Al-Shehri Hajri, Koukounari Artemis, Stanton Michelle C, Adriko Moses, Arinaitwe Moses, Atuhaire Aaron, Kabatereine Narcis B, Stothard J Russell
Department of Parasitology,Liverpool School of Tropical Medicine,Liverpool, L3 5QA,UK.
Department of Clinical Sciences,Liverpool School of Tropical Medicine,Liverpool, L3 5QA,UK.
Parasitology. 2018 Nov;145(13):1715-1722. doi: 10.1017/S003118201800029X. Epub 2018 Mar 21.
Programmatic surveillance of intestinal schistosomiasis during control can typically use four diagnostic tests, either singularly or in combination, but these have yet to be cross-compared directly. Our study assembled a complete diagnostic dataset, inclusive of infection intensities, from 258 children from five Ugandan primary schools. The schools were purposely selected as typical of the endemic landscape near Lake Albert and reflective of high- and low-transmission settings. Overall prevalence was: 44.1% (95% CI 38.0-50.2) by microscopy of duplicate Kato-Katz smears from two consecutive stools, 56.9% (95% CI 50.8-63.0) by urine-circulating cathodic antigen (CCA) dipstick, 67.4% (95% CI 61.6-73.1) by DNA-TaqMan® and 75.1% (95% CI 69.8-80.4) by soluble egg antigen enzyme-linked immunosorbent assay (SEA-ELISA). A cross-comparison of diagnostic sensitivities, specificities, positive and negative predictive values was undertaken, inclusive of a latent class analysis (LCA) with a LCA-model estimate of prevalence by each school. The latter ranged from 9.6% to 100.0%, and prevalence by school for each diagnostic test followed a static ascending order or monotonic series of Kato-Katz, urine-CCA dipstick, DNA-TaqMan® and SEA-ELISA. We confirm that Kato-Katz remains a satisfactory diagnostic standalone in high-transmission settings but in low-transmission settings should be augmented or replaced by urine-CCA dipsticks. DNA-TaqMan® appears suitable in both endemic settings though is only implementable if resources permit. In low-transmission settings, SEA-ELISA remains the method of choice to evidence an absence infection. We discuss the pros and cons of each method concluding that future surveillance of intestinal schistosomiasis would benefit from a flexible, context-specific approach both in choice and application of each diagnostic method, rather than a single one-size fits all approach.
在血吸虫病控制过程中，对肠道血吸虫病进行的常规监测通常可单独或联合使用四种诊断检测方法，但这些方法尚未直接进行交叉比较。我们的研究收集了来自乌干达五所小学的258名儿童的完整诊断数据集，包括感染强度。这些学校是特意挑选的，代表了阿尔伯特湖附近的典型流行地区，反映了高传播和低传播环境。总体患病率如下：连续两次粪便的重复Kato-Katz涂片镜检为44.1%（95%置信区间38.0 - 50.2），尿循环阴极抗原（CCA）试纸条检测为56.9%（95%置信区间50.8 - 63.0），DNA-TaqMan®检测为67.4%（95%置信区间61.6 - 73.1），可溶性虫卵抗原酶联免疫吸附测定（SEA-ELISA）为75.1%（95%置信区间69.8 - 80.4）。我们对诊断敏感性、特异性、阳性和阴性预测值进行了交叉比较，包括采用潜在类别分析（LCA）并通过LCA模型估计每所学校的患病率。后者范围为9.6%至100.0%，每种诊断检测方法按学校计算的患病率遵循Kato-Katz、尿CCA试纸条、DNA-TaqMan®和SEA-ELISA的静态升序或单调序列。我们证实，Kato-Katz在高传播环境中仍是一种令人满意的独立诊断方法，但在低传播环境中应增加或用尿CCA试纸条替代。DNA-TaqMan®在两种流行环境中似乎都适用，但只有在资源允许的情况下才可实施。在低传播环境中，SEA-ELISA仍然是证明未感染的首选方法。我们讨论了每种方法的优缺点，得出结论认为，未来肠道血吸虫病监测将受益于在每种诊断方法的选择和应用中采用灵活的、因地制宜的方法，而不是单一的一刀切方法。
