Departamento de Ciencias de la Vida y la Agricultura, Carrera de Ingeniería Agropecuaria, Universidad de las Fuerzas Armadas - ESPE, Sangolquí, Ecuador.
Research Unit of Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium.
Am J Trop Med Hyg. 2019 Jun;100(6):1312-1320. doi: 10.4269/ajtmh.18-0622.
Brucellosis is an important but neglected zoonosis that causes serious economic losses both in livestock and human populations. The aim of the present study was to estimate the true prevalence of brucellosis together with diagnostic sensitivity and specificity of three serological tests in humans of the northwestern part of Ecuador using a Bayesian approach adjusted for the dependencies among the multiple tests to avoid any misinterpretation. In addition, the causal agent responsible for human brucellosis was also identified. Using a total of 3,733 samples collected from humans in this area between 2006 and 2008, the prevalence of human brucellosis and the diagnostic test characteristics of the Rose Bengal fast agglutination test (RBT), Wright's slow agglutination test with ethylenediaminetetraacetic acid disodium salt dehydrate (EDTA) (SAT-EDTA), and indirect ELISA (iELISA) were estimated using a Bayesian approach. The estimated true prevalence of human brucellosis was 1% (credibility interval: 0.4-1.6). The sensitivities of iELISA and RBT were higher than and similar (95.1% and 95.0%, respectively) to those of SAT-EDTA (60.8%). Even though all tests indicated a high specificity (> 99.0%), the specificity of SAT-EDTA was highest (99.9%). The circulating strain in this study area was identified to be biotype 4 based on culture and microbiological characterization. The RBT and the iELISA are recommended for estimating the true prevalence of human brucellosis and/or for surveillance programs following their high sensitivities and specificities. The proposed strategy supports evidence-based medicine for clinicians and policy-makers to ensure appropriate preventive and control program of brucellosis worldwide.
布鲁氏菌病是一种重要但被忽视的动物源性传染病，它给畜牧业和人类带来了严重的经济损失。本研究的目的是使用贝叶斯方法估计厄瓜多尔西北部人类布鲁氏菌病的真实流行率以及三种血清学检测方法的诊断敏感性和特异性，同时调整了多个检测之间的依赖性，以避免任何误解。此外，还确定了导致人类布鲁氏菌病的病原体。使用 2006 年至 2008 年期间从该地区采集的总共 3733 个人类样本，使用贝叶斯方法估计了人类布鲁氏菌病的流行率以及孟加拉玫瑰红快速凝集试验（RBT）、含有乙二胺四乙酸二钠脱水物的 Wright 缓慢凝集试验（EDTA）（SAT-EDTA）和间接酶联免疫吸附试验（iELISA）的诊断试验特征。使用贝叶斯方法估计人类布鲁氏菌病的真实流行率为 1%（置信区间：0.4-1.6）。iELISA 和 RBT 的敏感性高于 SAT-EDTA（分别为 95.1%和 95.0%），而 SAT-EDTA 的敏感性为 60.8%。尽管所有检测均表明特异性较高（>99.0%），但 SAT-EDTA 的特异性最高（99.9%）。根据培养和微生物学特征，该研究地区的流行菌株被鉴定为 4 生物型。RBT 和 iELISA 因其高敏感性和特异性而被推荐用于估计人类布鲁氏菌病的真实流行率和/或监测方案。该建议的策略为临床医生和决策者提供循证医学支持，以确保全球范围内实施适当的布鲁氏菌病预防和控制计划。
