Title Participants "The clinical diagnosis of equine sarcoids, part 2 : assessment of case features typical of equine sarcoids and validation of a diagnostic protocol to guide equine clinicians in the diagnosis of equine sarcoids" "Maarten Haspeslagh, Vincenz Gerber, Derek C Knottenbelt, Gerti Schupbach, Christoph Koch" "Performance of clinical signs and symptoms, rapid and reference laboratory diagnostic tests for diagnosis of human African trypanosomiasis by passive screening in Guinea: a prospective diagnostic accuracy study" "Oumou Camara, Mamadou Camara, Laura Cristina Falzon, Hamidou Ilboudo, Jacques Kaboré, Charlie Franck Alfred Compaoré, Eric Maurice Fèvre, Philippe Büscher, Bruno Bucheton, Veerle Lejon" "BACKGROUND: Passive diagnosis of human African trypanosomiasis (HAT) at the health facility level is a major component of HAT control in Guinea. We examined which clinical signs and symptoms are associated with HAT, and assessed the performance of selected clinical presentations, of rapid diagnostic tests (RDT), and of reference laboratory tests on dried blood spots (DBS) for diagnosing HAT in Guinea.METHOD: The study took place in 14 health facilities in Guinea, where 2345 clinical suspects were tested with RDTs (HAT Sero-K-Set, rHAT Sero-Strip, and SD Bioline HAT). Seropositives underwent parasitological examination (reference test) to confirm HAT and their DBS were tested in indirect enzyme-linked immunoassay (ELISA)/Trypanosoma brucei gambiense, trypanolysis, Loopamp Trypanosoma brucei Detection kit (LAMP) and m18S quantitative PCR (qPCR). Multivariable regression analysis assessed association of clinical presentation with HAT. Sensitivity, specificity, positive and negative predictive values of key clinical presentations, of the RDTs and of the DBS tests for HAT diagnosis were determined.RESULTS: The HAT prevalence, as confirmed parasitologically, was 2.0% (48/2345, 95% CI: 1.5-2.7%). Odds ratios (OR) for HAT were increased for participants with swollen lymph nodes (OR = 96.7, 95% CI: 20.7-452.0), important weight loss (OR = 20.4, 95% CI: 7.05-58.9), severe itching (OR = 45.9, 95% CI: 7.3-288.7) or motor disorders (OR = 4.5, 95% CI: 0.89-22.5). Presence of at least one of these clinical presentations was 75.6% (95% CI: 73.8-77.4%) specific and 97.9% (95% CI: 88.9-99.9%) sensitive for HAT. HAT Sero-K-Set, rHAT Sero-Strip, and SD Bioline HAT were respectively 97.5% (95% CI: 96.8-98.1%), 99.4% (95% CI: 99.0-99.7%) and 97.9% (95% CI: 97.2-98.4%) specific, and 100% (95% CI: 92.5-100.0%), 59.6% (95% CI: 44.3-73.3%) and 93.8% (95% CI: 82.8-98.7%) sensitive for HAT. The RDT's positive and negative predictive values ranged from 45.2-66.7% and 99.2-100% respectively. All DBS tests had specificities ≥ 92.9%. While LAMP and m18S qPCR sensitivities were below 50%, trypanolysis and ELISA/T.b. gambiense had sensitivities of 85.3% (95% CI: 68.9-95.0%) and 67.6% (95% CI: 49.5-82.6%).CONCLUSIONS: Presence of swollen lymph nodes, important weight loss, severe itching or motor disorders are simple but accurate clinical criteria for HAT referral in HAT endemic areas in Guinea. Diagnostic performances of HAT Sero-K-Set and SD Bioline HAT are sufficient for referring positives to microscopy. Trypanolysis on DBS may discriminate HAT patients from false RDT positives. Trial registration The trial was registered under NCT03356665 in clinicaltrials.gov (November 29, 2017, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT03356665 )." "Early diagnosis of Alzheimer's disease (with the announcement of the diagnosis)" "Adrian Ivanoiu, Sebastiaan Engelborghs, Bernard Hanseeuw" "Early diagnosis of Alzheimer's disease (with the announcement of the diagnosis). The number of patients consulting to find out if they have Alzheimer's disease continues to grow. Reasons to consult most often include anxiety about being affected by this disease, confidence in medical and therapeutic advances relayed in the media and the desire to plan for the future, taking into account a possible deterioration. Advances in the knowledge of the natural history of the disease and the technical progress currently allow an early diagnosis, before the stage of dementia. Although the clinical use of biomarkers is justified in patients who have attended a Memory Clinic, ethical issues remain. The disclosure of the diagnosis of Alzheimer's disease to the person who is not yet suffering from dementia remains a sensitive subject. In this context, it seems appropriate at this stage to restrict the use of these methods to centers specializing in early diagnosis." "Diagnostic performance of three rK39 rapid diagnostic tests and two direct agglutination tests for the diagnosis of visceral leishmaniasis in Southern Iran" "Zahra Rezaei, Bahman Pourabbas, Vera Kühne, Parham Pourabbas, Philippe Büscher" "To evaluate the diagnostic performance of five alternative serodiagnostic tests, serum samples from 100 confirmed visceral leishmaniasis (VL) patients, 197 healthy endemic individuals, and 58 non-VL patients living in southern Iran were compared. The VL patients were defined as individuals with a positive result of the immunofluorescent antibody test (IFAT), having clinical signs and symptoms and appropriate response to treatment. The index tests were two direct agglutination tests, DAT-ITM (Institute of Tropical Medicine, Antwerp, Belgium) and DAT-KIT (Royal Tropical Institute, Amsterdam, The Netherlands), and three rapid diagnostic tests (RDTs), Kalazar Detect (InBios International Inc., USA), IT Leish (Bio-Rad, catalog 710124), and Leishmania test (Cypress Diagnostic Company, Belgium). Sensitivities of DAT-ITM and DAT-KIT were low, respectively, 56% and 59%, while specificities were acceptable, respectively, 98% and 93%. Observed sensitivities and specificities of RDTs were higher (71%, 81%, 70% and 99%, 99%, 98% for Kalazar Detect, IT Leish, and Leishmania test, respectively). Even with a maximum sensitivity of 81%, RDTs missed almost one-fifth of VL patients that were positive in IFAT. We conclude that RDTs in VL patients do not possess adequate performance in southern Iran and require some improvement, but they can still be helpful in the diagnosis and screening of the disease in this region due to their high specificity and speed." "A phase III diagnostic accuracy study of a rapid diagnostic test for diagnosis of second-stage human African trypanosomiasis in the Democratic Republic of the Congo" "Marleen Boelaert, Deby Mukendi, Emmanuel Bottieau, Jean Roger Kalo Lilo, Tine Verdonck, Luigi Minikulu, Barbara Barbé, Philippe Gillet, Cedric P Yansouni, François Chappuis, Pascal Lutumba" "OBJECTIVES: To estimate the diagnostic accuracy of HAT Sero K-SeT for the field diagnosis of second-stage human African trypanosomiasis (HAT).DESIGN: A phase III diagnostic accuracy design. Consecutive patients with symptoms clinically suggestive of HAT were prospectively enrolled. We compared results of the index test HAT Sero K-SeT with those of a composite reference standard: demonstration of trypanosomes in cerebrospinal fluid (CSF), or trypanosomes detected in any other body fluid AND white blood cell count in CSF >5/μl.SETTING: Rural hospital in the Democratic Republic of the Congo.PARTICIPANTS: All patients above five years old presenting at Mosango hospital with a neurological problem of recent onset at the exclusion of trauma.INTERVENTIONS: n.a.MAIN OUTCOME MEASURES: Sensitivity and specificity of HAT Sero K-SeT test.RESULTS: The sensitivity of the HAT Sero K-SeT was 8/8 or 100.0% (95% confidence interval: 67.6 to 100.0%) and the specificity was 258/266 or 97.0% (94.2% to 98.5%).CONCLUSION: The high sensitivity of the HAT Sero K-SeT is in line with previously published estimates, though the sample of HAT cases in this study was small. The specificity estimate was very high and precise. This test, when negative, allows the clinician to rule out HAT in a clinical suspect in a hospital setting in this endemic region." "Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study" "Miek Smeets, Jean-Marie Degryse, Stefan Janssens, Cathy Matheï, Bert Aertgeerts, Bert Vaes" "Different diagnostic algorithms for non-acute heart failure (HF) exist. Our aim was to compare the ability of these algorithms to identify HF in symptomatic patients aged 80 years and older and identify those patients at highest risk for mortality." "Early diagnosis of Alzheimer's disease (with the announcement of the diagnosis)" "Adrian Ivanoiu, Sebastiaan Engelborghs, Bernard Hanseeuw" "Early diagnosis of Alzheimer's disease (with the announcement of the diagnosis). The number of patients consulting to find out if they have Alzheimer's disease continues to grow. Reasons to consult most often include anxiety about being affected by this disease, confidence in medical and therapeutic advances relayed in the media and the desire to plan for the future, taking into account a possible deterioration. Advances in the knowledge of the natural history of the disease and the technical progress currently allow an early diagnosis, before the stage of dementia. Although the clinical use of biomarkers is justified in patients who have attended a Memory Clinic, ethical issues remain. The disclosure of the diagnosis of Alzheimer's disease to the person who is not yet suffering from dementia remains a sensitive subject. In this context, it seems appropriate at this stage to restrict the use of these methods to centers specializing in early diagnosis." "Diagnostic accuracy of loopamp Trypanosoma brucei detection kit for diagnosis of human African Trypanosomiasis in clinical samples" "Patrick Mitashi Mulopo, Epco Hasker, D Mumba Ngoyi, Patient Pyana Pati, W. Van der Veken, Pascal Lutumba, Philippe Büscher, Marleen Boelaert, Stijn Deborggraeve" "Added Diagnostic Value of Cerebrospinal Fluid Biomarkers for Differential Dementia Diagnosis in an Autopsy-Confirmed Cohort" "Ellis Niemantsverdriet, Bart F E Feyen, Nathalie Le Bastard, Jean-Jacques Martin, Johan Goeman, Peter Paul De Deyn, Maria Bjerke, Sebastiaan Engelborghs" "BACKGROUND: Differential dementia diagnosis remains a challenge due to overlap of clinical profiles, which often results in diagnostic doubt.OBJECTIVE: Determine the added diagnostic value of cerebrospinal fluid (CSF) biomarkers for differential dementia diagnosis as compared to autopsy-confirmed diagnosis.METHODS: Seventy-one dementia patients with autopsy-confirmed diagnoses were included in this study. All neuropathological diagnoses were established according to standard neuropathological criteria and consisted of Alzheimer's disease (AD) or other dementias (NONAD). CSF levels of Aβ1 - 42, T-tau, and P-tau181 were determined and interpreted based on the IWG-2 and NIA-AA criteria, separately. A panel of three neurologists experienced with dementia made clinical consensus dementia diagnoses. Clinical and CSF biomarker diagnoses were compared to the autopsy-confirmed diagnoses.RESULTS: Forty-two patients (59%) had autopsy-confirmed AD, whereas 29 patients (41%) had autopsy-confirmed NONAD. Of the 24 patients with an ambiguous clinical dementia diagnosis, a correct diagnosis would have been established in 67% of the cases applying CSF biomarkers in the context of the IWG-2 or the NIA-AA criteria respectively.CONCLUSION: AD CSF biomarkers have an added diagnostic value in differential dementia diagnosis and can help establishing a correct dementia diagnosis in case of ambiguous clinical dementia diagnoses." "Evaluation of the rapid diagnostic test SDFK40 (Pf-pLDH/pan-pLDH) for the diagnosis of malaria in a non-endemic setting" "Jessica Maltha, Philippe Gillet, Lieselotte Cnops, Emmanuel Bottieau, Marjan Van Esbroeck, C Bruggeman, Jan Jacobs" "BACKGROUND: The present study evaluated the SD Bioline Malaria Ag 05FK40 (SDFK40), a three-band RDT detecting Plasmodium falciparum-specific parasite lactate dehydrogenase (Pf-pLDH) and pan Plasmodium-specific pLDH (pan-pLDH), in a reference setting. METHODS: The SDFK40 was retrospectively and prospectively tested against a panel of stored (n=341) and fresh (n=181) whole blood samples obtained in international travelers suspected of malaria, representing the four Plasmodium species as well as Plasmodium negative samples, and compared to microscopy and PCR results. The prospective panel was run together with OptiMAL (Pf-pLDH/pan-pLDH) and SDFK60 (histidine-rich protein-2 (HRP-2)/pan-pLDH). RESULTS: Overall sensitivities for P. falciparum tested retrospectively and prospectively were 67.9% and 78.8%, reaching 100% and 94.6% at parasite densities >1,000/microl. Sensitivity at parasite densities 500/microl. Sensitivity for Plasmodium malariae was 21.4%. Species mismatch occurred in 0.7% of samples (3/411) and was limited to non-falciparum species erroneously identified as P. falciparum. None of the Plasmodium negative samples in the retrospective panel reacted positive. Compared to OptiMAL and SDFK60, SDFK40 showed lower sensitivities for P. falciparum, but better detection of P. ovale. Inter-observer agreement and test reproducibility were excellent, but lot-to-lot variability was observed for pan-pLDH results in case of P. falciparum. CONCLUSION: SDFK40 performance was poor at low (1,000/microl) parasite densities as well as for detection of P. vivax and P. ovale at parasite densities >500/microl."