Bayesian estimation of diagnostic accuracy of fecal smears, fecal PCR and serum ELISA for detecting Mycobacterium avium subsp. paratuberculosis infections in four domestic ruminant species in Saudi Arabia

Paratuberculosis, a chronic wasting disease affecting domestic and wild ruminants worldwide, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). Various diagnostic tests exist for detecting MAP infection; however, none of them possess perfect accuracy to be qualified as a reference standard test, particularly due to their notably low sensitivity. Therefore, we used Bayesian latent class models (BLCMs) to estimate diagnostic accuracy of fecal smears (FS), fecal PCR and serum ELISA for detecting MAP infections in sheep, goats, cattle, and camels older than 2 years in Saudi Arabia. Data from a cross-sectional study conducted in the Eastern Province of Saudi Arabia on 31 different farms with a history of MAP infection were analyzed. Fecal and blood samples from all animals older than 2 years in each farm were collected, resulting in a total of 220 sheep, 123 goats, 66 cattle, and 240 camels sampled. FS and IS900-PCR were performed on fecal samples to detect acid-fast bacilli and MAP DNA, respectively. The IDEXX ELISA kit was used to detect MAP antibodies in serum samples. For each ruminant species population, a BLCM was fitted to obtain posterior estimates [medians and 95 % Bayesian credible intervals (95 % BCI)] for sensitivity (Se) and specificity (Sp) of the three tests. We assumed FS and PCR to be conditionally dependent on the true animal MAP status. Prior distributions for test accuracy were used if available. FS had the highest Se among all tests and across all species with median values around 80 % in sheep, goats and camels, and near 50 % in cattle. Median Sp estimates of ELISA and PCR were higher than 90 % for all species. FS yielded the lowest Sp of the study when applied in camels, sheep, and goats. Using the prevalence observed in this study, median positive predictive value (PPV) was higher for PCR and ELISA than FS for camels, sheep, and goats. In cattle, PPV of all tests was similar with median estimates > 95 %. In camels, sheep, and goats, median negative predicative value (NPV) of all tests were > 60 %. The lowest median NPV for all tests were observed in cattle (< 30 %). Our results suggest that ELISA is a suitable option to identify MAP infected animals in farms with previous history of MAP in the Eastern region of Saudi Arabia.