Beal Stacy G, Couturier Marc Roger, Gander Rita M, Doern Christopher D
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Pathology, The University of Utah, Salt Lake City, Utah.
J Clin Lab Anal. 2016 Mar;30(2):155-60. doi: 10.1002/jcla.21829. Epub 2014 Dec 26.
Current practices for ordering stool studies in patients with abdominal and gastrointestinal symptoms are not standardized. We hypothesized that an algorithm involving first-line use of a Cryptosporidium/Giardia combination antigen test and stricter use of ova and parasite (O&P) examinations would be clinically and cost effective.
In this study, stool O&P test results for pediatric patients in Dallas, Texas, were reviewed. All results obtained between 2009 and 2012 were included. Patient charts were reviewed to determine test results, symptoms, treatment, travel, and past medical history. Using these data, a retrospective modeling study was done to evaluate the utility of a diagnostic algorithm that limits O&P testing to those patients who are immunocompromised or have travelled outside the United States.
Over the 3-year period of this study, we found that the prevalence of gastrointestinal parasitic disease in children was 1.9%. Analysis of the diagnostic algorithm for the judicious use of stool O&P showed that as much as 65% of testing may be unnecessary and could be eliminated.
Our findings show that the prevalence of pediatric gastrointestinal parasitic disease in Texas may be lower than expected. In addition, these data show that a diagnostic algorithm limiting O&P testing may be both clinically and cost effective in low-prevalence settings. However, such an algorithm would miss a significant number of infections due to Dientamoeba fragilis and Blastocystis hominis.
目前针对有腹部和胃肠道症状患者进行粪便检查的做法并不规范。我们推测，一种首先使用隐孢子虫/贾第虫联合抗原检测并更严格地使用虫卵和寄生虫（O&P）检查的算法在临床和成本效益方面是可行的。
在本研究中，回顾了得克萨斯州达拉斯市儿科患者的粪便O&P检测结果。纳入了2009年至2012年期间获得的所有结果。查阅患者病历以确定检测结果、症状、治疗情况、旅行史和既往病史。利用这些数据，进行了一项回顾性建模研究，以评估一种诊断算法的效用，该算法将O&P检测仅限于免疫功能低下或有美国境外旅行史的患者。
在本研究的3年期间，我们发现儿童胃肠道寄生虫病的患病率为1.9%。对合理使用粪便O&P的诊断算法分析表明，高达65%的检测可能是不必要的，可以取消。
我们的研究结果表明，得克萨斯州儿童胃肠道寄生虫病的患病率可能低于预期。此外，这些数据表明，在低患病率环境中，一种限制O&P检测的诊断算法在临床和成本效益方面可能都是可行的。然而，这样的算法会遗漏大量由脆弱双核阿米巴和人芽囊原虫引起的感染。
