Is urine a reliable clinical sample for the diagnosis of human visceral leishmaniasis? A systematic review and meta-analysis. Issue 5 (October 2018)

• Record Type: Journal Article
• Authors: Asfaram, Shabnam; Hosseini Teshnizi, Saeed; Fakhar, Mahdi; Banimostafavi, Elham Sadat; Soosaraei, Masoud
• Is Part Of: Parasitology international. Volume 67:Issue 5(2018:Oct.)
• Page Start: 575
• Page End: 583
• Publication Date: 2018-10
• Subjects: Human visceral leishmaniasis -- Diagnosis -- Urine -- Immunologic tools -- PCR -- Systematic review; Parasitology -- Periodicals; Parasites -- Periodicals; Parasitic Diseases -- Periodicals; Parasitology -- Periodicals; Parasitologie -- Périodiques; 571.99905
• DOI: 10.1016/j.parint.2018.05.008
• Languages: English
• ISSNs: 1383-5769

Abstract

Abstract: Visualization of amastigotes in lymph nodes, bone marrow, and other tissues samples remains the gold standard method for the diagnosis of visceral leishmaniasis (VL) in humans. This gold standard diagnostic method uses a technically challenging microscopy procedure that is often not accessible in many places in the world where VL is endemic. Here, we report the current systematic review and meta-analysis to evaluate whether urine is a reliable clinical sample for diagnosis of human VL. Data were extracted from ten available databases during the period from 2002 to 2017. Overall, 29 articles fulfilled the inclusion criteria and were used for data extraction in this systematic review. Most studies (72.4%) using urine specimens were reported from five countries: India 6 (20.7%), Iran 5 (17.2%), Bangladesh 4 (13.8%), Japan 3 (10.3%) and Spain 3 (10.3%), respectively. The most common diagnostic tests performed on urine were Katex (62.1%), ELISA (24.1%), and the rK39 (17.2%) assays. In meta-analysis the sensitivity and specificity of the three most commonly used diagnostic assays were rK39 (97%; CI: 91–99; 98%;76–100), ELISA (91%; 82–95; 99%; CI: 94–100), and Katex (83%; 73–90; 98%; 98–100), suggesting that the rK39 assay provided the highest sensitivity and the ELISA assay provided the highest specificity for diagnosis of VL from urine samples. Our findings suggest that urine is a valuable clinical sample for the diagnosis of human VL, particularly in areas where the gold standard test for VL is not available. Graphical abstract: Highlights: Our systematic review attempted to explore a reliable diagnostic test for diagnosis of visceral leishmaniasis (VL) using by urine specimen. Our study showed that the most common diagnostic test was KAtex, however the high sensitivity belonged to the rK39 (97%; CI: 91–99) and high specificity (99%; CI: 94–100) to the ELISA. The results of the present study confirm the urine is a valuable diagnostic sample in the diagnosis of HVL.