Krolewiecki Alejandro J, Ramanathan Roshan, Fink Valeria, McAuliffe Isabel, Cajal Silvana P, Won Kimberly, Juarez Marisa, Di Paolo Adriana, Tapia Laura, Acosta Norma, Lee Rogan, Lammie Patrick, Abraham David, Nutman Thomas B
Area de Investigaciones Clinicas, Fundacion Huesped., Pje. Peluffo 3932, Buenos Aires, Argentina.
Clin Vaccine Immunol. 2010 Oct;17(10):1624-30. doi: 10.1128/CVI.00259-10. Epub 2010 Aug 25.
The serodiagnosis of Strongyloides stercoralis infection by enzyme-linked immunosorbent assays based on crude antigen (CrAg-ELISA), while useful, has been limited by the reliance on crude parasite extracts. Newer techniques such as the luciferase immunoprecipitation system assay (LIPS), based on a 31-kDa recombinant antigen (termed NIE) from S. stercoralis and/or the recombinant antigen S. stercoralis immunoreactive antigen (SsIR), or the NIE-ELISA have shown promise in controlled settings. We compared each of these serologic assays in individuals from both regions of the world in which S. stercoralis is endemic and those in which it is not. A comprehensive stool evaluation (sedimentation concentration, Baermann concentration with charcoal cultures, agar plate, and Harada-Mori) and four different serologic techniques using CrAg-ELISA or recombinant NIE-ELISA as well as LIPS using NIE alone or in combination with a second recombinant antigen (NIE/SsIR-LIPS) were compared among individuals with parasitologically proven infection (n = 251) and healthy controls from regions of the world in which the infection is nonendemic (n = 11). Accuracy was calculated for each assay. The prevalence of S. stercoralis infection was 29.4% among Argentinean stool samples (n = 228). Sedimentation concentration and Baermann were the most sensitive stool-based methods. NIE-LIPS showed the highest sensitivity (97.8%) and specificity (100%) of the serologic assays. The calculated negative predictive value was highest for both the NIE-LIPS and CrAg-ELISA (>97%) irrespective of disease prevalence. No cross-reactivity with soil-transmitted helminths was noted. NIE-LIPS compares favorably against the current CrAg-ELISA and stool evaluation, providing additional accuracy and ease of performance in the serodiagnosis of S. stercoralis infections irrespective of disease prevalence.
基于粗抗原的酶联免疫吸附测定法（CrAg-ELISA）用于粪类圆线虫感染的血清学诊断虽有一定作用，但因依赖粗制寄生虫提取物而受到限制。较新的技术，如基于粪类圆线虫31 kDa重组抗原（称为NIE）和/或重组抗原粪类圆线虫免疫反应性抗原（SsIR）的荧光素酶免疫沉淀系统测定法（LIPS），或NIE-ELISA，已在对照实验中显示出前景。我们在粪类圆线虫流行地区和非流行地区的人群中比较了这些血清学检测方法。对有寄生虫学确诊感染的个体（n = 251）和来自世界非流行地区的健康对照者（n = 11），比较了综合粪便评估（沉淀浓缩、含木炭培养的贝曼氏浓缩法、琼脂平板法和原田-森氏法）以及四种不同的血清学技术，包括使用CrAg-ELISA或重组NIE-ELISA，以及单独使用NIE或与第二种重组抗原联合使用的LIPS（NIE/SsIR-LIPS）。计算了每种检测方法的准确性。阿根廷粪便样本（n = 228）中粪类圆线虫感染率为29.4%。沉淀浓缩法和贝曼氏法是最敏感的基于粪便的检测方法。NIE-LIPS在血清学检测中显示出最高的敏感性（97.8%）和特异性（100%）。无论疾病流行率如何，NIE-LIPS和CrAg-ELISA的计算阴性预测值均最高（>97%）。未发现与土源性蠕虫有交叉反应。NIE-LIPS与目前的CrAg-ELISA和粪便评估相比具有优势，在粪类圆线虫感染的血清学诊断中，无论疾病流行率如何，都能提供更高的准确性和操作便利性。
