A Clinical Prediction Rule for American Cutaneous Leishmaniasis in Colombia

Neither parasitological nor molecular diagnosis of leishmaniasis is widely available in clinical settings where American cutaneous leishmaniasis (ACL) is endemic. Therefore four clinical prediction rules for ACL were developed which in corporated physical examination findings (clinical rule), physic...

Full description

Saved in:
Bibliographic Details
Published in:International journal of epidemiology 1993-06, Vol.22 (3), p.548-558
Main Authors: WEIGLE, KRISTEN A, ESCOBAR, MIGUEL, ARIAS, ALBA LUCIA, MARTINEZ, FERNANDO, ROJAS, CARLOS
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Colombia
Human protozoal diseases
Humans
Infectious diseases
Leishmaniasis, Cutaneous - diagnosis
Leshmaniasis
Male
Medical History Taking
Medical sciences
Parasitic diseases
Physical Examination
Predictive Value of Tests
Protozoal diseases
Regression Analysis
Sensitivity and Specificity
Skin Tests
Time Factors
Tropical medicine
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Neither parasitological nor molecular diagnosis of leishmaniasis is widely available in clinical settings where American cutaneous leishmaniasis (ACL) is endemic. Therefore four clinical prediction rules for ACL were developed which in corporated physical examination findings (clinical rule), physical examination and lelshrnanin skin test (LST) (clinical LST rule), physical examination and historical information (clinical-historical rule), or physical examination, historical information and LST (clinical-histoncal-LST rule). One hundred parasitologically diagnosed ACL cases and 38 cases of chronic skin lesions of other aetiologies comprised the derivation set. The validation set consisted of 124 ACL cases and 35 patients with lesions of other aetiologies. Components of each rule were selected by bivanate analysis, then stepwise logistic regression. Sensitivity, specificity and efficiency were calculated for each score threshold; the threshold achieving greatest efficiency was selected for each rule. When these rules were applied to the validity set the sensitivity, specificity and efficiency were respectively: clinical 93%, 31%, 79%; cllnical-LST 90%, 73%, 85.9%; clinical-historical 97%, 51%, 87%; clinical-historical-LST 92%, 70%, 87%. Inclusion of LST skin test consistently improved the specificity of the rules. Should a given clinical setting warrant optimizing either sensitivity or specificity alone, the rule thresholds can be adjusted. These and other prediction rules, once evaluated in other settings, should be in corporated into leishmaniasis control programmes.
ISSN:0300-5771
1464-3685
DOI:10.1093/ije/22.3.548