Subject(s)
Diarrhea/therapy , Genetic Diseases, X-Linked/therapy , Hematopoietic Stem Cell Transplantation/methods , Immunologic Deficiency Syndromes/therapy , Polyendocrinopathies, Autoimmune/therapy , Transplantation Conditioning/methods , Diabetes Mellitus, Type 1/congenital , Diarrhea/diagnosis , Genetic Diseases, X-Linked/diagnosis , Humans , Immune System Diseases/congenital , Immunologic Deficiency Syndromes/diagnosis , Infant , Infant, Newborn , Polyendocrinopathies, Autoimmune/diagnosisABSTRACT
This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears (the gold standard) in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses (tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis) were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities.
Subject(s)
Antigens, Protozoan , Leishmania donovani/immunology , Leishmaniasis, Visceral/diagnosis , Reagent Strips , Animals , Antiprotozoal Agents/therapeutic use , Bone Marrow Examination/standards , Case-Control Studies , Child , Child, Preschool , Chromatography , Drug Monitoring/methods , Endemic Diseases/statistics & numerical data , False Positive Reactions , Fluorescent Antibody Technique/standards , Follow-Up Studies , Humans , Infant , Iran/epidemiology , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/parasitology , Meglumine/therapeutic use , Meglumine Antimoniate , Organometallic Compounds/therapeutic use , Sensitivity and Specificity , Treatment OutcomeABSTRACT
This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears [the gold standard] in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses [tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis] were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities
Subject(s)
Immunologic Tests , Predictive Value of Tests , Sensitivity and Specificity , Chromatography , Reagent Strips , Leishmaniasis, VisceralABSTRACT
OBJECTIVES: Fever is a common symptom in children presenting to casualty. Identifying the seriously ill is difficult. Previous studies, mainly from North America, suggest that symptoms, signs and simple investigations may help to do this. The aim of the present study was to assess the causes of fever and identify clinical and laboratory features suggesting serious disease in U.K. children presenting to hospital with temperatures >or=38 degrees C. METHODS: All children with a temperature of >or=38 degrees C seen in two hospitals between August and October 1999. RESULTS: One hundred and forty one children between 8 days and 16 years of age were studied, 64% male, 55% aged under 2 years. Eighty three percent had temperatures between 38 and 39 degrees C. Ninety six percent were casualty or GP referrals and 4% were tertiary referrals. Twenty nine percent (41/141) had serious disease but microbiologically or radiologically proven in only 22% (31/141); pneumonia (nine), meningitis (seven), sepsis (five), urinary tract infection (five), brain abscess (two), toxic shock syndrome (one), appendicitis (one), ischiorectal abscess (one). Forty two percent (5/12) of microbiologically proven meningitis and sepsis and 36% (8/22) of all meningitis and sepsis were meningococcal. Seventy one percent had non-serious diseases. In cases of serious disease the temperature was >39 degrees C in 15% (sensitivity: 14%, specificity: 82%, PPV: 25%). Poor feeding and restlessness predicted serious disease with a sensitivity of 78% and 76%, respectively. Full blood count (FBC) was taken in 50% of patients on admission; in 44% of serious and 24% of non-serious diseases WBC was between 5000 and 15,000/mm(3) and WBC >or=15,000/mm(3) was seen in 39% of serious diseases (sensitivity:10%, specificity: 95%, PPV: 44%). CONCLUSIONS: One out of three of children referred with fever had a serious disease. Degree of temperature and WBC count were poor predictors of serious disease. Interestingly, poor feeding and restlessness were more sensitive predictors, suggesting high fever and WBC count can not replace clinical assessment of the child with a temperature.
