Lorenz Eva, Razafindrakoto Ravo, Rausche Pia, Rasolojaona Zaraniaina Tahiry, Razafindralava Nantenaina Matthieu, Zerbo Alexandre, Höppner Yannick, von Thien Heidrun, Rakotozandrindrainy Njary, Doumbia Cheick Oumar, Klein Philipp, Kutz Jean-Marc, Corstjens Paul L A M, de Dood Claudia, Hoekstra Pytsje T, van Dam Govert J, Jaeger Anna, Schwarz Norbert Georg, Tannich Egbert, Andrianarivelo Mala Rakoto, Rakotozandrindrainy Raphael, Rakotoarivelo Rivo Andry, May Jürgen, Rasamoelina Tahinamandranto, Fusco Daniela
Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, 20359, Hamburg, Germany.
German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany.
Infect Dis Poverty. 2025 Mar 17;14(1):20. doi: 10.1186/s40249-025-01292-x.
Schistosoma haematobium and S. mansoni are endemic in Madagascar, but reliable diagnostic tools are often lacking, contributing to exacerbate transmission and morbidity. This study evaluated the diagnostic accuracy of three tests for schistosome infection in Malagasy adults from areas of medium to high endemicity.
This cross-sectional study enrolled adults from three primary health care centres in Madagascar. Urine and blood samples were tested for schistosome infection using polymerase chain reaction (PCR), up-converting reporter particle lateral flow for the circulating anodic antigen (UCP-LF CAA), and point-of-care circulating cathodic antigen (POC-CCA) tests. Bayesian latent class models were used to assess diagnostic accuracies and disease prevalence.
Of 1339 participants, 461 were from S. haematobium and 878 from S. mansoni endemic areas. Test detection rates were 52% (POC-CCA), 60% (UCP-LF CAA), and 66% (PCR) in the S. haematobium area, and 54%, 55%, and 59% respectively in the S. mansoni area. For S. haematobium, PCR and UCP-LF CAA showed high sensitivity (Se, median 95.2% and 87.8%) but moderate specificity (Sp, 60.3% and 66.2%), while POC-CCA performed moderately (Se: 64.5%; Sp: 59.6%). For S. mansoni, PCR and POC-CCA demonstrated high diagnostic accuracy (Se > 90%, Sp > 80%), while UCP-LF CAA showed good sensitivity (79.9%) but moderate specificity (69.7%).
While population-level prevalence estimates were similar across tests, individual-level agreement was only low to moderate. Our findings suggest that optimal diagnostic strategies should be tailored to specific endemic settings, continued development of accurate diagnostics suitable for highly endemic settings remains a priority.
埃及血吸虫和曼氏血吸虫在马达加斯加呈地方性流行，但往往缺乏可靠的诊断工具，这加剧了疾病传播和发病情况。本研究评估了三种检测方法在马达加斯加中度至高度流行地区成年人群中对血吸虫感染的诊断准确性。
这项横断面研究纳入了来自马达加斯加三个初级卫生保健中心的成年人。使用聚合酶链反应（PCR）、循环阳极抗原上转换报告粒子侧向流动分析法（UCP-LF CAA）和即时检测循环阴极抗原法（POC-CCA）对尿液和血液样本进行血吸虫感染检测。采用贝叶斯潜在类别模型评估诊断准确性和疾病流行率。
在1339名参与者中，461名来自埃及血吸虫流行地区，878名来自曼氏血吸虫流行地区。在埃及血吸虫流行地区，检测率分别为52%（POC-CCA）、60%（UCP-LF CAA）和66%（PCR）；在曼氏血吸虫流行地区，检测率分别为54%、55%和59%。对于埃及血吸虫，PCR和UCP-LF CAA显示出高灵敏度（中位数分别为95.2%和87.8%）但中等特异性（分别为60.3%和66.2%），而POC-CCA表现中等（灵敏度：64.5%；特异性：59.6%）。对于曼氏血吸虫，PCR和POC-CCA显示出高诊断准确性（灵敏度>90%，特异性>80%），而UCP-LF CAA显示出良好的灵敏度（79.9%）但中等特异性（69.7%）。
虽然各项检测在人群水平上的流行率估计相似，但个体水平的一致性仅为低到中等。我们的研究结果表明，最佳诊断策略应根据特定的流行情况进行调整，继续开发适用于高流行地区的准确诊断方法仍然是当务之急。
