Wongphutorn Phattharaphon, Kopolrat Kulthida Y, Worasith Chanika, Eamudomkarn Chatanun, Hongsrichan Nuttanan, Pitaksakulrat Opal, Sithithaworn Jiraporn, Tippayawat Patcharaporn, Techasen Anchalee, Noordin Rahmah, Crellen Thomas, Sithithaworn Paiboon
Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand.
Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand.
PLoS One. 2024 Dec 3;19(12):e0306732. doi: 10.1371/journal.pone.0306732. eCollection 2024.
Detection of Strogyloides-specific IgG antibodies in urine and serum has been used in diagnostic and epidemiological studies on strongyloidiasis. However, the usefulness of these assays in assessing responses to anthelmintic treatment is unclear. Thus, we evaluated the diagnostic performance and temporal profiles of Strongyloides-specific IgG antibodies in a cohort of participants at baseline and post-treatment. The participants were prospectively screened for baseline parasitic infections by fecal examination [agar plate culture technique (APCT) and formalin-ethyl acetate concentration technique (FECT)] and digital droplet polymerase reaction (ddPCR) for Strongyloides stercoralis. At each sampling point, Strongyloides-specific IgG in urine and serum were measured by an in-house S. ratti-based enzyme-linked immunosorbent assay (ELISA). At baseline, 169 of 351 participants (48.1%) had S. stercoralis infection by the combined fecal examination and ddPCR. The diagnostic sensitivities of IgG in urine and serum were 91.1% and 88.2%, respectively. The participants were given treatment with a single oral dose of ivermectin (IVM, 200 μg/kg) and were followed up by fecal and immunological diagnosis at 3 to 18 months post-treatment. The cure rate of IVM treatment evaluated by APCT and ddPCR was 88.3% at three months post-treatment. The profiles of IgG in urine in the curative treatment group showed a significant trend of decline with time post-treatment (Kruskal-Wallis test = 113.4-212.6, p value < 0.0001) and the lowest levels were seen 12 months post-treatment. The treatment response (> 50% reduction in urinary IgG antibody units) was 100%, and conversion from positive to negative results was 65.4%. The treatment response and conversion to negative assessed by serum IgG-ELISA were similar to those by urine IgG-ELISA. The results from this long-term diagnostic study highlight the utility of urinary IgG and serum IgG for screening and monitoring treatment outcomes in strongyloidiasis.
尿液和血清中类圆线虫特异性IgG抗体的检测已用于类圆线虫病的诊断和流行病学研究。然而，这些检测方法在评估抗蠕虫治疗反应方面的效用尚不清楚。因此，我们在一组参与者的基线期和治疗后评估了类圆线虫特异性IgG抗体的诊断性能和时间变化情况。通过粪便检查[琼脂平板培养技术（APCT）和福尔马林-乙酸乙酯浓缩技术（FECT）]以及针对粪类圆线虫的数字液滴聚合酶反应（ddPCR）对参与者进行前瞻性基线寄生虫感染筛查。在每个采样点，通过基于鼠类圆线虫的内部酶联免疫吸附测定（ELISA）测量尿液和血清中的类圆线虫特异性IgG。基线时，351名参与者中有169名（48.1%）通过联合粪便检查和ddPCR检测出粪类圆线虫感染。尿液和血清中IgG的诊断敏感性分别为91.1%和88.2%。参与者接受单剂量口服伊维菌素（IVM，200μg/kg）治疗，并在治疗后3至18个月通过粪便和免疫学诊断进行随访。治疗后三个月，通过APCT和ddPCR评估的IVM治疗治愈率为88.3%。治愈治疗组尿液中IgG的变化情况显示，治疗后随着时间推移有显著下降趋势（Kruskal-Wallis检验=113.4-212.6，p值<0.0001），且在治疗后12个月时达到最低水平。治疗反应（尿液IgG抗体单位减少>50%）为100%，从阳性转为阴性结果的比例为65.4%。通过血清IgG-ELISA评估的治疗反应和转为阴性的情况与尿液IgG-ELISA相似。这项长期诊断研究的结果突出了尿液IgG和血清IgG在类圆线虫病筛查和监测治疗效果方面的效用。
