

@article {3043,
	title = {Latent-class methods to evaluate diagnostics tests for {Echinococcus} infections in dogs},
	journal = {PLoS neglected tropical diseases},
	volume = {7},
	number = {2},
	year = {2013},
	pages = {e2068},
	abstract = {BACKGROUND: The diagnosis of canine echinococcosis can be a challenge in surveillance studies because there is no perfect gold standard that can be used routinely. However, unknown test specificities and sensitivities can be overcome using latent-class analysis with appropriate data. METHODOLOGY: We utilised a set of faecal and purge samples used previously to explore the epidemiology of canine echinococcosis on the Tibetan plateau. Previously only the purge results were reported and analysed in a largely deterministic way. In the present study, additional diagnostic tests of copro-PCR and copro-antigen ELISA were undertaken on the faecal samples. This enabled a Bayesian analysis in a latent-class model to examine the diagnostic performance of a genus specific copro-antigen ELISA, species-specific copro-PCR and arecoline purgation. Potential covariates including co-infection with Taenia, age and sex of the dog were also explored. The dependence structure of these diagnostic tests could also be analysed. PRINCIPLE FINDINGS: The most parsimonious result, indicated by deviance-information criteria, suggested that co-infection with Taenia spp. was a significant covariate with the Echinococcus infection. The copro-PCRs had estimated sensitivities of 89\% and 84\% respectively for the diagnoses of Echinococcus multilocularis and E. granulosus. The specificities for the copro-PCR were estimated at 93 and 83\% respectively. Copro-antigen ELISA had sensitivities of 55 and 57\% for the diagnosis of E. multilocularis and E. granulosus and specificities of 71 and 69\% respectively. Arecoline purgation with an assumed specificity of 100\% had estimated sensitivities of 76\% and 85\% respectively. SIGNIFICANCE: This study also shows that incorporating diagnostic uncertainty, in other words assuming no perfect gold standard, and including potential covariates like sex or Taenia co-infection into the epidemiological analysis may give different results than if the diagnosis of infection status is assumed to be deterministic and this approach should therefore be used whenever possible.},
	keywords = {Animals, Dog Diseases, Dogs, Echinococcosis, Enzyme-Linked Immunosorbent Assay, Feces, Parasitology, Polymerase Chain Reaction, Sensitivity and Specificity, Tibet, Veterinary Medicine},
	issn = {1935-2735},
	doi = {10.1371/journal.pntd.0002068},
	author = {Hartnack, Sonja and Budke, Christine M. and Craig, Philip S. and Jiamin, Qiu and Boufana, Belgees and Campos-Ponce, Maiza and Torgerson, Paul R.}
}
