In endemic African areas, such as Tanzania,
Brucellosis is a disease of humans and animals caused by several species of the genus
The incidence of human brucellosis varies widely among and within countries, with a higher disease incidence seen in low- and middle-income countries when compared to high-income countries. In Africa, for example, incidences calculated from two prospective studies in Egypt that involved a surveillance system for acute febrile illness in rural areas ranged from 18 to 70 cases per 100,000 person-years [
Understanding the true burden of human brucellosis in endemic settings, such as Tanzania, has been challenged by delayed diagnosis, underdiagnosis, and underreporting [
A definitive diagnosis of
Compared to most other serological tests, RBT is rapid, easy to use, and relatively affordable as a screening test for
Even with its limitations, the above features suggest RBT may be an especially useful test in endemic areas with limited laboratory facilities and access. Further assessment of RBT performance data is needed to facilitate the acceptance and uptake of point-of-care tests in endemic areas, such as Tanzania. Although brucellosis diagnostic testing is currently being conducted at some health facilities in Tanzania using RBT and other tests, there has not yet been formal approval by the government of Tanzania for any point-of-care brucellosis diagnostic test.
Evidence on RBT performance could provide useful information for local health authorities and governments to guide decisions on the appropriate choice of point-of-care tests, facilitate early clinical diagnosis and management of human brucellosis illnesses and other nonmalarial fevers in endemic regions, and contribute to reducing the impact of nonmalarial febrile illnesses.
The purpose of this study was to review available evidence on the diagnostic performance of RBT, with a focus on its potential use as a routine point-of-care test in endemic and resource-limited areas of Africa, with Tanzania as an example. The review was initially focused on studies conducted in Tanzania but was later extended to worldwide because few relevant studies from Tanzania were identified. The specific aims were to review the diagnostic sensitivity (DSe) and specificity (DSp) of RBT compared to culture which is considered the gold standard test.
A systematic literature review was conducted, through which published evidence on performance of RBT as a point-of-care test for human brucellosis was collected and assessed. Review of the literature was conducted following the PRISMA guidelines for systematic reviews and meta-analyses [
Eligible studies were full-text peer-reviewed manuscripts or scientific expert opinion reports published in English between January 1, 1970, and December 31, 2019, that used either RBT alone or a combination of RBT and other tests to detect
First, the PICO (population, intervention, comparator, and outcome) was defined, which guided the definition of the search terms of interest used to identify potentially eligible studies. Population: reports in which
The search strategy used science database search engines, grey literature websites, and citation tracking to identify potentially relevant studies. Electronic databases including MEDLINE (PubMed), Embase, Web of Science (WOS), and other sources (World Health Organization Global Index Medicus) were searched for relevant studies. Free text searches covered both title and abstract. Searches included Medical Subject Headings (MeSH) thesaurus headings and free text terms that covered the PIO criteria (e.g., population, interventions, and outcomes). The free terms and MeSH headings were combined with Boolean operator OR and/or combined with AND at a later stage of the search process (Table
All articles meeting search criteria from the literature were imported into EndNote reference management software, and duplicates were removed prior to the first stage sifting process. All identified studies were then screened for eligibility based on the title, abstract, and full text. The number of documents identified and screened was recorded at each stage and presented in a PRISMA diagram as described by Moher et al. [
Flow diagram of study selection procedures, adapted from Moher et al. [
Following data extraction into an Excel database, study characteristics (e.g., study design, sampling methods, patient groups compared, and diagnostic tests evaluated) and outcomes of interest were described. Data for RBT diagnostic sensitivity and specificity and positive and negative predictive values (where provided) compared to culture were assessed. Data on merits and limitations of RBT were also assessed.
Following the search criteria, literature searches in Web of Science, Embase, and MEDLINE identified 999, 469, and 268 studies, respectively. Additional searches in WHO Global Index Medicus and reference tracking retrieved 149 and 7 studies, respectively, resulting in an overall total of 1892 studies. After removing 901 duplicates, 991 studies were selected for further evaluation based on the title and abstract. Further screening and eligibility assessment resulted in additional exclusions. First, 953 studies were excluded because 615 did not describe use of RBT in humans, 261 studies did not use culture as the reference test, and 77 studies did not evaluate or report diagnostic sensitivity and specificity. The remaining 38 full-text articles were further assessed for eligibility. An additional 22 studies were excluded because RBT diagnostic performance was not assessed (
Key characteristics of the sixteen studies included in the review are summarized in Table
Summary of published studies that investigated the performance of Rose Bengal test compared to culture as the reference test for diagnosis of human
Study | Diagnostic tests investigated | RBT DSe and DSp reported | Patient groups used to assess RBT performance | Diagnostic criteria used to select patient groups | “True positive” or “true negative” patient group used | Country |
---|---|---|---|---|---|---|
Diaz et al. [ | RBT, titrated RBT | No, but DSe and DSp can be calculated from values provided. | (1) Individuals with brucellosis confirmed by culture ( | Clinical findings, laboratory criteria (culture, serology). | Suitable “true positive” patient group used. Based on culture-positive results and clinical and/or epidemiological criteria. | Spain |
(2) Individuals with professional contact with infected animals or products or accidentally injected with | Clinical findings, laboratory and epidemiological criteria. | NA | ||||
(3) Brucellosis patients showing prozone effect ( | ||||||
(4) Patients with no brucellosis symptoms (serum sent to the lab for diagnosis of other infections) ( | Clinical findings. | Suitable “true negative” patient group used. Even though patients had no brucellosis symptoms, no culture results were reported. Diagnosis based only on clinical and/or epidemiological criteria. | ||||
Gomez et al. [ | Titrated RBT | Yes, but patient group used to calculate DSp was unsuitable. | (1) Patients with acute brucellosis ( | Clinical findings and either positive culture or serology results (SAT ≥ 160). | Suitable “true positive” patient group used. Based on positive culture results and clinical findings. | Spain |
(2) Healthy individuals (blood donors) ( | Clinical findings (blood donors) and serology results. | Suitable “true negative” patient group used. Even though patients were considered “healthy,” culture was not performed. Diagnosis was based only on clinical findings and serology. | ||||
Mizanbayeva et al. [ | RBT, SAT, LFA IgM and IgG, culture. | Yes, DSe reported, but DSp was not assessed. | Patients with clinical suspicion of brucellosis ( | Clinical findings, laboratory findings (culture, serology). | Suitable “true positive” patient group used. Based on culture-positive results, clinical and/or epidemiological criteria. | Kazakhstan |
No “true negative” patient group assessed. | ||||||
Ruiz-Mesa et al. [ | RBT, culture | Yes, DSp can be calculated from values provided, but DSe for culture-positive patients could not be calculated. | (1) Individuals with brucellosis confirmed with culture ( | Laboratory (culture or serology) and clinical criteria. | Suitable “true positive” patient group used. Based on positive culture results and clinical findings. | Spain |
(2) Patients with different infectious, autoimmune, or neoplastic processes with a precise aetiological diagnosis, but which involved an initial differential diagnosis with brucellosis ( | Clinical criteria, serology done but not specified if done for this group. | Suitable “true negative” patient group used. Even though patients were not diagnosed with brucellosis, culture was not performed. | ||||
(3) Individuals exposed repeatedly to | Clinical and epidemiological criteria, serology done but not specified if done for this group. | NA. Culture was not performed, and patient group was exposed to brucellosis. | ||||
(4) Asymptomatic patients with history of brucellosis who had received appropriate treatment and shown no evidence of relapse after 1 year ( | History, clinical, and epidemiological criteria, serology done but not specified if done for this group. | NA. Culture was not performed, and patient group had a history of brucellosis. | ||||
Saz et al. [ | RBT, ELISA, SAT, Coombs, culture. | No, but DSe and DSp can be calculated from values provided. | (1) Patients from whom | Laboratory criteria (culture and serology). | Suitable “true positive” patient group used. Based on positive culture results and clinical findings. | Spain |
(2) Patients with suspected brucellosis and positive results by ≥two conventional tests ( | Clinical findings and laboratory criteria (serology—positive RBT, SAT ≥ 80 and ≥160, Coombs). | NA. Culture was not performed. | ||||
(3) Patients with fever but no other symptoms of brucellosis, from whom no | Based on clinical findings, negative culture and serology results (ELISA). | Suitable “true negative” group used. Based on negative culture results, serology and clinical findings. | ||||
Serra and Vinas [ | RBT, SAT, Coombs, ELISA IgG and IgM, CFT, culture. | Yes, DSe of the “true positive” group could be calculated independently, but DSp of the “true negative” group could not be calculated based on the information provided. | (1) Patients with primary infection (no personal history of brucellosis) and showing acute clinical symptoms ( | Based on either (1) positive culture and serology results (SAT ≥ 160) and clinical evidence, or (2) clinical evidence and positive serology (Coombs test). | Suitable “true positive” group used. Based on positive culture results and clinical criteria. | Spain |
(2) Individuals living in the same area examined ( | No information provided on laboratory or epidemiological criteria. | Suitable “true negative” patient group used. Even though patients were considered “healthy,” culture results were not reported. Based on clinical findings only. | ||||
(3) Patients with evidence of previous infection ( | Based on positive culture and serology results, clinical and epidemiological criteria. | NA. Patients with a history of brucellosis infection, and culture was performed. | ||||
(4) Healthy individuals in whom brucellosis had previously been diagnosed and subsequently treated more than 2 years before, with no subsequent symptoms of the disease (“cured” population) ( | Based on clinical and epidemiological criteria. | Not suitable “true negative” group. Culture was not performed, and individuals had a history of brucellosis. | ||||
Sisirak and Hukić [ | RBT, ELISA IgM and IgG, culture. | Yes, but DSp could not be calculated independently. | Patients with signs of brucellosis at presentation ( | Laboratory criteria (culture and/or serology), clinical findings. | Suitable “true positive” group. Based on positive culture results and clinical criteria. | Bosnia and Herzegovina |
Not suitable “true negative” group used. Unclear information provided on culture and RBT results. | ||||||
Taleski [ | RBT, Coombs, 2-ME, CFT, Indirect ELISA, cELISA, FPA, PCR, culture. | No, DSe and DSp were not reported and could not be calculated independently. | (1) Patients with acute brucellosis ( | Epidemiological data, clinical findings, and laboratory tests. | Not suitable “true positive” group. No information provided on culture and RBT results for the group. | Macedonia |
(2) Healthy, voluntary blood donors ( | Epidemiological data, clinical findings, and laboratory tests. | Not suitable “true negative” group. No information provided on culture and RBT results for the group. | ||||
(3) Healthy people from endemic areas ( | Epidemiological data, clinical findings, and laboratory tests. | Not suitable “true negative” group. No information provided on culture and RBT results for the group. | ||||
Yumuk et al. [ | RBT, culture. | No, information provided is incomplete to allow for independent calculation of DSe and DSp. | Patients with clinical signs of brucellosis at presentation. Enrolled if | Clinical findings and laboratory criteria (culture). | Not suitable “true positive” group. Information provided on culture, and RBT results are unclear. | Turkey |
Not suitable “true negative” group. Information provided on culture, and RBT results are not clear. | ||||||
Mert et al. [ | RBT, STAT, culture | No, information provided is incomplete to allow for independent calculation of DSe and DSp. | (1) Patients with culture-positive brucellosis ( | Clinical findings, laboratory criteria (culture, serology). | Suitable “true positive” patient group. Culture performed, but incomplete information provided on culture and RBT results. | Turkey |
(2) Patients with diseases that mimic brucellosis clinically (military tuberculosis, malaria, typhoid fever, adult-onset Still’s disease, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, and active lymphoma) ( | Clinical findings, laboratory criteria (serology). | Not suitable “true negative group” used. No information provided on culture and RBT results for this group. | ||||
Andriopoulos et al. [ | RBT, STA, culture | No, DSe and DSp were not assessed because no suitable patient groups were used. | (1) Patients with a history of diagnosis and treatment for brucellosis ( | Based on clinical findings and serology | Not suitable “true positive” patient group because culture was not performed when patients were retested. And DSe was not assessed. | Greece |
No “true negative” patient group used and no DSp assessed. | ||||||
Mantur et al. [ | Titrated RBT, SAT, 2-ME, culture. | Yes. DSe and DSp were not assessed correctly. | Patients presented with clinical signs of brucellosis ( | Clinical features, epidemiological evidence, and serology and culture considered for presumptive clinical diagnosis of brucellosis. | Suitable “true positive” patient group used; culture performed in a subset of 56 patients. | India |
No “true negative” patient group used and no DSp assessed | ||||||
Erdem et al. [ | RBT, STA, culture. | No. DSe and DSp were not assessed. No suitable patient groups were used. | Patients with a diagnosis of chronic neurobrucellosis (brucellar meningitis or meningoencephalitis). | Clinical features and laboratory findings (serology and culture). | Not suitable “true positive” patient group defined and used. | Turkey |
No “true negative patient group used and no DSp assessed | ||||||
Marei et al. [ | RBT, SAT, 2-ME, LFA IgM and IgG, PCR, culture. | Yes, but DSe and DSp incorrectly calculated and DSp based on unsuitable patient group. | Patients presented with clinical suspicion of brucellosis ( | Brucellosis diagnosis based on clinical findings confirmed by either a positive blood culture or presence of specific serum antibodies (SAT titer ≥ 1/160). | Suitable “true positive” patient group used but culture-positive patients were few ( | Egypt |
Not suitable “true negative” patient group used. Patients had signs of brucellosis and were not clear if culture was negative. | ||||||
Ivanov et al. [ | RBT, SAT, Coombs, ELISA IgM and IgG, culture. | No | Patients with and without clinical signs of brucellosis ( | Clinical picture and serology. | Not suitable “true positive” patient group used. Culture not performed. | Bulgaria |
No “true negative” patient group used. Culture not performed on “healthy” group and no DSp assessed. | ||||||
Araj et al. [ | ELISA (IgG, IgM, IgA), RBT, culture, MAT, SA. | Yes | Patients with brucellosis ( | Clinical picture, laboratory findings (serology, culture). | Suitable “true positive” patient group used. Based on culture-positive results and clinical findings. | Kuwait |
Patients used as “controls” ( | Clinical picture, laboratory findings (serology, culture). | Suitable “true negative” patient group used. Based on culture and clinical findings. |
DSe: diagnostic sensitivity, DSp: diagnostic specificity, SAT: serum agglutination test, STAT: standard tube agglutination test, STA: Wright standard tube agglutination, Coombs: antihuman globulin test, FPA: fluorescent polarization assay, LFA: lateral flow assay, LFiC: lateral flow immunochromatography assay, MAT: microagglutination test, Brucellacapt: immunocapture-agglutination test, 2-ME: 2-mercaptoethanol test, CFT: compliment fixation test, SA:
In 13 of the 16 studies included in this review, standard RBT performance was compared to culture as the reference test [
In 8 of the 16 studies included in this review, DSe and DSp of RBT compared to culture as the reference test were estimated by the authors and reported [
The characteristics of patient groups used to evaluate RBT performance compared to culture varied in the reviewed studies. In some of the reviewed studies, the patient comparison groups were described based on diagnostic criteria of brucellosis and stage/phase of brucellosis, as shown in Table
The use of patient groups that reflect the actual population in which a test is likely to be used is an important consideration for assessment of DSe and DSp. The patient comparison groups can be selected based on relevant diagnostic criteria including historical, epidemiological, clinical, and laboratory data, as well as stage of disease. Another important consideration for assessing DSe and DSp is the use of patient groups considered “true positive” (confirmed brucellosis cases) and “true negative” (confirmed brucellosis-free). For purposes of proper calculation and interpretation of DSe and DSp of RBT (compared to culture as the gold standard),“true positive” patient groups were defined as patients considered to have brucellosis based on culture-positive results and/or clinical and/or epidemiological criteria, and “true negative” patient groups were defined as patients who are considered brucellosis-free based on culture-negative results and/or clinical and/or epidemiological criteria. The reviewed studies were assessed to determine if “true positive” and “true negative” patient groups were used to estimate DSe and DSp of RBT compared to culture as the gold standard. Patient groups that met the definitions of “true positive” or “true negative” were described as either suitable or not suitable, as shown in Table
The reviewed studies were further categorised as high or moderate or poor quality to reflect the scientific quality of the reviewed studies with respect to use of appropriate “true positive” and “true negative” patient groups and proper assessment of DSe and DSp of RBT (compared to culture). High-quality studies were defined as studies in which suitable “true positive” patient groups (based on culture-positive results and clinical and/or epidemiological criteria) and “true negative” patient groups (based on culture-negative results and clinical and/or epidemiological criteria) were used to estimate DSe and DSp of RBT compared to culture. Moderate-quality studies were defined as studies that used a suitable “true positive” patient group (based on culture-positive results and clinical and/or epidemiological criteria) and a suitable “true negative” patient group (based on either culture-negative results or clinical and/or epidemiological criteria). Poor-quality studies were defined as studies that used a suitable “true positive” patient group but did not use a “true negative” patient group or as studies that did not use a suitable “true positive” or “true negative” patient group.
Of the sixteen studies, only two studies [
In [
Reported sensitivity and specificity of RBT in patient groups used in reviewed studies.
Patient groups | Test | RBT positive, | DSe | DSp |
---|---|---|---|---|
Titrated RBT | NR | 100 | 97 | |
MAT | NR | 92 | 100 | |
Brucellacapt | NR | 100 | 100 | |
IgG ELISA | NR | 84 | 100 | |
IgM ELISA | NR | 60 | 100 | |
IgA ELISA | NR | 96 | 98 | |
RBT (acute + subacute) | 49/52 | 94.2 | NS | |
RBT (chronic) | 6/11 | 54.5 | NS | |
RBT (total) | 45/63 | 71.4 | NS | |
SAT ≥ 1 : 200 (acute + subacute) | 26/52 | 50 | NS | |
SAT ≥ 1 : 200 (chronic) | 6/11 | 54.5 | NS | |
SAT ≥ 1 : 200 (total) | 32/63 | 50.8 | NS | |
LFA IgM and/or IgG (acute + subacute) | 52/52 | 100 | NS | |
LFA IgM and/or IgG (chronic) | 11/11 | 100 | NS | |
LFA IgM and/or IgG (total) | 63/63 | 100 | NS | |
LFA IgM (acute + subacute) | 47/52 | 90.4 | NS | |
LFA IgM (chronic) | 8/11 | 72.7 | NS | |
LFA IgM (total) | 55/63 | 87.3 | NS | |
LFA IgG (acute + subacute) | 39/52 | 75 | NS | |
LFA IgG (chronic) | 11/11 | 100 | NS | |
LFA IgG (total) | 50/63 | 79.4 | NS | |
Titrated RBT | 78/200 | 88.9 | 87.7 | |
RBT | 20/20 | 100 | 100 | |
RB screening test | 0/280 | NS | NS | |
STAT (≥1/160)b | 0/280 | NS | NS | |
RBT | 91/91 | 100 | NS | |
ELISA IgM | 59/91 | 64.8 | NS | |
ELISA IgG | 56.1 | NS | ||
RBT | NS | NS | NS | |
RBT | NS | NS | NS | |
Coombs | NS | NS | NS | |
2-ME | NS | NS | NS | |
CFT | NS | NS | NS | |
Indirect ELISA | NS | NS | NS | |
cELISA | 0/10 | NS | NS | |
FPA | NS | NS | NS | |
PCR | 0/30 | NS | NS | |
RBT | NS | 7 | NS | |
RB screening test | 288/307 | 93.8 | 94.3 | |
RB screening test | 49/51 | 96.1 | 76.9 | |
RB screening test | 311/339 | 91.7 | 94.3 | |
RB screening testc | 38/38 | 100 | 99 | |
Tube agglutination test (≥1/160) | NS | 97 | 99 | |
Coombs (≥1/320) | NS | 100 | 98 | |
ELISA IgG | NS | 78 | 83 | |
ELISA IgM | NS | 94 | 98 | |
CFT | NS | 91 | 99 | |
RB screening test | 22/24 | 92 | 52 | |
Tube agglutination test (≥1/160) | NS | 20 | 98 | |
Coombs (≥1/320) | NS | 100 | 80 | |
ELISA IgG | NS | 100 | 70 | |
ELISA IgM | NS | 54 | 76 | |
CFT | NS | 88 | 78 | |
RBT | 83/83 | 100 | 87.5 | |
RBT | 9/72 | NS | NS | |
RBT | 3/21 | NS | NS | |
RBT | 3/21 | NS | NS | |
RBT | 118/123 | NS | NS | |
RBT | 75/106 | NS | NS | |
RB screening test | 0/107 | NS | NS | |
SAT (≥1/180) | 0/107 | NS | NS | |
Coombs (≥1/160) | 0/107 | NS | NS | |
ELISA IgG | NS | NS | NS | |
ELISA IgM | NS | NS | NS | |
ELISA IgA | NS | NS | NS | |
ELISA Td | 4/107 | NS | NS | |
RB screening teste | 19/20 | NS | NS | |
RB titration test (>1 : 4)e | 0/20 | NS | NS | |
SAT (=160)e | 3/20 | NS | NS | |
Brucellacapt (≥320)e | 8/20 | NS | NS | |
Coombse | 16/20 | NS | NS | |
LFiC-IgMe | 4/20 | NS | NS | |
LFiC-IgGe | 8/20 | NS | NS | |
RB screening testf | 1/1559 | NS | NS | |
RBT | 98 | 100 | ||
RBT | 84 | 100 | ||
RBT | 61 | 100 | ||
RBT | 22 | 100 | ||
RBT | 100 |
RBT positive: Rose Bengal test positive, DSe: diagnostic sensitivity, DSp: diagnostic specificity, PPV: positive predictive value, NPV: negative predictive value, and NS: not specified. RBT: standard RBT, titrated RBT: titrations made by serial dilutions of serum with saline solution, SAT: serum agglutination test, LFA: lateral flow assay, MAT: microagglutination test, Brucellacapt: immunocapture-agglutination test, LFiC: lateral flow immunochromatography assay. bSTAT: only low titres were obtained in 3 patients, one with malaria (1/40), one with lymphoma (1/40), and another with typhoid fever (1/20). cReported test values were combined values for patients with primary infection (no personal history of brucellosis) showing acute clinical symptoms and patients with evidence of previous infection by
Four of the sixteen studies [
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Ten of the sixteen studies [
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In four studies, Andriopoulos et al. [
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The performance of RBT for diagnosing human brucellosis was reviewed in sixteen studies, and findings indicated that RBT can reliably detect
In the two studies considered to be of high scientific quality, DSe and DSp of RBT compared to culture as the gold standard were 87.5% and 100%, respectively [
In [
In the four studies considered to be of moderate scientific quality, DSe and DSp of RBT compared to culture varied from 92.5% to 100% and 94.3 to 99.9%, respectively [
In [
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It is important to note that even though the patient groups used to estimate DSp of RBT (compared to culture) in the studies by Diaz et al. [
Worthwhile noting as well that although the studies by Diaz et al. [
Findings from the reviewed studies that properly assessed DSe and DSp of RBT compared to culture (as the gold standard) suggest RBT is an excellent screening test that could provide needed clinical diagnostic support in endemic areas where febrile patients are currently only screened for malaria. Additionally, RBT has other merits, which are particularly relevant in endemic settings: it is inexpensive, simple, and easy to use, requires minimal infrastructure or local preparation, and can be used in small, clinic-based laboratories. The above combined diagnostic and logistic merits suggest RBT should be considered as a rapid point-of-care test for human brucellosis in endemic areas.
A number of limitations were identified while performing this review. First, few studies exist that evaluate RBT performance compared to the recognized reference standard, culture. Initially, this study was designed to assess studies investigating RBT performance in Tanzania, but the scope was extended to global level following scope searches that identified few relevant studies from this region. Second, in some studies, detailed information on patient comparison groups, test results for culture and RBT, and on DSe and DSp of RBT compared to culture was either incomplete or not reported or not specified by the patient group, which made it difficult to independently assess DSe and DSp of RBT compared to culture. Third, ten of the sixteen studies included in this review did not use suitable “true positive” and/or “true negative” patient groups to assess DSe and DSp of RBT compared to culture. Failure to use appropriate comparison groups while evaluating RBT performance can weaken the internal validity of a study and the inferences drawn. Comparison groups selected based on diagnostic criteria (historical, clinical, epidemiological, and laboratory data) and stage of disease are useful in reflecting the actual population in which the test is likely to be used. And finally, it is difficult to make proper comparisons of RBT performance across studies based on the stage of illness (acute, subacute, and chronic) because the definitions used varied and were subjective. Categorizing of patient groups by stage of illness is important because clinical course can influence the detection of brucellosis.
A knowledge gap identified as part of this review was that high-quality data on the true burden of human brucellosis and estimates of brucellosis disability-adjusted life years (DALY) calculations are limited, even more so for subpopulations in endemic settings, such as Tanzania. Brucellosis DALY data are useful for assessing disease burden and informing policy geared to human brucellosis control and prevention. Estimates of disability weights have been proposed for DALY calculation, using Mongolian patient data [
In conclusion, the good diagnostic performance combined with its simplicity, quickness, and affordability makes RBT an ideal (or close to) stand-alone point-of-care test for early clinical diagnosis and management of human brucellosis and nonmalarial fevers in small and understaffed health facilities and laboratories in endemic areas in Africa and elsewhere.
The research depicted was part of a project (HDTRA1-14-1-0053) funded by the U.S. Department of Defense’s Defense Threat Reduction Agency-Cooperative Biological Engagement Program (DTRA-CBEP) and a subsequent subcontract from Metabiota. The contents of this paper are the responsibility of the authors and do not necessarily reflect the views of DTRA-CBEP, or the United States Government, and no official endorsement should be inferred.
The authors declare that there are no conflicts of interest.
Supplementary 1: S1 Table: list of articles screened at the last stage but excluded and reasons for exclusion. Supplementary 2: S2 Table: search terms used for titles and abstracts and free full text for MEDLINE, Embase, and Web of Science.