Estimated sensitivity and specificity of diagnostic tests based on antibody detection for VL in HIV-infected patients, using a random effects model and their respective 95% confidence intervals [50].

<p>Data for antigen detection in urine <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003021#pntd.0003021-Riera1" target="_blank">[56]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003021#pntd.0003021-Vilaplana1" target="_blank">[55]</a>. Abbreviations: CI, confidence interval; ELISA, enzyme-linked immunosorbent assay; IFAT, indirect fluorescent antibody test.</p

Therapy for visceral leishmaniasis in HIV-coinfected patients in the Mediterranean area.

<p>Evidence-based recommendation. <b>Strength of recommendation:</b><b>A</b> = Good evidence to support a recommendation for use; <b>B</b> = Moderate evidence to support a recommendation for use; <b>C</b> = Poor evidence to support a recommendation; <b>D</b> = Moderate evidence to support a recommendation against use; <b>E</b> = Good evidence to support a recommendation against use.</p><p><b>Quality of evidence</b>: <b>I</b> = Evidence from one or more randomized clinical trials; <b>II</b> = Evidence from one or more well-designed clinical trials, without randomization; from cohort or case-controlled analytic studies (preferably from >1 center); from multiple time series; or from dramatic results from uncontrolled experiments; <b>III</b> = Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003021#pntd.0003021-Khan1" target="_blank">[77]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003021#pntd.0003021-Kish1" target="_blank">[78]</a>. Abbreviations: IM, intramuscular; IV, intravenous; po, per os.</p

Studies on secondary prophylaxis regimens performed in the Mediterranean region for visceral leishmaniasis in HIV+ patients.

<p>Studies on secondary prophylaxis regimens performed in the Mediterranean region for visceral leishmaniasis in HIV+ patients.</p

Sample households characteristics (N = 218).^*

<p>*Information only collected in the 2009 survey.</p>†<p>Totals may not add up to 218 due to missing values.</p

Knowledge about VL signs and symptoms.

<p><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002799#s3" target="_blank">Results</a> for 2009 and 2011 surveys, stratified by households with and without history of VL.</p>(*)<p>As reported in the 2009 survey.</p><p>(†)Results of McNemar test for matched data.</p><p>(§)p<0,05 for differences between HH with and without history of VL.</p><p>(‡)Other signs and symptoms reported: foot and face edema, epistaxis, fatigue, chills, headache and vomiting.</p><p>(¶)Proper knowledge defined as a spontaneous answer that included at least one of the following “Fever”, “Weight loss” or “Abdominal swelling” in the VL signs & symptoms question.</p

Practices related to household characteristics and protection measures associated with <i>Leishmania</i> transmission in 2009 and in 2011.

<p>(†)Results of McNemar test for matched data.</p

Knowledge, Attitudes and Practices Related to Visceral Leishmaniasis in Rural Communities of Amhara State: A Longitudinal Study in Northwest Ethiopia

<div><p>Background</p><p>In the northwest of Ethiopia, at the South Gondar region, there was a visceral leishmaniasis (VL) outbreak in 2005, making the disease a public health concern for the regional health authorities ever since. The knowledge on how the population perceives the disease is essential in order to propose successful control strategies.</p><p>Methodology/Principal findings</p><p>Two surveys on VL knowledge, attitudes and practices were conducted at the beginning (May 2009) and at the end (February 2011) of a VL longitudinal study carried out in rural communities of Libo Kemkem and Fogera, two districts of the Amhara Regional State. <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002799#s3" target="_blank">Results</a> showed that VL global knowledge was very low in the area, and that it improved substantially in the period studied. Specifically, from 2009 to 2011, the frequency of proper knowledge regarding VL signs and symptoms increased from 47% to 71% (p<0.0001), knowledge of VL causes increased from 8% to 25% (p<0.0001), and knowledge on VL protection measures from 16% to 55% (p<0.0001). Moreover, the improvement observed in VL knowledge was more marked among the families with no previous history of VL case. Finally, in 2011 more than 90% of the households owned at least an impregnated bed net and had been sprayed, and attitudes towards these and other protective measures were very positive (over 94% acceptance for all of them).</p><p>Conclusions/Significance</p><p>In 2009 the level of knowledge regarding VL was very low among the rural population of this area, although it improved substantially in the study period, probably due to the contribution of many actors in the area. VL patients and relatives should be appropriately informed and trained as they may act as successful health community agents. VL risk behavioural patterns are subject to change as attitudes towards protective measures were very positive overall.</p></div

Validation of rK39 immunochromatographic test and direct agglutination test for the diagnosis of Mediterranean visceral leishmaniasis in Spain

<div><p>Background</p><p>Visceral leishmaniasis (VL), the most severe form of leishmaniasis, is endemic in Europe with Mediterranean countries reporting endemic status alongside a worrying northward spread. Serological diagnosis, including immunochromatographic test based on the recombinant antigen rK39 (rK39-ICT) and a direct agglutination test (DAT) based on the whole parasite antigen, have been validated in regions with high VL burden, such as eastern Africa and the Indian subcontinent. To date, no studies using a large set of patients have performed an assessment of both methods within Europe.</p><p>Methodology/Principal findings</p><p>We selected a range of clinical serum samples from patients with confirmed VL (including HIV co-infection), Chagas disease, malaria, other parasitic infections and negative samples (n = 743; years 2009–2015) to test the performance of rK39-ICT rapid test (Kalazar Detect Rapid Test; InBios International, Inc., USA) and DAT (ITM-DAT/VLG; Institute of Tropical Medicine Antwerp, Belgium). An in-house immunofluorescence antibody test (IFAT), was included for comparison. Estimated sensitivities for rK39-ICT and DAT in HIV-negative VL patients were 83.1% [75.1–91.2] and 84.2% [76.3–92.1], respectively. Sensitivity was reduced to 67.3% [52.7–82.0] for rK39 and increased to 91.3% [82.1–100.0] for DAT in HIV/VL co-infected patients. The in-house IFAT was more sensitive in HIV-negative VL patients, 84.2% [76.3–92.1] than in HIV/VL patients, 79.4% [73.3–96.2]. DAT gave 32 false positives in sera from HIV-negative VL suspects, compared to 0 and 2 for rK39 and IFAT, respectively, but correctly detected more HIV/VL patients (42/46) than rK39 (31/46) and IFAT (39/46).</p><p>Conclusions/Significance</p><p>Though rK39-ICT and DAT exhibited acceptable sensitivity and specificity a combination with other tests is required for highly sensitive diagnosis of VL cases in Spain. Important variation in the performance of the tests were seen in patients co-infected with HIV or with other parasitic infections. This study can help inform the choice of serological test to be used when screening or diagnosing VL in a European Mediterranean setting.</p></div

Timeline and demographics of suspected visceral leishmaniasis (VL) cases tested at the WHOCCL-ISCIII, Spain, 2009–2015.

<p>Panel A shows the number of VL cases and non-cases tested by month. Panel B shows the age and sex distribution of suspected VL cases and non-cases. Panel C maps the location of health centres in Spain where VL cases sought diagnosis (circles) and the number of VL cases per health centre (size of circle). Map tiles by Stamen Design, under CC BY 3.0. Data by OpenStreetMap, under ODbL.</p

Type and number of samples used in this study and diagnostic outcome from each test assessed.

<p>Type and number of samples used in this study and diagnostic outcome from each test assessed.</p