bovigam® assay and the inter-laboratory agreement were lower than expected.
自1996年以来，德国已正式消灭牛结核病。然而，在过去几年中，牛结核病病例有所增加，特别是在德国南部的阿尔高地区。因此，重新审视了一次性结核病监测计划，采用了不同的生前和死后检测方法。本文的目的是估计该监测计划中使用的不同检测方法的诊断敏感性和特异性。由于缺乏具有100%敏感性和100%特异性的完美检测方法，即缺乏金标准，因此采用了贝叶斯潜在类别方法，使用了两个不同的数据集。第一个数据集包括389只动物，进行了单剂量皮内比较颈静脉结核菌素（SICCT）检测、聚合酶链反应（PCR）和病理学检查；第二个数据集包含175只动物，进行了单剂量皮内颈静脉结核菌素（SICT）检测、Bovigam®检测、病理学检查和培养。模型中考虑了双向条件依赖性。此外，使用科恩kappa检验（21份血样）评估了Bovigam®检测在不同实验室之间的一致性（五个官方认可的实验室）。结果以均值后验和95%可信区间给出。SICT检测、SICCT检测、PCR和病理学检查的特异性在75.8%[68.8-82.2%]至99.0%[96.8-100%]之间。Bovigam®检测的特异性非常低（6.9%[3.6-11.1%]），尽管其敏感性最高（95.7%[91.3-99.2%]）。SICCT检测、PCR、SICT检测、病理学检查和培养的敏感性在57.8%[48.0-67.6%]至88.9%[65.5-99.7%]之间。患病率分别为19.8%[14.6-26.5%]（三检测数据集）和7.7%[4.2-12.3%]（四检测数据集）。在所有两两比较中，最高一致性为0.62[0.15-1]。总之，Bovigam®检测的特异性和不同实验室之间的一致性低于预期。
