Hoekstra Pytsje T, Chernet Afona, de Dood Claudia J, Brienen Eric A T, Corstjens Paul L A M, Labhardt Niklaus D, Nickel Beatrice, Wammes Linda J, van Dam Govert J, Neumayr Andreas, van Lieshout Lisette
Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Am J Trop Med Hyg. 2022 Feb 28;106(4):1240-1246. doi: 10.4269/ajtmh.21-0803. Print 2022 Apr 6.
The increasing number of refugees coming from or passing through Schistosoma-endemic areas and arriving in Europe highlights the importance of screening for schistosomiasis on arrival, and focuses attention on the choice of diagnostic test. We evaluate the diagnostic performance of circulating anodic antigen (CAA) detection in 92 asymptomatic refugees from Eritrea. Results were compared with already-available stool microscopy, serology, and urine point-of-care circulating cathodic antigen (POC-CCA) data. For a full diagnostic comparison, real-time polymerase chain reaction (PCR) and the POC-CCA were included. All outcomes were compared against a composite reference standard. Urine and serum samples were subjected to the ultra-sensitive and highly specific up-converting particle lateral flow CAA test, Schistosoma spp. real-time PCR was performed on urine and stool, and the POC-CCA was used on urine using the G-score method. CAA was detected in 43% of urine and in 40% of serum samples. Urine PCR was negative in all 92 individuals, whereas 25% showed Schistosoma DNA in stool. POC-CCA was positive in 30% of individuals. The CAA test confirmed all microscopy positives, except for two cases that were also negative by all other diagnostic procedures. Post-treatment, a significant reduction in the number of positives and infection intensity was observed, in particular regarding CAA levels. Our findings confirm that microscopy, serology, and POC-CCA lack the sensitivity to detect all active Schistosoma infections. Accuracy of stool PCR was similar to microscopy, indicating that this method also lacks sensitivity. The CAA test appeared to be the most accurate method for screening active Schistosoma infections and for monitoring treatment efficacy.
来自或途经血吸虫病流行地区并抵达欧洲的难民数量不断增加，这凸显了难民抵达时进行血吸虫病筛查的重要性，并使人们将注意力集中在诊断检测方法的选择上。我们评估了循环阳极抗原（CAA）检测在92名来自厄立特里亚的无症状难民中的诊断性能。将结果与现有的粪便显微镜检查、血清学检查以及尿即时检验循环阴极抗原（POC-CCA）数据进行了比较。为了进行全面的诊断比较，纳入了实时聚合酶链反应（PCR）和POC-CCA。所有结果均与综合参考标准进行比较。对尿液和血清样本进行超灵敏且高度特异的上转换颗粒侧向流动CAA检测，对尿液和粪便进行血吸虫属实时PCR检测，并使用G评分法对尿液进行POC-CCA检测。在43%的尿液样本和40%的血清样本中检测到了CAA。92名个体的尿液PCR检测均为阴性，而25%的个体粪便中显示有血吸虫DNA。30%的个体POC-CCA检测呈阳性。CAA检测确认了所有显微镜检查呈阳性的结果，但有两例通过所有其他诊断程序检测也为阴性。治疗后，阳性数量和感染强度显著降低，尤其是CAA水平。我们的研究结果证实，显微镜检查、血清学检查和POC-CCA缺乏检测所有活动性血吸虫感染的敏感性。粪便PCR的准确性与显微镜检查相似，表明该方法也缺乏敏感性。CAA检测似乎是筛查活动性血吸虫感染和监测治疗效果的最准确方法。
