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Rodrigues JGM, Miranda GS, Camelo GMA, Rodrigues VF, Silva JKAO, Gouveia CBG, Porto WJN, Wanderley FS, Geiger SM, Negrão-Corrêa DA. Modifications to the parasitological technique of Rugai increase the diagnostic sensitivity for strongyloidiasis. Parasitol Res 2024; 123:101. [PMID: 38233532 DOI: 10.1007/s00436-023-08111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused mainly by Strongyloides stercoralis, a nematode that can persist for decades in the human host with a very low parasitic burden and without specific symptoms. Hence, it is difficult to diagnose and control. Larval concentration and culture methods with fecal samples show higher sensitivity for the diagnosis of Strongyloides-infected individuals; however, these techniques are not routinely used, primarily due to the challenges associated with processing a substantial volume of fecal samples. In the current study, we comparatively evaluated the sensitivity and applicability of modifications made to the Rugai parasitological method for the diagnosis of strongyloidiasis in fecal samples of experimentally infected rats and in 68 individuals from an urban community close to Maceió, Brazil. The presence and quantity of parasite larvae in the feces were comparatively evaluated using different parasitological techniques. In the experimental model, we demonstrated that the modified Rugai technique (RMOD) allowed for significantly higher recovery of larvae than the original Rugai technique (RO). Moreover, the sediment was cleaner and easier to evaluate using optical microscopy. Compared to other parasitological techniques, such as agar-plate culture (A-PC) and spontaneous sedimentation (SS), the RMOD technique showed higher sensitivity in the detection of larvae in all infected groups and presented comparatively better performance, especially in rats with a low parasite burden. In the human population, among the 68 stool samples evaluated, Strongyloides larvae were detected in the feces of six individuals with an estimated prevalence of 8.82%. However, the performance of each parasitological method was remarkably different. SS identified Strongyloides larvae in only two individuals and A-PC in three, whereas RMOD was able to identify six infected individuals, resulting in sensitivities of 33.3%, 50%, and 100%, respectively. In conclusion, the modifications introduced to the Rugai technique resulted in improved sensitivity for the detection of Strongyloides spp. infections, especially in stool samples with a low parasite burden, in comparison with other routinely used parasitological techniques.
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Affiliation(s)
- João Gustavo Mendes Rodrigues
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Silva Miranda
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Biology, Federal Institute of Education, Science and Technology of Maranhão, São Raimundo das Mangabeiras, Brazil
| | - Genil Mororó Araújo Camelo
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vanessa Fernandes Rodrigues
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Caio Brandão Goes Gouveia
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Flaviana Santos Wanderley
- Laboratory of Parasitic Infectious Diseases, State University of Health Sciences of Alagoas, Maceió, Brazil
| | - Stefan Michael Geiger
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Nosková E, Sambucci KM, Petrželková KJ, Červená B, Modrý D, Pafčo B. Strongyloides in non-human primates: significance for public health control. Philos Trans R Soc Lond B Biol Sci 2024; 379:20230006. [PMID: 38008123 PMCID: PMC10676817 DOI: 10.1098/rstb.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/18/2023] [Indexed: 11/28/2023] Open
Abstract
Primates are an important source of infectious disease in humans. Strongyloidiasis affects an estimated 600 million people worldwide, with a global distribution and hotspots of infection in tropical and subtropical regions. Recently added to the list of neglected tropical diseases, global attention has been demanded in the drive for its control. Through a literature review of Strongyloides in humans and non-human primates (NHP), we analysed the most common identification methods and gaps in knowledge about this nematode genus. The rise of molecular-based methods for Strongyloides detection is evident in both humans and NHP and provides an opportunity to analyse all data available from primates. Dogs were also included as an important host species of Strongyloides and a potential bridge host between humans and NHP. This review highlights the lack of molecular data across all hosts-humans, NHP and dogs-with the latter highly underrepresented in the database. Despite the cosmopolitan nature of Strongyloides, there are still large gaps in our knowledge for certain species when considering transmission and pathogenicity. We suggest that a unified approach to Strongyloides detection be taken, with an optimized, repeatable molecular-based method to improve our understanding of this parasitic infection. This article is part of the Theo Murphy meeting issue 'Strongyloides: omics to worm-free populations'.
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Affiliation(s)
- Eva Nosková
- Institute of Vertebrate Biology, Czech Academy of Sciences, 603 00 Brno, Czech Republic
- Department of Botany and Zoology, Faculty of Science, Masaryk University, 625 00 Brno, Czech Republic
| | - Kelly M. Sambucci
- Institute of Vertebrate Biology, Czech Academy of Sciences, 603 00 Brno, Czech Republic
- Department of Anthropology, Faculty of Science, Masaryk University, 611 37 Brno, Czech Republic
| | - Klára J. Petrželková
- Institute of Vertebrate Biology, Czech Academy of Sciences, 603 00 Brno, Czech Republic
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, 370 05 České Budějovice, Czech Republic
| | - Barbora Červená
- Institute of Vertebrate Biology, Czech Academy of Sciences, 603 00 Brno, Czech Republic
| | - David Modrý
- Department of Botany and Zoology, Faculty of Science, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, 370 05 České Budějovice, Czech Republic
- Department of Veterinary Sciences, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Barbora Pafčo
- Institute of Vertebrate Biology, Czech Academy of Sciences, 603 00 Brno, Czech Republic
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3
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Becker SL, Schneitler S. Antiparasitic stewardship: a call to action. Future Microbiol 2024; 19:5-8. [PMID: 38348569 DOI: 10.2217/fmb-2023-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 02/15/2024] Open
Abstract
Tweetable abstract There is an urgent need to consider antiparasitic drugs in global efforts to achieve and implement equitable and sustainable antimicrobial stewardship initiatives worldwide.
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Affiliation(s)
- Sören L Becker
- Institute of Medical Microbiology & Hygiene, Saarland University, Homburg/Saar, Germany
- Swiss Tropical & Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology & Hygiene, Saarland University, Homburg/Saar, Germany
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology & Allergology, Centre of Sleep Medicine & Respiratory Care, Solingen, Germany
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4
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Boonroumkaew P, Sadaow L, Janwan P, Rodpai R, Sanpool O, Buadee P, Suprom C, Thanchomnang T, Intapan PM, Maleewong W. Improved diagnostic sensitivity of human strongyloidiasis using point-of-care mixed recombinant antigen-based immunochromatography. Parasite 2023; 30:60. [PMID: 38099622 PMCID: PMC10723528 DOI: 10.1051/parasite/2023063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/25/2023] [Indexed: 12/17/2023] Open
Abstract
Strongyloidiasis is a neglected tropical disease that can cause fatal complications due to hyperinfection and disseminated strongyloidiasis in immunocompromised patients. We used two Strongyloides stercoralis recombinant antigenic proteins, L3NieAg.01 (NIE) and IgG-immunoreactive antigen (SsIR), to develop the recombinant antigen-based immunochromatography test (ICT) kit. We constructed and compared kits using either the NIE (NIE ICT kit) or the SsIR (SsIR ICT kit) antigens and a kit using a mixture of both (NIE-SsIR ICT kit) for detection of anti-Strongyloides IgG antibody in human serum samples. Serum samples from normal healthy individuals (Group I, n = 40), proven strongyloidiasis patients (Group II, n = 100), and those with other parasitic infections (Group III, n = 154) were evaluated. Sensitivity and specificity were 81.0% and 84.0% for the NIE ICT kit, 89.0% and 83.5% for the SsIR ICT kit, and 95.0% and 90.2% for the NIE-SsIR ICT kit, respectively. The NIE-SsIR ICT kit provided the best diagnostic results; it can supplement stool examination for clinical diagnosis and can be used to screen for asymptomatic S. stercoralis infection in people at risk in endemic areas. The NIE-SsIR ICT kit can also be used in large-scale sero-epidemiological investigations in endemic areas without the need for additional facilities or ancillary supplies.
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Affiliation(s)
- Patcharaporn Boonroumkaew
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Lakkhana Sadaow
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Penchom Janwan
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
- Department of Medical Technology, School of Allied Health Sciences, Walailak University 80161 Nakhon Si Thammarat Thailand
- Hematology and Transfusion Science Research Center, Walailak University 80161 Nakhon Si Thammarat Thailand
| | - Rutchanee Rodpai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Oranuch Sanpool
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Punyisa Buadee
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Chanida Suprom
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Tongjit Thanchomnang
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
- Faculty of Medicine, Mahasarakham University 44000 Maha Sarakham Thailand
| | - Pewpan M. Intapan
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
| | - Wanchai Maleewong
- Department of Parasitology, Faculty of Medicine, Khon Kaen University 40002 Khon Kaen Thailand
- Mekong Health Science Research Institute, Khon Kaen University 40002 Khon Kaen Thailand
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Buonfrate D, Tamarozzi F, Paradies P, Watts MR, Bradbury RS, Bisoffi Z. The diagnosis of human and companion animal Strongyloides stercoralis infection: Challenges and solutions. A scoping review. ADVANCES IN PARASITOLOGY 2022; 118:1-84. [PMID: 36088083 DOI: 10.1016/bs.apar.2022.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Strongyloidiasis is the infection caused by soil-transmitted nematodes of Strongyloides species, infecting humans and some animals. Strongyloides stercoralis is the species with most clinical and epidemiological relevance in humans and dogs, due to its high prevalence and its capacity of inducing a life-threatening hyperinfection. Diagnosis of strongyloidiasis is challenging, due to the absence of a single reference standard test with high sensitivity and specificity, which also hampers the estimation of the accuracy of other diagnostic tests. In this chapter, we review the deployment and performance of the parasitological, immunological, molecular tests for the diagnosis of strongyloidiasis in humans and in dogs. Further, we comment the available evidence from genotyping studies that have addressed the zoonotic potential of S. stercoralis. Finally, we discuss the use of different diagnostic methods in relation to the purpose (i.e., screening, individual diagnosis, inclusion in a clinical trial) and the setting (endemic/non-endemic areas) and report the accuracy figures reported by systematic reviews on either parasitological, serological or molecular techniques published in literature.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.
| | - Francesca Tamarozzi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, Bari, Italy
| | - Matthew R Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research - New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, VC, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Unterköfler MS, Eipeldauer I, Merz S, Pantchev N, Hermann J, Brunthaler R, Basso W, Hinney B. Strongyloides stercoralis infection in dogs in Austria: two case reports. Parasit Vectors 2022; 15:168. [PMID: 35570317 PMCID: PMC9107779 DOI: 10.1186/s13071-022-05270-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Strongyloides stercoralis is endemic in tropical and subtropical regions, but reports of infections in central and northern Europe have been recently increasing. Infections occur mainly in humans and dogs. In dogs, both dog-adapted and zoonotic S. stercoralis genotypes seem to occur. Clinical manifestations mainly include gastrointestinal and respiratory signs. The severity of the disease can vary greatly and depends on the immune status of the host. The infection is potentially fatal in immunosuppressed individuals, either medically induced or due to an underlying disease, in which hyperinfections and disseminated infections with extraintestinal parasite dissemination may occur. Methods Diagnosis was based on coproscopy, including flotation and the Baermann funnel technique, histology of small intestinal biopsies and molecular analysis of mitochondrial cytochrome oxidase subunit I (COI) and hypervariable regions I and IV (HVR I and HVR IV) of the nuclear 18S rDNA loci. Results Two independent cases of severe canine S.stercoralis infection in Austria are presented. In both cases, S. stercoralis was detected in histological sections of the small intestine and with the Baermann funnel technique. Molecular analysis revealed strains with zoonotic potential. Case 1 was a 1-year-old female French bulldog with a long history of respiratory and gastrointestinal signs, severe emaciation and apathy before S.stercoralis infection was diagnosed. Treatment with moxidectin (2.5 mg/kg body weight [BW], oral route) did not eliminate the infection, but treatment with ivermectin (0.2 mg/kg BW, subcutaneously) was successful. Case 2 consisted of two 2-month-old Pomeranian puppies, one female and one male, from a litter of four, which died soon after presenting dyspnoea and haemorrhagic diarrhoea (female) or torticollis (male); S.stercoralis infection was first diagnosed post-mortem. Conclusion More attention should be paid to this nematode because although it appears to be rare in Austria, it is easily overlooked on standard coproscopy unless a Baermann funnel technique is used, and even then, it can be missed. Moxidectin is not always successful in eliminating the infection, and treatment with ivermectin should be considered in cases of infection. Graphical Abstract ![]()
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Affiliation(s)
| | - Iris Eipeldauer
- Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | | | - Josef Hermann
- Veterinary Practice Dipl.Tzt. Josef Hermann, Trautmannsdorf, Austria
| | - René Brunthaler
- Institute of Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Walter Basso
- Institute of Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Barbara Hinney
- Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
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Gelaye W, Williams NA, Kepha S, Junior AM, Fleitas PE, Marti-Soler H, Damtie D, Menkir S, Krolewiecki AJ, van Lieshout L, Enbiale W. Performance evaluation of Baermann techniques: The quest for developing a microscopy reference standard for the diagnosis of Strongyloides stercoralis. PLoS Negl Trop Dis 2021; 15:e0009076. [PMID: 33600434 PMCID: PMC7891789 DOI: 10.1371/journal.pntd.0009076] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) are common in low and middle income countries where there is lack of access to clean water and sanitation. Effective diagnosis and treatment are essential for the control of STH infections. However, among STH parasites, Strongyloides stercoralis is the most neglected species, both in diagnostics and control strategies. Diagnostic methods cover different approaches, each with different sensitivities and specificities, such as serology, molecular techniques and microscopy based techniques. Of the later, the Baermann technique is the most commonly used procedure. In the literature, several ways have been described to perform the Baermann method, which illustrates the overall lack of a '(gold) reference standard' method for the diagnosis of S. stercoralis infection. In this study we have evaluated the performance of three Baermann techniques in order to improve the reference standard for the microscopic diagnosis of S. stercoralis infection thereby facilitating individual case detection, mapping of the disease and proper evaluation of treatment responses. METHODS/PRINCIPAL FINDINGS A community based cross sectional study was conducted at Zenzelima, Bahir Dar Zuria Ethiopia. A total of 437 stool samples were collected and analyzed by the following procedures: conventional Baermann (CB), modified Baermann (MB), and modified Baermann with charcoal pre-incubation (MBCI). The diagnostic sensitivity and Negative Predictive Value (NPV) of each technique was calculated using the combination of all the three techniques as a composite reference standard. Our result indicated that larvae of S. stercoralis were detected in 151 (34.6%) stool samples. The prevalence of S. stercoralis infection based on the three diagnostic methods was 9.6%, 8.0%, and 31.3% by CB, MB, and MBCI respectively. The sensitivity and NPV for CB, MB, and MBCI were 26.7% and 70.8%, 22.1% and 69.6%, and 87.0% and 93.2%, respectively. The MBCI showed significant difference (P- value = <0.001) in the sensitivity and NPV values when compared with CB and MB values. The agreement between CB, MB, and MBCI with the composite reference standard was 31.8%, 26.7%, 89.6%, respectively. CONCLUSION/SIGNIFICANCE Our results suggest the superior performance of MBCI. It is relatively easy to implement, simple to perform and comparatively cheaper. The CB is by far the commonly used method in routine diagnostic although this technique significantly underestimates the true burden of the disease and thereby contributing to the exclusion of S. stercoralis from the control strategies. Therefore, MBCI is recommended as a routine microscopy-based diagnostic test for S. stercoralis infection, particularly in settings where molecular procedures are not available.
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Affiliation(s)
- Woyneshet Gelaye
- Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
| | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Spain
| | - Stella Kepha
- Kenya Medical Research Institution, Nairobi, Kenya
| | | | - Pedro Emanuel Fleitas
- Universidad Nacional de Salta, Instituto de Investigaciones de Enfermedades Tropicales/CONICET, Oran, Salta, Argentina
| | - Helena Marti-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Spain
| | - Destaw Damtie
- Bahir Dar University, College of Science, Department of Biology, Bahir Dar, Ethiopia
| | - Sissay Menkir
- Bahir Dar University, College of Science, Department of Biology, Bahir Dar, Ethiopia
| | - Alejandro J. Krolewiecki
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Spain
- Universidad Nacional de Salta, Instituto de Investigaciones de Enfermedades Tropicales/CONICET, Oran, Salta, Argentina
| | - Lisette van Lieshout
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Wendemagegn Enbiale
- Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
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Kridaningsih TN, Sukmana DJ, Mufidah H, Diptyanusa A, Kusumasari RA, Burdam FH, Kenangalem E, Poespoprodjo JR, Fuad A, Mahendradhata Y, Supargiyono S, Utzinger J, Becker SL, Murhandarwati EEH. Epidemiology and risk factors of Strongyloides stercoralis infection in Papua, Indonesia: a molecular diagnostic study. Acta Trop 2020; 209:105575. [PMID: 32505594 DOI: 10.1016/j.actatropica.2020.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Strongyloides stercoralis is a parasitic worm that is of considerable clinical relevance. Indeed, it may persist asymptomatically for many years, but can lead to potentially fatal dissemination when the host's immune status is impaired. As commonly employed stool microscopy techniques (e.g. Kato-Katz thick smear) fail to detect S. stercoralis, the epidemiology is poorly understood. In 2013, we conducted a cross-sectional household survey in the district of Mimika in Papua, Indonesia. A total of 331 individuals, aged 1 month to 44 years, had a single stool sample subjected to real-time polymerase chain reaction (PCR) for S. stercoralis diagnosis. The prevalence of S. stercoralis infection was 32.0% (106/331 individuals); higher than any of the three main soil-transmitted helminths (Ascaris lumbricoides, 23.9%; Trichuris trichiura, 18.4%; and hookworm, 17.2%). Amongst the S. stercoralis-infected individuals, 73.6% were concurrently infected with another helminth, with hookworm being the most frequent co-infection (27.4%). Fourteen percent of the S. stercoralis infections had low cycle threshold values on real-time PCR, which may indicate a higher infection intensity. Multivariate logistic regression analysis revealed that age ≥5 years (adjusted odds ratio (OR) 5.8, 95% confidence interval (CI): 3.1-10.8) was significantly associated with S. stercoralis infection. There is a need for in-depth clinical and diagnostic studies to elucidate the public health impact of S. stercoralis infection in Indonesia.
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Boonroumkaew P, Sadaow L, Sanpool O, Rodpai R, Thanchomnang T, Phupiewkham W, Intapan PM, Maleewong W. Effectiveness of Strongyloides Recombinant IgG Immunoreactive Antigen in Detecting IgG and IgG4 Subclass Antibodies for Diagnosis of Human Strongyloidiasis Using Rapid Immunochromatographic Tests. Diagnostics (Basel) 2020; 10:diagnostics10090615. [PMID: 32825495 PMCID: PMC7555090 DOI: 10.3390/diagnostics10090615] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Human strongyloidiasis is an important soil-transmitted helminthiasis that affects millions worldwide and can develop into fatal systemic strongyloidiasis in immunosuppressed patients. We have developed two new rapid and simple-to-use immunochromatographic test (ICT) kits for rapid serodiagnosis that support stool examination for clinical diagnosis. Strongyloides stercoralis recombinant IgG immunoreactive antigen (GenBank: AAB97359.1; rSsIR-based ICT kit) was used for detection of IgG and IgG4 antibodies. The diagnostic efficacy of both kits was evaluated using human serum samples from strongyloidiasis patients, healthy individuals, and those with other parasitosis. At a prevalence of infection of 36.4%, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the rSsIR-based IgG ICT kit were 91.7%, 83.8%, 76.4%, 94.6%, and 86.7%, respectively, and those of the rSsIR-based IgG4 ICT kit were 78.3%, 84.8%, 74.6%, 87.3%, and 82.4% respectively. The concordance between the two kits was 89.7%. The recombinant antigen can be produced to an unlimited extent and the kits can be used as point-of-care diagnostic tools and in large-scale surveys in endemic areas throughout tropical regions without necessitating additional facilities or ancillary supplies.
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Affiliation(s)
- Patcharaporn Boonroumkaew
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Lakkhana Sadaow
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Oranuch Sanpool
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Rutchanee Rodpai
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Tongjit Thanchomnang
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
- Faculty of Medicine, Mahasarakham University, Maha Sarakham 44000, Thailand
| | - Weeraya Phupiewkham
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Pewpan M. Intapan
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Wanchai Maleewong
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.B.); (L.S.); (O.S.); (R.R.); (W.P.); (P.M.I.)
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand;
- Correspondence: ; Tel.: +66-4336-3434
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10
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Balachandra D, Ahmad H, Arifin N, Noordin R. Direct detection of Strongyloides infection via molecular and antigen detection methods. Eur J Clin Microbiol Infect Dis 2020; 40:27-37. [DOI: 10.1007/s10096-020-03949-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
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11
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Aramendia AA, Anegagrie M, Zewdie D, Dacal E, Saugar JM, Herrador Z, Hailu T, Yimer M, Periago MV, Rodriguez E, Benito A. Epidemiology of intestinal helminthiases in a rural community of Ethiopia: Is it time to expand control programs to include Strongyloides stercoralis and the entire community? PLoS Negl Trop Dis 2020; 14:e0008315. [PMID: 32497042 PMCID: PMC7297378 DOI: 10.1371/journal.pntd.0008315] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/16/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Soil transmitted helminths are highly prevalent worldwide. Globally, approximately 1.5 billion people are infected with Ascaris lumbricoides, Trichuris trichiura or hookworm. Endemic countries carry out periodic mass treatment of at-risk populations with albendazole or mebendazole as a control measure. Most prevalence studies have focused on school aged children and therefore control programs are implemented at school level, not at community level. In this study, the prevalence of intestinal helminths, including Strongyloides stercoralis, was examined using a comprehensive laboratory approach in a community in north-western Ethiopia. METHODS A cross-sectional survey was conducted on 792 individuals ≥5 years old in randomly selected houses in a rural district. Stools were examined using three techniques: a formol-ether concentration, the Baermann technique and a real time polymerase chain reaction test (these last two specific for S. stercoralis). Statistical analyses were performed between two large age groups, children (≤14 years old) and adults (≥15 years old). RESULTS The prevalence of helminths was 91.3%; (95% CI: 89.3-93.3%). Hookworm was the most prevalent, 78.7% (95% CI 75.6-81.4%), followed by S. stercoralis 55.7% (95% CI 52.2-59.1%). Co-infection with both was detected in 45.4% (95% CI 42.0-49.0%) of the participants. The mean age of hookworm-infected individuals was significantly higher than non-infected ones (p = 0.003). Also, S. stercoralis infection was significantly associated with age, being more prevalent in adults (p = 0.002). CONCLUSIONS This is the highest prevalence of S. stercoralis detected in Ethiopia so far. Our results highlight the need of searching specifically for infection by this parasite since it usually goes unnoticed if helminth studies rely only on conventional diagnostic techniques, i.e. Kato-Katz. Moreover, the focus of these programs on children undermines the actual prevalence of hookworm. The adult population acts as a reservoir for both hookworm and S. stercoralis and this fact may negatively impact the current control programs in Ethiopia which only target treatment of school aged children. This reservoir, together with a lack of adequate water, sanitation and hygiene, increases the probability of re-infection in children. Finally, the high prevalence of S. stercoralis found calls for a comprehensive diagnostic approach in endemic areas in addition to a revision of control measures that is, adding ivermectin to current albendazole/mebendazole, since it is the drug of choice for S. stercoralis.
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Affiliation(s)
- Aranzazu Amor Aramendia
- Mundo Sano Foundation, Madrid, Spain
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- * E-mail:
| | - Melaku Anegagrie
- Mundo Sano Foundation, Madrid, Spain
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Derjew Zewdie
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elena Dacal
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Jose M. Saugar
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Zaida Herrador
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Tadesse Hailu
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Mulat Yimer
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - María V. Periago
- Mundo Sano Foundation, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Esperanza Rodriguez
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Agustín Benito
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
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12
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de Souza JN, Oliveira CDL, Araújo WAC, Souza ABS, Silva MLS, da Cruz IDR, Sampaio LM, dos Santos JSB, Teixeira MCA, Soares NM. Strongyloides stercoralis in Alcoholic Patients: Implications of Alcohol Intake in the Frequency of Infection and Parasite Load. Pathogens 2020; 9:pathogens9060422. [PMID: 32481753 PMCID: PMC7350291 DOI: 10.3390/pathogens9060422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
Strongyloides stercoralis infection in immunocompromised subjects, including chronic alcoholics, can lead to a severe disease. Moreover, its prevalence in alcoholic patients seems to be higher than that in the general population. The aims of this study were to evaluate the frequency of S. stercoralis infection in alcoholic patients and to investigate the influence of alcohol intake on the parasite load, as well as to evaluate the sensitivity of three different parasitological methods according to the larval output. Fecal samples of 1290 chronic alcoholic patients were examined by spontaneous sedimentation, Baermann-Moraes, and agar plate culture (APC) methods. S. stercoralis was the most frequent parasite found (14.5%; n = 187). Alcoholic individuals infected with Strongyloides stercoralis had a higher daily consumption of alcohol than those who were not infected, 528.6 and 403.0 g/day, respectively (p < 0.05). In addition, individuals with higher alcohol intake presented an increase in parasite load. The S. stercoralis diagnostic method with the highest sensitivity was APC, 97.9% (183/187). In conclusion, S. stercoralis seems to be the most frequent parasite found in alcoholic individuals from endemic areas and alcohol intake is positively associated with S. stercoralis larvae output. In addition, this study confirms that APC is the most sensitive parasitological method used for Strongyloides diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Neci M. Soares
- Correspondence: or ; Tel.: +55-71-32836950; Fax: +55-71-32836919
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13
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Kaewrat W, Sengthong C, Yingklang M, Intuyod K, Haonon O, Onsurathum S, Dangtakot R, Saisud P, Sangka A, Anutrakulchai S, Pinlaor S, Cha'on U, Pinlaor P. Improved agar plate culture conditions for diagnosis of Strongyloides stercoralis. Acta Trop 2020; 203:105291. [PMID: 31816322 DOI: 10.1016/j.actatropica.2019.105291] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 10/09/2019] [Accepted: 12/04/2019] [Indexed: 01/29/2023]
Abstract
Strongyloides stercoralis infection causes gastrointestinal symptoms and can lead to severe disease in immunocompromised hosts. Live larvae are passed in feces, encouraging the common use of diagnosis by cultivation methods including agar plate culture (APC), the gold-standard technique. Nevertheless, APC has limitations, especially since there can be considerable day-to-day fluctuations in numbers of larvae produced. Herein, we collected stool samples from heavily infected subjects with strongyloidiasis in Khon Kaen Province, Thailand, to evaluate modifications (temperature, pH, nutrition source and salinity) to APC conditions to maximize the number of S. stercoralis worms counted. Best results were obtained using a modified APC with the following conditions: pH 6.0, 0.5% of NaCl, addition of yeast extract for nutrition and incubation at 29-30 °C. This modified APC was more sensitive for detection of S. stercoralis than was standard APC or the formalin-ethyl acetate concentration technique. In brief, this finding suggests that a modification of standard APC conditions increases the counts of S. stercoralis.
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Sengthong C, Yingklang M, Intuyod K, Hongsrichan N, Pinlaor S. An optimized agar plate culture improves diagnostic efficiency for Strongyloides stercoralis infection in an endemic community. Parasitol Res 2020; 119:1409-1413. [PMID: 32086591 DOI: 10.1007/s00436-020-06626-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/14/2020] [Indexed: 02/05/2023]
Abstract
We aimed to compare the efficacy of modified agar plate fecal culture (mAPC) and standard agar plate culture (sAPC) for diagnosis of Strongyloides stercoralis infection in a community at Khon Kaen Province, Thailand. Fecal samples were collected from participants individually (n = 1076) and were tested using these two methods. Modified APC and sAPC detected 129 (11.99%) and 91 (8.46%) infected individuals, respectively. Thirty-eight participants were negative according to sAPC, but positive for mAPC. Moreover, in the participants who were positive for both methods, the number of worm developmental stages obtained was higher for mAPC than for sAPC. Our study suggests that mAPC is an effective and useful tool for S. stercoralis diagnosis and can be applied for mass-screening in community and/or control programs.
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Affiliation(s)
- Chatchawan Sengthong
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Medical Technology Unit of Bangkatum Hospital, Phitsanulok, 65110, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Manachai Yingklang
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Kitti Intuyod
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Nuttanan Hongsrichan
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Somchai Pinlaor
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. .,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand.
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Sadaow L, Sanpool O, Rodpai R, Boonroumkaew P, Maleewong W, Intapan PM. Development of immunochromatographic device as a point-of-care tool for serodiagnosis of human strongyloidiasis cases. Eur J Clin Microbiol Infect Dis 2019; 39:465-470. [PMID: 31758442 PMCID: PMC7040067 DOI: 10.1007/s10096-019-03745-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
Human strongyloidiasis is an important gastrointestinal disease with an estimated 30 to 100 million people infected. Prevalence is generally underestimated since many infections are asymptomatic, and traditional diagnostic tests based on parasitological examination of stool samples are not adequately sensitive. Serological tests are useful and supportive but are still only available in a reference research setting. We made an immunochromatographic test (ICT) kit for rapid serodiagnosis of human strongyloidiasis. The antigen used in the ICT kit was extracted from larvae of Strongyloides stercoralis. Diagnostic efficacy of the kit was evaluated using human serum samples from strongyloidiasis patients, healthy persons, and those with other parasitoses. When using a cutoff level of 0.5 or above, the diagnostic sensitivity, specificity, and positive and negative predictive values at the prevalence of infection of 34.4%, were 93.3%, 83.7%, 76.7%, and 95.6%, respectively. This ICT kit is easy to use at the point-of-care and a result can be obtained in 15 min. Sophisticated instruments and highly trained staff are not required. It can be used in several diagnostic and public-health settings, e.g., prevalence surveys in endemic areas, confirmation and monitoring of cure post-treatment, diagnosis and screening of infected but asymptomatic individuals, and populations “at risk” for hyperinfection syndrome or disseminated strongyloidiasis if they are given immunosuppressive treatment for other conditions.
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Affiliation(s)
- Lakkhana Sadaow
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Oranuch Sanpool
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Rutchanee Rodpai
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Patcharaporn Boonroumkaew
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Wanchai Maleewong
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Pewpan M Intapan
- Department of Parasitology and Excellence in Medical Innovation, and Technology Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
- Research and Diagnostic Center for Emerging Infectious Diseases, Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand.
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[Acute renal failure and rare severe complication of systemic steroid treatment in a 73-year-old woman]. Internist (Berl) 2019; 60:1201-1208. [PMID: 31511906 DOI: 10.1007/s00108-019-00677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.
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