A Bayesian evaluation of three diagnostic assays for the detection of Giardia duodenalis in symptomatic and asymptomatic dogs

A Bayesian approach was used to evaluate three commonly used diagnostic assays for the detection of Giardia duodenalis in dogs: microscopical examination (ME), a commercial immunofluorescence assay (IFA: Merifluor®Giardia test) and a commercial immunochromatographic assay (SNAP: Idexx SNAP®Giardia test). These assays were evaluated for use in two different settings: in a cross-sectional epidemiological survey in household dogs and in a clinical survey, both conducted in the northern part of Belgium. A total of 272 faecal samples from household dogs and 141 faecal samples from clinically affected dogs were examined using these three diagnostic assays. The Bayesian analysis indicated that all tests were highly specific (specificity above 90%), and that the IFA is more sensitive than SNAP and ME, both in an epidemiological and in a clinical setting. For all three tests, the estimated sensitivity values were higher in the clinical compared to the epidemiological survey, whereas the specificity values were comparable in both studies. The results of the present study indicate that IFA is a highly specific and sensitive technique for the detection of G. duodenalis cysts, both for use in an epidemiological or clinical survey. The SNAP is a specific and fairly sensitive technique for the diagnosis of Giardia in clinically affected dogs. Overall, the ME was found to be a specific diagnostic technique, although lacking sensitivity.