Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam.
Effective control of tuberculosis (TB) depends on early diagnosis of disease, yet available tests are unable to perfectly detect infected individuals. In novel hosts diagnostic testing methods for TB are extrapolated from other species, with unknown accuracy. The primary challenge to evaluating the...
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| Format: | Article |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0313007 |
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| author | Kirsty Officer Juan Carlos Arango-Sabogal Simon Dufour Konstantin P Lyashchenko Jonathan Cracknell Shaun Thomson Sokleaph Cheng Kris Warren Bethany Jackson |
| author_facet | Kirsty Officer Juan Carlos Arango-Sabogal Simon Dufour Konstantin P Lyashchenko Jonathan Cracknell Shaun Thomson Sokleaph Cheng Kris Warren Bethany Jackson |
| author_sort | Kirsty Officer |
| collection | DOAJ |
| description | Effective control of tuberculosis (TB) depends on early diagnosis of disease, yet available tests are unable to perfectly detect infected individuals. In novel hosts diagnostic testing methods for TB are extrapolated from other species, with unknown accuracy. The primary challenge to evaluating the accuracy of TB tests is the lack of a perfect reference test. Here we use a Bayesian latent class analysis approach to evaluate five tests available for ante-mortem detection of pulmonary TB in captive sun bears and Asiatic black bears in Southeast Asia. Using retrospective results from screening of 344 bears at three rescue centres, we estimate accuracy parameters for thoracic radiography, a serological assay (DPP VetTB), and three microbiological tests (microscopy, PCR (Xpert MTB/RIF, Xpert MTB/RIF Ultra), mycobacterial culture) performed on bronchoalveolar lavage samples. While confirming the high specificities (≥ 0.99) of the three microbiological tests, our model demonstrated their sub-optimal sensitivities (<0.7). Thoracic radiography was the only diagnostic method with sensitivity (0.95, 95% BCI: 0.76, 0.998) and specificity (0.95, 95% BCI: 0.91, 0.98) estimated above 0.9. We recommend caution when interpreting DPP VetTB results, with the increased sensitivity resulting from treatment of weakly visible reactions as positive accompanied by a drop in specificity, and we illustrate how the diagnostic value of weak DPP VetTB reactions is particularly reduced if disease prevalence and/or clinical suspicion is low. Conversely, the reduced utility of negative microbiological tests on bronchoalveolar lavage fluid samples when prevalence and/or clinical suspicion is high is demonstrated. Taken together our results suggest multiple tests should be applied and accompanied by consideration of the testing context, to minimise the consequences of misclassification of disease status of bears at risk of TB in sanctuary settings. |
| format | Article |
| id | doaj-art-10bde5ed01394e428e3f9ff25ab5e3aa |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-10bde5ed01394e428e3f9ff25ab5e3aa2024-11-19T05:31:34ZengPublic Library of Science (PLoS)PLoS ONE1932-62032024-01-011911e031300710.1371/journal.pone.0313007Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam.Kirsty OfficerJuan Carlos Arango-SabogalSimon DufourKonstantin P LyashchenkoJonathan CracknellShaun ThomsonSokleaph ChengKris WarrenBethany JacksonEffective control of tuberculosis (TB) depends on early diagnosis of disease, yet available tests are unable to perfectly detect infected individuals. In novel hosts diagnostic testing methods for TB are extrapolated from other species, with unknown accuracy. The primary challenge to evaluating the accuracy of TB tests is the lack of a perfect reference test. Here we use a Bayesian latent class analysis approach to evaluate five tests available for ante-mortem detection of pulmonary TB in captive sun bears and Asiatic black bears in Southeast Asia. Using retrospective results from screening of 344 bears at three rescue centres, we estimate accuracy parameters for thoracic radiography, a serological assay (DPP VetTB), and three microbiological tests (microscopy, PCR (Xpert MTB/RIF, Xpert MTB/RIF Ultra), mycobacterial culture) performed on bronchoalveolar lavage samples. While confirming the high specificities (≥ 0.99) of the three microbiological tests, our model demonstrated their sub-optimal sensitivities (<0.7). Thoracic radiography was the only diagnostic method with sensitivity (0.95, 95% BCI: 0.76, 0.998) and specificity (0.95, 95% BCI: 0.91, 0.98) estimated above 0.9. We recommend caution when interpreting DPP VetTB results, with the increased sensitivity resulting from treatment of weakly visible reactions as positive accompanied by a drop in specificity, and we illustrate how the diagnostic value of weak DPP VetTB reactions is particularly reduced if disease prevalence and/or clinical suspicion is low. Conversely, the reduced utility of negative microbiological tests on bronchoalveolar lavage fluid samples when prevalence and/or clinical suspicion is high is demonstrated. Taken together our results suggest multiple tests should be applied and accompanied by consideration of the testing context, to minimise the consequences of misclassification of disease status of bears at risk of TB in sanctuary settings.https://doi.org/10.1371/journal.pone.0313007 |
| spellingShingle | Kirsty Officer Juan Carlos Arango-Sabogal Simon Dufour Konstantin P Lyashchenko Jonathan Cracknell Shaun Thomson Sokleaph Cheng Kris Warren Bethany Jackson Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam. PLoS ONE |
| title | Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam. |
| title_full | Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam. |
| title_fullStr | Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam. |
| title_full_unstemmed | Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam. |
| title_short | Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam. |
| title_sort | bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears helarctos malayanus and asiatic black bears ursus thibetanus in cambodia and vietnam |
| url | https://doi.org/10.1371/journal.pone.0313007 |
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