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Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis.
Paul Arora1, Kristian Thorlund2, Darren R Brenner3
1Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Ontario, Canada.
Plos Neglected Tropical Diseases
|May 9, 2019
Summary
Accurate typhoid fever diagnosis in children is crucial. Lateral-flow IgG, TPT, and Reverse Passive Hemagglutination Assay show high accuracy, with combinations improving sensitivity for pediatric typhoid diagnosis.
Area of Science:
- Infectious Diseases
- Microbiology
- Pediatrics
Background:
- Typhoid fever, caused by Salmonella Typhi and Paratyphi bacteria, affects millions annually, predominantly children.
- The diagnostic accuracy of existing typhoid fever tests is not well-established.
- This study focuses on evaluating diagnostic test accuracy specifically within the pediatric population.
Purpose of the Study:
- To determine the comparative accuracy of diagnostic tests for typhoid fever in children.
- To identify the most effective diagnostic methods for pediatric typhoid fever.
- To inform clinical practice and public health strategies for typhoid diagnosis in children.
Main Methods:
- Conducted a systematic literature review of studies comparing typhoid diagnostic tests in children (≤15 years) against blood culture.
- Employed a Bayesian latent-class network meta-analysis model.
- Incorporated data on bone marrow culture and its relationship with blood culture as informative priors.
Main Results:
- Evaluated 510 comparisons from 196 studies, with 57 focusing on pediatric cases.
- IgM-based tests outperformed IgG-based ELISA and Typhidot tests.
- Lateral flow IgG tests demonstrated 92% sensitivity and 94% specificity; Reverse Passive Hemagglutination Assay showed 99% sensitivity in South Asian children.
- Combination of lateral flow IgG rapid test with typhoid/paratyphoid (TPT) assay was the best performing combination.
Conclusions:
- Lateral-flow IgG, TPT, and Reverse Passive Hemagglutination Assay exhibit high diagnostic accuracy in the pediatric population.
- Combining diagnostic tests can enhance sensitivity for typhoid fever detection.
- Further research is needed to expand the evidence base for typhoid diagnostic accuracy in regions beyond South Asia.
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