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Background  The diagnosis of canine echinococcosis can be a challenge in surveillance studies because there is no perfect gold standard that can be used routinely. However, unknown test specificities and sensitivities can be overcome using latent-class analysis with appropriate data.    Methodology  We utilised a set of faecal and purge samples used previously to explore the epidemiology of canine echinococcosis on the Tibetan plateau. Previously only the purge results were reported and analysed in a largely deterministic way. In the present study, additional diagnostic tests of copro-PCR and copro-antigen ELISA were undertaken on the faecal samples. This enabled a Bayesian analysis in a latent-class model to examine the diagnostic performance of a genus specific copro-antigen ELISA, species-specific copro-PCR and arecoline purgation. Potential covariates including co-infection with  Taenia , age and sex of the dog were also explored. The dependence structure of these diagnostic tests could also be analysed.    Principle findings  The most parsimonious result, indicated by deviance-information criteria, suggested that co-infection with  Taenia  spp. was a significant covariate with the  Echinococcus  infection. The copro-PCRs had estimated sensitivities of 89% and 84% respectively for the diagnoses of  Echinococcus multilocularis  and  E. granulosus . The specificities for the copro-PCR were estimated at 93 and 83% respectively. Copro-antigen ELISA had sensitivities of 55 and 57% for the diagnosis of  E. multilocularis  and  E. granulosus  and specificities of 71 and 69% respectively. Arecoline purgation with an assumed specificity of 100% had estimated sensitivities of 76% and 85% respectively.    Significance  This study also shows that incorporating diagnostic uncertainty, in other words assuming no perfect gold standard, and including potential covariates like sex or  Taenia  co-infection into the epidemiological analysis may give different results than if the diagnosis of infection status is assumed to be deterministic and this approach should therefore be used whenever possible.

Latent-Class Methods to Evaluate Diagnostics Tests for Echinococcus Infections in Dogs