Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
권호 표지

Evaluation of Diagnostic Performance of a Polymerase Chain Reaction for Detection of Canine Dirofilaria immitis

개 심장사상충을 진단하기 위한 중합연쇄반응검사 (PCR)의 진단적 특성 평가

  • Pak, Son-Il (School of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University) ;
  • Kim, Doo (School of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University)
  • 박선일 (강원대학교 수의학부대학) ;
  • 김두 (강원대학교 수의학부대학)
  • Published : 2007.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Diagnostic performance of polymerase chain reaction (PCR) for detecting Dirofilaria immitis in dogs was evaluated when no gold standard test was employed. An enzyme-linked immunosorbent assay test kit (SnapTM, IDEXX, USA) with unknown parameters was also employed. The sensitivity and specificity of the PCR from two-population model were estimated by using both maximum likelihood using expectation-maximization (EM) algorithm and Bayesian method, assuming conditional independence between the two tests. A total of 266 samples, 133 samples in each trial, were randomly retrieved from the heartworm database records during the year 2002-2004 in a university animal hospital. These data originated from the test results of military dogs which were brought for routine medical check-up or testing for heartworm infection. When combined 2 trials, sensitivity and specificity of the PCR was 96.4-96.7% and 97.6-98.8% in EM and 94.4-94.8% and 97.1-98% in Bayesian. There were no statistical differences between estimates. This finding indicates that the PCR assay could be useful screening tool for detecting heartworm antigen in dogs. This study was provided further evidences that Bayesian approach is an alternative approach to draw better inference about the performance of a new diagnostic test in case when either gold test is not available.

본 연구는 개에서 심장사상충을 검출하기 위하여 표준검사를 적용하지 않은 상황에서 중합연쇄반응검사 (PCR)의 진단 능력을 평가하였다. 효소면역검사법 (ELISA)과 PCR 검사를 동시에 사용한 경우 PCR 검사의 민감도와 특이도는 두 검사의 조건부 독립을 가정한 상태에서expectation-maximization (EM) 알고리즘을 이용한 최대우도법과 Bayesian 기법으로 두 집단 검사 모형으로 분석하였다 2002-2004년 기간 중 심장사상충검사 결과를 기록한 의무기록에서 무작위로 266개 결과를 추출하여 133개씩 2회의 시험으로 배치하였다. 2회의 분석결과를 종합할 때 EM 알고리즘에서 PCR 검사의 민감도와 특이도는 각각 96.4-96.7%와 97.6-98.8%, Bayesian기법에서는 94.4-94.8h와 97.1-98%로 추정되었다. PCR 검사는 심장사상충을 스크리닝하는 도구로 유용하며, 표준검사를 적용하지 않은 상황에서 진단검사의 특성을 추론하는 방법으로 Bayesian 기법은 매우 유용함을 확인하였다.

Keywords

References

  1. Alonzo TA, Pepe MS. Using a combination of reference tests to assess the accuracy of a new diagnostic test. Stat Med 1999; 18: 2987-3003 https://doi.org/10.1002/(SICI)1097-0258(19991130)18:22<2987::AID-SIM205>3.0.CO;2-B
  2. Boelaert M, Aoun K, Liinev J, Goetghebeur E, van der Stuyft P. The potential of latent class analysis in diagnostic test validation for canine Leishmania infantum infection. Epidemiol Infect 1999; 123: 499-506 https://doi.org/10.1017/S0950268899003040
  3. Brunner CJ, Hendrix CM, Blagburn BL, Hanrahan LA. Comparison of serologic tests for detection of antigen in canine heartwonn infections. J Am Vet Med Assoc 1988; 192: 14231427
  4. Choi BCK. Causal modeling to estimate sensitivity and specificity of a test when prevalence changes. Epidemiology 1997; 8: 80-86 https://doi.org/10.1097/00001648-199701000-00013
  5. Courtney CH, Zeng QY, Bean ES. Sensitivity and specificity of the Diro-$CHEK^{(R)}$ heartworm antigen test for immunodiagnosis of canine dirofilariasis and a comparison with other immunodiagnostic tests. J Am Anim Hosp Assoc 1988; 24: 27-32
  6. Courtney CH, Zeng QY. Comparison of two antigen tests and the modified Knott's test for the detection of canine heartworm at different worm burdens. Canine Pract 1993; 18: 5-7
  7. Courtney CH, Zeng QY. Comparison of heartworm antigen test kit performance in dogs having low heartworm burdens. Vet Parasitol 2001; 96: 317-322 https://doi.org/10.1016/S0304-4017(01)00374-0
  8. Dempster A, Laird N, Rubin D. Maximum likelihood from incomplete data via the EM algorithm. J Roy Stat Soc Ser B 1977; 39: 1-38
  9. Ely ML, Courtney CH. Sensitivity and specificity of FilarochekiR) heartworm antigen test and Dirotect(R) heartworm antibody test for immunodiagnosis of canine filariasi. J Am Anim Hosp Assoc 1987; 23: 367-371
  10. Enoe C, Georgiadis MP, Johnson WO. Estimation of sensitivity and specificity of diagnostic tests and disease prevalence when the true disease state is unknown. Prev Vet Med 2000; 45: 61-81 https://doi.org/10.1016/S0167-5877(00)00117-3
  11. Faraone SV, Tsuang MT. Measuring diagnostic accuracy in the absence of a 'gold standard'. Am J Psychiatry 1994; 151: 650-657 https://doi.org/10.1176/ajp.151.5.650
  12. Favia G, Lanfrancotti A, Torre AD, Cancrini G, Coluzzi M. Polymerase chain reaction: identification of Dirofilaria repens and Dirofilaria immitis. Parasitol 1996; 113: 567-571 https://doi.org/10.1017/S0031182000067615
  13. Gardner lA, Stryhn H, Lind P, Collins MT. Conditional dependence between tests affects the diagnosis and surveillance of animal diseases. Prev Vet Med 2000; 45: 107-122 https://doi.org/10.1016/S0167-5877(00)00119-7
  14. Georgiadis MP, Gardner lA, Hedrick RP. Field evaluation of sensitivity and specificity of a polymerase chain reaction (PCR) for detection of Nucleospora salmonis in rainbow trout. J Aquat Anim Health 1998; 10: 372-380 https://doi.org/10.1577/1548-8667(1998)010<0372:FEOSAS>2.0.CO;2
  15. Hui SL, Walter SO. Estimating the error rates of diagnostic tests. Biometrics 1980; 36: 167-171 https://doi.org/10.2307/2530508
  16. Johnson WO, Gastwirth JL. Bayesian inference for medical screening tests: approximations useful for the analysis of acquired immune deficiency syndrome. J Roy Statist Soc Ser B 1991; 53: 427-439
  17. Johnson WO, Gastwirth JL. Dual group screening. J Statist Plann Inference 2000; 83: 449-473 https://doi.org/10.1016/S0378-3758(99)00100-7
  18. Johnson WO, Gastwirth JL, Pearson LM. Screening without a gold standard: the Hui-Walter paradigm revisited. Am J Epidemiol 2001; 153: 921-924 https://doi.org/10.1093/aje/153.9.921
  19. Joseph L, Gyorkos TW, Coupal L. Bayesian estimation of disease prevalence and the parameters of diagnostic tests in the absence of a gold standard. Am J Epidemiol 1995; 141: 263-272 https://doi.org/10.1093/oxfordjournals.aje.a117428
  20. Mar P, Yang I, Chang G, Fei AC. Specific polymerase chain reaction for differential diagnosis of Dirofilaria immitis and Dipetaloma reconditum using primers derived from internal transcribed spacer region 2 (ITS2). Vet Parasitol 2002; 106: 243-252 https://doi.org/10.1016/S0304-4017(02)00032-8
  21. Martin TE, Collins GH. Prevalence of Dirofilaria immitis and Dipetalonema reconditum in greyhounds. Aust Vet J 1985; 62: 159-163 https://doi.org/10.1111/j.1751-0813.1985.tb07278.x
  22. Mendoza-Blanco JTX, Lyengar S. Bayesian inference on prevalence using a missing-data approach with simulation-based techniques: applications to HIV screening. Stat Med 1996; 15: 2161-2176 https://doi.org/10.1002/(SICI)1097-0258(19961030)15:20<2161::AID-SIM359>3.0.CO;2-D
  23. Pak SI, Kim D, Salman M. Estimation of paratuberculosis prevalence in dairy cattle in a province of Korea using an enzyme-linked immunosorbent assay: application of Bayesian approach. J Vet Sci 2003; 4: 51-56
  24. Rosa A, Ribicich M, Betti A, Kistermann JC, Cardillo N, Basso N, Hallu R. Prevalence of canine dirofilariasis in the city of Buenos Aires and its outskirts (Argentina). Vet Parasitol 2002; 109: 261-264 https://doi.org/10.1016/S0304-4017(02)00286-8
  25. Smith RD. Veterinary clinical epidemiology: a problem-oriented approach. 2nd ed. CRC Press: Boca Raton, 1995: 31-52
  26. Song KH, Lee SE, Hayasaki M, Shiramizu K, Kim DH, Cho KW. Seroprevalence of canine dirofilariasis in South Korea. Vet Parasitol 2003; 114: 231-236 https://doi.org/10.1016/S0304-4017(03)00137-7
  27. Tanner MA. Tools for statistical inference. In: Methods for the exploration of posterior distributions and likelihood functions. 3rd ed. Springer, New York, 1996: 78-79
  28. Vacek PM. The effect of conditional dependence on the evaluation of diagnostic tests. Biometrics 1985; 41: 959-968 https://doi.org/10.2307/2530967
  29. Valenstein, P. N. Evaluating diagnostic tests with imperfect standards. Am J Clin Pathol 1990, 93: 252-258 https://doi.org/10.1093/ajcp/93.2.252
  30. Walter SO, Irwig LM. Estimation of test error rates, disease prevalence and relative risk from misclassified data: a review. J Clin Epidemiol 1988; 41; 923-937 https://doi.org/10.1016/0895-4356(88)90110-2
  31. Walter SO, Frommer DG, Cook RJ. The estimation of sensitivity and specificity in colorectal cancer screening methods. Cancer Detect Prev 1991; 15: 465-469
  32. Watts KJ, Courtney CH, Reddy GR. Development of a PCR-based test for the sensitive and specific detection of the dog heartworm, Dirofilaria immitis, in its mosquito intermediate host. Mol Cell Probes 1999; 14: 425-430