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评估加藤-卡茨技术诊断曼氏血吸虫病和钩虫病的敏感性与感染强度的关系。

Estimating sensitivity of the Kato-Katz technique for the diagnosis of Schistosoma mansoni and hookworm in relation to infection intensity.

作者信息

Bärenbold Oliver, Raso Giovanna, Coulibaly Jean T, N'Goran Eliézer K, Utzinger Jürg, Vounatsou Penelope

机构信息

Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.

Faculty of Science, University of Basel, Basel, Switzerland.

出版信息

PLoS Negl Trop Dis. 2017 Oct 4;11(10):e0005953. doi: 10.1371/journal.pntd.0005953. eCollection 2017 Oct.

Abstract

The Kato-Katz technique is the most widely used diagnostic method in epidemiologic surveys and drug efficacy trials pertaining to intestinal schistosomiasis and soil-transmitted helminthiasis. However, the sensitivity of the technique is low, particularly for the detection of light-intensity helminth infections. Examination of multiple stool samples reduces the diagnostic error; yet, most studies rely on a single Kato-Katz thick smear, thus underestimating infection prevalence. We present a model which estimates the sensitivity of the Kato-Katz technique in Schistosoma mansoni and hookworm, as a function of infection intensity for repeated stool sampling and provide estimates of the age-dependent 'true' prevalence. We find that the sensitivity for S. mansoni diagnosis is dominated by missed light infections, which have a low probability to be diagnosed correctly even through repeated sampling. The overall sensitivity strongly depends on the mean infection intensity. In particular at an intensity of 100 eggs per gram of stool (EPG), we estimate a sensitivity of 50% and 80% for one and two samples, respectively. At an infection intensity of 300 EPG, we estimate a sensitivity of 62% for one sample and 90% for two samples. The sensitivity for hookworm diagnosis is dominated by day-to-day variation with typical values for one, two, three, and four samples equal to 50%, 75%, 85%, and 95%, respectively, while it is only weakly dependent on the mean infection intensity in the population. We recommend taking at least two samples and estimate the 'true' prevalence of S. mansoni considering the dependence of the sensitivity on the mean infection intensity and the 'true' hookworm prevalence by taking into account the sensitivity given in the current study.

摘要

加藤-卡茨技术是在肠道血吸虫病和土源性蠕虫病的流行病学调查及药物疗效试验中使用最广泛的诊断方法。然而,该技术的灵敏度较低,尤其是在检测轻度蠕虫感染方面。检查多个粪便样本可减少诊断误差;然而,大多数研究仅依赖一次加藤-卡茨厚涂片,因此低估了感染率。我们提出了一个模型,该模型可根据重复粪便采样的感染强度来估计加藤-卡茨技术对曼氏血吸虫和钩虫的检测灵敏度,并提供年龄依赖性“真实”感染率的估计值。我们发现,曼氏血吸虫诊断的灵敏度主要受轻度感染漏诊的影响,即使通过重复采样,这些轻度感染被正确诊断的概率也很低。总体灵敏度强烈依赖于平均感染强度。特别是在每克粪便含100个虫卵(EPG)的强度下,我们估计一次采样的灵敏度为50%,两次采样的灵敏度为80%。在感染强度为300 EPG时,我们估计一次采样的灵敏度为62%,两次采样的灵敏度为90%。钩虫诊断的灵敏度主要受每日变化的影响,一次、两次、三次和四次采样的典型值分别为50%、75%、85%和95%,而它仅微弱依赖于人群中的平均感染强度。我们建议至少采集两个样本,并考虑到灵敏度对平均感染强度的依赖性来估计曼氏血吸虫的“真实”感染率,同时根据本研究给出的灵敏度来估计钩虫的“真实”感染率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7727/5643140/85f36b77c306/pntd.0005953.g001.jpg

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