Evaluation of Ziehl-Neelsen stained faecal smear and ELISA as tools for surveillance of clinical paratuberculosis in cattle in the Netherlands

Testing cattle suspected of clinical paratuberculosis is an important element of surveillance of paratuberculosis. The aim of this study was to evaluate the diagnostic-test characteristics of microscopic examination of Ziehl-Neelsen stained faecal smears for acid-fast Mycobacteria (ZN-test) and serum-ELISA in cattle suspected of clinical paratuberculosis in the Netherlands. Results of all samples submitted for ZN-test and serum-ELISA between April 2003 and April 2006 to our laboratory were retrieved. Results from cattle for which both tests were performed were analysed using two Bayesian latent-class models for evaluation of diagnostic tests in two populations without a gold standard, assuming (a) conditional independence of tests, or (b) conditional dependence of tests in both infected and non-infected cattle. Sampled cattle were divided into two populations in different ways using four known risk factors for clinical paratuberculosis: region, soil type, clinical signs, and age. For 892 cattle suspected of clinical paratuberculosis, both ZN-test and serum-ELISA results were retrieved: 250 ZN-positive and ELISA-positive, 12 ZN-positive and ELISA-negative, 260 ZN-negative and ELISA-positive, and 370 ZN-negative and ELISA-negative cattle. With priors based on the available literature, the posterior estimates of sensitivity, specificity, and positive and negative predictive values of the ELISA were always higher than those of the ZN-test. Furthermore, lower limits of the 95% credibility intervals of the posterior positive predictive values of the ELISA were >or=99.7%, and of the negative predictive values of the ELISA >or=56.4%. We conclude that the ELISA is preferred to the ZN-test to confirm the presumptive diagnosis of clinical paratuberculosis in the Netherlands. Little diagnostic information can be gained by performing the ZN-test in addition to the ELISA.