Rapid Diagnostic Tests and Clinical/Laboratory Predictors of Tropical Diseases in Neurological Disorders in DRC (Nidiag-Neuro)
The impact of neurological disorders is enormous worldwide, and it is increased in poor settings, due to lack of diagnosis and treatment facilities as well as delayed management. In sub-Saharan Africa, the few observational studies conducted for the past 20 years show that neurological disorders accounted for 7 to 24% of all admissions. Central nervous system (CNS) infections were suspected in one third of all patients admitted with neurological symptoms, with a specific microbial aetiology identified in half of these. Most CNS infections may be considered as "severe and treatable diseases", e.g. human African trypanosomiasis (HAT), cerebral malaria, bacterial meningitis, CNS tuberculosis etc. If left untreated, death or serious sequels occur (mortality rates were as high as 30% in the above mentioned studies), but the outcome may be favourable with timely and appropriate management.
In poor settings, such conditions should be targeted in priority in the clinical decision-making process. Unfortunately, most neuro-infections present with non-specific symptoms in their early stages, leading to important diagnostic delays. Moreover, they require advanced diagnostic technology, which is not available in most tropical rural settings: here, you have to rely on clinical judgment and first-line laboratory results, whose confirming or excluding powers are limited or unknown. Several rapid diagnostic tests (RDTs) have been recently developed for conditions like malaria or HIV, but their diagnostic contribution has not been evaluated within a multi-disease approach.
Thus, this research aims at improving the early diagnosis of severe and treatable neglected and non-neglected infectious diseases which present with neurological symptoms in the province of Bandundu, Democratic Republic of Congo (DRC), by combining classic clinical predictors with a panel of simple point-of-care rapid diagnostic tests.
The evaluation of existing algorithms and elaboration/validation of new guidelines will be described in a subsequent protocol.
|Neurological Disorders Cerebral Malaria Bacterial Meningitis Central Nervous System Tuberculosis Neurosyphilis Cryptococcal Meningitis||Device: Immunochromatographic HAT tests (DSD) Device: Card Agglutination Trypanosoma Test Device: TB POC Nucleic Acid Amplification Test (Molbio Diagnostics) Device: TB 3-marker RDT (Tulip diagnostics) Device: Cryptococcal Antigen Lateral Flow Assay (Immy)||Phase 3|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
|Official Title:||Rapid Diagnostic Tests in Association With Clinical and Laboratory Predictors for the Diagnosis of Neglected Tropical Diseases in Patients With Neurological Disorders in Rural Hospitals of Bandundu,Democratic Republic of Congo|
- Prevalence of HAT and other NTDs/IDs [ Time Frame: 18 months ]Number of patients diagnosed with HAT and other NTDs/IDs among those presenting with neurological disorders in rural hospitals of Bandundu, DRC (pre-test probability)
- Identification of reliable diagnostic tests [ Time Frame: 18 months ]Assessment of the sensitivity, likelihood ratios and performances (diagnostic accuracy) of the novel study RDTs for the respective target conditions, and identification of those that should be included in future diagnostic protocols
- Predictive values of RDTs [ Time Frame: 18 months ]Predictive values (post-test probabilities) of novel and existing RDTs, alone and in combination, for the respective target conditions within this multi-disease approach
- Identification of clinical and laboratory diagnostic indicators [ Time Frame: 18 months ]Assessment of the specificity of the different clinical and first-line laboratory features for the diagnosis of HAT and other priority NTDs/IDs in the setting, for determining those that should be included in future diagnostic protocols
- Cure rate [ Time Frame: 18 months ]Number of patients who positively respond to specific/empirical therapies, as assessed as final patient outcomes (cure, referral, sequelae, death)
- Cost-effectiveness of the diagnostic tests [ Time Frame: 18 months ]Unit costs of diagnostic tests for the diagnosis of HAT and other priority NTDs/IDs in the setting
|Study Start Date:||September 2012|
|Study Completion Date:||May 2015|
|Primary Completion Date:||January 2015 (Final data collection date for primary outcome measure)|
Experimental: Phase 3 RDTs
The different interventions will be assessed for estimation of sensitivity, specificity and predictive values in the patients' cohort, for the respective target conditions. [To be noted that, in addition, also the predictive values of validated RDTs when used alone and in various combinations will be estimated].
Device: Immunochromatographic HAT tests (DSD)
Immunochromatographic HAT diagnostic tests manufactured by DSD, Korea and FINDDevice: Card Agglutination Trypanosoma Test
Card Agglutination Trypanosoma Test on whole blood and as dilution
Other Name: CATTDevice: TB POC Nucleic Acid Amplification Test (Molbio Diagnostics)
TB POC Nucleic Acid Amplification Test: "microPCR handheld device" (Molbio Diagnostics PVT ltd, India)
Other Name: NAATDevice: TB 3-marker RDT (Tulip diagnostics)
TB 3-marker RDT: ADA2/IFN-g/LAM (Tulip diagnostics, ltd, India) - pending availability for phase 3 validationDevice: Cryptococcal Antigen Lateral Flow Assay (Immy)
Cryptococcal Antigen Lateral Flow Assay (Immy, USA)
Other Name: CrAg-LAT
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01589289
|Congo, The Democratic Republic of the|
|Reference Hospital Mosango|
|Mosango, Bandundu, Congo, The Democratic Republic of the|
|Study Director:||Emmanuel Bottieau, MD||ITM|
|Study Chair:||Marleen Boelaert, MD, PhD||ITM|