Department of Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy.
Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Rome, Italy.
PLoS Negl Trop Dis. 2024 Sep 18;18(9):e0012104. doi: 10.1371/journal.pntd.0012104. eCollection 2024 Sep.
Infection with Schistosoma haematobium causes urogenital disease associated with organ disfunction, bleeding, pain, and higher susceptibility to infections and cancer. Timely and accurate diagnosis is crucial for prompt and appropriate treatment as well as surveillance efforts, and the use of plasma biomarkers offers important advantages over parasitological examination of urine, including increased sensitivity and the possibility to use the same specimen for multiple investigations. The present study aims to evaluate the diagnostic performance of different plasma biomarkers in endemic populations from Burkina Faso, West Africa. Schistosoma spp. Circulating Anodic Antigen (CAA), cell free S. haematobium DNA (cfDNA), class M and G antibodies against S. haematobium Soluble Worm Antigen Preparation (SWAP) and Soluble Egg Antigen (SEA) were measured in 406 plasma samples. Results of each biomarker test were compared to those of CAA, a Composite Reference Standard (CRS) and Latent Class Analysis (LCA). An identical proportion of positive samples (29%) was observed as a result of CAA and cfDNA testing, with a substantial agreement (84%, Cohen k = 0.62) between the results of the two tests, and a comparable agreement with the results of CRS and LCA. A higher positivity was observed, as expected, as a result of specific antibody testing (47%-72%), with IgG showing a higher agreement than IgM with the three references. Also, higher IgG levels were observed in current vs past infection, and ROC analysis identified optimal cutoff values for improved testing accuracy. This study provides compelling evidence that can inform the choice of the most appropriate diagnostic plasma biomarker for urogenital schistosomiasis in endemic areas, depending on the purpose, context, and available resources for testing. Either CAA or cfDNA testing can be used for the diagnosis of patients and for epidemiological investigations, even in absence of urine filtration microscopy, whereas anti-SWAP or anti-SEA IgG can be employed for surveillance and integrated monitoring of control interventions against poverty-associated diseases.
曼氏血吸虫感染会导致与器官功能障碍、出血、疼痛相关的泌尿生殖系统疾病，并增加感染和癌症的易感性。及时、准确的诊断对于及时、恰当的治疗以及监测工作至关重要，而血浆生物标志物的使用相对于尿液寄生虫检查具有重要优势，包括提高敏感性和能够使用相同标本进行多项研究。本研究旨在评估不同血浆生物标志物在来自西非布基纳法索的流行地区的人群中的诊断性能。曼氏血吸虫循环阳极抗原 (CAA)、游离曼氏血吸虫 DNA (cfDNA)、针对曼氏血吸虫可溶性虫体抗原制剂 (SWAP) 和可溶性卵抗原 (SEA) 的 M 类和 G 类抗体在 406 份血浆样本中进行了测量。每种生物标志物检测的结果与 CAA、综合参考标准 (CRS) 和潜在类别分析 (LCA) 的结果进行了比较。CAA 和 cfDNA 检测的阳性样本比例相同 (29%)，两种检测结果之间具有实质性一致性 (84%，Cohen k = 0.62)，与 CRS 和 LCA 的结果具有可比一致性。如预期的那样，特异性抗体检测的阳性率更高 (47%-72%)，与三种参考标准相比，IgG 的一致性高于 IgM。此外，在现症感染中观察到更高的 IgG 水平，ROC 分析确定了提高检测准确性的最佳截断值。本研究提供了令人信服的证据，可以根据目的、背景和检测可用资源，为流行地区泌尿生殖系统血吸虫病选择最合适的诊断血浆生物标志物提供信息。无论是否进行尿液过滤显微镜检查，CAA 或 cfDNA 检测都可用于诊断患者和进行流行病学研究，而抗 SWAP 或抗 SEA IgG 可用于监测和对与贫困相关疾病的控制干预进行综合监测。
