Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
PLoS Negl Trop Dis. 2021 Mar 17;15(3):e0009244. doi: 10.1371/journal.pntd.0009244. eCollection 2021 Mar.
Most of national schistosomiasis elimination programmes in Asia are relying on stool examination, particularly Kato Katz stool examination technique for regular transmission monitoring. However, the Kato-Katz technique has shown low sensitivity for the detection of light-intensity infections, and therefore highly sensitive diagnostic tools are urgently required to monitor prevalence of infection in low transmission settings. The objective of this systematic review was to evaluate and synthesize the performance of diagnostic tests for detecting Schistosoma japonicum and S. mekongi infection in people living in endemic areas.
METHODOLOGY/PRINCIPAL FINDINGS: We comprehensively searched these nine electronic databases and other resources until July 2019, with no language or publication limits: PubMed, EMBASE, MEDLINE, Web of Science, BIOSIS Citation Index, HTA, CINAHL PLUS, The Cochrane Library, and PsycINFO. We included original studies that assessed diagnostic performance using antibody, antigen, and molecular tests with stool examination test as a reference standard. Two reviewers independently extracted a standard set of data and assessed study quality. We estimated the pooled estimates of sensitivity and specificity for each index test. We used diagnostic odds ratio to determine the overall accuracy and hierarchical summary receiver operating characteristics (HSROC) curve to assess the index tests performance. Fifteen studies (S. japonicum [n = 13] and S. mekongi [n = 2]) testing 15,303 participants were included in the review. Five studies reported performance of enzyme-linked immunosorbent assay (ELISA), seven studies reported indirect hemagglutination assay (IHA), and four studies reported polymerase chain reaction (PCR) for detecting S. japonicum. The pooled sensitivity and specificity were 0.93 (95% CI: 0.84-0.98) and 0.40 (95% CI: 0.29-0.53) for ELISA, 0.97 (95% CI: 0.90-0.99) and 0.66 (95% CI: 0.58-0.73) for IHA, and 0.89 (95% CI: 0.71-0.96) and 0.49 (95% CI: 0.29-0.69) for PCR respectively. A global summary indicated the best performance for IHA, closely followed by ELISA. We were unable to perform meta-analysis for S. mekongi due to insufficient number of studies.
CONCLUSIONS/SIGNIFICANCE: IHA showed the highest detection accuracy for S. japonicum. Further studies are needed to determine the suitable diagnostic methods to verify the absence of transmission of S. mekongi and also to compare detection accuracy against more sensitive reference standards such as PCR.
亚洲大多数国家血吸虫病消除规划依赖于粪便检查，特别是加藤厚涂片检查技术用于定期传播监测。然而，加藤厚涂片检查技术对轻度感染的检测敏感性较低，因此迫切需要高度敏感的诊断工具来监测低传播地区的感染流行率。本系统评价的目的是评估和综合用于检测生活在流行地区的日本血吸虫和湄公血吸虫感染的诊断检测的性能。
方法/主要发现：我们全面检索了这九个电子数据库和其他资源，直到 2019 年 7 月，没有语言或出版限制：PubMed、EMBASE、MEDLINE、Web of Science、BIOSIS Citation Index、HTA、CINAHL PLUS、The Cochrane Library 和 PsycINFO。我们纳入了使用抗体、抗原和分子检测，并以粪便检查作为参考标准评估诊断性能的原始研究。两名评审员独立提取一套标准数据并评估研究质量。我们估计了每个指标测试的敏感性和特异性的汇总估计值。我们使用诊断比值比来确定总体准确性，使用分层综合接收者操作特征（HSROC）曲线来评估指标测试的性能。共有 15 项研究（日本血吸虫[n=13]和湄公血吸虫[n=2]）纳入了对 15303 名参与者的综述。五项研究报告了酶联免疫吸附试验（ELISA）的性能，七项研究报告了间接血凝试验（IHA）的性能，四项研究报告了聚合酶链反应（PCR）检测日本血吸虫的性能。ELISA 的汇总敏感性和特异性分别为 0.93（95%CI：0.84-0.98）和 0.40（95%CI：0.29-0.53），IHA 的汇总敏感性和特异性分别为 0.97（95%CI：0.90-0.99）和 0.66（95%CI：0.58-0.73），PCR 的汇总敏感性和特异性分别为 0.89（95%CI：0.71-0.96）和 0.49（95%CI：0.29-0.69）。综合分析表明，IHA 的检测准确性最高，紧随其后的是 ELISA。由于研究数量不足，我们无法对湄公血吸虫进行荟萃分析。
结论/意义：IHA 对日本血吸虫的检测准确性最高。需要进一步研究来确定合适的诊断方法，以验证湄公血吸虫传播的终止，并且还需要使用更敏感的参考标准（如 PCR）来比较检测准确性。
