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Macalanda AMC, Wanlop A, Ona KAL, Galon EMS, Khieu V, Sayasone S, Yajima A, Angeles JMM, Kawazu SI. Current advances in serological and molecular diagnosis of Schistosoma mekongi infection. Trop Med Health 2024; 52:32. [PMID: 38650044 PMCID: PMC11034094 DOI: 10.1186/s41182-024-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
Schistosomiasis, a neglected tropical disease, caused by blood flukes belonging to the genus Schistosoma; it persists as a public health problem in selected regions throughout Africa, South America, and Asia. Schistosoma mekongi, a zoonotic schistosome species endemic to the Mekong River in Laos and Cambodia, is one of the significant causes of human schistosomiasis along with S. japonicum, S. mansoni, S. haematobium and S. intercalatum. Since its discovery, S. mekongi infection has been highly prevalent in communities along the Mekong River. Although surveillance and control measures have shown success in recent years, more robust diagnostic tools are still needed to establish more efficient control and prevention strategies to achieve and sustain an elimination status. Diagnosis of S. mekongi infection still relies on copro-parasitological techniques, commonly made by Kato-Katz stool examination. Serological techniques such as enzyme-linked immunosorbent assay (ELISA) may also be applicable but in a limited setting. Targeted molecular and serological tools specific to the species, on the other hand, have been limited. This is due, in part, to the limited research and studies on the molecular biology of S. mekongi since genome information of this species has not yet been released. In this review, current advances, and gaps and limitations in the molecular and immunological diagnosis of S. mekongi are discussed.
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Affiliation(s)
- Adrian Miki C Macalanda
- Department of Immunopathology and Microbiology, College of Veterinary Medicine and Biomedical Sciences, Cavite State University, Indang, 4122, Cavite, Philippines.
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, 080-8555, Japan.
| | - Atcharaphan Wanlop
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, 080-8555, Japan
- Department of Parasitology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8131, Japan
| | - Kevin Austin L Ona
- College of Medicine, The University of the Philippines - Manila, Pedro Gil St., Ermita Manila, Manila, Philippines
| | - Eloiza May S Galon
- Department of Immunopathology and Microbiology, College of Veterinary Medicine and Biomedical Sciences, Cavite State University, Indang, 4122, Cavite, Philippines
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, 080-8555, Japan
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Aya Yajima
- World Health Organization Regional Office for Southeast Asia, New Delhi, India
| | - Jose Ma M Angeles
- Department of Parasitology, College of Public Health, The University of the Philippines - Manila, Pedro Gil St., Ermita Manila, Manila, Philippines
| | - Shin-Ichiro Kawazu
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, 080-8555, Japan.
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De Marco Verissimo C, Cwiklinski K, Nilsson J, Mirgorodskaya E, Jin C, Karlsson NG, Dalton JP. Glycan Complexity and Heterogeneity of Glycoproteins in Somatic Extracts and Secretome of the Infective Stage of the Helminth Fasciola hepatica. Mol Cell Proteomics 2023; 22:100684. [PMID: 37993102 PMCID: PMC10755494 DOI: 10.1016/j.mcpro.2023.100684] [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: 07/24/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023] Open
Abstract
Fasciola hepatica is a global helminth parasite of humans and their livestock. The invasive stage of the parasite, the newly excysted juvenile (NEJs), relies on glycosylated excreted-secreted (ES) products and surface/somatic molecules to interact with host cells and tissues and to evade the host's immune responses, such as disarming complement and shedding bound antibody. While -omics technologies have generated extensive databases of NEJs' proteins and their expression, detailed knowledge of the glycosylation of proteins is still lacking. Here, we employed glycan, glycopeptide, and proteomic analyses to determine the glycan profile of proteins within the NEJs' somatic (Som) and ES extracts. These analyses characterized 123 NEJ glycoproteins, 71 of which are secreted proteins, and allowed us to map 356 glycopeptides and their associated 1690 N-glycan and 37 O-glycan forms to their respective proteins. We discovered abundant micro-heterogeneity in the glycosylation of individual glycosites and between different sites of multi-glycosylated proteins. The global heterogeneity across NEJs' glycoproteome was refined to 53 N-glycan and 16 O-glycan structures, ranging from highly truncated paucimannosidic structures to complex glycans carrying multiple phosphorylcholine (PC) residues, and included various unassigned structures due to unique linkages, particularly in pentosylated O-glycans. Such exclusive glycans decorate some well-known secreted molecules involved in host invasion, including cathepsin B and L peptidases, and a variety of membrane-bound glycoproteins, suggesting that they participate in host interactions. Our findings show that F. hepatica NEJs generate exceptional protein variability via glycosylation, suggesting that their molecular portfolio that communicates with the host is far more complex than previously anticipated by transcriptomic and proteomic analyses. This study opens many avenues to understand the glycan biology of F. hepatica throughout its life-stages, as well as other helminth parasites, and allows us to probe the glycosylation of individual NEJs proteins in the search for innovative diagnostics and vaccines against fascioliasis.
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Affiliation(s)
- Carolina De Marco Verissimo
- Molecular Parasitology Lab (MPL) - Centre for One Health and Ryan Institute, School of Natural Science, National University of Ireland Galway, Galway, Republic of Ireland.
| | - Krystyna Cwiklinski
- Molecular Parasitology Lab (MPL) - Centre for One Health and Ryan Institute, School of Natural Science, National University of Ireland Galway, Galway, Republic of Ireland; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Jonas Nilsson
- Proteomics Core Facility, Sahlgrenska Academy of Science, University of Gothenburg, Gothenburg, Sweden
| | - Ekaterina Mirgorodskaya
- Proteomics Core Facility, Sahlgrenska Academy of Science, University of Gothenburg, Gothenburg, Sweden
| | - Chunsheng Jin
- Proteomics Core Facility, Sahlgrenska Academy of Science, University of Gothenburg, Gothenburg, Sweden
| | - Niclas G Karlsson
- Department of Life Science and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - John P Dalton
- Molecular Parasitology Lab (MPL) - Centre for One Health and Ryan Institute, School of Natural Science, National University of Ireland Galway, Galway, Republic of Ireland
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Comelli A, Genovese C, Gobbi F, Brindicci G, Capone S, Corpolongo A, Crosato V, Mangano VD, Marrone R, Merelli M, Prato M, Santoro CR, Scarso S, Vanino E, Marchese V, Antinori S, Mastroianni C, Raglio A, Bruschi F, Minervini A, Donà D, Garazzino S, Galli L, Lo Vecchio A, Galli A, Dragoni G, Cricelli C, Colacurci N, Ferrazzi E, Pieralli A, Montresor A, Richter J, Calleri G, Bartoloni A, Zammarchi L. Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian Society of Tropical Medicine and Global Health (SIMET), endorsed by the Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), the Italian Society of Parasitology (SoIPa), the Italian Society of Gastroenterology and Digestive Endoscopy (SIGE), the Italian Society of Gynaecology and Obstetrics (SIGO), the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), the Italian Society of General Medicine and Primary Care (SIMG), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Pediatrics (SIP), the Italian Society of Paediatric Infectious Diseases (SITIP), the Italian Society of Urology (SIU). Infection 2023; 51:1249-1271. [PMID: 37420083 PMCID: PMC10545632 DOI: 10.1007/s15010-023-02050-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Genovese
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - Gaetano Brindicci
- AOU Consorziale Policlinico di Bari, Infectious Diseases Unit, Bari, Italy
| | - Susanna Capone
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Dianora Mangano
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Marco Prato
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Salvatore Scarso
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Vanino
- Unit of Infectious Diseases, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annibale Raglio
- Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), Milan, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Urology, University of Florence, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Paediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Claudio Cricelli
- Health Search-Istituto di Ricerca della SIMG (Italian Society of General Medicine and Primary Care), Florence, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Pieralli
- Ginecologia Chirurgica Oncologica, Careggi University and Hospital, Florence, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Joachim Richter
- Institute of International Health, Charité Universitätsmedizin, Corporate Member of Freie und Humboldt Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Guido Calleri
- Amedeo Di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Fasogbon IV, Aja PM, Ondari EN, Adebayo I, Ibitoye OA, Egesa M, Tusubira D, Sasikumar S, Onohuean H. UCP-LF and other assay methods for schistosome circulating anodic antigen between 1978 and 2022. Biol Methods Protoc 2023; 8:bpad006. [PMID: 37197579 PMCID: PMC10185406 DOI: 10.1093/biomethods/bpad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Detection of circulating anodic antigen (CAA) is known for its high sensitivity in diagnosing schistosomiasis infection, even in low-prevalence settings. The Up-Converting Phosphor-Lateral Flow (UCP-LF) assay developed in 2008 presented greater sensitivity than other assay methods in use for CAA detection. Our study aims to comprehensively review all studies conducted in this area and thus generate informed conclusions on the potential for adopting the UCP-LF assay for diagnosing this important yet neglected tropical disease. Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, we generated search criteria to capture all studies in English journals available in the Scopus and PubMed databases on 20 December 2022. A total of 219 articles were identified, and 84 that met the inclusion criteria were retrieved and eventually included in the study. Twelve different assay methods were identified with a noteworthy transition from enzyme-linked immunosorbent assay (ELISA) to the UCP-LF assay, a laboratory-based assay that may be applicable as a point-of-care (POC) diagnostic test for schistosomiasis. Reducing the time, cost, and dependence on specialized laboratory skills and equipment, especially relating to the trichloroacetic acid extraction step and centrifugation in the UCP-LF CAA assay may go a long way to aid its potential as a POC tool. We also propose the development of a CAA-specific aptamer (short protein/antigen-binding oligonucleotide) as a possible alternative to monoclonal antibodies in the assay. UCP-LF has great potential for POC application.
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Affiliation(s)
| | - Patrick Maduabuchi Aja
- Department of Biochemistry, Kampala International University-Western Campus, Kampala, Uganda
| | - Erick Nyakundi Ondari
- Department of Biochemistry, Kampala International University-Western Campus, Kampala, Uganda
- Department of Biological Sciences, School of Pure & Applied Sciences, Kisii University, Kisii, Kenya
| | - Ismail Adebayo
- Department of Microbiology, Kampala International University-Western Campus, Kampala, Uganda
| | | | - Moses Egesa
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Deusdedit Tusubira
- Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Hope Onohuean
- Department of Pharmacology and Toxicology, Biopharmaceutics Unit, Kampala International University-Western Campus, Kampala, Uganda
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Limited efficacy of repeated praziquantel treatment in Schistosoma mansoni infections as revealed by highly accurate diagnostics, PCR and UCP-LF CAA (RePST trial). PLoS Negl Trop Dis 2022; 16:e0011008. [PMID: 36548444 PMCID: PMC9822103 DOI: 10.1371/journal.pntd.0011008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/06/2023] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Most studies assessing praziquantel (PZQ) efficacy have used relatively insensitive diagnostic methods, thereby overestimating cure rate (CR) and intensity reduction rate (IRR). To determine accurately PZQ efficacy, we employed more sensitive DNA and circulating antigen detection methods. METHODOLOGY A sub-analysis was performed based on a previously published trial conducted in children from Côte d'Ivoire with a confirmed Schistosoma mansoni infection, who were randomly assigned to a standard (single dose of PZQ) or intense treatment group (4 repeated doses of PZQ at 2-week intervals). CR and IRR were estimated based on PCR detecting DNA in a single stool sample and the up-converting particle lateral flow (UCP-LF) test detecting circulating anodic antigen (CAA) in a single urine sample, and compared with traditional Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA). PRINCIPAL FINDINGS Individuals positive by all diagnostic methods (i.e., KK, POC-CCA, PCR, and UCP-LF CAA) at baseline were included in the statistical analysis (n = 125). PCR showed a CR of 45% (95% confidence interval (CI) 32-59%) in the standard and 78% (95% CI 66-87%) in the intense treatment group, which is lower compared to the KK results (64%, 95% CI 52-75%) and 88%, 95% CI 78-93%). UCP-LF CAA showed a significantly lower CR in both groups, 16% (95% CI 11-24%) and 18% (95% CI 12-26%), even lower than observed by POC-CCA (31%, 95% CI 17-35% and 36%, 95% CI 26-47%). A substantial reduction in DNA and CAA-levels was observed after the first treatment, with no further decrease after additional treatment and no significant difference in IRR between treatment groups. CONCLUSION/SIGNIFICANCE The efficacy of (repeated) PZQ treatment was overestimated when using egg-based diagnostics (i.e. KK and PCR). Quantitative worm-based diagnostics (i.e. POC-CCA and UCP-LF CAA) revealed that active Schistosoma infections are still present despite multiple treatments. These results stress the need for using accurate diagnostic tools to monitor different PZQ treatment strategies, in particular when moving toward elimination of schistosomiasis. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT02868385.
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Hoekstra PT, Madinga J, Lutumba P, van Grootveld R, Brienen EAT, Corstjens PLAM, van Dam GJ, Polman K, van Lieshout L. Diagnosis of Schistosomiasis without a Microscope: Evaluating Circulating Antigen (CCA, CAA) and DNA Detection Methods on Banked Samples of a Community-Based Survey from DR Congo. Trop Med Infect Dis 2022; 7:tropicalmed7100315. [PMID: 36288056 PMCID: PMC9608707 DOI: 10.3390/tropicalmed7100315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Detection of Schistosoma eggs in stool or urine is known for its low sensitivity in diagnosing light infections. Alternative diagnostics with better sensitivity while remaining highly specific, such as real-time PCR and circulating antigen detection, are progressively used as complementary diagnostic procedures but have not yet replaced microscopy. This study evaluates these alternative methods for the detection of Schistosoma infections in the absence of microscopy. Schistosomiasis presence was determined retrospectively in 314 banked stool and urine samples, available from a previous survey on the prevalence of taeniasis in a community in the Democratic Republic of the Congo, using real-time PCR, the point-of-care circulating cathodic antigen (POC-CCA) test, as well as the up-converting particle lateral flow circulating anodic antigen (UCP-LF CAA) test. Schistosoma DNA was present in urine (3%) and stool (28%) samples, while CCA (28%) and CAA (69%) were detected in urine. Further analysis of the generated data indicated stool-based PCR and the POC-CCA test to be suitable diagnostics for screening of S. mansoni infections, even in the absence of microscopy. A substantial proportion (60%) of the 215 CAA-positive cases showed low antigen concentrations, suggesting that even PCR and POC-CCA underestimated the “true” number of schistosome positives.
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Affiliation(s)
- Pytsje T. Hoekstra
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
| | - Joule Madinga
- Institute of Health and Society, Université Catholique de Louvain, 1348 Brussels, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa 1197, Democratic Republic of the Congo
- Department of Tropical Medicine, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo
| | - Rebecca van Grootveld
- Department of Clinical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eric A. T. Brienen
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Department of Health Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Tabios IKB, Sato MO, Tantengco OAG, Fornillos RJC, Kirinoki M, Sato M, Rojo RD, Fontanilla IKC, Chigusa Y, Medina PMB, Kikuchi M, Leonardo LR. Diagnostic Performance of Parasitological, Immunological, Molecular, and Ultrasonographic Tests in Diagnosing Intestinal Schistosomiasis in Fieldworkers From Endemic Municipalities in the Philippines. Front Immunol 2022; 13:899311. [PMID: 35774791 PMCID: PMC9237846 DOI: 10.3389/fimmu.2022.899311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Schistosomiasis remains to ha/ve a significant public health impact in the Philippines. The Kato-Katz (K-K) technique is the reference standard and most used technique for definitive diagnosis of intestinal schistosomiasis for control programs in endemic regions. However, this has a very low sensitivity when applied in areas of low endemicity and patients with light infection. Hence, this study determined the diagnostic performance of immunological, molecular, parasitological, and ultrasonographic tests in diagnosing intestinal schistosomiasis in endemic municipalities in the Philippines. We performed a community-based cross-sectional study to determine the positivity of schistosomiasis in Leyte, Philippines. The diagnostic performance of five different detection techniques: (1) three stool K-K with duplicate smears; (2) soluble egg antigen IgG ELISA; (3) urine point-of-care circulating cathodic antigen (POC-CCA) test; (4) detection of Schistosoma japonicum circulating DNA (SjcDNA) in serum and urine samples; (5) focused abdominal ultrasound (US), were also obtained in this study. Multiple stool examinations enhanced the sensitivity of K-K from 26.2% (95% CI [16.4, 38.8]) with single stool to 53.8% (95% CI [41.1, 66.1]) and 69.2% (95% CI [56.4, 80.0]) with two and three stools from consecutive days, respectively. Among the SjcDNA nucleic acid amplification test (NAAT)-based detection assays, loop-mediated isothermal amplification (LAMP) PCR using sera had the highest sensitivity at 92.3% (95% CI [82.2, 97.1]) with LAMP consistently identifying more positive cases in both serum and urine samples. This study showed that single stool K-K, which remains the only diagnostic test available in most endemic areas in the Philippines, had low sensitivity and failed to identify most patients with light infection. SjcDNA detection assay and POC-CCA urine test were more sensitive than stool microscopy in detecting schistosomiasis. On the other hand, US was less sensitive than the widely utilized K-K technique in diagnosing schistosomiasis. This study emphasizes the need to revisit the use of single stool K-K in the surveillance and case detection of schistosomiasis in endemic areas of the Philippines. The availability of advanced and more sensitive diagnostic tests will help better control, prevent, and eliminate schistosomiasis in the country.
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Affiliation(s)
- Ian Kim B. Tabios
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
- College of Medicine, University of the Philippines Manila, Manila, Philippines
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Tochigi, Japan
- *Correspondence: Marcello Otake Sato, ; Ian Kim B. Tabios,
| | - Marcello Otake Sato
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Tochigi, Japan
- *Correspondence: Marcello Otake Sato, ; Ian Kim B. Tabios,
| | | | - Raffy Jay C. Fornillos
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Masashi Kirinoki
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Tochigi, Japan
| | - Megumi Sato
- Graduate School of Health Sciences, Niigata University, Niigata City, Japan
| | - Raniv D. Rojo
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ian Kendrich C. Fontanilla
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Yuichi Chigusa
- Center for International Cooperation, Dokkyo Medical University, Tochigi, Japan
| | - Paul Mark B. Medina
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Mihoko Kikuchi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lydia R. Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
- Office of Research Coordination, University of the East, Manila, Philippines
- College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines
- University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines
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8
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Cai P, Mu Y, Weerakoon KG, Olveda RM, Ross AG, McManus DP. Performance of the point-of-care circulating cathodic antigen test in the diagnosis of schistosomiasis japonica in a human cohort from Northern Samar, the Philippines. Infect Dis Poverty 2021; 10:121. [PMID: 34556183 PMCID: PMC8460201 DOI: 10.1186/s40249-021-00905-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Zoonotic schistosomiasis, caused by Schistosoma japonicum, remains a major public health problem in the Philippines. This study aimed to evaluate the commercially available rapid diagnostic point-of-care circulating cathodic antigen (POC-CCA) test in detecting individuals infected with S. japonicum in a human cohort from an endemic area for schistosomiasis japonica in the Philippines. METHODS Clinical samples were collectedin 18 barangays endemic for S. japonicum infection in Laoang and Palapag municipalities, Northern Samar, the Philippines, in 2015. The presence of CCA in filter-concentrated urine samples (n = 412) was evaluated using the commercial kits and the results were converted to images, which were further analyzed by ImageJ software to calculate R values. The diagnostic performance of the immunochromatographic POC-CCA test was compared using the Kato-Katz (KK) procedure, in-house enzyme-linked immunosorbent assays (ELISAs) and droplet digital (dd) PCR assays as reference. RESULTS The POC-CCA test was able to detect S. japonicum-infected individuals in the cohort with an eggs per gram of faeces (EPG) more than or equal to 10 with sensitivity/specificity values of 63.3%/93.3%. However, the assay showed an inability to diagnose schistosomiasis japonica infections in all cohort KK-positive individuals, of which the majority had an extremely low egg burden (EPG: 1-9). The prevalence of S. japonicum infection in the total cohort determined by the POC-CCA test was 12.4%, only half of that determined by the KK method (26.2%). When compared with the ELISAs and ddPCR assays as a reference, the POC-CCA assay was further shown to be a test with low sensitivity. Nevertheless, the assay exhibited significant positive correlations with egg burden determined by the KK technique and the target gene copy number index values determined by the ddPCR assays within the entire cohort. CONCLUSIONS By using in silico image analysis, the POC-CCA cassette test could be converted to a quantitative assay to avoid reader-variability. Because of its low sensitivity, the commercially available POC-CCA assay had limited potential for determining the status of a S. japonicum infection in the target cohort. The assay should be applied with caution in populations where schistosome parasites (especially S. japonicum) are present at low infection intensity.
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Affiliation(s)
- Pengfei Cai
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Yi Mu
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kosala G Weerakoon
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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9
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Hoekstra PT, van Dam GJ, van Lieshout L. Context-Specific Procedures for the Diagnosis of Human Schistosomiasis – A Mini Review. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.722438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Schistosomiasis is a parasitic disease caused by trematode blood flukes of the genus Schistosoma, affecting over 250 million people mainly in the tropics. Clinically, the disease can present itself with acute symptoms, a stage which is relatively more common in naive travellers originating from non-endemic regions. It can also develop into chronic disease, with the outcome depending on the Schistosoma species involved, the duration and intensity of infection and several host-related factors. A range of diagnostic tests is available to determine Schistosoma infection, including microscopy, antibody detection, antigen detection using the Point-Of-Care Circulating Cathodic Antigen (POC-CCA) test and the Up-Converting Particle Lateral Flow Circulating Anodic Antigen (UCP-LF CAA) test, as well as Nucleic Acid Amplification Tests (NAATs) such as real-time PCR. In this mini review, we discuss these different diagnostic procedures and explore their most appropriate use in context-specific settings. With regard to endemic settings, diagnostic approaches are described based on their suitability for individual diagnosis, monitoring control programs, determining elimination as a public health problem and eventual interruption of transmission. For non-endemic settings, we summarize the most suitable diagnostic approaches for imported cases, either acute or chronic. Additionally, diagnostic options for disease-specific clinical presentations such as genital schistosomiasis and neuro-schistosomiasis are included. Finally, the specific role of diagnostic tests within research settings is described, including a controlled human schistosomiasis infection model and several clinical studies. In conclusion, context-specific settings have different requirements for a diagnostic test, stressing the importance of a well-considered decision of the most suitable diagnostic procedure.
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10
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Belizario VY, Delos Trinos JPCR, Lentejas N, Alonte AJ, Cuayzon AN, Isiderio ME, Delgado R, Tejero M, Molina VB. Use of geographic information system as a tool for schistosomiasis surveillance in an endemic Municipality in Eastern Samar, The Philippines. GEOSPATIAL HEALTH 2021; 16. [PMID: 34000789 DOI: 10.4081/gh.2021.957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to demonstrate the use of geographic information systems (GIS) in identifying factors contributing to schistosomiasis endemicity and identifying high-risk areas in a schistosomiasis- endemic municipality in the Philippines, which was devastated by Typhoon Haiyan in 2013. Data on schistosomiasis determinants, obtained through literature review, the Philippine Department of Health, and concerned local government units, were standardized and incorporated into a GIS map using ArcGIS. Data gathered included modifiable [agriculture, poverty, sanitation, presence of intermediate and reservoir hosts, disease prevalence and mass drug administration (MDA) coverage] and nonmodifiable (geography and climate) determinants for schistosomiasis. Results showed that most barangays (villages) are characterized by favourable conditions for schistosomiasis transmission which include being located in flood-prone areas, presence of vegetation, low sanitary toilet coverage, presence of snail intermediate host, high carabao (water buffalo) population density, previously reported ≥1% prevalence using Kato-Katz technique, and low MDA coverage. Similarly, barangays not known to be endemic for schistosomiasis but also characterized by the same favourable conditions for schistosomiasis as listed above and may therefore be considered as potentially endemic, even if not being high-risk areas. This study demonstrated the importance of GIS technology in characterizing schistosomiasis transmission. Maps generated through application of GIS technology are useful in guiding program policy and planning at the local level for an effective and sustainable schistosomiasis control and prevention.
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Affiliation(s)
- Vicente Y Belizario
- College of Public Health, University of the Philippines Manila, Manila, Philippines; Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila, Manila.
| | - John Paul Caesar R Delos Trinos
- Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila, Manila, Philippines; Kirby Institute, University of New South Wales Sydney, Sydney.
| | | | - Allen J Alonte
- Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila, Manila.
| | - Agnes N Cuayzon
- Department of Health Centre for Health Development, Eastern Visayas.
| | | | | | | | - Victorio B Molina
- College of Public Health, University of the Philippines Manila, Manila.
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11
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Hoekstra PT, van Esbroeck M, de Dood CJ, Corstjens PL, Cnops L, van Zeijl-van der Ham CJ, Wammes LJ, van Dam GJ, Clerinx J, van Lieshout L. Early diagnosis and follow-up of acute schistosomiasis in a cluster of infected Belgian travellers by detection of antibodies and circulating anodic antigen (CAA): A diagnostic evaluation study. Travel Med Infect Dis 2021; 41:102053. [PMID: 33823289 DOI: 10.1016/j.tmaid.2021.102053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In order to evaluate the diagnostic value of schistosome circulating anodic antigen (CAA) detection, serum and urine CAA-levels were determined in a single cluster of 34 Belgian tourists at three timepoints within a period of 14 weeks following proven Schistosoma exposure in South Africa and compared with two in-house antibody assays. METHODS Samples were collected 4-5 and 7-8 weeks post-exposure and subsequently 5-6 weeks following praziquantel treatment. Schistosoma antibodies were detected by an adult worm antigen-immunofluorescence assay (AWA-IFA) and a soluble egg antigen-enzyme-linked immunosorbent assay (SEA-ELISA), while CAA concentrations were determined by the Up-Converting reporter Particle labelled Lateral Flow (UCP-LF) test. RESULTS Antibodies were detected in 25/34 (73%) travellers pre-treatment and in 27/34 (79%) post-treatment, with the AWA-IFA showing better performance than the SEA-ELISA. Pre-treatment, CAA was detected in 13/34 (38%) and 33/34 (97%) of the travellers in urine and serum, respectively. Post-treatment, all except one traveller became serum CAA negative. This in contrast to the detected antibodies, as well as the previously reported diagnostic results of this cluster. CONCLUSIONS The UCP-LF CAA serum assay has been demonstrated as the most sensitive method for the diagnosis of early Schistosoma infections and post-treatment monitoring in travellers.
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Affiliation(s)
- Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Marjan van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Belgium
| | - Claudia J de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul Lam Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Belgium
| | | | - Linda J Wammes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Belgium
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
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12
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Wu HW, Park S, Pond-Tor S, Stuart R, Zhou S, Hong Y, Ruiz AE, Acosta L, Jarilla B, Friedman JF, Jiz M, Kurtis JD. Whole-Proteome Differential Screening Identifies Novel Vaccine Candidates for Schistosomiasis japonica. J Infect Dis 2021; 223:1265-1274. [PMID: 33606021 DOI: 10.1093/infdis/jiab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/05/2021] [Indexed: 12/31/2022] Open
Abstract
Schistosomiasis remains a leading cause of chronic morbidity in endemic regions despite decades of widespread mass chemotherapy with praziquantel. Using our whole proteome differential screening approach, and plasma and epidemiologic data from a longitudinal cohort of individuals living in a Schistosoma japonicum-endemic region of the Philippines, we interrogated the parasite proteome to identify novel vaccine candidates for Schistosoma japonicum. We identified 16 parasite genes which encoded proteins that were recognized by immunoglobulin G or immunoglobulin E antibodies in the plasma of individuals who had developed resistance to reinfection, but were not recognized by antibodies in the plasma of individuals who remained susceptible to reinfection. Antibody levels to Sj6-8 and Sj4-1 measured in the entire cohort (N = 505) 1 month after praziquantel treatment were associated with significantly decreased risk of reinfection and lower intensity of reinfection over 18 months of follow-up.
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Affiliation(s)
- Hannah W Wu
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA
| | - Sangshin Park
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
| | - Sunthorn Pond-Tor
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA
| | - Ron Stuart
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA
| | - Sha Zhou
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, China
| | - Yang Hong
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture of China, Shanghai, China
| | - Amanda E Ruiz
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA
| | - Luz Acosta
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Blanca Jarilla
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA
| | - Mario Jiz
- Department of Immunology, Research Institute of Tropical Medicine, Manila, Philippines
| | - Jonathan D Kurtis
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.,Department of Pathology and Laboratory Medicine, Brown University Medical School, Providence, Rhode Island, USA
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13
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Hoekstra PT, Schwarz NG, Adegnika AA, Andrianarivelo MR, Corstjens PLAM, Rakotoarivelo RA, Rakotozandrindrainy R, Sicuri E, Kreidenweiss A, van Dam GJ. Fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers: An introduction to the freeBILy project. Acta Trop 2020; 211:105631. [PMID: 32679109 DOI: 10.1016/j.actatropica.2020.105631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Schistosoma antigen detection tests have a large potential for schistosomiasis control programs due to their ability to detect active and ongoing Schistosoma infections, their much higher sensitivity compared to microscopical methods, and the possibility to use non-invasive urine samples. Pregnant women and young children could especially benefit from affordable and easy-to-use antigen tests as inclusion of these vulnerable groups in mass drug administration campaigns will always require higher justification hurdles, especially in low to middle endemic regions with a higher proportion of individuals who are not infected and thus unnecessarily exposed to praziquantel. The overall objective of the 'fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers' (freeBILy, www.freeBILy.eu) project is to thoroughly evaluate the point-of-care circulating cathodic antigen (POC-CCA) and the up-converting phosphor reporter particle, lateral flow circulating anodic antigen (UCP-LF CAA) urine strip tests to diagnose Schistosoma infections in pregnant women and young children and to assess their potential as a schistosomiasis control tool in test-and-treat strategies. The freeBILy project will generate valuable, evidence-based findings on improved tools and test-and-treat strategies to reduce the burden of schistosomiasis in pregnant women and young children.
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Affiliation(s)
- Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Norbert G Schwarz
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany; German Center for Infection Research, Germany
| | - Ayola A Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; German Center for Infection Research, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Andrea Kreidenweiss
- German Center for Infection Research, Germany; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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14
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Corstjens PLAM, de Dood CJ, Knopp S, Clements MN, Ortu G, Umulisa I, Ruberanziza E, Wittmann U, Kariuki T, LoVerde P, Secor WE, Atkins L, Kinung’hi S, Binder S, Campbell CH, Colley DG, van Dam GJ. Circulating Anodic Antigen (CAA): A Highly Sensitive Diagnostic Biomarker to Detect Active Schistosoma Infections-Improvement and Use during SCORE. Am J Trop Med Hyg 2020; 103:50-57. [PMID: 32400344 PMCID: PMC7351307 DOI: 10.4269/ajtmh.19-0819] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/09/2020] [Indexed: 01/05/2023] Open
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato-Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications.
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Affiliation(s)
- Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Claudia J. de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Michelle N. Clements
- SCI Foundation, London, United Kingdom
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | | | - Irenee Umulisa
- Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
- African Leaders Malaria Alliance, Dar-es-Salam, Tanzania
| | - Eugene Ruberanziza
- Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Udo Wittmann
- SCI Foundation, London, United Kingdom
- Consult AG Statistical Services, Zurich, Switzerland
| | - Thomas Kariuki
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
- African Academy of Sciences, Alliance for Accelerating Excellence in Science in Africa, Nairobi, Kenya
| | - Philip LoVerde
- Department of Biochemistry and Structural Biology, University of Texas Health, San Antonio, Texas
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lydia Atkins
- Ministry of Health and Wellness, Castries, St. Lucia
| | - Safari Kinung’hi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H. Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Daniel G. Colley
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
- Department of Microbiology, University of Georgia, Athens, Georgia
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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15
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Betson M, Alonte AJI, Ancog RC, Aquino AMO, Belizario VY, Bordado AMD, Clark J, Corales MCG, Dacuma MG, Divina BP, Dixon MA, Gourley SA, Jimenez JRD, Jones BP, Manalo SMP, Prada JM, van Vliet AHM, Whatley KCL, Paller VGV. Zoonotic transmission of intestinal helminths in southeast Asia: Implications for control and elimination. ADVANCES IN PARASITOLOGY 2020; 108:47-131. [PMID: 32291086 DOI: 10.1016/bs.apar.2020.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intestinal helminths are extremely widespread and highly prevalent infections of humans, particularly in rural and poor urban areas of low and middle-income countries. These parasites have chronic and often insidious effects on human health and child development including abdominal problems, anaemia, stunting and wasting. Certain animals play a fundamental role in the transmission of many intestinal helminths to humans. However, the contribution of zoonotic transmission to the overall burden of human intestinal helminth infection and the relative importance of different animal reservoirs remains incomplete. Moreover, control programmes and transmission models for intestinal helminths often do not consider the role of zoonotic reservoirs of infection. Such reservoirs will become increasingly important as control is scaled up and there is a move towards interruption and even elimination of parasite transmission. With a focus on southeast Asia, and the Philippines in particular, this review summarises the major zoonotic intestinal helminths, risk factors for infection and highlights knowledge gaps related to their epidemiology and transmission. Various methodologies are discussed, including parasite genomics, mathematical modelling and socio-economic analysis, that could be employed to improve understanding of intestinal helminth spread, reservoir attribution and the burden associated with infection, as well as assess effectiveness of interventions. For sustainable control and ultimately elimination of intestinal helminths, there is a need to move beyond scheduled mass deworming and to consider animal and environmental reservoirs. A One Health approach to control of intestinal helminths is proposed, integrating interventions targeting humans, animals and the environment, including improved access to water, hygiene and sanitation. This will require coordination and collaboration across different sectors to achieve best health outcomes for all.
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Affiliation(s)
- Martha Betson
- University of Surrey, Guildford, Surrey, United Kingdom.
| | | | - Rico C Ancog
- University of the Philippines Los Baños, Laguna, Philippines
| | | | | | | | - Jessica Clark
- University of Surrey, Guildford, Surrey, United Kingdom
| | | | | | - Billy P Divina
- University of the Philippines Los Baños, Laguna, Philippines
| | | | | | | | - Ben P Jones
- University of Surrey, Guildford, Surrey, United Kingdom
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16
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An update on non-invasive urine diagnostics for human-infecting parasitic helminths: what more could be done and how? Parasitology 2019; 147:873-888. [PMID: 31831084 PMCID: PMC7284843 DOI: 10.1017/s0031182019001732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Reliable diagnosis of human helminth infection(s) is essential for ongoing disease surveillance and disease elimination. Current WHO-recommended diagnostic assays are unreliable in low-endemic near-elimination settings and typically involve the invasive, onerous and potentially hazardous sampling of bodily fluids such as stool and blood, as well as tissue via biopsy. In contrast, diagnosis by use of non-invasive urine sampling is generally painless, more convenient and low risk. It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients. In some instances, urine-based diagnostic assays have also been shown to provide a more reliable diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, particularly in low-endemicity settings. Given these relative benefits, we identify and review current research literature to evaluate whether non-invasive urine sampling is currently exploited to its full potential in the development of diagnostic tools for human helminthiases. Though further development, assessment and validation are needed before their routine use in control programmes, low-cost, rapid and reliable assays capable of detecting transrenal helminth-derived antigens and cell-free DNA show excellent promise for future use at the point-of-care in high-, medium- and even low-endemicity elimination settings.
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17
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Vellere I, Mangano VD, Cagno MC, Gobbi F, Ragusa A, Bartoloni A, Biancofiore G, De Simone P, Campani D, Bruschi F, Zammarchi L. Imported human Schistosoma japonicum: A report on two cases in Filipino migrants present in Italy and a systematic review of literature. Travel Med Infect Dis 2019; 36:101496. [PMID: 31561021 DOI: 10.1016/j.tmaid.2019.101496] [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: 05/21/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Schistosoma japonicum is endemic in the Philippines, China, and Indonesia, and is the third-most common schistosoma species. The infection can be asymptomatic for years but, if left untreated, can lead to irreversible complications. METHOD We report the results of a systematic review of the literature on imported S. japonicum infection and describe two previously unpublished cases diagnosed in Filipino migrants in Italy. RESULTS Twenty-five imported cases of S. japonicum schistosomiasis were retrieved. All patients but one were migrants. Most subjects acquired the infection in Philippines (n = 18, 72%). Median age at diagnosis was 46 years. Median period of residence in non-endemic countries before diagnosis was 14.5 years. Cases of prevalent hepatosplenic involvement were 10 (40%), those with prevalent intestinal involvement were 10 (40%), whereas five (20%) had overlapping manifestations. Ten patients suffered from cirrhosis; two underwent liver transplantation. Three patients presented with acute abdomen due to intestinal complications, leading to explorative laparotomy. In all cases, but one, the diagnosis was based on a histological examination of biopsy specimen, revealing S. japonicum ova. Seventeen patients were treated with praziquantel, and in three of them, possible treatment failures occurred. CONCLUSIONS S. japonicum infection is uncommonly reported in non-endemic areas, but is probably underestimated because of a low threshold awareness of clinicians and unavailability of specific diagnostic tools. Viable S. japonicum adults may persist for decades, indicating that migrants or travellers previously exposed in areas with high-risk areas can harbour viable worms and deserve treatment.
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Affiliation(s)
- Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | | | | | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, I.R.C.C.S., Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Andrea Ragusa
- Department of Infectious-Tropical Diseases and Microbiology, I.R.C.C.S., Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
| | | | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy.
| | - Daniela Campani
- Department of Surgical, Medical and Molecular Pathology, Pisa University Hospital, Pisa, Italy.
| | - Fabrizio Bruschi
- Department of Translational Research, University of Pisa, Pisa, Italy; Department of Laboratory Medicine, Pisa University Hospital, Pisa, Italy.
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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18
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Abstract
Over the past 20 years, RNAS+ has been generating research results from highly collaborative projects meant to promote and advance understanding in various aspects of schistosomiasis. Epidemiological studies in endemic countries like the Philippines, the People's Republic of China (PR China), the Lao People's Democratic Republic (Lao PDR) and Cambodia clarified the role of reservoir hosts in transmission and the use of spatio-temporal methods such as remote sensing and geographical information systems (GIS) in surveillance of schistosomiasis. Morbidity studies proposed factors that might influence development of fibrosis, anaemia and malnutrition in schistosomiasis. Immune responses in schistosomiasis continue to be an interesting focus in research to explain possible development of resistance with age. Results of evaluation of candidate vaccine molecules are also presented. New diagnostics are continually being developed in response to the call for more sensitive and field applicable techniques that will be used for surveillance in areas nearing elimination of the disease. Several studies presented here show the insufficiency of mass drug administration (MDA) with praziquantel in eliminating the disease. Emphasis is given to an integrated control approach that can be accomplished through intensive and extensive intersectoral collaboration.
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Bergquist R, Leonardo L, Zhou XN. From inspiration to translation: Closing the gap between research and control of helminth zoonoses in Southeast Asia. ADVANCES IN PARASITOLOGY 2019; 105:111-124. [PMID: 31530392 DOI: 10.1016/bs.apar.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Poverty magnifies limitations resulting from traditional biases and environmental risks in endemic areas. Any approach towards disease control needs to recognise that socially embedded vulnerabilities can be as powerful as externally imposed infections. Important for RNAS was networking across borders, not just on schistosomiasis but on the whole spectrum of endemic helminthiases, and this bore fruit in the form of the expansion of RNAS into the 'Regional Network on Asian Schistosomiasis and other Helminth Zoonoses (RNAS+)', which focuses on technical standardization, supporting the growth of research capacity and the further development of networking. Administration is lean and largely virtual with the focus on connecting members via the Internet, providing databases and administrative back-up. The strategy emphasizes ways and means to alleviate the spectre of disease and poverty from the endemic areas through boosting research on target diseases and supporting collaboration between basic and operational research on the one hand and control/elimination activities on the other. RNAS+ also benefits from continuing input from outside research institutions in areas outside Southeast Asia. This paper is aiming to identify the priority actions to close the gap between researcher and policy makers.
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Affiliation(s)
| | - Lydia Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines; University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, China; Shanghai, China
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20
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Schistosoma japonicum cathepsin B as potential diagnostic antigen for Asian zoonotic schistosomiasis. Parasitol Res 2019; 118:2601-2608. [PMID: 31377909 DOI: 10.1007/s00436-019-06410-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Abstract
In this study, the diagnostic value of Schistosoma japonicum cathepsin B (SjCatB) was evaluated as an antigen for the early detection of S. japonicum infection. SjCatB is a key protease used by the cercaria to penetrate the intact skin of the host for transdermal infection. The early exposure of the host's immune system to this enzyme may elicit early production of antibodies against this molecule. Therefore, the recombinant SjCatB (rSjCatB) was expressed in Escherichia coli with N-terminal 6xHis-tag. rSjCatB was tested for its performance as a diagnostic antigen using indirect enzyme-linked immunosorbent assay (ELISA) with sera from experimentally infected mice collected at > 8 weeks post-infection. Showing 100% sensitivity and 95.0% specificity in the ELISA, rSjCatB was then evaluated with sera from experimentally infected mice collected at 1-7 weeks post-infection to determine how early the antibodies can be detected. Results showed that as early as 6 weeks post-infection, 2 of the 3 infected mice were found to be positive with the antibodies against SjCatB. Furthermore, the potential of the recombinant antigen in detecting human schistosomiasis was evaluated with archived serum samples collected from individuals who had been diagnosed with S. japonicum infection by stool examination. Results showed 86.7% sensitivity and 96.7% specificity suggesting its high diagnostic potential for human schistosomiasis. In addition, SjCatB showed minimal cross-reaction with the sera collected from patients with other parasitic diseases. In conclusion, the results of this study suggest that SjCatB will be useful in the development of a sensitive and specific early detection test for S. japonicum infection.
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21
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Sousa MS, van Dam GJ, Pinheiro MCC, de Dood CJ, Peralta JM, Peralta RHS, Daher EDF, Corstjens PLAM, Bezerra FSM. Performance of an Ultra-Sensitive Assay Targeting the Circulating Anodic Antigen (CAA) for Detection of Schistosoma mansoni Infection in a Low Endemic Area in Brazil. Front Immunol 2019; 10:682. [PMID: 31019510 PMCID: PMC6458306 DOI: 10.3389/fimmu.2019.00682] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/13/2019] [Indexed: 12/03/2022] Open
Abstract
Techniques with high sensitivity and specificity are required for an accurate diagnosis in low-transmission settings, where the conventional parasitological methods are insensitive. We determined the accuracy of an up-converting phosphor-lateral flow circulating anodic antigen (UCP-LF CAA) assay in urine and serum for Schistosoma mansoni diagnosis in low-prevalence settings in Ceará, Brazil, before and after praziquantel treatment. Clinical samples of a total of 258 individuals were investigated by UCP-LF CAA, point-of-care-circulating cathodic antigen (POC-CCA), soluble worm antigen preparation (SWAP)-ELISA and Kato-Katz (KK); a selection of 128 stools by real-time PCR technique. Three and 6-weeks after treatment, samples were collected and evaluated by detection Schistosoma circulating antigens (CAA and CCA). The UCP-LF CAA assays detected 80 positives (31%) with urine and 82 positives (31.8%) with serum. The urine POC-CCA and serum SWAP-ELISA assays detected 30 (11.6%) and 107 (40.7%) positives, respectively. The Kato-Katz technique revealed only 4 positive stool samples (1.6%). Among the 128 individuals with complete data records, 19 cases were identified by PCR (14.8%); Sensitivities and specificities of the UCP-LF CAA assays, determined versus a combined reference standard based on CCA/KK/PCR positivity, ranged from 60-68% to 68-77%, respectively. In addition only for comparative purposes, sensitivities of the different assays were determined vs. a comparative reference based on CAA/KK/PCR positivity, showing the highest sensitivity for the urine CAA assay (80%), followed by the serum CAA (70.9%), SWAP-ELISA (43.6%), PCR (34.5%), POC-CCA (29.1%), whilst triplicate Kato-Katz thick smears had a very low sensitivity (3.6%). CAA concentrations were higher in serum than in urine and were significantly correlated. There was a significant decrease in urine and serum CAA levels 3 and 6-weeks after treatment. The UCP-LF CAA assays revealed 33 and 28 S. mansoni-infected patients at the 3- and 6-week post-treatment follow-up, respectively. The UCP-LF CAA assays show high sensitivity for the diagnosis of S. mansoni in low-endemicity settings. It detects a considerably higher number of infections than microscopy, POC-CCA or PCR. Also it shows to be very useful for evaluating cure rates after treatment. Hence, the UCP-LF CAA assay is a robust and promising diagnostic approach in low-transmission settings.
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Affiliation(s)
- Mariana Silva Sousa
- Medical Sciences Post Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Parasitology and Mollusks Biology Research Laboratory, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Fortaleza, Brazil
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Marta Cristhiany Cunha Pinheiro
- Parasitology and Mollusks Biology Research Laboratory, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Fortaleza, Brazil
| | - Claudia J. de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Jose Mauro Peralta
- Department of Immunology, Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Elizabeth de Francesco Daher
- Medical Sciences Post Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Fernando Schemelzer Moraes Bezerra
- Medical Sciences Post Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Parasitology and Mollusks Biology Research Laboratory, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Fortaleza, Brazil
- Pathology Post Graduate Program, Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza, Brazil
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Markwalter C, Kantor AG, Moore CP, Richardson KA, Wright DW. Inorganic Complexes and Metal-Based Nanomaterials for Infectious Disease Diagnostics. Chem Rev 2019; 119:1456-1518. [PMID: 30511833 PMCID: PMC6348445 DOI: 10.1021/acs.chemrev.8b00136] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 12/12/2022]
Abstract
Infectious diseases claim millions of lives each year. Robust and accurate diagnostics are essential tools for identifying those who are at risk and in need of treatment in low-resource settings. Inorganic complexes and metal-based nanomaterials continue to drive the development of diagnostic platforms and strategies that enable infectious disease detection in low-resource settings. In this review, we highlight works from the past 20 years in which inorganic chemistry and nanotechnology were implemented in each of the core components that make up a diagnostic test. First, we present how inorganic biomarkers and their properties are leveraged for infectious disease detection. In the following section, we detail metal-based technologies that have been employed for sample preparation and biomarker isolation from sample matrices. We then describe how inorganic- and nanomaterial-based probes have been utilized in point-of-care diagnostics for signal generation. The following section discusses instrumentation for signal readout in resource-limited settings. Next, we highlight the detection of nucleic acids at the point of care as an emerging application of inorganic chemistry. Lastly, we consider the challenges that remain for translation of the aforementioned diagnostic platforms to low-resource settings.
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Affiliation(s)
| | | | | | | | - David W. Wright
- Department of Chemistry, Vanderbilt
University, Nashville, Tennessee 37235, United States
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23
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Repeated doses of Praziquantel in Schistosomiasis Treatment (RePST) - single versus multiple praziquantel treatments in school-aged children in Côte d'Ivoire: a study protocol for an open-label, randomised controlled trial. BMC Infect Dis 2018; 18:662. [PMID: 30547750 PMCID: PMC6295059 DOI: 10.1186/s12879-018-3554-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/23/2018] [Indexed: 11/30/2022] Open
Abstract
Background Large scale administration of the anthelminthic drug praziquantel (PZQ) to at-risk populations is the cornerstone of schistosomiasis control, although persisting high prevalence of infections in some areas and growing concerns of PZQ resistance have revealed the limitations of this strategy. Most studies assessing PZQ efficacy have used relatively insensitive parasitological diagnostics, such as the Kato-Katz (KK) and urine-filtration methods, thereby overestimating cure rates (CRs). This study aims to determine the efficacy of repeated PZQ treatments against Schistosoma mansoni infection in school-aged children in Côte d’Ivoire using the traditional KK technique, as well as more sensitive antigen- and DNA-detection methods. Methods An open-label, randomised controlled trial will be conducted in school-aged children (5 to 18 years) from the region of Taabo, Côte d’Ivoire, an area endemic for S. mansoni. This 8-week trial includes four two-weekly standard doses of PZQ in the “intense treatment” intervention group and one standard dose of PZQ in the “standard treatment” control group. The efficacy of PZQ will be evaluated in stool samples using the KK technique and real-time PCR as well as in urine using the point-of-care circulating cathodic antigen test and the up-converting phosphor, lateral flow, circulating anodic antigen assay. The primary outcome of the study will be the difference in CR of intense versus standard treatment with PZQ on individuals with a confirmed S. mansoni infection measured by KK. Secondary outcomes include the difference in CR and intensity reduction rate between the intense and standard treatment groups as measured by the other diagnostic tests, as well as the accuracy of the different diagnostic tests, and the safety of PZQ. Discussion This study will provide data on the efficacy of repeated PZQ treatment on the clearance of S. mansoni as measured by several diagnostic techniques. These findings will inform future mass drug administration policy and shed light on position of novel diagnostic tools to evaluate schistosomiasis control strategies. Trial registration The study is registered at EudraCT (2016–003017-10, date of registration: 22 July 2016) and (NCT02868385, date of registration: 16 August 2016). Electronic supplementary material The online version of this article (10.1186/s12879-018-3554-2) contains supplementary material, which is available to authorized users.
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24
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de Dood CJ, Hoekstra PT, Mngara J, Kalluvya SE, van Dam GJ, Downs JA, Corstjens PLAM. Refining Diagnosis of Schistosoma haematobium Infections: Antigen and Antibody Detection in Urine. Front Immunol 2018; 9:2635. [PMID: 30487796 PMCID: PMC6246739 DOI: 10.3389/fimmu.2018.02635] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Traditional microscopic examination of urine or stool for schistosome eggs lacks sensitivity compared to measurement of schistosome worm-derived circulating antigens in serum or urine. The ease and non-invasiveness of urine collection makes urine an ideal sample for schistosome antigen detection. In this study several user-friendly, lateral-flow (LF) based urine assays were evaluated against a composite reference that defined infection as detection of either eggs in urine or anodic antigen in serum. Method: In a Tanzanian population with a S. haematobium prevalence of 40-50% (S. mansoni prevalence <2%), clinical samples from 44 women aged 18 to 35 years were analyzed for Schistosoma infection. Urine and stool samples were examined microscopically for eggs, and serum samples were analyzed for the presence of the anodic antigen. Urines were further subjected to a set of LF assays detecting (circulating) anodic (CAA) and cathodic antigen (CCA) as well as antibodies against soluble egg antigens (SEA) and crude cercarial antigen preparation (SCAP). Results: The urine LF anodic antigen assay utilizing luminescent upconverting reporter particles (UCP) confirmed its increased sensitivity when performed with larger sample volume. Qualitatively, the anodic antigen assay performed on 250 μL urine matched the performance of the standard anodic antigen assay performed on 20 μL serum. However, the ratio of anodic antigen levels in urine vs. serum of individual patients varied with absolute levels always higher in serum. The 10 μL urine UCP-LF cathodic antigen assay correlated with the commercially available urine POC-CCA (40 μL) test, while conferring better sensitivity with a quantitative result. Urinary antibodies against SEA and SCAP overlap and correlate with the presence of urinary egg and serum anodic antigen levels. Conclusions: The UCP-LF anodic antigen assay using 250 μL of urine is an expedient user-friendly assay and a suitable non-invasive alternative to serum-based antigen testing and urinary egg detection. Individual biological differences in the clearance process of the circulating antigens are thought to explain the observed high variation in the type and level of antigen (anodic or cathodic) measured in urine or serum. Simultaneous detection of anodic and cathodic antigen may be considered to further increase accuracy.
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Affiliation(s)
- Claudia J. de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Pytsje T. Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Julius Mngara
- National Institute for Medical Research, Mwanza, Tanzania
| | - Samuel E. Kalluvya
- Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
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25
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Evaluating a point-of-care circulating cathodic antigen test (POC-CCA) to detect Schistosoma mansoni infections in a low endemic area in north-eastern Brazil. Acta Trop 2018. [PMID: 29526480 DOI: 10.1016/j.actatropica.2018.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Schistosomiasis is still a public health problem in Brazil. The Kato-Katz test is the most frequently used diagnostic method for Schistosoma mansoni infection. However, it lacks sensitivity in areas of low prevalence. We have assessed the positivity rate of S. mansoni infection in Bananeiras, a village on Capistrano, Ceara, Brazil by performing a point-of-care test in urine to determine the circulating cathodic antigens (POC-CCA), and we compared the findings with those of the Kato-Katz technique for egg detection in stool and an enzyme-linked immunosorbent assay for specific antibodies against adult worms (SWAP-ELISA) in serum before treatment (baseline). Additionally, the POC-CCA and Kato-Katz test results were compared at one and two years post-treatment, and only POC-CCA strips were utilised for follow-up testing on urine samples at 3-6 weeks. Only one sample of stool and urine was collected per event. Overall, 258 individuals were investigated at the baseline. The POC-CCA test detected 10 (3.9%) positive cases; however, this amount increased to 30 (11.6%) when considering trace readings as positive (t + ), whereas the Kato-Katz method found only 4 (1.6%) positive cases and the SWAP-ELISA detected 105 (40.7%) positive cases. The consistency observed between a single POC-CCA (t + ) or (t-) and the Kato-Katz (three slides) was poor (Kappa indexes <0.20). The highest positivity rate as determined by CCA and Kato-Katz was found in adults. At the baseline, a praziquantel treatment was administered to all individuals regardless of their infection status. According to the POC-CCA test, 93% of the previous positive cases became negative by the third week after the treatment; this rate reached 100% at the sixth week assessment. The follow-up showed that of the 175 individuals evaluated at one year post-treatment, only one (0.6%) showed 'trace' results, and all the individuals were negative for eggs in the stool. At two years, all 185 examined individuals were negative by the Kato-Katz method, and 11 (5.9%) presented traces by POC-CCA. Our results indicate that a single POC-CCA test reveals a significantly higher number of positive cases than the Kato-Katz technique for diagnosing S. mansoni in a low endemic setting, when trace results are considered as positive cases. Nevertheless, the true significance of the trace is not clear. These findings reinforce the need to associate different tools for improved schistosomiasis diagnosis in individuals with low parasite burdens.
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26
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Ajibola O, Gulumbe BH, Eze AA, Obishakin E. Tools for Detection of Schistosomiasis in Resource Limited Settings. Med Sci (Basel) 2018; 6:medsci6020039. [PMID: 29789498 PMCID: PMC6024580 DOI: 10.3390/medsci6020039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/20/2022] Open
Abstract
Schistosomiasis is a debilitating disease affecting over 200 million people, with the highest burden of morbidity and mortality in African countries. Despite its huge impact on the health and socio-economic burden of the society, it remains a neglected tropical disease, with limited attention from governments and stakeholders in healthcare. One of the critical areas that is hugely under-developed is the development of accurate diagnostics for both intestinal and urogenital schistosomiasis. Diagnosis of schistosomiasis is important for the detection and treatment of disease in endemic and non-endemic settings. A conclusive detection method is also an indispensable part of treatment, both in the clinic and during mass drug administration (MDA), for the monitoring efficacy of treatment. Here, we review the available diagnostic methods and discuss the challenges encountered in diagnosis in resource limited settings. We also present the available diagnostics and cost implications for deployment in resource limited settings. Lastly, we emphasize the need for more funding directed towards the development of affordable diagnostic tools that is affordable for endemic countries as we work towards the elimination of the disease.
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Affiliation(s)
- Olumide Ajibola
- Department of Microbiology, Federal University Birnin Kebbi, P.M.B. 1157 Kalgo Road, Birnin Kebbi 860222, Kebbi State, Nigeria.
| | - Bashar Haruna Gulumbe
- Department of Microbiology, Federal University Birnin Kebbi, P.M.B. 1157 Kalgo Road, Birnin Kebbi 860222, Kebbi State, Nigeria.
| | - Anthonius Anayochukwu Eze
- Department of Medical Biochemistry, University of Nigeria, Enugu Campus, Enugu 400241, Enugu State, Nigeria.
| | - Emmanuel Obishakin
- Biotechnology Division, National Veterinary Research Institute, P.M.B. 001, Vom, Jos, 930281, Plateau State, Nigeria.
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27
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Macalanda AMC, Angeles JMM, Moendeg KJ, Dang AT, Higuchi L, Inoue N, Xuan X, Kirinoki M, Chigusa Y, Leonardo LR, Villacorte EA, Rivera PT, Goto Y, Kawazu SI. Evaluation of Schistosoma japonicum thioredoxin peroxidase-1 as a potential circulating antigen target for the diagnosis of Asian schistosomiasis. J Vet Med Sci 2017; 80:156-163. [PMID: 29187698 PMCID: PMC5797876 DOI: 10.1292/jvms.17-0579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Asian schistosomiasis caused by Schistosoma japonicum is a serious zoonotic disease endemic in China, the Philippines and parts of Indonesia. Mass drug administration in endemic areas resulted to
decline in disease severity and intensity. The low intensity of infection limits the use of current parasitological methods for schistosomiasis diagnosis. Detection of parasite circulating antigens might provide more
informative result as it may indicate the true status of infection. In this study, S. japonicum thioredoxin peroxidase-1 (SjTPx-1) a 22 kDa secreted antioxidant enzyme expressed throughout the life
stages of the parasite was evaluated for its potential use as a biomarker for schistosomiasis japonica infection. Rabbit polyclonal antibody and mouse monoclonal antibodies (mAbs) were raised against the recombinant
SjTPx-1 (rSjTPx-1). The antibodies produced against the recombinant antigen was confirmed to detect the native SjTPx-1 in crude adult worm lysate. Likewise, the specific binding of mAbs to parasite TPx-1 and not to
mammalian peroxiredoxin-1 orthologues was also confirmed. The double antibody sandwich ELISA developed in this study was able to detect at least 1 ng/ml of rSjTPx-1. In addition, this
method was able to detect the antigen from all serum samples of experimentally infected rabbit and mice. The diagnostic potential of SjTPx-1 in human clinical samples was also evaluated, in which 4 out of 10
stool-confirmed serum samples had detectable levels of the antigen. The results suggest that SjTPx-1 can be a potential biomarker for Asian zoonotic schistosomiasis.
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Affiliation(s)
- Adrian Miki C Macalanda
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Jose Ma M Angeles
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Kharleezelle J Moendeg
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Anh Tm Dang
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Luna Higuchi
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Noboru Inoue
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Xuenan Xuan
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Masashi Kirinoki
- Department of Tropical Medicine and Parasitology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan
| | - Yuichi Chigusa
- Department of Tropical Medicine and Parasitology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan
| | - Lydia R Leonardo
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Philippines
| | - Elena A Villacorte
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Philippines
| | - Pilarita T Rivera
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Philippines
| | - Yasuyuki Goto
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo 113-8657, Japan
| | - Shin-Ichiro Kawazu
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
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28
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Corstjens PLAM, Hoekstra PT, de Dood CJ, van Dam GJ. Utilizing the ultrasensitive Schistosoma up-converting phosphor lateral flow circulating anodic antigen (UCP-LF CAA) assay for sample pooling-strategies. Infect Dis Poverty 2017; 6:155. [PMID: 29089064 PMCID: PMC5664425 DOI: 10.1186/s40249-017-0368-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/09/2017] [Indexed: 01/08/2023] Open
Abstract
Background Methodological applications of the high sensitivity genus-specific Schistosoma CAA strip test, allowing detection of single worm active infections (ultimate sensitivity), are discussed for efficient utilization in sample pooling strategies. Besides relevant cost reduction, pooling of samples rather than individual testing can provide valuable data for large scale mapping, surveillance, and monitoring. Method The laboratory-based CAA strip test utilizes luminescent quantitative up-converting phosphor (UCP) reporter particles and a rapid user-friendly lateral flow (LF) assay format. The test includes a sample preparation step that permits virtually unlimited sample concentration with urine, reaching ultimate sensitivity (single worm detection) at 100% specificity. This facilitates testing large urine pools from many individuals with minimal loss of sensitivity and specificity. The test determines the average CAA level of the individuals in the pool thus indicating overall worm burden and prevalence. When requiring test results at the individual level, smaller pools need to be analysed with the pool-size based on expected prevalence or when unknown, on the average CAA level of a larger group; CAA negative pools do not require individual test results and thus reduce the number of tests. Results Straightforward pooling strategies indicate that at sub-population level the CAA strip test is an efficient assay for general mapping, identification of hotspots, determination of stratified infection levels, and accurate monitoring of mass drug administrations (MDA). At the individual level, the number of tests can be reduced i.e. in low endemic settings as the pool size can be increased as opposed to prevalence decrease. Conclusions At the sub-population level, average CAA concentrations determined in urine pools can be an appropriate measure indicating worm burden. Pooling strategies allowing this type of large scale testing are feasible with the various CAA strip test formats and do not affect sensitivity and specificity. It allows cost efficient stratified testing and monitoring of worm burden at the sub-population level, ideally for large-scale surveillance generating hard data for performance of MDA programs and strategic planning when moving towards transmission-stop and elimination.
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Affiliation(s)
- Paul L A M Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Claudia J de Dood
- Department of Molecular Cell Biology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
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Vonghachack Y, Sayasone S, Khieu V, Bergquist R, van Dam GJ, Hoekstra PT, Corstjens PLAM, Nickel B, Marti H, Utzinger J, Muth S, Odermatt P. Comparison of novel and standard diagnostic tools for the detection of Schistosoma mekongi infection in Lao People's Democratic Republic and Cambodia. Infect Dis Poverty 2017; 6:127. [PMID: 28793922 PMCID: PMC5550959 DOI: 10.1186/s40249-017-0335-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/12/2017] [Indexed: 12/29/2022] Open
Abstract
Background Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic (Lao PDR) and two provinces in Cambodia, together with progress of the national control programmes aimed at reducing morbidity and infection prevalence, the elimination of schistosomiasis mekongi seems feasible. However, sensitive diagnostic tools will be required to determine whether elimination has been achieved. We compared several standard and novel diagnostic tools in S. mekongi-endemic areas. Methods The prevalence and infection intensity of S. mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination, antibody detection based on an enzyme-linked immunosorbent assay (ELISA) and schistosome circulating antigen detection by lateral-flow tests. Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens (CCA, CAA) in urine and serum were utilized. Results Stool microscopy revealed an overall prevalence of S. mekongi of 6.4% (one case in Cambodia and 23 cases in Lao PDR), while that of Opisthorchis viverrini, hookworm, Trichuris trichiura, Ascaris lumbricoides and Taenia spp. were 50.4%, 28.1%, 3.5%, 0.3% and 1.9%, respectively. In the urine samples, the tests for CCA and CAA detected S. mekongi infections in 21.0% and 38.7% of the study participants, respectively. In the serum samples, the CAA assay revealed a prevalence of 32.4%, while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%. There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR. Conclusions The CCA, CAA and ELISA results showed substantially higher prevalence estimates for S. mekongi compared to Kato-Katz thick smears. Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously. Hence, sustained control efforts are still needed to break transmission of S. mekongi. The pivotal role of highly sensitive diagnostic assays in areas targeting elimination cannot be overemphasised. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0335-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youthanavanh Vonghachack
- Faculty of Basic Sciences, University of Health Sciences, Ministry of Health, Vientiane, Lao People's Democratic Republic.,Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Somphou Sayasone
- National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L A M Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Beatrice Nickel
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Hanspeter Marti
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Sinuon Muth
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
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Colley DG, Andros TS, Campbell CH. Schistosomiasis is more prevalent than previously thought: what does it mean for public health goals, policies, strategies, guidelines and intervention programs? Infect Dis Poverty 2017; 6:63. [PMID: 28327187 PMCID: PMC5361841 DOI: 10.1186/s40249-017-0275-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/06/2017] [Indexed: 01/08/2023] Open
Abstract
Mapping and diagnosis of infections by the three major schistosome species (Schistosoma haematobium, S. mansoni and S. japonicum) has been done with assays that are known to be specific but increasingly insensitive as prevalence declines or in areas with already low prevalence of infection. This becomes a true challenge to achieving the goal of elimination of schistosomiasis because the multiplicative portion of the life-cycle of schistosomes, in the snail vector, favors continued transmission as long as even a few people maintain low numbers of worms that pass eggs in their excreta. New mapping tools based on detection of worm antigens (circulating cathodic antigen – CCA; circulating anodic antigen – CAA) in urine of those infected are highly sensitive and the CAA assay is reported to be highly specific. Using these tools in areas of low prevalence of all three of these species of schistosomes has demonstrated that more people harbor adult worms than are regularly excreting eggs at a level detectable by the usual stool assay (Kato-Katz) or by urine filtration. In very low prevalence areas this is sometimes 6- to10-fold more. Faced with what appears to be a sizable population of “egg-negative/worm-positive schistosomiasis” especially in areas of very low prevalence, national NTD programs are confounded about what guidelines and strategies they should enact if they are to proceed toward a goal of elimination. There is a critical need for continued evaluation of the assays involved and to understand the contribution of this “egg-negative/worm-positive schistosomiasis” condition to both individual morbidity and community transmission. There is also a critical need for new guidelines based on the use of these more sensitive assays for those national NTD programs that wish to move forward to strategies designed for elimination.
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Affiliation(s)
- Daniel G Colley
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, 500 DW Brooks Drive, Room 330B Coverdell Center, Athens, Georgia, 30602, USA. .,Department of Microbiology, University of Georgia, Athens, Georgia, 30602, USA.
| | - Tamara S Andros
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, 500 DW Brooks Drive, Room 330B Coverdell Center, Athens, Georgia, 30602, USA
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, 500 DW Brooks Drive, Room 330B Coverdell Center, Athens, Georgia, 30602, USA
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Hawkins KR, Cantera JL, Storey HL, Leader BT, de los Santos T. Diagnostic Tests to Support Late-Stage Control Programs for Schistosomiasis and Soil-Transmitted Helminthiases. PLoS Negl Trop Dis 2016; 10:e0004985. [PMID: 28005900 PMCID: PMC5179049 DOI: 10.1371/journal.pntd.0004985] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Global efforts to address schistosomiasis and soil-transmitted helminthiases (STH) include deworming programs for school-aged children that are made possible by large-scale drug donations. Decisions on these mass drug administration (MDA) programs currently rely on microscopic examination of clinical specimens to determine the presence of parasite eggs. However, microscopy-based methods are not sensitive to the low-intensity infections that characterize populations that have undergone MDA. Thus, there has been increasing recognition within the schistosomiasis and STH communities of the need for improved diagnostic tools to support late-stage control program decisions, such as when to stop or reduce MDA. Failure to adequately address the need for new diagnostics could jeopardize achievement of the 2020 London Declaration goals. In this report, we assess diagnostic needs and landscape potential solutions and determine appropriate strategies to improve diagnostic testing to support control and elimination programs. Based upon literature reviews and previous input from experts in the schistosomiasis and STH communities, we prioritized two diagnostic use cases for further exploration: to inform MDA-stopping decisions and post-MDA surveillance. To this end, PATH has refined target product profiles (TPPs) for schistosomiasis and STH diagnostics that are applicable to these use cases. We evaluated the limitations of current diagnostic methods with regards to these use cases and identified candidate biomarkers and diagnostics with potential application as new tools. Based on this analysis, there is a need to develop antigen-detecting rapid diagnostic tests (RDTs) with simplified, field-deployable sample preparation for schistosomiasis. Additionally, there is a need for diagnostic tests that are more sensitive than the current methods for STH, which may include either a field-deployable molecular test or a simple, low-cost, rapid antigen-detecting test.
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Affiliation(s)
- Kenneth R. Hawkins
- Diagnostics Program, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Jason L. Cantera
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Helen L. Storey
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Brandon T. Leader
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Tala de los Santos
- Diagnostics Program, PATH, Seattle, Washington, United States of America
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Hinz R, Schwarz NG, Hahn A, Frickmann H. Serological approaches for the diagnosis of schistosomiasis - A review. Mol Cell Probes 2016; 31:2-21. [PMID: 27986555 DOI: 10.1016/j.mcp.2016.12.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 01/14/2023]
Abstract
Schistosomiasis is a common disease in endemic areas of Sub-Saharan Africa, South America and Asia. It is rare in Europe, mainly imported from endemic countries due to travelling or human migration. Available methods for the diagnosis of schistosomiasis comprise microscopic, molecular and serological approaches, with the latter detecting antigens or antibodies associated with Schistosoma spp. infection. The serological approach is a valuable screening tool in low-endemicity settings and for travel medicine, though the interpretation of any diagnostic results requires knowledge of test characteristics and a patient's history. Specific antibody detection by most currently used assays is only possible in a relatively late stage of infection and does not allow for the differentiation of acute from previous infections for therapeutic control or the discrimination between persisting infection and re-infection. Throughout the last decades, new target antigens have been identified, and assays with improved performance and suitability for use in the field have been developed. For numerous assays, large-scale studies are still required to reliably characterise assay characteristics alone and in association with other available methods for the diagnosis of schistosomiasis. Apart from S. mansoni, S. haematobium and S. japonicum, for which most available tests were developed, other species of Schistosoma that occur less frequently need to be taken into account. This narrative review describes and critically discusses the results of published studies on the evaluation of serological assays that detect antibodies against different Schistosoma species of humans. It provides insights into the diagnostic performance and an overview of available assays and their suitability for large-scale use or individual diagnosis, and thus sets the scene for serological diagnosis of schistosomiasis and the interpretation of results.
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Affiliation(s)
- Rebecca Hinz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Germany.
| | | | - Andreas Hahn
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Germany; Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
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Danso-Appiah A, Minton J, Boamah D, Otchere J, Asmah RH, Rodgers M, Bosompem KM, Eusebi P, De Vlas SJ. Accuracy of point-of-care testing for circulatory cathodic antigen in the detection of schistosome infection: systematic review and meta-analysis. Bull World Health Organ 2016; 94:522-533A. [PMID: 27429491 PMCID: PMC4933137 DOI: 10.2471/blt.15.158741] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/19/2015] [Accepted: 01/26/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To assess the accuracy of point-of-care testing for circulatory cathodic antigen in the diagnosis of schistosome infection. METHODS We searched MEDLINE, EMBASE, LILACS and other bibliographic databases for studies published until 30 September 2015 that described circulatory cathodic antigen testing compared against one to three Kato-Katz tests per subject - for Schistosoma mansoni - or the filtration of one 10-ml urine sample per subject - for S. haematobium. We extracted the numbers of true positives, false positives, true negatives and false negatives for the antigen testing and performed meta-analyses using a bivariate hierarchical regression model. FINDINGS Twenty-six studies published between 1994 and 2014 met the inclusion criteria. In the detection of S. mansoni, a single antigen test gave a pooled sensitivity of 0.90 (95% confidence interval, CI: 0.84-0.94) and a pooled specificity of 0.56 (95% CI: 0.39-0.71; n = 7) when compared against a single Kato-Katz test. The corresponding values from comparisons with two to three Kato-Katz tests per subject were 0.85 (95% CI: 0.80-0.88) and 0.66 (95% CI: 0.53-0.76; n = 14), respectively. There appeared to be no advantage in using three antigen tests per subject instead of one. When compared against the results of urine filtration, antigen testing for S. haematobium showed poor sensitivity and poor specificity. The performance of antigen testing was better in areas of high endemicity than in settings with low endemicity. CONCLUSION Antigen testing may represent an effective tool for monitoring programmes for the control of S. mansoni.
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Affiliation(s)
- Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, PO Box LG13, Legon, Ghana
| | - Jonathan Minton
- School of Social and Political Sciences, University of Glasgow, Glasgow, Scotland
| | - Daniel Boamah
- Department of Microbiology, Centre for Plant Medicine Research, Mampong, Ghana
| | - Joseph Otchere
- Department of Parasitology, University of Ghana, Legon, Ghana
| | - Richard H Asmah
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, England
| | | | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Sake J De Vlas
- Department of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
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Weerakoon KG, Gordon CA, Gobert GN, Cai P, McManus DP. Optimisation of a droplet digital PCR assay for the diagnosis of Schistosoma japonicum infection: A duplex approach with DNA binding dye chemistry. J Microbiol Methods 2016; 125:19-27. [PMID: 27021661 DOI: 10.1016/j.mimet.2016.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/03/2016] [Accepted: 03/21/2016] [Indexed: 11/19/2022]
Abstract
Schistosomiasis is a chronically debilitating helminth infection with a significant socio-economic and public health impact. Accurate diagnostics play a pivotal role in achieving current schistosomiasis control and elimination goals. However, many of the current diagnostic procedures, which rely on detection of schistosome eggs, have major limitations including lack of accuracy and the inability to detect pre-patent infections. DNA-based detection methods provide a viable alternative to the current tests commonly used for schistosomiasis diagnosis. Here we describe the optimisation of a novel droplet digital PCR (ddPCR) duplex assay for the diagnosis of Schistosoma japonicum infection which provides improved detection sensitivity and specificity. The assay involves the amplification of two specific and abundant target gene sequences in S. japonicum; a retrotransposon (SjR2) and a portion of a mitochondrial gene (nad1). The assay detected target sequences in different sources of schistosome DNA isolated from adult worms, schistosomules and eggs, and exhibits a high level of specificity, thereby representing an ideal tool for the detection of low levels of parasite DNA in different clinical samples including parasite cell free DNA in the host circulation and other bodily fluids. Moreover, being quantitative, the assay can be used to determine parasite infection intensity and, could provide an important tool for the detection of low intensity infections in low prevalence schistosomiasis-endemic areas.
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Affiliation(s)
- Kosala G Weerakoon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia; Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Catherine A Gordon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Geoffrey N Gobert
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Pengfei Cai
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Donald P McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Hosking CG, McWilliam HEG, Driguez P, Piedrafita D, Li Y, McManus DP, Ilag LL, Meeusen ENT, de Veer MJ. Generation of a Novel Bacteriophage Library Displaying scFv Antibody Fragments from the Natural Buffalo Host to Identify Antigens from Adult Schistosoma japonicum for Diagnostic Development. PLoS Negl Trop Dis 2015; 9:e0004280. [PMID: 26684756 PMCID: PMC4686158 DOI: 10.1371/journal.pntd.0004280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/13/2015] [Indexed: 12/27/2022] Open
Abstract
The development of effective diagnostic tools will be essential in the continuing fight to reduce schistosome infection; however, the diagnostic tests available to date are generally laborious and difficult to implement in current parasite control strategies. We generated a series of single-chain antibody Fv domain (scFv) phage display libraries from the portal lymph node of field exposed water buffaloes, Bubalus bubalis, 11–12 days post challenge with Schistosoma japonicum cercariae. The selected scFv-phages showed clear enrichment towards adult schistosomes and excretory-secretory (ES) proteins by immunofluorescence, ELISA and western blot analysis. The enriched libraries were used to probe a schistosome specific protein microarray resulting in the recognition of a number of proteins, five of which were specific to schistosomes, with RNA expression predominantly in the adult life-stage based on interrogation of schistosome expressed sequence tags (EST). As the libraries were enriched by panning against ES products, these antigens may be excreted or secreted into the host vasculature and hence may make good targets for a diagnostic assay. Further selection of the scFv library against infected mouse sera identified five soluble scFv clones that could selectively recognise soluble whole adult preparations (SWAP) relative to an irrelevant protein control (ovalbumin). Furthermore, two of the identified scFv clones also selectively recognised SWAP proteins when spiked into naïve mouse sera. These host B-cell derived scFvs that specifically bind to schistosome protein preparations will be valuable reagents for further development of a cost effective point-of-care diagnostic test. Mass drug administration using the highly effective drug praziquantel (PZQ) is currently the method of choice to combat schistosomiasis. However, this treatment regime has limitations; in particular, it does not prevent re-infection and sporadic parasite resistance against PZQ is a continuing threat. The path to the successful control of schistosomiasis is highly challenging and must consider, not only the complex nature of the host-parasite interaction, but also the capacity to assess disease burden and parasite re-emergence in communities where successful control has been achieved. Furthermore, control programs must be economically sustainable in endemic countries and despite significant recent advancements the elimination of schistosomiasis may still be some time away. Accordingly, there is a definitive need to formulate innovative approaches for the development of improved diagnostic tools to accurately assess the disease burden associated with active schistosome infections. Here we describe the usefulness of a phage display library to mature antibody fragments derived from lymph node RNA of the natural buffalo host of the Asian schistosome, Schistosoma japonicum, following an experimental infection. These mature antibody fragments were able to bind native parasite proteins and could thus be used to develop a low cost and accurate point-of-care diagnostic test.
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Affiliation(s)
| | - Hamish E. G. McWilliam
- Department of Microbiology and Immunology, The University of Melbourne, the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Patrick Driguez
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - David Piedrafita
- School of Applied Sciences and Engineering, Federation University, Churchill, Victoria, Australia
| | - Yuesheng Li
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Donald P. McManus
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Leodevico L. Ilag
- Bio21 Molecular Sciences and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Els N. T. Meeusen
- Department of Microbiology, Monash University, Clayton, Victoria, Australia
| | - Michael J. de Veer
- Department of Physiology, Monash University, Clayton, Victoria, Australia
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Abstract
Schistosomiasis is a major neglected tropical disease that afflicts more than 240 million people, including many children and young adults, in the tropics and subtropics. The disease is characterized by chronic infections with significant residual morbidity and is of considerable public health importance, with substantial socioeconomic impacts on impoverished communities. Morbidity reduction and eventual elimination through integrated intervention measures are the focuses of current schistosomiasis control programs. Precise diagnosis of schistosome infections, in both mammalian and snail intermediate hosts, will play a pivotal role in achieving these goals. Nevertheless, despite extensive efforts over several decades, the search for sensitive and specific diagnostics for schistosomiasis is ongoing. Here we review the area, paying attention to earlier approaches but emphasizing recent developments in the search for new diagnostics for schistosomiasis with practical applications in the research laboratory, the clinic, and the field. Careful and rigorous validation of these assays and their cost-effectiveness will be needed, however, prior to their adoption in support of policy decisions for national public health programs aimed at the control and elimination of schistosomiasis.
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Abstract
Mass drug administration using praziquantel is the backbone of the current strategy for the control of schistosomiasis. As the theoretical plans have moved into practical application, certain challenges with this approach have surfaced, and it is likely that annual mass drug administration alone may not be sufficient to achieve program goals. However, mass drug administration is still the only available intervention that can be readily used in the wide variety of settings where schistosomiasis is endemic. The task then becomes how to improve this approach and identify what adjuncts to mass drug administration are effective, as programs move from morbidity control to elimination goals. Other aspects worthy of consideration include how best to employ new diagnostic tools to more easily identify where treatment is needed, and new formulations of praziquantel to extend the availability of treatment to all age groups. The aim of this review is to highlight both areas of challenge and of opportunity to improve the public health impact of schistosomiasis control programs.
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Affiliation(s)
- W Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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Detection of Schistosoma mansoni and Schistosoma haematobium by Real-Time PCR with High Resolution Melting Analysis. Int J Mol Sci 2015; 16:16085-103. [PMID: 26193254 PMCID: PMC4519940 DOI: 10.3390/ijms160716085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/19/2015] [Accepted: 07/01/2015] [Indexed: 12/13/2022] Open
Abstract
The present study describes a real-time PCR approach with high resolution melting-curve (HRM) assay developed for the detection and differentiation of Schistosoma mansoni and S. haematobium in fecal and urine samples collected from rural Yemen. The samples were screened by microscopy and PCR for the Schistosoma species infection. A pair of degenerate primers were designed targeting partial regions in the cytochrome oxidase subunit I (cox1) gene of S. mansoni and S. haematobium using real-time PCR-HRM assay. The overall prevalence of schistosomiasis was 31.8%; 23.8% of the participants were infected with S. haematobium and 9.3% were infected with S. mansoni. With regards to the intensity of infections, 22.1% and 77.9% of S. haematobium infections were of heavy and light intensities, respectively. Likewise, 8.1%, 40.5% and 51.4% of S. mansoni infections were of heavy, moderate and light intensities, respectively. The melting points were distinctive for S. mansoni and S. haematobium, categorized by peaks of 76.49 ± 0.25 °C and 75.43 ± 0.26 °C, respectively. HRM analysis showed high detection capability through the amplification of Schistosoma DNA with as low as 0.0001 ng/µL. Significant negative correlations were reported between the real-time PCR-HRM cycle threshold (Ct) values and microscopic egg counts for both S. mansoni in stool and S. haematobium in urine (p < 0.01). In conclusion, this closed-tube HRM protocol provides a potentially powerful screening molecular tool for the detection of S. mansoni and S. haematobium. It is a simple, rapid, accurate, and cost-effective method. Hence, this method is a good alternative approach to probe-based PCR assays.
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Sensitivity and Specificity of a Urine Circulating Anodic Antigen Test for the Diagnosis of Schistosoma haematobium in Low Endemic Settings. PLoS Negl Trop Dis 2015; 9:e0003752. [PMID: 25973845 PMCID: PMC4431728 DOI: 10.1371/journal.pntd.0003752] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/11/2015] [Indexed: 01/14/2023] Open
Abstract
Background Elimination of schistosomiasis as a public health problem and interruption of transmission in selected areas are key goals of the World Health Organization for 2025. Conventional parasitological methods are insensitive for the detection of light-intensity infections. Techniques with high sensitivity and specificity are required for an accurate diagnosis in low-transmission settings and verification of elimination. We determined the accuracy of a urine-based up-converting phosphor-lateral flow circulating anodic antigen (UCP-LF CAA) assay for Schistosoma haematobium diagnosis in low-prevalence settings in Zanzibar, Tanzania. Methodology A total of 1,740 urine samples were collected in 2013 from children on Pemba Island, from schools where the S. haematobium prevalence was <2%, 2–5%, and 5–10%, based on a single urine filtration. On the day of collection, all samples were tested for microhematuria with reagent strips and for the presence of S. haematobium eggs with microscopy. Eight months later, 1.5 ml of urine from each of 1,200 samples stored at -20°C were analyzed by UCP-LF CAA assay, while urine filtration slides were subjected to quality control (QCUF). In the absence of a true ‘gold’ standard, the diagnostic performance was calculated using latent class analyses (LCA). Principal Findings The ‘empirical’ S. haematobium prevalence revealed by UCP-LF CAA, QCUF, and reagent strips was 14%, 5%, and 4%, respectively. LCA revealed a sensitivity of the UCP-LF CAA, QCUF, and reagent strips of 97% (95% confidence interval (CI): 91–100%), 86% (95% CI: 72–99%), and 67% (95% CI: 52–81%), respectively. Test specificities were consistently above 90%. Conclusions/Significance The UCP-LF CAA assay shows high sensitivity for the diagnosis of S. haematobium in low-endemicity settings. Empirically, it detects a considerably higher number of infections than microscopy. Hence, the UCP-LF CAA employed in combination with QCUF, is a promising tool for monitoring and surveillance of urogenital schistosomiasis in low-transmission settings targeted for elimination. The World Health Organization aspires to eliminate snail fever (schistosomiasis) as a public health problem and to interrupt the transmission of this disease in selected areas by 2025. Efforts to achieve these goals are currently being intensified. As a result, the prevalence and intensity of infection will decline in many parts of the world. To detect light-intensity infections, diagnostic tools with a high sensitivity and specificity are needed. We assessed the accuracy of a method that is able to diagnose schistosomiasis via the detection of circulating anodic antigen (CAA) in urine. We examined 1,200 urine samples from children living on Pemba Island, Tanzania, a low-endemic area targeted for schistosomiasis elimination. We found that the CAA-test had a considerably higher sensitivity than conventional urine filtration microscopy and reagent strips that are widely used in schistosomiasis control programs. The empirical prevalence of infection with the parasite Schistosoma haematobium determined by the CAA-test was up to 10 times higher than that obtained by urine filtration. Our results suggest that the CAA-test—in combination with urine filtration—is a promising approach for the diagnosis of S. haematobium in low-transmission settings that are targeted for elimination.
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Utzinger J, Becker SL, van Lieshout L, van Dam GJ, Knopp S. New diagnostic tools in schistosomiasis. Clin Microbiol Infect 2015; 21:529-42. [PMID: 25843503 DOI: 10.1016/j.cmi.2015.03.014] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/21/2015] [Accepted: 03/21/2015] [Indexed: 12/22/2022]
Abstract
Schistosomiasis is a water-based parasitic disease that affects over 250 million people. Control efforts have long been in vain, which is one reason why schistosomiasis is considered a neglected tropical disease. However, since the new millennium, interventions against schistosomiasis are escalating. The initial impetus stems from a 2001 World Health Assembly resolution, urging member states to scale-up deworming of school-aged children with the anthelminthic drug praziquantel. Because praziquantel is safe, efficacious and inexpensive when delivered through the school platform, diagnosis before drug intervention was deemed unnecessary and not cost-effective. Hence, there was little interest in research and development of novel diagnostic tools. With the recent publication of the World Health Organization (WHO) Roadmap to overcome the impact of neglected tropical diseases in 2020, we have entered a new era. Elimination of schistosomiasis has become the buzzword and this has important ramifications for diagnostic tools. Indeed, measuring progress towards the WHO Roadmap and whether local elimination has been achieved requires highly accurate diagnostic assays. Here, we introduce target product profiles for diagnostic tools that are required for different stages of a schistosomiasis control programme. We provide an update of the latest developments in schistosomiasis diagnosis, including microscopic techniques, rapid diagnostic tests for antigen detection, polymerase chain reaction (PCR) assays and proxy markers for morbidity assessments. Particular emphasis is placed on challenges and solutions for new technologies to enter clinical practice.
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Affiliation(s)
- J Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - S L Becker
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Institute of Medical Microbiology and Hygiene, Saarland University Medical Centre, Homburg/Saar, Germany
| | - L van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S Knopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Life Sciences, Natural History Museum, London, UK
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van Lieshout L, Roestenberg M. Clinical consequences of new diagnostic tools for intestinal parasites. Clin Microbiol Infect 2015; 21:520-8. [PMID: 25843505 DOI: 10.1016/j.cmi.2015.03.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 02/06/2023]
Abstract
Following the success of nucleic acid-based detection in virology and bacteriology, multiplex real-time PCRs are increasingly used as first-line diagnostics in clinical parasitology, replacing microscopy. The detection and quantification of parasite-specific DNA in faeces is highly sensitive and specific and allows for cost-effective high-throughput screening. In this paper we discuss the clinical consequences of this radical change in diagnostic approach, as well as its potential drawbacks. In the Netherlands, routine diagnostic laboratories have been pioneering the implementation of multiplex real-time PCR for the detection of pathogenic intestinal protozoa and this has resulted in increased detection rates of Giardia lamblia and Cryptosporidium spp. As a consequence of this new diagnostic approach, expertise in the field of parasite morphology by conventional light microscopy seems to be disappearing in most of the high-throughput microbiological laboratories. As a result, to maintain a high standard of care, a formalized exchange of critical information between clinicians and laboratory staff is necessary to determine the most appropriate testing either in local laboratories or in reference centres, based on clinical signs and symptoms, exposure and immune status. If such a diagnostic algorithm is lacking, important infections in travellers, immigrants and immunocompromised patients may be missed.
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Affiliation(s)
- L van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - M Roestenberg
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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Utzinger J, Brattig NW, Leonardo L, Zhou XN, Bergquist R. Progress in research, control and elimination of helminth infections in Asia. Acta Trop 2015; 141:135-45. [PMID: 25446170 DOI: 10.1016/j.actatropica.2014.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Global health has substantially improved over the past 20 years. In low- and middle-income countries, in particular, great strives have been made in the control of communicable diseases, including helminth infections. Nevertheless, the most marginalised communities still suffer from infectious diseases that are intimately connected with poverty and lack of access to essential commodities and services, such as clean water, improved sanitation and sufficient food. A two-pronged approach is thus necessary: (i) intensifying control in remaining high-endemicity areas and pockets of high transmission; and (ii) moving from morbidity control to interruption of disease transmission in low-endemicity areas with the goal of local elimination. The latter will require new tools and strategies, going hand-in-hand with strong partnerships and new strategic alliances. In this special issue of Acta Tropica, 35 articles are featured that, together, provide an up-to-date overview of the latest progress made in research, control and elimination of helminth infections in East and Southeast Asia. The first 12 articles expound tools and approaches for improved detection, surveillance and monitoring of helminth infections. Control and elimination approaches for the most important helminth infections are revisited in the next 20 articles. The three remaining articles are cross-cutting pieces examining the interface of agriculture, environment and helminth infections and providing a rationale for integrated, multi-sectorial control approaches that are necessary for sustaining helminthiasis control and progressively moving towards elimination. An interesting aspect revealed through an in-depth analysis of the provenance of the 35 contributions is that the People's Republic of China emerges as a key player in global health, which is documented through its prominent role in research and control of helminth infection and networking throughout Asia. Policy implications are discussed and will hopefully shape the future agenda for the control and elimination of helminth infections the world over.
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Affiliation(s)
- Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
| | - Norbert W Brattig
- Tropical Medicine Section, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, D-20359 Hamburg, Germany
| | - Lydia Leonardo
- College of Public Health, University of the Philippines-Manila, Manila, Philippines
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai 200025, People's Republic of China; Key Laboratory on Biology of Parasite and Vector, Ministry of Health, WHO Collaborating Center for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, People's Republic of China
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van Dam GJ, Xu J, Bergquist R, de Dood CJ, Utzinger J, Qin ZQ, Guan W, Feng T, Yu XL, Zhou J, Zheng M, Zhou XN, Corstjens PL. An ultra-sensitive assay targeting the circulating anodic antigen for the diagnosis of Schistosoma japonicum in a low-endemic area, People's Republic of China. Acta Trop 2015; 141:190-7. [PMID: 25128703 DOI: 10.1016/j.actatropica.2014.08.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/28/2014] [Accepted: 08/05/2014] [Indexed: 12/31/2022]
Abstract
The downward trend in prevalence and intensity of Schistosoma japonicum infection in the People's Republic of China (P.R. China) has reached a level where accurate methods are required for monitoring the national schistosomiasis control programme and to verify whether transmission has been interrupted. We have assessed the prevalence of active S. japonicum infection by use of an up-converting phosphor lateral-flow (UCP-LF) assay for determination of circulating anodic antigens (CAA) in urine and serum, and compared the findings with those of the Kato-Katz technique for egg detection in stool and an immunohaemagglutination assay (IHA) for specific antibodies in serum. The study was carried out in three villages located in a remaining S. japonicum-endemic area in P.R. China. Overall, 423 individuals were investigated by Kato-Katz, 395 by IHA, 371 with the UCP-LF CAA assay adapted for urine and 178 with the UCP-LF CAA assay applied on serum. The IHA showed the highest number of positive results (n=107, 27.1%). The UCP-LF CAA urine assay detected 36 CAA positives (9.7%) and the serum-based CAA assay 21 positives (11.8%). The Kato-Katz technique revealed only six positive stool samples (1.4%). Among those 166 individuals with complete data records, sensitivities of the different assays were determined versus a combined 'gold' standard, showing the highest sensitivity for the urine CAA assay (93%), followed by the serum CAA (73%) and IHA (53%), whilst triplicate Kato-Katz thick smears had a very low sensitivity (13%). Serum CAA concentrations were about 10-fold higher than in urine and were significantly correlated. Highest prevalences as determined by CAA were found in older age groups (>40 years). Half of the CAA- or egg-positive cases were negative for antibodies by IHA, thereby revealing an important obstacle for the effectiveness of the current schistosomiasis control and elimination efforts. The significantly higher prevalence of active schistosome infections as shown by the urine and serum UCP-LF CAA assays has implications for the national control and elimination programme in P.R. China, particularly in respect to case-finding and intervention strategies.
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Bergquist R, Yang GJ, Knopp S, Utzinger J, Tanner M. Surveillance and response: Tools and approaches for the elimination stage of neglected tropical diseases. Acta Trop 2015; 141:229-34. [PMID: 25301340 DOI: 10.1016/j.actatropica.2014.09.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 12/18/2022]
Abstract
The presentation of the World Health Organization (WHO)'s roadmap for neglected tropical diseases (NTDs) in January 2012 raised optimism that many NTDs can indeed be eliminated. To make this happen, the endemic, often low-income countries with still heavy NTD burdens must substantially strengthen their health systems. In particular, they need not only to apply validated, highly sensitive diagnostic tools and sustainable effective control approaches for treatment and transmission control, but also to participate in the development and use of surveillance-response schemes to ensure that progress made also is consolidated and sustained. Surveillance followed-up by public health actions consisting of response packages tailored to interruption of transmission in different settings will help to effectively achieve the disease control/elimination goals by 2020, as anticipated by the WHO roadmap. Risk-mapping geared at detection of transmission hotspots by means of geospatial and other dynamic approaches facilitates decision-making at the technical as well as the political level. Surveillance should thus be conceived and developed as an intervention approach and at the same time function as an early warning system for the potential re-emergence of endemic infections as well as for new, rapidly spread epidemics and pandemics.
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Affiliation(s)
| | - Guo-Jing Yang
- Jiangsu Institute of Parasitic Diseases, Wuxi 214064, People's Republic of China; Key Laboratory of Parasitic Disease Control and Prevention, Ministry of Health, Wuxi 214064, People's Republic of China; Jiangsu Provincial Key Laboratory of Parasite Molecular Biology, Wuxi 214064, People's Republic of China
| | - Stefanie Knopp
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London SW7 5BD, United Kingdom; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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