Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain.
PLoS Negl Trop Dis. 2013;7(1):e2002. doi: 10.1371/journal.pntd.0002002. Epub 2013 Jan 17.
Strongyloidiasis is frequently under diagnosed since many infections remain asymptomatic and conventional diagnostic tests based on parasitological examination are not sufficiently sensitive. Serology is useful but is still only available in reference laboratories. The need for improved diagnostic tests in terms of sensitivity and specificity is clear, particularly in immunocompromised patients or candidates to immunosuppressive treatments. This review aims to evaluate both conventional and novel techniques for the diagnosis of strongyloidiasis as well as available cure markers for this parasitic infection.
METHODOLOGY/PRINCIPAL FINDINGS: The search strategy was based on the data-base sources MEDLINE, Cochrane Library Register for systematic review, EmBase, Global Health and LILACS and was limited in the search string to articles published from 1960 to August 2012 and to English, Spanish, French, Portuguese and German languages. Case reports, case series and animal studies were excluded. 2003 potentially relevant citations were selected for retrieval, of which 1649 were selected for review of the abstract. 143 were eligible for final inclusion.
Sensitivity of microscopic-based techniques is not good enough, particularly in chronic infections. Furthermore, techniques such as Baermann or agar plate culture are cumbersome and time-consuming and several specimens should be collected on different days to improve the detection rate. Serology is a useful tool but it might overestimate the prevalence of disease due to cross-reactivity with other nematode infections and its difficulty distinguishing recent from past (and cured) infections. To evaluate treatment efficacy is still a major concern because direct parasitological methods might overestimate it and the serology has not yet been well evaluated; even if there is a decline in antibody titres after treatment, it is slow and it needs to be done at 6 to 12 months after treatment which can cause a substantial loss to follow-up in a clinical trial.
由于许多感染仍然无症状，并且基于寄生虫检查的常规诊断测试不够敏感，因此 Strongyloidiasis 经常被误诊。血清学检测很有用，但仍仅在参考实验室中可用。显然，需要在敏感性和特异性方面改进诊断测试，特别是在免疫功能低下的患者或接受免疫抑制治疗的患者中。本综述旨在评估 Strongyloidiasis 的常规和新型诊断技术，以及针对这种寄生虫感染的现有治愈标志物。
方法/主要发现：搜索策略基于 MEDLINE、Cochrane 系统评价登记处、EmBase、全球卫生和 LILACS 数据库资源，搜索字符串限于 1960 年至 2012 年 8 月发表的文章，以及英语、西班牙语、法语、葡萄牙语和德语。排除病例报告、病例系列和动物研究。选择了 2003 个潜在相关引文进行检索，其中 1649 个被选为摘要审查。143 个符合最终纳入标准。
基于显微镜的技术的敏感性不够好，特别是在慢性感染中。此外，Baermann 或琼脂平板培养等技术繁琐且耗时，并且应在不同天收集多个标本以提高检测率。血清学是一种有用的工具，但由于与其他线虫感染的交叉反应，它可能会高估疾病的患病率，并且难以区分近期和既往（和治愈）感染。评估治疗效果仍然是一个主要问题，因为直接寄生虫学方法可能会高估它，并且血清学尚未得到很好的评估；即使在治疗后抗体滴度下降，它也很慢，需要在治疗后 6 至 12 个月进行，这可能会导致临床试验中的大量随访损失。
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