Standardisation of lymphatic filariasis microfilaraemia prevalence estimates based on different diagnostic methods: a sy
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arasites & Vectors Open Access
RESEARCH
Standardisation of lymphatic filariasis microfilaraemia prevalence estimates based on different diagnostic methods: a systematic review and meta‑analysis Natalie V. S. Vinkeles Melchers* , Luc E. Coffeng, Sake J. de Vlas and Wilma A. Stolk
Abstract Background: Lymphatic filariasis (LF) infection is generally diagnosed through parasitological identification of microfilariae (mf ) in the blood. Although historically the most commonly used technique for counting mf is the thick blood smear based on 20 µl blood (TBS20), various other techniques and blood volumes have been applied. It is therefore a challenge to compare mf prevalence estimates from different LF-survey data. Our objective was to standardise microfilaraemia (mf ) prevalence estimates to TBS20 as the reference diagnostic technique. Methods: We first performed a systematic review to identify studies reporting on comparative mf prevalence data as measured by more than one diagnostic test, including TBS20, on the same study population. Associations between mf prevalences based on different diagnostic techniques were quantified in terms of odds ratios (OR, with TBS20 blood as reference), using a meta-regression model. Results: We identified 606 articles matching our search strategy and included 14 in our analyses. The OR of the mf prevalences as measured by the more sensitive counting chamber technique (≥ 50 µl blood) was 2.90 (95% confidence interval (CI): 1.60–5.28). For membrane filtration (1 ml blood) the OR was 2.39 (95% CI: 1.62–3.53), Knott’s technique it was 1.54 (95% CI: 0.72–3.29), and for TBS in ≥ 40 µl blood it was 1.37 (95% CI: 0.81–2.30). Conclusions: We provided transformation factors to standardise mf prevalence estimates as detected by different diagnostic techniques to mf prevalence estimates as measured by TBS20. This will facilitate the use and comparison of more datasets in meta-analyses and geographic mapping initiatives across countries and over time. Keywords: Lymphatic filariasis, Diagnostic comparison, Meta-regression, Counting chamber, Blood smear, Blood film, Knott’s technique, Membrane filtration Background Lymphatic filariasis (LF) is a severely disabling, mosquito-borne infectious disease, causing elephantiasis and hydrocele. Active infection can be parasitologically diagnosed by demonstrating the presence of microfilaraemia *Correspondence: [email protected]; Natalie. [email protected] Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
(mf ) in the blood, for which several methods are available. The diagnostic accuracy varies between methods, depending on timing of specimen collection (there is variation in the periodicity of LF parasite species in the blood), the type of blood sample (venous or capillary blood), blood volume examined, and blood sample processing methods (e.g. concentration, filtration, dehaemoglobinisation, etc.). The decision of the diagnostic techniques to be used in LF-
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