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Field evaluation of a rapid immunochromatographic dipstick test for the diagnosis of cholera in a high-risk population

DOI: 10.1186/1471-2334-6-17

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Abstract:

The performance of an immunochromatographic dipstick test (Institute Pasteur, Paris, France) specific for Vibrio cholerae O1 was evaluated in a prospective study in Beira, Mozambique, during the 2004 cholera season (January-May). Fecal specimens were collected from 391 patients with acute watery nonbloody diarrhea and tested by dipstick and conventional culture.The overall sensitivity and specificity of the rapid test compared to culture were 95% (95% confidence interval [CI]: 91%–99%) and 89% (95% CI: 86%–93%), respectively. After stratification by type of sample (rectal swab/bulk stool) and severity of diarrhea, the sensitivity ranged between 85% and 98% and specificity between 77% and 97%.This one-step dipstick test performed well in the diagnosis of V. cholerae O1 in a setting with seasonal outbreaks where rapid tests are most urgently needed.The cardinal clinical feature of cholera is a severe dehydrating diarrhea, which can lead to severe and rapidly progressing dehydration and shock. Despite advances in the understanding of its pathophysiology and transmission, cholera remains a major international health concern. In 2003, the World Health Organization (WHO) received reports from 45 countries of 11,575 cholera cases and 1,894 related deaths. The majority of cholera cases occurred in sub-Saharan Africa [1]. However, these numbers are considered gross underestimates since outbreaks are often not reported due to fear of travel and trade sanctions. Critical interventions for cholera control include improved access to efficient treatment facilities, education to promote good personal hygiene, and improvement of sanitation and safe water supply [2-4]. But successful interventions depend on early detection of cholera outbreaks. Therefore, an efficient cholera surveillance system should be a high priority in the control of cholera [1,5].The conventional culture methods currently used for diagnosis of Vibrio cholerae remain the gold standard but require a functioning

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