Validation of Two Rapid Diagnostic Tests for Visceral Leishmaniasis in Kenya

BACKGROUND: Visceral leishmaniasis (VL) is a systemic parasitic disease that is fatal unless treated. In Kenya, national VL guidelines rely on microscopic examination of spleen aspirate to confirm diagnosis. As this procedure is invasive, it cannot be safely implemented in peripheral health structures, where non-invasive, accurate, easy to use diagnostic tests are needed. METHODOLOGY: We evaluated the sensitivity, specificity and predictive values of two rapid diagnostic tests (RDT), DiaMed IT LEISH and Signal-KA, among consecutive patients with clinical suspicion of VL in two treatment centres located in Baringo and North Pokot District, Rift Valley province, Kenya. Microscopic examination of spleen aspirate was the reference diagnostic standard. Patients were prospectively recruited between May 2010 and July 2011. PRINCIPAL FINDINGS: Of 251 eligible patients, 219 patients were analyzed, including 131 VL and 88 non-VL patients. The median age of VL patients was 16 years with predominance of males (66%). None of the tested VL patients were co-infected with HIV. Sensitivity and specificity of the DiaMed IT LEISH were 89.3% (95%CI: 82.7-94%) and 89.8% (95%CI: 81.5-95.2%), respectively. The Signal KA showed trends towards lower sensitivity (77.1%; 95%CI: 68.9-84%) and higher specificity (95.5%; 95%CI: 88.7-98.7%). Combining the tests did not improve the overall diagnostic performance, as all patients with a positive Signal KA were also positive with the DiaMed IT LEISH. CONCLUSION/SIGNIFICANCE: The DiaMed IT LEISH can be used to diagnose VL in Kenyan peripheral health facilities where microscopic examination of spleen aspirate or sophisticated serological techniques are not feasible. There is a crucial need for an improved RDT for VL diagnosis in East Africa

Influence of environmental conditions on production of volatiles by Trichoderma atroviride in relation with the sick building syndrome

A Trichoderma atroviride strain was isolated from a water-damaged office and the production of microbial volatile organic compounds (MVOCs) was investigated by means of headspace solid phase microextraction GCeMS. Different growth conditions (substrate, temperature, relative humidity) were selected, resembling indoor parameters, to elucidate a possible relationship between MVOCs, produced by Trichoderma atroviride, and the Sick Building Syndrome. In general, the range of MVOCs and the emitted quantities were larger on malt extract agar (MEA) than on wallpaper and plasterboard. Particular attention was dedicated to the volatile marker 6-pentyl-2-pyrone, a compound produced in high quantities on MEA, and its mucosal irritation potency was shown in a slug mucosal irritation assay. Some compounds characteristic for growth on specific building materials were detected, e.g. 2-ethylcyclopentanone, menthone, iso-menthone and trans-p-menth-2-en-7-ol on plasterboard and 4-heptanone and 1-octen-3-ol on wallpaper. Relative humidity and substrate had a more important effect on MVOC production than temperature

Sensitivity, specificity, negative and positive predictive values of the DiaMed IT-LEISH and the Signal KA for VL diagnosis in Kacheliba and Kimalel, Rift Valley province, Kenya.

<p>Abbreviations: PPV = positive predictive value, NPV = negative predictive value, CI = Confidence Interval.</p

Comparison of demographic and laboratory characteristics between VL and non-VL patients in Kacheliba and Kimalel, Rift Valley province, Kenya.

<p>IQR = inter-quartile range.</p>*<p>p-value from t-test or Kruskal-Wallis test for continuous variables and Chi-square or Fisher Exact test for categorical variables.</p>**<p>measured between tip of spleen and left costal margin (at anterior axillary line level).</p