BMJ  2006;333 (7 October), doi:10.1136/bmj.333.7571.0

Serological tests for kala-azar work well

The direct agglutination test and rK39 dipstick have a similar, good to excellent performance for the diagnosis of visceral leishmaniasis (kala-azar). Chappuis and colleagues (p 723) carried out a meta-analysis of 43 original studies evaluating the two diagnostic tests and found similar sensitivity estimates of 94.8% for the direct agglutination test and 93.9% for the rK39 dipstick. However, sensitivities were lower for patients from east Africa. Specificity estimates varied widely and were influenced by type of controls. The authors conclude that both tests generally work well and should be more widely used, but their lower performance in some situations show that better diagnostic tools need to be developed.

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