Poor performance of the rapid test for human brucellosis in health facilities in Kenya

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cg.authorship.typesCGIAR and developing country instituteen_US
cg.authorship.typesCGIAR and advanced research instituteen_US
cg.contributor.affiliationUniversity of Edinburghen_US
cg.contributor.affiliationUniversity of Glasgowen_US
cg.contributor.affiliationInternational Livestock Research Instituteen_US
cg.contributor.affiliationUniversity of Navarraen_US
cg.contributor.affiliationKenya Medical Research Instituteen_US
cg.contributor.affiliationFriedrich Loeffler Instituten_US
cg.contributor.affiliationUppsala Universityen_US
cg.contributor.affiliationUniversity of Liverpoolen_US
cg.contributor.crpAgriculture for Nutrition and Healthen_US
cg.contributor.donorBiotechnology and Biological Sciences Research Council, United Kingdomen_US
cg.contributor.donorMedical Research Council, United Kingdomen_US
cg.contributor.donorWellcome Trusten_US
cg.contributor.donorDepartment for International Development, United Kingdomen_US
cg.contributor.donorEconomic and Social Research Council, United Kingdomen_US
cg.contributor.donorNatural Environment Research Council, United Kingdomen_US
cg.contributor.donorDefence Science and Technology Laboratory, United Kingdomen_US
cg.coverage.countryKenyaen_US
cg.coverage.iso3166-alpha2KEen_US
cg.coverage.regionAfricaen_US
cg.coverage.regionEastern Africaen_US
cg.creator.identifierWilliam de Glanville: 0000-0003-2474-0356en_US
cg.creator.identifierElizabeth Cook: 0000-0001-6081-8363en_US
cg.creator.identifierMark Bronsvoort: 0000-0002-3271-8485en_US
cg.creator.identifierLian Thomas: 0000-0001-8447-1210en_US
cg.creator.identifierEric M. Fèvre: 0000-0001-8931-4986en_US
cg.howPublishedFormally Publisheden_US
cg.identifier.doihttps://doi.org/10.1371/journal.pntd.0005508en_US
cg.isijournalISI Journalen_US
cg.issn1935-2735en_US
cg.issue4en_US
cg.journalPLOS Neglected Tropical Diseasesen_US
cg.reviewStatusPeer Reviewen_US
cg.subject.ilriANIMAL DISEASESen_US
cg.subject.ilriBRUCELLOSISen_US
cg.subject.ilriDIAGNOSTICSen_US
cg.subject.ilriHEALTHen_US
cg.subject.ilriLIVESTOCKen_US
cg.subject.ilriZOONOTIC DISEASESen_US
cg.volume11en_US
dc.contributor.authorGlanville, William A. deen_US
dc.contributor.authorConde-Álvarez, R.en_US
dc.contributor.authorMoriyón, I.en_US
dc.contributor.authorNjeru, J.en_US
dc.contributor.authorDíaz, R.en_US
dc.contributor.authorCook, Elizabeth A.J.en_US
dc.contributor.authorMorin, M.en_US
dc.contributor.authorBronsvoort, B.M. de C.en_US
dc.contributor.authorThomas, Lian F.en_US
dc.contributor.authorKariuki, S.en_US
dc.contributor.authorFèvre, Eric M.en_US
dc.date.accessioned2017-04-12T11:43:19Zen_US
dc.date.available2017-04-12T11:43:19Zen_US
dc.identifier.urihttps://hdl.handle.net/10568/80714en_US
dc.titlePoor performance of the rapid test for human brucellosis in health facilities in Kenyaen_US
dcterms.abstractHuman brucellosis is considered to be an important but typically under-diagnosed cause of febrile illness in many low and middle-income countries. In Kenya, and throughout East Africa, laboratory diagnosis for the disease is based primarily on the febrile antigen Brucella agglutination test (FBAT), yet few studies of the diagnostic accuracy of this test exist. Assessment of the performance of the FBAT is essential for its appropriate clinical use, as well as for evaluating surveillance data reported by public health systems. To assess FBAT performance, we collected sera from people with symptoms compatible with brucellosis attending two health facilities in Busia County, Kenya. Sera were tested using the FBAT and results compared with those from the Rose Bengal Test (RBT), an assay with well-known performance characteristics. Positives on either test were confirmed using the classical serum agglutination test (SAT)-Coombs test combination and a rapid IgM/IgG lateral flow immunochromatography assay (LFA). A questionnaire focussing on known risk factors for exposure to Brucella spp. was also conducted, and relationships with FBAT positivity examined using logistic regression. Out of 825 recruited individuals, 162 (19.6%) were classified as positive using the FBAT. In contrast, only eight (1.0%) were positive using the RBT. Of the 162 FBAT positives, one (0.62%) had an atypical agglutination in SAT and three (1.9%) showed low Coombs titres. Out of 148 FBAT positive individuals tested using the LFA, five (3.4%) were IgM positive and none were IgG positive. Poor or no correlation was observed between FBAT results and most established risk factors for Brucella infection. We observed substantial disagreement between the FBAT and a number of well-known serological tests, with the majority of reactive FBAT results appearing to be false positives. Poor FBAT specificity, combined with a lack of confirmatory testing, strongly suggests overdiagnosis of brucellosis is common in this low prevalence setting. This is expected to have important economic impacts on affected patients subjected to the long and likely unnecessary courses of multiple antibiotics required for treatment of the disease.en_US
dcterms.accessRightsOpen Accessen_US
dcterms.audienceScientistsen_US
dcterms.available2017-04-07en_US
dcterms.bibliographicCitationGlanville, W.A. de, Conde-Álvarez, R., Moriyón, I., Njeru, J., Díaz, R., Cook, E.A.J., Morin, M., Bronsvoort, B.M. de C., Thomas, L.F., Kariuki, S. and Fèvre, E.M. 2017. Poor performance of the rapid test for human brucellosis in health facilities in Kenya. PLoS Neglected Tropical Diseases 11(4): e0005508.en_US
dcterms.issued2017-04-07en_US
dcterms.languageenen_US
dcterms.licenseCC-BY-4.0en_US
dcterms.publisherPublic Library of Scienceen_US
dcterms.subjectanimal diseasesen_US
dcterms.subjectlivestocken_US
dcterms.subjecthealthen_US
dcterms.subjectbrucellosisen_US
dcterms.subjectdiagnosisen_US
dcterms.subjectzoonosesen_US
dcterms.subjectinfectious diseasesen_US
dcterms.typeJournal Articleen_US

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