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Journal of Tropical Medicine
Volume 2013 (2013), Article ID 150746, 8 pages
http://dx.doi.org/10.1155/2013/150746
Review Article

Systematic Review into Diagnostics for Post-Kala-Azar Dermal Leishmaniasis (PKDL)

1Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
2Royal Tropical Institute, KIT Biomedical Research, 1105 AZ Amsterdam, The Netherlands
3Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Received 21 January 2013; Revised 22 April 2013; Accepted 8 May 2013

Academic Editor: Abul Faiz

Copyright © 2013 Emily R. Adams et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). We summarized the published literature about the accuracy of diagnostic tests for PKDL. We searched Medline for eligible studies investigating the diagnostic accuracy of any test for PKDL. Study quality was assessed using QUADAS-2. Data were extracted from 21 articles including 43 separate studies. Twenty-seven studies evaluated serological tests (rK39 dipstick, ELISA, DAT, and leishmanin tests), six studies molecular tests, eight microscopy, and two cultures. Only a few of these studies reported a valid estimate of diagnostic accuracy, as most were case-control designs or used a reference standard with low sensitivity. The included studies were very heterogeneous, for example, due to a large variety of reference standards used. Hence, no summary estimates of sensitivity or specificity could be made. We recommend well-designed diagnostic accuracy trials that evaluate, side-by-side, all currently available diagnostics, including clinical symptoms, serological, antigen, molecular, and parasitological tests and possible use of statistical modelling to evaluate diagnostics when there is no suitable gold standard.