1
|
Ligero-López J, Corbacho-Loarte MD, Antón-Berenguer V, Merino-Fernández FJ, Rubio-Muñoz JM, Valle-Borrego B. A 14-year review (2007-2020) of helminthiasis epidemiology in a hospital in Southern Madrid, Spain. Eur J Clin Microbiol Infect Dis 2024; 43:659-671. [PMID: 38277032 DOI: 10.1007/s10096-024-04746-6] [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: 08/21/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE Vast majority of helminth diseases remain neglected tropical diseases (NTDs), causing significant morbidity. The widespread and periodic distribution of antiparasitic drugs, remains the cornerstone for controlling these diseases. In Spain, most helminthiasis cases are imported, and suspicion and diagnosis have become increasingly important. Our primary objective is to present the epidemiological landscape of helminthiasis diagnoses within our facility, while also detailing the demographic characteristics of the affected population. METHODS A retrospective study was conducted at the Hospital Universitario Severo Ochoa (HUSO) from January 1, 2007, to December 31, 2020, encompassing all diagnosed cases of helminthiasis during this period. Comprehensive epidemiological, clinical, and microbiological data were gathered for all diagnosed patients. The study population comprised patients receiving treatment at the HUSO, as well as those receiving treatment at the Leganés and Fuenlabrada Primary Care Units. Subsequently, descriptive and comparative statistics were performed, comparing Spanish and foreign patients. RESULTS During this period, a total of 952 patients were diagnosed with some form of helminthiasis. Among them, 495 were Spanish, and 457 were foreign. The total number of helminths identified, including patients with multiple infections, was 1,010. Significant differences were observed between Africans and Americans in terms of age distribution, with a higher prevalence among Africans in the 0-15 age range and among Americans in the 31-60 age range. Variations were noted in the distribution of helminths, with S. stercoralis significantly affecting Americans. For Spanish patients, the presence of Trichuris trichiura and S. stercoralis was significantly associated with eosinophilia, whereas among foreign patients, it was associated with Trichuris trichiura, Ascaris lumbricoides among others. Regarding symptoms, skin manifestations were more frequent among Spanish, while digestive were more common among foreigners. CONCLUSIONS This study offers crucial epidemiological insights into helminth infections observed over time in a Madrid hospital. Although the prevalence of helminth infections has been decreasing, there is still a need for screening and diagnosing foreign patients.
Collapse
Affiliation(s)
- Jorge Ligero-López
- Microbiology and Parasitology Department, Hospital Universitario Severo Ochoa, Madrid, Spain.
- Clinical Microbiology and Parasitology Department, Hospital Clínico Universitario Lozano Blesa, C. de San Juan Bosco, 15, 50009, Zaragoza, Spain.
| | - María Dolores Corbacho-Loarte
- National Referral Unit for Tropical Disease, Infectious Diseases Department, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Víctor Antón-Berenguer
- Microbiology and Parasitology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Francisco Jesús Merino-Fernández
- Microbiology and Parasitology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
- Faculty of Medicine, Alfonso X el Sabio University, Madrid, Spain
| | - José Miguel Rubio-Muñoz
- Malaria & Parasitic Emerging Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Valle-Borrego
- Faculty of Medicine, Alfonso X el Sabio University, Madrid, Spain
- Internal Medicine, Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| |
Collapse
|
2
|
Gryschek RCB, Corral MA, Sitta RB, Gottardi M, Pierrotti LC, Costa SF, Abdala E, Chieffi PP, de Paula FM. Strongyloides infection screening in transplant candidates: What is the best strategy? Transpl Infect Dis 2023; 25:e14153. [PMID: 37750481 DOI: 10.1111/tid.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The potential that Strongyloides stercoralis infection has to cause major morbidity and high mortality when the disseminated form occurs in transplant patients is of particular concern. METHODS In this study, the objective was to observe S. stercoralis infection in patients who are candidates for transplantation by using parasitological, serological, and molecular techniques and to propose an algorithm for the detection of that infection in transplant candidates. RESULTS By parasitological techniques, 10% of fecal samples were positive. Anti-Strongyloides antibodies immunoglobulin G were detected in 19.3% and 20.7% of patients by immunofluorescence assay and enzyme-linked immunosorbent assay, respectively. S. stercoralis DNA was observed in 17.3% of samples by conventional polymerase chain reaction and 32.7% of samples by quantitative polymerase chain reaction (qPCR). CONCLUSION The set of results allows us to reinforce that a positive result by parasitological techniques and/or qPCR indicates that the specific treatment should be applied. However, the improvement of diagnostic techniques may suggest changes in the screening for strongyloidiasis in these patients.
Collapse
Affiliation(s)
- Ronaldo Cesar Borges Gryschek
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Marcelo Andreetta Corral
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Renata Barnabé Sitta
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Maiara Gottardi
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ligia Camera Pierrotti
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Silvia Figueiredo Costa
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edson Abdala
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Pedro Paulo Chieffi
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Sao Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| |
Collapse
|
3
|
Marquet F, Mora N, Incani RN, Jesus J, Méndez N, Mujica R, Trosel H, Ferrer E. Comparison of different PCR amplification targets for molecular diagnosis of Strongyloides stercoralis. J Helminthol 2023; 97:e88. [PMID: 37974436 DOI: 10.1017/s0022149x23000743] [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] [Indexed: 11/19/2023]
Abstract
Molecular techniques are an alternative for the diagnosis of strongyloidiasis, produced by Strongyloides stercoralis. However, it is necessary to determine the best amplification target for the populations of this parasite present in a geographical area and standardize a polymerase chain reaction (PCR) protocol for its detection. The objectives of this work were the comparison of different PCR targets for molecular detection of S. stercoralis and the standardization of a PCR protocol for the selected target with the best diagnostic results. DNA extraction was performed from parasite larvae by saline precipitation. Three amplification targets of the genes encoding ribosomal RNA 18S (18S rDNA) and 5.8S (5.8S rDNA) and cytochrome oxidase 1 (COX1) of S. stercoralis were compared, and the PCR reaction conditions for the best target were standardized (concentration of reagents and template DNA, hybridization temperature, and number of cycles). The analytical sensitivity and specificity of the technique were determined. DNA extraction by saline precipitation made it possible to obtain DNA of high purity and integrity. The ideal target was the 5.8S rDNA, since the 18S rDNA yielded non-reproducible results and COX1 never amplified under any condition tested. The optimal conditions for the 5.8S rDNA-PCR were: 1.5 mM MgCl2, 100 μM dNTPs, 0.4 μM primers, and 0.75 U DNA polymerase, using 35 cycles and a hybridization temperature of 60 °C. The analytical sensitivity of the PCR was 1 attogram of DNA, and the specificity was 100%. Consequently, the 5.8S rDNA was shown to be highly sensitive and specific for the detection of S. stercoralis DNA.
Collapse
Affiliation(s)
- F Marquet
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - N Mora
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - R N Incani
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Carabobo, Universidad de Carabobo, Valencia, estado Carabobo, Venezuela
| | - J Jesus
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Carabobo, Universidad de Carabobo, Valencia, estado Carabobo, Venezuela
| | - N Méndez
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Carabobo, Universidad de Carabobo, Valencia, estado Carabobo, Venezuela
| | - R Mujica
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - H Trosel
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - E Ferrer
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| |
Collapse
|
4
|
Mateo M, Montoya A, Bailo B, Köster PC, Dashti A, Hernández‐Castro C, Saugar JM, Matas P, Xiao L, Carmena D. Prevalence and public health relevance of enteric parasites in domestic dogs and cats in the region of Madrid (Spain) with an emphasis on Giardia duodenalis and Cryptosporidium sp. Vet Med Sci 2023; 9:2542-2558. [PMID: 37725371 PMCID: PMC10650246 DOI: 10.1002/vms3.1270] [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: 05/16/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Pet dogs and cats exert an unquestionable beneficial effect in the well-being of their owners, but can also act as a source of zoonotic infections if improperly cared. OBJECTIVES We investigated the occurrence, risk factors, genetic variability and zoonotic potential of intestinal parasites in dogs and cats attended in a clinical veterinary setting in Spain. METHODS Canine (n = 252) and feline (n = 35) faecal samples were collected during 2017-2019 and analysed by coproparasitological methods. A rapid lateral immunochromatographic test (ICT) was used for detecting Giardia duodenalis and Cryptosporidium sp. Samples positive at microscopy examination and/or ICT were reassessed by molecular methods. RESULTS Overall, 48.8% (123/252) of dogs and 48.6% (17/35) of cats were infected by enteric parasites. In dogs, G. duodenalis was the most prevalent species (40.9%), followed by Cystoisospora sp. (7.1%), and Toxocara canis (5.2%). In cats, Joyeuxiella sp. and Toxocara cati were the dominant species (20.0% each), followed by G. duodenalis (14.3%), D. caninum (5.7%) and Cystoisospora felis and Toxascaris leonina (2.9% each). Pups and kittens were more likely to harbour intestinal parasites and develop clinical signs. Sequence analyses of dog isolates revealed the presence of assemblages A (n = 1), C (n = 4), D (n = 4) and C+D (n = 1) within G. duodenalis; C. parvum (n = 1) and C. canis (n = 4) within Cryptosporidium and PtEb IX (n = 1) in Enterocytozoon bieneusi. A novel C. canis subtype family, named XXi, is reported. CONCLUSIONS Our results highlight that (i) well-cared dogs carry zoonotic enteric protozoan parasites of public health relevance, (ii) proper hygiene practices and routine veterinary treatment are essential to prevent zoonotic infections, (iii) vulnerable populations should avoid contact with pups/kittens with diarrhoea and (iv) infected dogs might be major contributors to the environmental contamination with soil-transmitted helminths (STHs) eggs.
Collapse
Affiliation(s)
- Marta Mateo
- Department of Microbiology and ParasitologyFaculty of PharmacyComplutense University of MadridMadridSpain
| | - Ana Montoya
- Department of Animal HealthFaculty of VeterinaryComplutense University of MadridMadridSpain
| | - Begoña Bailo
- Parasitology Reference and Research LaboratorySpanish National Centre for MicrobiologyHealth Institute Carlos IIIMajadahondaMadridSpain
| | - Pamela C. Köster
- Parasitology Reference and Research LaboratorySpanish National Centre for MicrobiologyHealth Institute Carlos IIIMajadahondaMadridSpain
| | - Alejandro Dashti
- Parasitology Reference and Research LaboratorySpanish National Centre for MicrobiologyHealth Institute Carlos IIIMajadahondaMadridSpain
| | - Carolina Hernández‐Castro
- Parasitology Reference and Research LaboratorySpanish National Centre for MicrobiologyHealth Institute Carlos IIIMajadahondaMadridSpain
- Parasitology Group, Faculty of Medicine, Academic Corporation for the Study of Tropical PathologiesUniversity of AntioquiaMedellínColombia
| | - José M. Saugar
- Parasitology Reference and Research LaboratorySpanish National Centre for MicrobiologyHealth Institute Carlos IIIMajadahondaMadridSpain
- Centre for Biomedical Research Network (CIBER) in Infectious DiseasesHealth Institute Carlos IIIMadridSpain
| | - Pablo Matas
- Faculty of Veterinary, Alfonso X El Sabio University (UAX)Villanueva de la CañadaMadridSpain
| | - Lihua Xiao
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
| | - David Carmena
- Parasitology Reference and Research LaboratorySpanish National Centre for MicrobiologyHealth Institute Carlos IIIMajadahondaMadridSpain
- Centre for Biomedical Research Network (CIBER) in Infectious DiseasesHealth Institute Carlos IIIMadridSpain
| |
Collapse
|
5
|
Chan AHE, Thaenkham U. From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis. Parasit Vectors 2023; 16:123. [PMID: 37041645 PMCID: PMC10088203 DOI: 10.1186/s13071-023-05763-8] [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: 12/26/2022] [Accepted: 03/30/2023] [Indexed: 04/13/2023] Open
Abstract
Strongyloides stercoralis is a soil-transmitted helminth that is mainly found in the tropical and subtropical regions and affects approximately 600 million people globally. The medical importance of strongyloidiasis lies in its capacity to remain asymptomatic and chronically unnoticed until the host is immunocompromised. Additionally, in severe strongyloidiasis, hyperinfection syndrome and larva dissemination to various organs can occur. Parasitological techniques such as Baermann-Moraes and agar plate culture to detect larvae in stool samples are the current gold standard. However, the sensitivity might be inadequate, especially with reduced worm burden. Complementing parasitological techniques, immunological techniques including immunoblot and immunosorbent assays are employed, with higher sensitivity. However, cross-reactivity to other parasites may occur, hampering the assay's specificity. Recently, advances in molecular techniques such as polymerase chain reaction and next-generation sequencing technology have provided the opportunity to detect parasite DNA in stool, blood, and environmental samples. Molecular techniques, known for their high sensitivity and specificity, have the potential to circumvent some of the challenges associated with chronicity and intermittent larval output for increased detection. Here, as S. stercoralis was recently included by the World Health Organization as another soil-transmitted helminth targeted for control from 2021 to 2030, we aimed to present a review of the current molecular techniques for detecting and diagnosing S. stercoralis in a bid to consolidate the molecular studies that have been performed. Upcoming molecular trends, especially next-generation sequencing technologies, are also discussed to increase the awareness of its potential for diagnosis and detection. Improved and novel detection methods can aid in making accurate and informed choices, especially in this era where infectious and non-infectious diseases are increasingly commonplace.
Collapse
Affiliation(s)
| | - Urusa Thaenkham
- Department of Helminthology, Mahidol University, Bangkok, Thailand
| |
Collapse
|
6
|
Mewara A, Gudisa R, Sharma N, Kanaujia R. A fatal case of Strongyloides hyperinfection with obscure risk factors. Eur J Clin Microbiol Infect Dis 2023; 42:661-663. [PMID: 36930391 DOI: 10.1007/s10096-023-04588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rajendra Gudisa
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
7
|
Buonfrate D, Tamarozzi F, Paradies P, Watts MR, Bradbury RS, Bisoffi Z. The diagnosis of human and companion animal Strongyloides stercoralis infection: Challenges and solutions. A scoping review. ADVANCES IN PARASITOLOGY 2022; 118:1-84. [PMID: 36088083 DOI: 10.1016/bs.apar.2022.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Strongyloidiasis is the infection caused by soil-transmitted nematodes of Strongyloides species, infecting humans and some animals. Strongyloides stercoralis is the species with most clinical and epidemiological relevance in humans and dogs, due to its high prevalence and its capacity of inducing a life-threatening hyperinfection. Diagnosis of strongyloidiasis is challenging, due to the absence of a single reference standard test with high sensitivity and specificity, which also hampers the estimation of the accuracy of other diagnostic tests. In this chapter, we review the deployment and performance of the parasitological, immunological, molecular tests for the diagnosis of strongyloidiasis in humans and in dogs. Further, we comment the available evidence from genotyping studies that have addressed the zoonotic potential of S. stercoralis. Finally, we discuss the use of different diagnostic methods in relation to the purpose (i.e., screening, individual diagnosis, inclusion in a clinical trial) and the setting (endemic/non-endemic areas) and report the accuracy figures reported by systematic reviews on either parasitological, serological or molecular techniques published in literature.
Collapse
Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.
| | - Francesca Tamarozzi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, Bari, Italy
| | - Matthew R Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research - New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, VC, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| |
Collapse
|
8
|
Hailu T, Amor A, Nibret E, Munshea A, Anegagrie M, Flores-Chavez MD, Tang THT, Saugar JM, Benito A. Evaluation of five diagnostic methods for Strongyloides stercoralis infection in Amhara National Regional State, northwest Ethiopia. BMC Infect Dis 2022; 22:297. [PMID: 35346087 PMCID: PMC8962492 DOI: 10.1186/s12879-022-07299-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Strongyloides stercoralis is an intestinal parasite that can cause chronic infection, hyperinfection and/or a dissemination syndrome in humans. The use of techniques targeting ova fails to detect S. stercoralis, as only larvae of the parasite are excreted in faeces. Due to the absence of “Gold” standard diagnostic method for S. stercoralis, there is a paucity of reported data worldwide.
Objective
This study aimed to evaluate the performance of diagnostic methods of S. stercoralis infection by taking the composite reference as a “Gold” standard.
Methods
A cross-sectional study was conducted among 844 schoolchildren in Amhara Region, Ethiopia, from April to December 2019. Stool samples were collected and processed with formol-ether concentration technique (FECT), spontaneous tube sedimentation technique (STST), Baermann concentration technique (BCT), agar plate culture (APC) and real-time polymerase chain reaction (RT-PCR). Sensitivity, specificity, positive predictive value, and negative predictive value of each diagnostic method were computed against the composite reference. The agreements of diagnostic methods were evaluated by Kappa value at 95% CI.
Results
The composite detection rate of S. stercoralis by the five diagnostic methods was 39.0% (329/844). The detection rate of the parasite from stool samples by FECT, STST, BCT, APC and RT-PCR was 2.0% (17/844), 4.0% (34/844), 10.2% (86/844), 10.9% (92/844) and 28.8% (243/844), respectively. The highest detection rate (37.8%; 319/844) of S. stercoralis was recorded by a combination of BCT, APC, and RT-PCR followed by a combination of STST, BCT, APC and RT-PCR (37.3%; 315/844). The sensitivity of FECT, STST, BCT, APC and RT-PCR against the composite reference was 5.2%, 10.3%, 26.4%, 28.0% and 73.9%, respectively. The diagnostic agreements of RT-PCR, APC, BCT, STST and FECT with the composite reference in detection of S. stercoralis were substantial (0.775), fair (0.321), fair (0.305), slight (0.123), and slight (0.062), respectively.
Conclusion
RT-PCR detected the highest number of S. stercoralis infections. A combination of RT-PCR with APC and/or BCT better detected S. stercoralis from stool samples compared to other combinations or single diagnostic methods. Therefore, RT-PCR and combination of RT-PCR with APC and/or BCT diagnostic methods should be advocated for detection of S. stercoralis infection.
Collapse
|
9
|
Hailu T, Nibret E, Amor A, Munshea A, Anegagrie M. Determinant factors of chronic Strongyloides stercoralis infection among schoolchildren in Amhara National Regional State, northwest Ethiopia. Acta Trop 2022; 226:106280. [PMID: 34919948 DOI: 10.1016/j.actatropica.2021.106280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/11/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strongyloides stercoralis is one of the most neglected parasites that is commonly found in tropical and sub-tropical countries. The majority of chronic S. stercoralis infections are characterized by minor clinical signs and symptoms. The extent to which socio-demographic, personal and environmental risk factors associated with S. stercoralis infection is not well known in Amhara Regional, Ethiopia. OBJECTIVE This study aimed to assess socio-demographic, personal and environmental risk factors associated with S. stercoralis infection among schoolchildren in Amhara Region. METHODS A total of 844 schoolchildren were randomly selected and participated in the study. Stool samples were collected and checked for S. stercoralis infection using five diagnostic methods. A structured questionnaire was also used to obtain socio-demographic, personal and environmental data from parents of the children. The degree of association between socio-demographic, personal and environmental factors with S. stercoralis infection was first assessed by univariate logistic regression and then analyzed by multivariate logistic regression. Variables with p<0.05 were considered as statistically significant. RESULTS Among 844 participants, 329 (39.0%) were infected with S. stercoralis. Prevalences of S. stercoralis among 12-14 years old, males, and rural dwellers were 48.2% (109/226), 45.0% (196/436) and 41.1% (306/745), respectively. Being in the age group of 10-11years (AOR=1.56;95%CI:1.10-2.24), and 12-14 years (AOR=1.96;95%CI:1.32-2.90), male (AOR=1.55;95%CI:1.16-2.06), and rural dweller (AOR=1.86;95%CI:1.12-3.10); having family income of < 1000 Birr per month (AOR=2.03;95%CI:1.48-2.77), and family size of 5-9 members (AOR=2.36; 95%CI:1.57-3.54) were significantly associated with S. stercoralis infection. The habit of not wearing shoes (AOR=1.41; 95%CI:1.05-1.90), close contacting with pets (AOR=1.49;95%:1.09-2.04), participating in irrigation (AOR=1.49; 95%CI:1.10-2.00) and playing with soil (AOR=1.62;95%CI:1.20-2.18) were risk factors of S. stercoralis infection. Besides, presence of wet environment (AOR=1.62;95%CI:1.19-2.22), living around sandy soil (AOR=2.75; 95%CI: 1.81-4.19) and red clay soil (AOR=2.24;95%CI:1.58-3.17), living in semi-highland folds (AOR=2.47;95%CI:1.48-4.14) and highland areas (AOR=1.65;95%CI:1.06-2.57) were determinant factors for S. stercoralis. CONCLUSION S. stercoralis infection among schoolchildren was highly prevalent in Amhara Region. Several determinant factors were also identified. Therefore, proper implementation of sanitation and hygiene programs and health care of pets should be advocated to break the transmission cycle of S. stercoralis.
Collapse
Affiliation(s)
- Tadesse Hailu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia, P. O. Box: 79.
| | - Endalkachew Nibret
- Biology Department, Science College, Bahir Dar University, Ethiopia, P. O. Box: 79
| | - Arancha Amor
- Mundo Sano Foundations, Institute of Health Carlos III, Spain
| | - Abaineh Munshea
- Biology Department, Science College, Bahir Dar University, Ethiopia, P. O. Box: 79
| | | |
Collapse
|
10
|
Costa IN, Bosqui LR, Corral MA, Costa-Cruz JM, Gryschek RCB, de Paula FM. Diagnosis of human strongyloidiasis: Application in clinical practice. Acta Trop 2021; 223:106081. [PMID: 34364894 DOI: 10.1016/j.actatropica.2021.106081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
This review considers the advantages and disadvantages of parasitological techniques, methods of detecting antibodies and antigens, as well as molecular biology techniques in the diagnosis of human strongyloidiasis. In addition, it elucidates the potential of different techniques for rapid and effective detection of clinical cases, thus enabling early treatment and preventing fatal consequences of this helminthiasis.
Collapse
|
11
|
Nascimento RC, Melo GB, Fonseca PDM, Gryschek RCB, Paula FM. Evaluation of targets for Strongyloides genus specific molecular diagnosis in experimental strongyloidiasis. Exp Parasitol 2021; 230:108157. [PMID: 34543651 DOI: 10.1016/j.exppara.2021.108157] [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: 09/29/2020] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
Strongyloides venezuelensis has been used in different experimental studies, such as those aimed at the evaluation of diagnostic techniques for human strongyloidiasis, mainly the molecular diagnosis. In this study, three regions (genus, 18S and 28S targets) of Strongyloides ribosomal DNA were evaluated for the molecular diagnosis of experimental strongyloidiasis. Rats were infected subcutaneously with 400 or 4000 S. venezuelensis infective larvae (400iL3 and 4000iL3), and kept for 35 days. Fecal samples were collected daily to count eggs per gram of feces (EPG) and to perform the polymerase chain reaction (PCR). Egg count started on the 5th day post-infection (pi) and ended on days 33 and 34 pi, in 400iL3 and 4000iL3 groups, respectively. Based in EPG, fecal samples were selected from days 2, 5, 8, 11, 15, 23 and 35 pi for DNA extraction; PCR (genus, 18S and 28S); and sequencing. The PCR-28S products showed higher values of identity (95-100%) in the database with the Strongyloides sequences. Therefore, it is possible to reinforce the application of PCR-28S in the diagnosis of experimental and human strongyloidiasis.
Collapse
Affiliation(s)
- Rafael C Nascimento
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Gessica B Melo
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Priscilla D M Fonseca
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Ronaldo C B Gryschek
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - F M Paula
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil.
| |
Collapse
|
12
|
Dacal E, Köster PC, Carmena D. Diagnóstico molecular de parasitosis intestinales. Enferm Infecc Microbiol Clin 2021; 38 Suppl 1:24-31. [PMID: 32111362 DOI: 10.1016/j.eimc.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Infections causes by parasites of the gastrointestinal tract are a global public health problem. In industrialised countries, their particular epidemiological (low general prevalence of enteroparasites), economic (high labour costs) and clinical characteristics (constant increase in the number of samples and diagnostic determinations to be performed) have led molecular techniques to progressively replace conventional microscopy as the first-line diagnostic method of these pathogens in modern clinical laboratories. PCR-based techniques, particularly those developed for the simultaneous detection of the various agents that can cause the same infectious disease (syndromic diagnosis), already represent a cost-effective option that allow process automisation, workflow optimisation, and comparison of results among different laboratories, and facilitate accreditation of diagnostic procedures. This review clearly and concisely discusses the current situation of the molecular diagnosis of the main species of intestinal parasites in humans, particularly the enteric protozoans causing diarrhoea (Cryptosporidium spp., Giardia duodenalis, Entamoeba histolytica), the most important members the Microsporidia phyla (Enterocytozoon bieneusi) and Stramenopiles phyla (Blastocystis sp.), as well as the helminths transmitted by soil (Ancylostoma spp., Ascaris lumbricoides, Necator americanus, Strongyloides stercoralis and Trichuris trichiura) and food (Anisakis spp., Clonorchis sinensis, Fasciola spp., Taenia solium, and Trichinella spiralis). Special attention is paid to the description of available techniques and formats, to their diagnostic benefits and the most widely used genetic markers for their detection, both in clinical laboratories and genotyping in referral and research centres.
Collapse
Affiliation(s)
- Elena Dacal
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - Pamela C Köster
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - David Carmena
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
| |
Collapse
|
13
|
Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol. Pathogens 2021; 10:pathogens10070812. [PMID: 34199000 PMCID: PMC8308528 DOI: 10.3390/pathogens10070812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022] Open
Abstract
Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.
Collapse
|
14
|
Le Pogam A, Lopinto J, Pecriaux A, Fartoukh M, Guitard J, Voiriot G. Strongyloides stercoralis disseminated infection in an HIV-infected adult. PLoS Negl Trop Dis 2020; 14:e0008766. [PMID: 33151939 PMCID: PMC7643935 DOI: 10.1371/journal.pntd.0008766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this visual case of Strongyloides stercoralis disseminated infection with Enterobacteriaceae-related invasive infection, we demonstrated the in-host S. stercoralis circulation with DNA found in different fluids and specimens, but also in cerebrospinal fluid (CSF), supporting the role of migrant larvae in the Enterobacteriaceae-related invasive and central nervous system infection.
Collapse
Affiliation(s)
- Ambroise Le Pogam
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Julien Lopinto
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Adrien Pecriaux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Mycologie-Parasitologie, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, INSERM UMR S 938, Centre de Recherche Saint Antoine (CRSA), Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
- * E-mail:
| |
Collapse
|
15
|
Lucas Dato A, Pacheco-Tenza MI, Borrajo Brunete E, Martínez López B, García López M, González Cuello I, Gregori Colomé J, Navarro Cots M, Saugar JM, García-Vazquez E, Ruiz-Maciá JA, Llenas-García J. Strongyloidiasis in Southern Alicante (Spain): Comparative Retrospective Study of Autochthonous and Imported Cases. Pathogens 2020; 9:pathogens9080601. [PMID: 32717912 PMCID: PMC7460300 DOI: 10.3390/pathogens9080601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. METHODS Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. RESULTS We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15-24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4-73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). CONCLUSION In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.
Collapse
Affiliation(s)
- Ana Lucas Dato
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Correspondence: (A.L.D.); (J.L.-G.)
| | - María Isabel Pacheco-Tenza
- Internal Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Emilio Borrajo Brunete
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Microbiology Department, Hospital Vega Baja, 03314 Orihuela, Spain
| | - Belén Martínez López
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - María García López
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - Inmaculada González Cuello
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - Joan Gregori Colomé
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - María Navarro Cots
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Microbiology Department, Hospital Vega Baja, 03314 Orihuela, Spain
| | - José María Saugar
- Parasitology Department, Centro Nacional de Microbiología, Instituto Carlos III, 28903 Madrid, Spain;
| | - Elisa García-Vazquez
- Infectious Diseases Unit, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
- Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, 30120 Murcia, Spain
| | - José Antonio Ruiz-Maciá
- Pathological Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Clinical Medicine Department, Universidad Miguel Hernández de Elche, 03202 Elche, Spain
- Correspondence: (A.L.D.); (J.L.-G.)
| |
Collapse
|
16
|
Asymptomatic Strongyloidiasis among Latin American Migrants in Spain: A Community-Based Approach. Pathogens 2020; 9:pathogens9060511. [PMID: 32599871 PMCID: PMC7350301 DOI: 10.3390/pathogens9060511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
Strongyloides stercoralis infection is frequently underdiagnosed since many infections remain asymptomatic. Aim: To estimate the prevalence and characteristics of asymptomatic S. stercoralis infection in Latin American migrants attending a community-based screening program for Chagas disease in Spain. Methodology: Three community-based Chagas disease screening campaigns were performed in Alicante (Spain) in 2016, 2017, and 2018. Serological testing for S. stercoralis infection was performed using a non-automatized IVD-ELISA detecting IgG (DRG Instruments GmbH, Marburg, Germany). Results: Of the 616 migrants from Central and South America who were screened, 601 were included in the study: 100 children and adolescents (<18 years of age) and 501 adults. Among the younger group, 6 participants tested positive (prevalence 6%, 95% confidence interval [CI] 2.5% to 13.1%), while 60 adults did so (prevalence 12%, 95% CI 9.3% to 15.3%). S. stercoralis infection was more common in men than in women (odds ratio adjusted [ORa] 2.28, 95% CI 1.289 to 4.03) and in those from Bolivia (ORa 2.03, 95% CI 1.15 to 3.59). Prevalence increased with age (ORa 1.02, 95% CI 0.99 to 1.05). In contrast, a university education had a protective effect (ORa 0.29, 95% CI 0.31 to 0.88). Forty-one (41/66; 62.1%) of the total cases of S. stercoralis infection were treated at the health care center. Positive stool samples were observed in 19.5% of the followed-up positive cases. Conclusion: Incorporating serological screening for S. stercoralis into community-based screening for Chagas disease is a useful intervention to detect asymptomatic S. stercoralis infection in Central and South American migrants and an opportunity to tackle neglected tropical diseases in a transversal way. The remaining challenge is to achieve patients’ adherence to the medical follow-up.
Collapse
|
17
|
Aramendia AA, Anegagrie M, Zewdie D, Dacal E, Saugar JM, Herrador Z, Hailu T, Yimer M, Periago MV, Rodriguez E, Benito A. Epidemiology of intestinal helminthiases in a rural community of Ethiopia: Is it time to expand control programs to include Strongyloides stercoralis and the entire community? PLoS Negl Trop Dis 2020; 14:e0008315. [PMID: 32497042 PMCID: PMC7297378 DOI: 10.1371/journal.pntd.0008315] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/16/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Soil transmitted helminths are highly prevalent worldwide. Globally, approximately 1.5 billion people are infected with Ascaris lumbricoides, Trichuris trichiura or hookworm. Endemic countries carry out periodic mass treatment of at-risk populations with albendazole or mebendazole as a control measure. Most prevalence studies have focused on school aged children and therefore control programs are implemented at school level, not at community level. In this study, the prevalence of intestinal helminths, including Strongyloides stercoralis, was examined using a comprehensive laboratory approach in a community in north-western Ethiopia. METHODS A cross-sectional survey was conducted on 792 individuals ≥5 years old in randomly selected houses in a rural district. Stools were examined using three techniques: a formol-ether concentration, the Baermann technique and a real time polymerase chain reaction test (these last two specific for S. stercoralis). Statistical analyses were performed between two large age groups, children (≤14 years old) and adults (≥15 years old). RESULTS The prevalence of helminths was 91.3%; (95% CI: 89.3-93.3%). Hookworm was the most prevalent, 78.7% (95% CI 75.6-81.4%), followed by S. stercoralis 55.7% (95% CI 52.2-59.1%). Co-infection with both was detected in 45.4% (95% CI 42.0-49.0%) of the participants. The mean age of hookworm-infected individuals was significantly higher than non-infected ones (p = 0.003). Also, S. stercoralis infection was significantly associated with age, being more prevalent in adults (p = 0.002). CONCLUSIONS This is the highest prevalence of S. stercoralis detected in Ethiopia so far. Our results highlight the need of searching specifically for infection by this parasite since it usually goes unnoticed if helminth studies rely only on conventional diagnostic techniques, i.e. Kato-Katz. Moreover, the focus of these programs on children undermines the actual prevalence of hookworm. The adult population acts as a reservoir for both hookworm and S. stercoralis and this fact may negatively impact the current control programs in Ethiopia which only target treatment of school aged children. This reservoir, together with a lack of adequate water, sanitation and hygiene, increases the probability of re-infection in children. Finally, the high prevalence of S. stercoralis found calls for a comprehensive diagnostic approach in endemic areas in addition to a revision of control measures that is, adding ivermectin to current albendazole/mebendazole, since it is the drug of choice for S. stercoralis.
Collapse
Affiliation(s)
- Aranzazu Amor Aramendia
- Mundo Sano Foundation, Madrid, Spain
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- * E-mail:
| | - Melaku Anegagrie
- Mundo Sano Foundation, Madrid, Spain
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Derjew Zewdie
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elena Dacal
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Jose M. Saugar
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Zaida Herrador
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Tadesse Hailu
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Mulat Yimer
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - María V. Periago
- Mundo Sano Foundation, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Esperanza Rodriguez
- Laboratory of Reference and Research on Parasitology, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Agustín Benito
- National Center for Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
18
|
Muadica AS, Balasegaram S, Beebeejaun K, Köster PC, Bailo B, Hernández-de-Mingo M, Dashti A, Dacal E, Saugar JM, Fuentes I, Carmena D. Risk associations for intestinal parasites in symptomatic and asymptomatic schoolchildren in central Mozambique. Clin Microbiol Infect 2020; 27:624-629. [PMID: 32505583 DOI: 10.1016/j.cmi.2020.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Chronic infections by enteric parasites including protist and helminthic species produce long-term sequelae on the health status of infected children. This study assesses potential associations linked with enteric parasite infections in symptomatic and asymptomatic children in Zambézia province, Mozambique. METHODS In this prospective cross-sectional study, stool samples and epidemiological questionnaires on demographics and risk associations were collected from symptomatic children (n = 286) from clinical settings and asymptomatic (n = 807) children from 17 schools and creches aged 3‒14 years. We detected enteric parasites using PCR-based methods. We calculated prevalence (adjusted for age, sex, house construction, drinking water, and latrine use) and odds ratios (ORs) for risk associations with logistic regression, after adjusting for district, neighbourhood and symptoms. RESULTS Numbers and adjusted prevalence (95% confidence intervals in parentheses) for the symptomatic and asymptomatic populations were Giardia duodenalis 120, 52% (22-82), 339, 42% (25-59); followed by Strongyloides stercoralis 52, 14% (9‒20), 180, 20% (15-25). Risk associations for G. duodenalis included drinking untreated river/spring water, OR 2.91 (1.80-4.70); contact with ducks, OR 14.96 (2.93‒76.31); dogs, OR 1.92 (1.04-3.52); cats, OR 1.73 (1.16-2.59), and a relative with diarrhoea, OR 2.59 (1.54‒4.37). Risk associations for S. stercoralis included having no latrine, OR 2.41 (1.44-4.02); drinking well water, OR 1.82 (1.02-3.25), and increasing age, OR 1.11 (1.04-1.20). CONCLUSIONS We found a high prevalence of intestinal parasites regardless of the children's symptoms. Drinking well or river water, domestic animals, and latrine absence were contributing factors of human infections.
Collapse
Affiliation(s)
- A S Muadica
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain; Departamento de Ciências e Tecnologia, Universidade Licungo, Quelimane, Zambézia, Mozambique
| | - S Balasegaram
- Field Epidemiology Services, National Infection Service, Public Health England, London, UK
| | - K Beebeejaun
- Field Epidemiology Services, National Infection Service, Public Health England, London, UK
| | - P C Köster
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - B Bailo
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - M Hernández-de-Mingo
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - A Dashti
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - E Dacal
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - J M Saugar
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - I Fuentes
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain
| | - D Carmena
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Madrid, Spain.
| |
Collapse
|
19
|
Rivero-Juarez A, Dashti A, López-López P, Muadica AS, Risalde MDLA, Köster PC, Machuca I, Bailo B, de Mingo MH, Dacal E, García-Bocanegra I, Saugar JM, Calero-Bernal R, González-Barrio D, Rivero A, Briz V, Carmena D. Protist enteroparasites in wild boar (Sus scrofa ferus) and black Iberian pig (Sus scrofa domesticus) in southern Spain: a protective effect on hepatitis E acquisition? Parasit Vectors 2020; 13:281. [PMID: 32493465 PMCID: PMC7271453 DOI: 10.1186/s13071-020-04152-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Several studies have independently evaluated the occurrence of hepatitis E virus (HEV) and enteroparasites in swine, but no surveys have been conducted to jointly assess the prevalence and genetic diversity of enteroparasites in pigs and wild boars, their sympatric transmission between hosts, and their potential interaction with HEV. METHODS We prospectively collected serum and faecal samples from black Iberian domestic pigs and wild boars from southern Spain between 2015‒2016. We evaluated for HEV in serum and faeces, and for the presence of enteroparasites (Giardia duodenalis, Cryptosporidium spp., Blastocystis sp., Neobalantidium coli and Strongyloides spp.) in the same faecal samples. The prevalence of each intestinal parasite species was calculated. RESULTS A total of 328 animals (56.7% black Iberian pigs and 43.3% wild boars) were included in the study. The overall global prevalence of HEV in serum was 16.8%. The overall global prevalence of each enteroparasite species was 19.5% for G. duodenalis, 8.2% for Cryptosporidium spp., 41.8% for Blastocystis sp., 31.4% for N. coli, and 8.8% for Strongyloides spp. HEV-infected animals showed a significantly lower prevalence of G. duodenalis (3.2 vs 20%; P = 0.002) and Blastocystis sp. (38.7 vs 80%; P < 0.001) than those uninfected by HEV. Animals carrying G. duodenalis and Blastocystis sp. infections showed a significantly lower rate of HEV infection than those not harbouring these enteroparasites (P < 0.001). CONCLUSIONS Our study found a high prevalence of enteroparasites in black Iberian pigs and wild boars in southern Spain, suggesting a sympatric co-transmission of some of the species investigated. It is suggested that extracellular G. duodenalis and Blastocystis sp. might have a protective effect on HEV acquisition in swine.
Collapse
Affiliation(s)
- Antonio Rivero-Juarez
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, Córdoba, University of Córdoba, Córdoba, Spain
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Pedro López-López
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, Córdoba, University of Córdoba, Córdoba, Spain
| | - Aly Salimo Muadica
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Maria de los Angeles Risalde
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, Córdoba, University of Córdoba, Córdoba, Spain
- Department of Anatomy and Compared Pathological Anatomy, University of Córdoba, Agrifood Excellence International Campus (ceiA3), Córdoba, Spain
| | - Pamela C. Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, Córdoba, University of Córdoba, Córdoba, Spain
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Marta Hernández de Mingo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Elena Dacal
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Ignacio García-Bocanegra
- Department of Animal Health, Faculty of Veterinary, University of Córdoba-Agrifood Excellence International Campus (ceiA3), Córdoba, Spain
| | - José M. Saugar
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Rafael Calero-Bernal
- SALUVET, Department of Animal Health, Faculty of Veterinary, Complutense University of Madrid, Madrid, Spain
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
- SALUVET, Department of Animal Health, Faculty of Veterinary, Complutense University of Madrid, Madrid, Spain
- Viral Hepatitis Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, Córdoba, University of Córdoba, Córdoba, Spain
| | - Verónica Briz
- Viral Hepatitis Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Majadahonda, Madrid Spain
| |
Collapse
|
20
|
Yunus MH, Arifin N, Balachandra D, Anuar NS, Noordin R. Lateral Flow Dipstick Test for Serodiagnosis of Strongyloidiasis. Am J Trop Med Hyg 2020; 101:432-435. [PMID: 31218996 DOI: 10.4269/ajtmh.19-0053] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The conventional method of detecting Strongyloides stercoralis in fecal samples has poor diagnostic sensitivity. Detection of Strongyloides-specific antibodies increases the sensitivity; however, most tests are ELISAs that use parasite extract which may cross-react with the sera of other helminth infections. To improve the serological diagnosis of strongyloidiasis, this study aimed at developing a sensitive and specific lateral flow rapid dipstick test. Two recombinant proteins, recombinant NIE (rNIE) and recombinant Ss1a (rSs1a), were used in preparing the dipstick, with gold-conjugated antihuman IgG4 as detector reagent. In parallel, the corresponding ELISA was performed. Both assays demonstrated diagnostic sensitivity of 91.3% (21/23) when tested with serum samples of patients with Strongyloides infection, and 100% specificity with 82 sera of asymptomatic (healthy) and those with other parasitic infections. The ELISA and dipstick test results were positively correlated to each other (r = 0.6114, P = 0.0019). The developed lateral flow dipstick test may improve the serodiagnosis of strongyloidiasis and merit further validation studies.
Collapse
Affiliation(s)
- Muhammad Hafiznur Yunus
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Norsyahida Arifin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Dinesh Balachandra
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Nor Suhada Anuar
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia
| |
Collapse
|
21
|
Sanchez-Thevenet P, Carmena D, Adell-Aledón M, Dacal E, Arias E, Saugar JM, Rodríguez E, Dea-Ayuela MA. High Prevalence and Diversity of Zoonotic and Other Intestinal Parasites in Dogs from Eastern Spain. Vector Borne Zoonotic Dis 2019; 19:915-922. [DOI: 10.1089/vbz.2019.2468] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Paula Sanchez-Thevenet
- Department of Medicine, Cardenal Herrera-CEU University, CEU Universities, Castellón, Spain
| | - David Carmena
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - Manuel Adell-Aledón
- Department of Medicine, Cardenal Herrera-CEU University, CEU Universities, Castellón, Spain
| | - Elena Dacal
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - Eva Arias
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - José María Saugar
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - Esperanza Rodríguez
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | | |
Collapse
|
22
|
Umemneku Chikere CM, Wilson K, Graziadio S, Vale L, Allen AJ. Diagnostic test evaluation methodology: A systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard - An update. PLoS One 2019; 14:e0223832. [PMID: 31603953 PMCID: PMC6788703 DOI: 10.1371/journal.pone.0223832] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To systematically review methods developed and employed to evaluate the diagnostic accuracy of medical test when there is a missing or no gold standard. STUDY DESIGN AND SETTINGS Articles that proposed or applied any methods to evaluate the diagnostic accuracy of medical test(s) in the absence of gold standard were reviewed. The protocol for this review was registered in PROSPERO (CRD42018089349). RESULTS Identified methods were classified into four main groups: methods employed when there is a missing gold standard; correction methods (which make adjustment for an imperfect reference standard with known diagnostic accuracy measures); methods employed to evaluate a medical test using multiple imperfect reference standards; and other methods, like agreement studies, and a mixed group of alternative study designs. Fifty-one statistical methods were identified from the review that were developed to evaluate medical test(s) when the true disease status of some participants is unverified with the gold standard. Seven correction methods were identified and four methods were identified to evaluate medical test(s) using multiple imperfect reference standards. Flow-diagrams were developed to guide the selection of appropriate methods. CONCLUSION Various methods have been proposed to evaluate medical test(s) in the absence of a gold standard for some or all participants in a diagnostic accuracy study. These methods depend on the availability of the gold standard, its' application to the participants in the study and the availability of alternative reference standard(s). The clinical application of some of these methods, especially methods developed when there is missing gold standard is however limited. This may be due to the complexity of these methods and/or a disconnection between the fields of expertise of those who develop (e.g. mathematicians) and those who employ the methods (e.g. clinical researchers). This review aims to help close this gap with our classification and guidance tools.
Collapse
Affiliation(s)
- Chinyereugo M. Umemneku Chikere
- Institute of Health & Society, Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Kevin Wilson
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Sara Graziadio
- National Institute for Health Research, Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals National Health Services Foundation Trust, Newcastle upon Tyne, England, United Kingdom
| | - Luke Vale
- Institute of Health & Society, Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - A. Joy Allen
- National Institute for Health Research, Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| |
Collapse
|
23
|
Fradejas I, Herrero-Martínez JM, Lizasoaín M, Rodríguez de Las Parras E, Pérez-Ayala A. Comparative study of two commercial tests for Strongyloides stercoralis serologic diagnosis. Trans R Soc Trop Med Hyg 2019; 112:561-567. [PMID: 30219904 DOI: 10.1093/trstmh/try101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/16/2018] [Indexed: 11/14/2022] Open
Abstract
Background Serological diagnosis of Strongyloides stercoralis is often limited by its low specificity due to cross-reactivity with other parasitic nematodes. Novel serological tests assumed to be more specific have been recently developed. The aim of our study was to compare two commercial tests based on different antigens for S. stercoralis diagnosis in humans from a non-endemic area. Methods A retrospective laboratory-based study was conducted in the Hospital Universitario 12 de Octubre, Madrid, Spain. Samples from patients with a requested S. stercoralis serology from January 2013 to October 2016 were tested with two commercial enzyme-linked immunosorbent assay (ELISA) tests (crude larval suspension ELISA [CrAg-ELISA] and recombinant antigen ELISA [NIE-ELISA]). Sensitivity, specificity and predictive values were calculated using primary and composite gold standards. The κ index was calculated. Results A total of 249 samples from 233 patients were tested (κ=0.735). The CrAg-ELISA yielded sensitivities from 89.2% (95% confidence interval [CI] 80.7 to 94.2) to 94.7% (95% CI 75.4 to 99.0) and the NIE-ELISA from 72.3% (95% CI 58.2 to 83.1) to 78.9% (95% CI 56.7 to 91.5). Specificity ranged from 72.3% (95% CI 58.2 to 83.1) to 89.3% (95% CI 83.1 to 93.4) for the CrAg-ELISA and from 85.1% (95% CI 72.3 to 92.6) to 93.6% (95% CI 88.2 to 96.6) for the NIE-ELISA. Conclusions The NIE-ELISA is more specific than the CrAg-ELISA, but its low sensitivity limits its use in S. stercoralis screening. New diagnostic tests are needed for the diagnosis of S. stercoralis.
Collapse
Affiliation(s)
- Isabel Fradejas
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, Madrid, Spain
| | - J M Herrero-Martínez
- Internal Medicine and Infectious Diseases Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Lizasoaín
- Internal Medicine and Infectious Diseases Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Ana Pérez-Ayala
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, Madrid, Spain
| |
Collapse
|
24
|
Renelies-Hamilton J, Noguera-Julian M, Parera M, Paredes R, Pacheco L, Dacal E, Saugar JM, Rubio JM, Poulsen M, Köster PC, Carmena D. Exploring interactions between Blastocystis sp., Strongyloides spp. and the gut microbiomes of wild chimpanzees in Senegal. INFECTION GENETICS AND EVOLUTION 2019; 74:104010. [PMID: 31442596 DOI: 10.1016/j.meegid.2019.104010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/02/2019] [Accepted: 08/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gut parasites exert an important influence on the gut microbiome, with many studies focusing on the human gut microbiome. It has, however, undergone severe richness depletion. Hygienic lifestyle, antimicrobial treatments and altered gut homeostasis (e.g., chronic inflammation) reduce gut microbiome richness and also parasite prevalence; which may confound results. Studying species closely related to humans could help overcome this problem by providing insights into the ancestral relationship between humans, their gut microbiome and their gut parasites. Chimpanzees are a particularly promising model as they have similar gut microbiomes to humans and many parasites infect both species. AIMS We study the interaction between gut microbiome and enteric parasites in chimpanzees. Investigating what novel insights a closely related species can reveal when compared to studies on humans. METHODS Using eighty-seven faecal samples from wild western chimpanzees (Pan troglodytes verus) in Senegal, we combine 16S rRNA gene amplicon sequencing for gut microbiome characterization with PCR detection of parasite taxa (Blastocystis sp., Strongyloides spp., Giardia duodenalis, Cryptosporidium spp., Plasmodium spp., Filariae and Trypanosomatidae). We test for differences in gut microbiota ecosystem traits and taxonomical composition between Blastocystis and Strongyloides bearing and non-bearing samples. RESULTS For Blastocystis, twelve differentially abundant taxa (e.g., Methanobrevibacter), including Prevotella and Ruminococcus-Methanobrevibacter enterotype markers, replicate findings in humans. However, several richness indices are lower in Blastocystis carriers, contradicting human studies. This indicates Blastocystis, unlike Strongyloides, is associated to a "poor health" gut microbiome, as does the fact that Faecalibacterium, a bacterium with gut protective traits, is absent in Blastocystis-positive samples. Strongyloides was associated to Alloprevotella and five other taxonomic groups. Each parasite had its unique impact on the gut microbiota indicating parasite-specific niches. Our results suggest that studying the gut microbiomes of wild chimpanzees could help disentangle biological from artefactual associations between gut microbiomes and parasites.
Collapse
Affiliation(s)
- Justinn Renelies-Hamilton
- Section for Ecology and Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark; Jane Goodall Institute Spain, Station Biologique Fouta Djallon, Dindéfélo, Kédougou, Senegal.
| | - Marc Noguera-Julian
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain; Chair in AIDS and Related Illnesses, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Vic, Spain
| | - Mariona Parera
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain; Chair in AIDS and Related Illnesses, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Vic, Spain
| | - Liliana Pacheco
- Jane Goodall Institute Spain, Station Biologique Fouta Djallon, Dindéfélo, Kédougou, Senegal
| | - Elena Dacal
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - José M Saugar
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - José M Rubio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - Michael Poulsen
- Section for Ecology and Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Pamela C Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Spain
| |
Collapse
|
25
|
Comparison of Loop-Mediated Isothermal Amplification and Real-Time PCR Assays for Detection of Strongyloides Larvae in Different Specimen Matrices. J Clin Microbiol 2019; 57:JCM.01173-18. [PMID: 30728195 DOI: 10.1128/jcm.01173-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/29/2019] [Indexed: 12/27/2022] Open
Abstract
Strongyloides stercoralis can cause disease that ranges from asymptomatic chronic infection to fatal hyperinfection. Diagnosis from stool can be challenging because the most sensitive conventional tests require live larvae to be effective and there can be low larval output in chronic infection. Nucleic acid amplification tests (NAAT) have been developed to complement existing diagnostic methods. We compared a recently developed loop-mediated isothermal amplification (LAMP) assay with a real-time PCR that has previously been validated with larval microscopy. The limits of detection-quantified using serial dilutions of DNA extracts from single Strongyloides ratti third-stage (L3) larvae spiked into approximately 250 µl of 5 different S. stercoralis-negative stool specimens-were 10-3 (1/5 replicates) and 10-2 (1/5 replicates) dilutions for PCR and LAMP, respectively. PCR was positive for 4/5 replicates at 10-2 LAMP was compared to PCR using extracts from 396 stool specimens collected in Bangladesh and Australia, of which 53 were positive and 343 were negative by PCR. The positive percentage agreement of LAMP was 77.3% (95% score confidence interval [CI], 64.5 to 86.6). The negative percentage agreement was 100% (95% CI, 98.9 to 100). In a preliminary investigation, PCR and LAMP assays were positive using DNA extracted from serum (PCR, 3/16 extracts; LAMP, 2/16 extracts) and bronchoalveolar lavage fluid (PCR and LAMP, 2/2 extracts), demonstrating proof of concept. Compared to PCR, the lower number of positive results using the LAMP assay may have been due to reaction inhibitors and DNA degradation, and strategies to improve the LAMP assay are discussed.
Collapse
|
26
|
Kristanti H, Meyanti F, Wijayanti MA, Mahendradhata Y, Polman K, Chappuis F, Utzinger J, Becker SL, Murhandarwati EEH. Diagnostic comparison of Baermann funnel, Koga agar plate culture and polymerase chain reaction for detection of human Strongyloides stercoralis infection in Maluku, Indonesia. Parasitol Res 2018; 117:3229-3235. [PMID: 30074085 DOI: 10.1007/s00436-018-6021-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/19/2018] [Indexed: 12/27/2022]
Abstract
Human infection with the nematode Strongyloides stercoralis, which may have a life-threatening course, primarily occurs in tropical settings. Epidemiological data on the occurrence of strongyloidiasis are scarce, and microscopic stool-based detection methods are insensitive. Polymerase chain reaction (PCR) assays have been developed, yet conflicting results have been reported. Our goal was to determine whether there was diagnostic agreement between an in-house PCR and two microscopic techniques, the Baermann funnel (BM) and the Koga agar plate culture (KAP) for the detection of S. stercoralis in stool samples. Eighty ethanol-fixed stool samples stemming from a cross-sectional survey in Maluku, Indonesia, were purposefully selected for PCR analysis. The final sample size comprised four groups, each with 20 samples: group 1, positive for S. stercoralis on both BM and KAP; group 2, positive only by BM; group 3, positive only by KAP; and group 4, negative on both BM and KAP. A Strongyloides-specific PCR targeting the internal transcribed spacer 2 (ITS2) region was carried out in an Indonesian reference laboratory. The overall agreement between PCR and microscopy was 61% (49/80 samples), being highest in group 1 (15/20, 75%) and lowest in group 3 (9/20, 45%). PCR revealed eight additional S. stercoralis infections in group 4. Future studies should elucidate the 'true' infection status of samples that are negative by PCR, but positive upon microscopy. Taken together, there is a lack of agreement between microscopy and PCR results for the diagnosis of human S. stercoralis infection in Indonesia. ClinicalTrials.gov (identifier: NCT02105714).
Collapse
Affiliation(s)
- Handriani Kristanti
- Postgraduate Programme of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fransiska Meyanti
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mahardika Agus Wijayanti
- Postgraduate Programme of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Katja Polman
- Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
| | - E Elsa Herdiana Murhandarwati
- Postgraduate Programme of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Department of Parasitology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| |
Collapse
|
27
|
Paula FM, Malta FM, Marques PD, Melo GB, Corral MA, Gottardi M, Pinho JRR, Gonçalves EMN, Castilho VLP, Pierrotti LC, Abdala E, Costa SF, Chieffi PP, Gryschek RCB. Molecular diagnosis of Strongyloides stercoralis among transplant candidates. Transpl Infect Dis 2018; 20:e12909. [PMID: 29679429 DOI: 10.1111/tid.12909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 02/22/2018] [Accepted: 03/25/2018] [Indexed: 11/29/2022]
Abstract
Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection, principally in immunosuppressed patients. Our study aimed to evaluate the application of conventional polymerase chain reaction (cPCR) and real-time PCR (qPCR). Polymerase chain reaction (PCR) and real-time PCR (qPCR) targeting the 18S rRNA gene for detection of Strongyloides stercoralis infection among transplant candidates were applied in stool samples obtained from 150 transplant candidates, preliminarily analyzed by parasitological methods. S. stercoralis larvae were visualized in 15/150 (10.0%) transplant candidates by parasitological methods. DNA from S. stercoralis was amplified in 26/150 (17.3%) and 49/150 (32.7%) stool samples of transplant candidates, using cPCR and qPCR, respectively. The results suggest that molecular methods, especially qPCR, should be used as an additional tool for diagnostic of S. stercoralis infection among transplant candidates.
Collapse
Affiliation(s)
- Fabiana M Paula
- Laboratório de Investigação Médica (LIM/06 - Laboratório de Imunopatologia da Esquistossomose), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil.,Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil
| | - Fernanda M Malta
- Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil.,Laboratório de Investigação Médica (LIM/07 - Laboratório de Gastroenterologia e Hepatologia Tropical), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil
| | - Priscilla D Marques
- Laboratório de Investigação Médica (LIM/06 - Laboratório de Imunopatologia da Esquistossomose), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil.,Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil
| | - Gessica B Melo
- Laboratório de Investigação Médica (LIM/06 - Laboratório de Imunopatologia da Esquistossomose), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil.,Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil
| | - Marcelo A Corral
- Laboratório de Investigação Médica (LIM/06 - Laboratório de Imunopatologia da Esquistossomose), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil
| | - Maiara Gottardi
- Laboratório de Investigação Médica (LIM/06 - Laboratório de Imunopatologia da Esquistossomose), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil
| | - João R R Pinho
- Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil.,Laboratório de Investigação Médica (LIM/07 - Laboratório de Gastroenterologia e Hepatologia Tropical), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil
| | - Elenice M N Gonçalves
- Seção de Parasitologia da Divisão de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil
| | - Vera L P Castilho
- Seção de Parasitologia da Divisão de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil
| | | | | | | | - Pedro P Chieffi
- Faculdade de Ciências Médicas, Santa Casa, São Paulo, Brazil
| | - Ronaldo C B Gryschek
- Laboratório de Investigação Médica (LIM/06 - Laboratório de Imunopatologia da Esquistossomose), Hospital das Clínicas da Faculdade de Medicina, USP, São Paulo, Brazil.,Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil.,Faculdade de Medicina, USP, São Paulo, Brazil
| |
Collapse
|
28
|
Evaluation of Two DNA Extraction Methods for Detection of Strongyloides stercoralis Infection. J Clin Microbiol 2018; 56:JCM.01941-17. [PMID: 29367294 DOI: 10.1128/jcm.01941-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/17/2018] [Indexed: 11/20/2022] Open
Abstract
Strongyloides stercoralis is present worldwide, but its prevalence is still uncertain, mainly due to the lack of sensitivity of diagnostic methods. Molecular techniques are under development, but a standardized protocol is still unavailable. We compared the sensitivity of real-time PCR, using two extraction protocols, with that of the Baermann technique. Samples were collected in the framework of the baseline screening of a randomized clinical trial evaluating moxidectin against S. stercoralis in Lao People's Democratic Republic. Two stool samples from each participant were processed by the Baermann method, and one subsample was processed by PCR. DNA was extracted using the QIAamp DNA stool minikit based on the standard protocol for the QIAamp DNA minikit (QIA) and using a modification of the QIA procedure (POL). Subsequently, all extracted samples were analyzed by real-time PCR. Overall, 95 samples were analyzed by the three diagnostic methods. Sixty-nine (72.6%) samples were positive according to the Baermann method, 25 (26.3%) by the QIA method, and 62 (65.3%) by the POL method. The sensitivities were 86% (95% confidence interval [CI], 76.7 to 92.9), 31.0% (95% CI, 21.3 to 42.6), and 78.0% (95% CI, 66.8 to 86.1) for the Baermann, QIA, and POL methods, respectively. The sensitivities calculated for each day of the Baermann method separately were 60% (48.4 to 70.8%) and 64% (52.2 to 74.2%) for days 1 and 2, respectively. In conclusion, the POL method revealed a good performance and was comparable to the Baermann test performed on two stool samples and superior to the Baermann method performed on one stool sample. Additional studies are needed to standardize a PCR protocol for S. stercoralis diagnosis.
Collapse
|
29
|
Flores MD, Gonzalez LM, Hurtado C, Motta YM, Domínguez-Hidalgo C, Merino FJ, Perteguer MJ, Gárate T. HDP2: a ribosomal DNA (NTS-ETS) sequence as a target for species-specific molecular diagnosis of intestinal taeniasis in humans. Parasit Vectors 2018; 11:117. [PMID: 29486767 PMCID: PMC6389257 DOI: 10.1186/s13071-018-2646-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Taenia solium, T. asiatica and T. saginata tapeworms cause human taeniasis and are the origin of porcine and bovine cysticercosis. Furthermore, T. solium eggs can cause human cysticercosis, with neurocysticercosis being the most serious form of the disease. These helminth infections are neglected tropical diseases and are endemic in several countries in the Americas, Asia and Africa. As a result of globalization, migration in particular, the infections have been extending to non-endemic territories. Species-specific diagnosis of taeniasis is subject to drawbacks that could be resolved using molecular approaches. In the present study, conventional and real-time amplification protocols (cPCR and qPCR) based on the T. saginata HDP2 sequence were applied in the differential diagnosis of taeniasis (T. saginata, T. solium) in both fecal samples and proglottids expelled by patients. The HDP2 homolog in T. solium was cloned and characterized. Results Semi-nested cPCR and qPCR (Sn-HDP2 cPCR and Sn-HDP2 qPCR) amplified T. saginata and T. solium DNA, with an analytical sensitivity of 40 and 400 fg, respectively, and identically in both protocols. Eighteen taeniasis patients were diagnosed directly with T. saginata or T. solium, either from proglottids or fecal samples with/without eggs (detected using microscopy), based on the optimized Sn-HDP2 qPCR. After cloning, the T. solium HDP2 homolog sequence was confirmed to be a ribosomal sequence. The HDP2 fragment corresponded to a non-transcribed sequence/external transcribed repeat (NTS/ETS) of ribosomal DNA. Compared with the T. saginata HDP2 homolog, the T solium HDP2 sequence lacked the first 900 nt at the 5′ end and showed nucleotide substitutions and small deletions. Conclusions Sn-HDP2 cPCR and Sn-HDP2 qPCR were set up for the diagnosis of human taeniasis, using proglottids and fecal samples from affected patients. The new Sn-HDP2 qPCR protocol was the best option, as it directly differentiated T. saginata from T. solium. The diagnosis of an imported T. solium-taeniasis case and nine European T. saginata cases was relevant. Finally, the cloning and sequencing of the T. solium HDP2 fragment confirmed that HDP2 was part of a ribosomal unit. Electronic supplementary material The online version of this article (10.1186/s13071-018-2646-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- María D Flores
- Parasitology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Crtra, Majadahonda-Pozuelo, km 2.2, 28220, Majadahonda, Madrid, Spain.
| | - Luis M Gonzalez
- Parasitology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Crtra, Majadahonda-Pozuelo, km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Carolina Hurtado
- Parasitology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Crtra, Majadahonda-Pozuelo, km 2.2, 28220, Majadahonda, Madrid, Spain.,Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, 28668, Montepríncipe, Madrid, Spain
| | - Yamileth Monje Motta
- Programa de Medicina, Facultad de Salud, Universidad del Magdalena, 47004, Santa Marta D.T.C.H, Colombia
| | - Cristina Domínguez-Hidalgo
- Parasitology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Crtra, Majadahonda-Pozuelo, km 2.2, 28220, Majadahonda, Madrid, Spain
| | | | - María J Perteguer
- Parasitology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Crtra, Majadahonda-Pozuelo, km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Teresa Gárate
- Parasitology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Crtra, Majadahonda-Pozuelo, km 2.2, 28220, Majadahonda, Madrid, Spain.
| |
Collapse
|
30
|
Dacal E, Saugar JM, de Lucio A, Hernández-de-Mingo M, Robinson E, Köster PC, Aznar-Ruiz-de-Alegría ML, Espasa M, Ninda A, Gandasegui J, Sulleiro E, Moreno M, Salvador F, Molina I, Rodríguez E, Carmena D. Prevalence and molecular characterization of Strongyloides stercoralis, Giardia duodenalis, Cryptosporidium spp., and Blastocystis spp. isolates in school children in Cubal, Western Angola. Parasit Vectors 2018; 11:67. [PMID: 29378626 PMCID: PMC5789528 DOI: 10.1186/s13071-018-2640-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Human infections by the gastrointestinal helminth Strongyloides stercoralis and the enteric protozoans Giardia duodenalis, Cryptosporidium spp. and Blastocystis spp. are not formally included in the list of 20 neglected tropical diseases prioritised by the World Health Organization. Although largely underdiagnosed and considered of lower public health relevance, these infections have been increasingly demonstrated to cause significant morbidity and even mortality globally, particularly among children living in resource-poor settings. METHODS In this cross-sectional survey the prevalence, frequency and molecular diversity of S. stercoralis, G. duodenalis, Cryptosporidium spp. and Blastocystis spp. were investigated in a school children population in the province of Benguela (Angola). A total of 351 stool samples were collected during January to June 2015. The presence of S. stercoralis and G. duodenalis was confirmed by qPCR methods. Giardia duodenalis assemblages and sub-assemblages were determined by multilocus sequence-based genotyping of the glutamate dehydrogenase and β-giardin genes of the parasite. Detection and identification of Cryptosporidium and Blastocystis species and subtypes was carried out by amplification and sequencing of a partial fragment of the small-subunit ribosomal RNA gene of both protozoan. Analyses of risk factors potentially associated with the transmission of these pathogens were also conducted. RESULTS Prevalences of S. stercoralis, G. duodenalis, Cryptosporidium spp., and Blastocystis spp. were estimated at 21.4% (95% CI: 17.1-25.7%), 37.9% (95% CI: 32.8-43.0%), 2.9% (95% CI: 1.1-4.5%) and 25.6% (95% CI: 21.18-30.2%), respectively. Overall, 64.1% (225/351) of the children were infected by at least one of the pathogens investigated. Sequence analyses of the 28 G. duodenalis isolates that were successfully genotyped allowed the identification of sub-assemblages AI (14.3%), AII (14.3%), BIII (7.1%) and BIV (25.0%). Discordant typing results AII/AIII and BIII/BIV were identified in 7.1% and 14.3% of the isolates, respectively. A total of five additional isolates (17.9%) were identified as assemblage B. Three Cryptosporidium species including C. hominis (70%), C. parvum (20%) and C. canis (10%) were found circulating in the children population under study. A total of 75 Blastocystis isolates were assigned to the subtypes ST1 (30.7%), ST2 (30.7%), ST3 (36.0%), ST5 (1.3%) and ST7 (1.3%), respectively. Children younger than seven years of age had significantly higher risk of infections by protozoan enteropathogens (PRR: 1.35, P < 0.01), whereas being underweight seemed to have a protective effect against these infections (PRR: 0.74, P = 0.005). CONCLUSIONS The burden of disease attributable to human strongyloidiasis, giardiosis, cryptosporidiosis and blastocystosis in Angola is considerably higher than initially estimated in previous surveys. Surveillance and control of these infections should be jointly tackled with formally considered neglected tropical diseases in order to maximize effort and available resources. Our data also demonstrate the added value of using molecular diagnostic methods in high transmission areas.
Collapse
Affiliation(s)
- Elena Dacal
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | - José M. Saugar
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | - Aida de Lucio
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | - Marta Hernández-de-Mingo
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | - Elena Robinson
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | - Pamela C. Köster
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | | | - Mateu Espasa
- 0000 0001 0675 8654grid.411083.fMicrobiology Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Arlette Ninda
- Hospital Nossa Senhora da Paz, Cubal, Benguela, Angola
| | - Javier Gandasegui
- 0000 0001 2180 1817grid.11762.33Biomedical Research Institute of Salamanca - Research Center for Tropical Diseases at the University of Salamanca (IBSAL-CIETUS), Faculty of Pharmacy, University of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
| | - Elena Sulleiro
- 0000 0001 0675 8654grid.411083.fMicrobiology Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | | | - Fernando Salvador
- 0000 0001 0675 8654grid.411083.fInfectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Israel Molina
- 0000 0001 0675 8654grid.411083.fInfectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Esperanza Rodríguez
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| | - David Carmena
- 0000 0000 9314 1427grid.413448.eParasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid Spain
| |
Collapse
|
31
|
Application of PCR-Based Tools to Explore Strongyloides Infection in People in Parts of Northern Australia. Trop Med Infect Dis 2017; 2:tropicalmed2040062. [PMID: 30270919 PMCID: PMC6082066 DOI: 10.3390/tropicalmed2040062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 12/24/2022] Open
Abstract
Strongyloidiasis, which is caused by infection with the nematode Strongyloides stercoralis, is endemic to areas of northern Australia. Diagnosis in this region remains difficult due to the distances between endemic communities and diagnostic laboratories, leading to lengthy delays in stool processing for microscopy and culture. PCR represents a viable solution to this difficulty, having potential for high sensitivity detection of S. stercoralis, even in older, unpreserved faecal samples. We prospectively collected 695 faecal specimens that were submitted to The Townsville Hospital Microbiology Laboratory from the North Queensland region for routine parasitological examination, and subjected them to a Strongyloides sp. real-time (q)PCR. Results were confirmed with a novel nested conventional PCR assay targeting the 18S rRNA gene, followed by single-strand conformation polymorphism analysis (SSCP). Of the 695 specimens tested, S. stercoralis was detected in three specimens (0.4%) by classical parasitological methods (direct microscopy and formyl-ether acetate concentration), whereas 42 positives were detected by qPCR (6.0%). Conventional PCR confirmed the real-time PCR results in 24 of the samples (3.5%). Several apparent false-positive results occurred at higher cycle times (Ct) in the qPCR. Use of real-time PCR in these populations is promising for the enhanced detection of disease and to support eradication efforts.
Collapse
|
32
|
Mobley CM, Dhala A, Ghobrial RM. Strongyloides stercoralis in solid organ transplantation: early diagnosis gets the worm. Curr Opin Organ Transplant 2017; 22:336-344. [PMID: 28562417 DOI: 10.1097/mot.0000000000000428] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Strongyloidiasis is a parasitic infection affecting millions of people worldwide. Complications of infection are strongly associated with alcoholism, immunosuppression, and organ transplantation. Delayed diagnosis results in hyperinfection syndrome and disseminated strongyloidiasis leading to mortality rates approaching 80%. Early detection, and prevention of infection and transmission are key to diminish this illness. RECENT FINDINGS In this review, we cover the basic concepts in immunity, immunosuppression, and disorder necessary for understanding the infectious syndromes associated with Strongyloides stercoralis infection. Focused discussion on donor-derived transmission and recipient risk in solid organ transplantation is presented. Current methodology for diagnosis, screening algorithms, and treatment are also reviewed. SUMMARY Strongyloidiasis complicated by hyperinfection and dissemination remains associated with a poor outcome. The poor outcome pleads for a high level of suspicion and aggressive treatment in at-risk patients. As the population of transplant patients continues to increase, the risk of infection also increases, compelling us to address this highly fatal infectious complication in solid organ transplantation (SOT). Here we review the pathology, immunology, diagnosis, and treatment of strongyloides infection in the immunosuppressed SOT population.
Collapse
Affiliation(s)
- Constance M Mobley
- aDepartment of Surgery, Division of Surgical Critical Care bSherrie & Alan Conover Center for Liver Disease & Transplantation, Houston Methodist Hospital, Houston, Texas, USA
| | | | | |
Collapse
|
33
|
Sow D, Parola P, Sylla K, Ndiaye M, Delaunay P, Halfon P, Camiade S, Dieng T, Tine RCK, Faye B, Ndiaye JL, Dieng Y, Gaye O, Raoult D, Bittar F. Performance of Real-Time Polymerase Chain Reaction Assays for the Detection of 20 Gastrointestinal Parasites in Clinical Samples from Senegal. Am J Trop Med Hyg 2017; 97:173-182. [PMID: 28719290 DOI: 10.4269/ajtmh.16-0781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Gastrointestinal parasite infections represent one of the biggest public health problems in the world. Therefore, appropriate innovative tools are needed for assessing interventions to control these infections. This study aims to compare the performance of real-time polymerase chain reaction (PCR) assays to microscopic examination for detection of intestinal parasites. A direct microscopic examination and stool concentration was performed on 98 stool samples from patients attending Senegalese hospitals. Negative microscopic control samples were also collected in Nice and Marseille (France). Species-specific primers/probes were used to detect 20 common gastrointestinal protozoans and helminths. Positive frequency and the sensitivity of each real-time PCR assay were compared with conventional microscopic examination. Real-time PCR was positive in 72 of 98 samples (73.5%), whereas microscopic examination was positive in 37 (37.7%) samples (P < 0.001). The real-time PCR assays were more sensitive than microscopy, with 57.4% (31/54) versus 18.5% (10/54), respectively, in the detection of parasites in asymptomatic patients (P < 0.05). In terms of polyparasitism, there were more coinfections detected by real-time PCR assays compared with microscopic methods (25.5% versus 3.06%). In comparison to parasite prevalence on individual samples, the results showed a perfect agreement (100%) between the two techniques for seven species, whereas discrepancies were observed for the others (agreement percentage varying from 64.2% to 98.9%). Real-time PCR appeared to be superior to microscopic examination for the detection of parasites in stool samples. This assay will be useful in diagnostic laboratories and in the field for evaluating the efficacy of mass drug administration programs.
Collapse
Affiliation(s)
- Doudou Sow
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France.,Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Philippe Parola
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
| | - Khadime Sylla
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Magatte Ndiaye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Pascal Delaunay
- Parasitologie-Mycologie, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, France - MIVEGEC, UMR IRD224 -CNRS 5290-Université de Montpellier, Montpellier Cedex 5, France
| | | | - Sabine Camiade
- Laboratoire Alphabio Hôpital Européen, Marseille, France
| | - Thérèse Dieng
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Roger C K Tine
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Babacar Faye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Jean Louis Ndiaye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Yémou Dieng
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Oumar Gaye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Didier Raoult
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
| | - Fadi Bittar
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
| |
Collapse
|
34
|
Erdem Kivrak E, Atalay Şahar E, Can H, Döşkaya M, Yilmaz M, Pullukçu H, Caner A, Töz H, Gürüz AY, Işikgöz Taşbakan M. Screening of immunocompromised patients at risk of strongyloidiasis in western Turkey using ELISA and real-time PCR. Turk J Med Sci 2017; 47:897-901. [PMID: 28618740 DOI: 10.3906/sag-1605-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/21/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Strongyloides stercoralis causes life-threatening hyperinfection or disseminated strongyloidiasis in immunocompromised patients such as HIV-positive, organ transplantation, and cancer patients. This study investigated the presence of strongyloidiasis in immunocompromised patients for the first time in Turkey. MATERIALS AND METHODS Serum and stool samples were collected from 108 patients (25.9% of them were chronic renal failure and 74.1% were renal transplantation patients) who were admitted to Ege University Medical School in İzmir, located in western Turkey. Serum samples were analyzed by ELISA (DRG, Germany) and the presence of 18S rRNA gene of S. stercoralis was detected in stool samples by real-time PCR. RESULTS The analysis of serum samples showed that only one patient was anti-S. stercoralis IgG antibody and real-time PCR positive (0.92%). The patient was treated twice with albendazole (400 mg/day for 3 days) at 2-week intervals. Follow up real-time PCR was negative and the patient became seronegative 6 months after the initial diagnosis. CONCLUSION This screening showed that the prevalence of strongyloidiasis in this small group of patients who were at risk of strongyloidiasis was 0.92%. Overall, the results showed that more systematic studies are required in Turkey to show the prevalence of strongyloidiasis.
Collapse
Affiliation(s)
- Esra Erdem Kivrak
- Department of Infectious Diseases, Medical School, Ege University, İzmir, Turkey
| | - Esra Atalay Şahar
- Department of Biology, Faculty of Sciences, Ege University, İzmir, Turkey
| | - Hüseyin Can
- Department of Biology, Faculty of Sciences, Ege University, İzmir, Turkey
| | - Mert Döşkaya
- Department of Parasitology, Medical School, Ege University, İzmir, Turkey
| | - Mümtaz Yilmaz
- Department of Internal Medicine, Medical School, Ege University, İzmir, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Diseases, Medical School, Ege University, İzmir, Turkey
| | - Ayşe Caner
- Department of Parasitology, Medical School, Ege University, İzmir, Turkey
| | - Hüseyin Töz
- Department of Internal Medicine, Medical School, Ege University, İzmir, Turkey
| | - Adnan Yüksel Gürüz
- Department of Parasitology, Medical School, Ege University, İzmir, Turkey
| | | |
Collapse
|
35
|
Detection and quantification of soil-transmitted helminths in environmental samples: A review of current state-of-the-art and future perspectives. Acta Trop 2017; 169:187-201. [PMID: 28214519 DOI: 10.1016/j.actatropica.2017.02.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 12/20/2022]
Abstract
It is estimated that over a billion people are infected with soil-transmitted helminths (STHs) globally with majority occurring in tropical and subtropical regions of the world. The roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworms (Ancylostoma duodenale and Necator americanus) are the main species infecting people. These infections are mostly gained through exposure to faecally contaminated water, soil or contaminated food and with an increase in the risk of infections due to wastewater and sludge reuse in agriculture. Different methods have been developed for the detection and quantification of STHs eggs in environmental samples. However, there is a lack of a universally accepted technique which creates a challenge for comparative assessments of helminths egg concentrations both in different samples matrices as well as between locations. This review presents a comparison of reported methodologies for the detection of STHs eggs, an assessment of the relative performance of available detection methods and a discussion of new emerging techniques that could be applied for detection and quantification. It is based on a literature search using PubMed and Science Direct considering all geographical locations. Original research articles were selected based on their methodology and results sections. Methods reported in these articles were grouped into conventional, molecular and emerging techniques, the main steps in each method were then compared and discussed. The inclusion of a dissociation step aimed at detaching helminth eggs from particulate matter was found to improve the recovery of eggs. Additionally the selection and application of flotation solutions that take into account the relative densities of the eggs of different species of STHs also results in higher egg recovery. Generally the use of conventional methods was shown to be laborious and time consuming and prone to human error. The alternate use of nucleic acid-based techniques has improved the sensitivity of detection and made species specific identification possible. However, these nucleic acid based methods are expensive and less suitable in regions with limited resources and skill. The loop mediated isothermal amplification method shows promise for application in these settings due to its simplicity and use of basic equipment. In addition, the development of imaging soft-ware for the detection and quantification of STHs shows promise to further reduce human error associated with the analysis of environmental samples. It may be concluded that there is a need to comparatively assess the performance of different methods to determine their applicability in different settings as well as for use with different sample matrices (wastewater, sludge, compost, soil, vegetables etc.).
Collapse
|
36
|
Buonfrate D, Baldissera M, Abrescia F, Bassetti M, Caramaschi G, Giobbia M, Mascarello M, Rodari P, Scattolo N, Napoletano G, Bisoffi Z. Epidemiology of Strongyloides stercoralis in northern Italy: results of a multicentre case-control study, February 2013 to July 2014. ACTA ACUST UNITED AC 2017; 21:30310. [PMID: 27525375 PMCID: PMC4998510 DOI: 10.2807/1560-7917.es.2016.21.31.30310] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/18/2016] [Indexed: 12/04/2022]
Abstract
Strongyloides stercoralis is a soil-transmitted helminth widely diffused in tropical and subtropical regions of the world. Autochthonous cases have been also diagnosed sporadically in areas of temperate climate. We aimed at defining the epidemiology of strongyloidiasis in immigrants and Italians living in three northern Italian Regions. Screening for S. stercoralis infection was done with serology, confirmation tests were a second serological method or stool agar culture. A case–control approach was adopted and patients with a peripheral eosinophil count ≥ 500/mcL were classified as cases. Of 2,701 individuals enrolled here 1,351 were cases and 1,350 controls; 86% were Italians, 48% women. Italians testing positive were in 8% (97/1,137) cases and 1% (13/1,178) controls (adjusted odds ratio (aOR) 8.2; 95% confidence interval (CI): 4.5–14.8), while positive immigrants were in 17% (36/214) cases and in 2% (3/172) controls (aOR 9.6; 95% CI: 2.9–32.4). Factors associated with a higher risk of infection for all study participants were eosinophilia (p < 0.001) and immigration (p = 0.001). Overall, strongyloidiasis was nine-times more frequent in individuals with eosinophilia than in those with normal eosinophil count.
Collapse
Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar (Verona), Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Strongyloidiasis Current Status with Emphasis in Diagnosis and Drug Research. J Parasitol Res 2017; 2017:5056314. [PMID: 28210503 PMCID: PMC5292188 DOI: 10.1155/2017/5056314] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/08/2016] [Indexed: 12/27/2022] Open
Abstract
Strongyloidiasis is a parasitic neglected disease caused by the nematode Strongyloides stercoralis affecting 30 to 100 million people worldwide. Complications, strongly associated with alcoholism, organ transplants, and HTLV-1 virus, often arise due to late diagnosis, frequently leading to patient death. Lack of preemptive diagnosis is not the only difficulty when dealing with this parasite, since there are no gold standard diagnostic techniques, and the ones used have problems associated with sensitivity, resulting in false negatives. Treatment is also an issue as ivermectin and benzimidazoles administration leads to inconsistent cure rates and several side effects. Researching new anti-Strongyloides drugs is a difficult task since S. stercoralis does not develop until the adult stages in Mus musculus (with the exception of SCID mice), the main experimental host model. Fortunately, alternative parasite models can be used, namely, Strongyloides ratti and S. venezuelensis. However, even with these models, there are other complications in finding new drugs, which are associated with specific in vitro assay protocol steps, such as larvae decontamination. In this review, we highlight the challenges associated with new drug search, the compounds tested, and a list of published in vitro assay methodologies. We also point out advances being made in strongyloidiasis diagnosis so far.
Collapse
|
38
|
A retrospective study comparing agar plate culture, indirect immunofluorescence and real-time PCR for the diagnosis of Strongyloides stercoralis infection. Parasitology 2017; 144:812-816. [DOI: 10.1017/s0031182016002559] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SUMMARYStrongyloides stercoralis is a parasite that can cause death in immunocompromised people. A proper diagnosis is hence essential. The real-time polymerase-chain reaction (RT–PCR) is a novel, promising diagnostic method, that detects the DNA of the parasite in stool samples. In this retrospective study, we compared the sensitivity of agar plate coproculture (APC), an in-house immunofluorescence test (IFAT) and an in-house RT–PCR for the diagnosis of S. stercoralis infection. The study sample was composed by 223 samples. Samples resulting positive to APC, IFAT and RT–PCR were 20, 140 and 25, respectively. When sensitivity was calculated against a composite reference standard, serology confirmed the best performance (sensitivity 95%), followed by RT–PCR (57%) and APC (45%). In conclusion, in a non-endemic setting, serology is the best screening method, while the combination of APC and RT–PCR does not seem a reasonable approach to increase sensitivity. Both methods can have a role as confirmatory tests for selected cases.
Collapse
|
39
|
Amor A, Rodriguez E, Saugar JM, Arroyo A, López-Quintana B, Abera B, Yimer M, Yizengaw E, Zewdie D, Ayehubizu Z, Hailu T, Mulu W, Echazú A, Krolewieki AJ, Aparicio P, Herrador Z, Anegagrie M, Benito A. High prevalence of Strongyloides stercoralis in school-aged children in a rural highland of north-western Ethiopia: the role of intensive diagnostic work-up. Parasit Vectors 2016; 9:617. [PMID: 27903301 PMCID: PMC5131444 DOI: 10.1186/s13071-016-1912-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/24/2016] [Indexed: 12/11/2022] Open
Abstract
Background Soil-transmitted helminthiases (hookworms, Ascaris lumbricoides and Trichuris trichiura) are extremely prevalent in school-aged children living in poor sanitary conditions. Recent epidemiological data suggest that Strongyloides stercoralis is highly unreported. However, accurate data are essential for conducting interventions aimed at introducing control and elimination programmes. Methods We conducted a cross-sectional survey of 396 randomly selected school-aged children in Amhara region in rural area in north-western Ethiopia, to assess the prevalence of S. stercoralis and other intestinal helminths. We examined stools using three techniques: conventional stool concentration; and two S. stercoralis-specific methods, i.e. the Baermann technique and polymerase chain reaction. The diagnostic accuracy of these three methods was then compared. Results There was an overall prevalence of helminths of 77.5%, with distribution differing according to school setting. Soil-transmitted helminths were recorded in 69.2%. Prevalence of S. stercoralis and hookworm infection was 20.7 and 54.5%, respectively, and co-infection was detected in 16.3% of cases. Schistosoma mansoni had a prevalence of 15.7%. Prevalence of S. stercoralis was shown 3.5% by the conventional method, 12.1% by the Baermann method, and 13.4% by PCR, which thus proved to be the most sensitive. Conclusions Our results suggest that S. stercoralis could be overlooked and neglected in Ethiopia, if studies of soil-transmitted helminths rely on conventional diagnostic techniques alone. A combination of molecular and stool microscopy techniques yields a significantly higher prevalence. In view of the fact that current control policies for triggering drug administration are based on parasite prevalence levels, a comprehensive diagnostic approach should instead be applied to ensure comprehensive control of helminth infections.
Collapse
Affiliation(s)
- Aranzazu Amor
- National Center of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain. .,Mundo Sano Foundation, Madrid, Spain.
| | - Esperanza Rodriguez
- Parasitology Service, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - José M Saugar
- Parasitology Service, National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Ana Arroyo
- Service of Microbiology and Parasitology, Hospital La Paz-Carlos III, Madrid, Spain
| | | | - Bayeh Abera
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Yimer
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalew Yizengaw
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Derejew Zewdie
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zimman Ayehubizu
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadesse Hailu
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adriana Echazú
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta, sede regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alejandro J Krolewieki
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta, sede regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Pilar Aparicio
- National School of Health, Institute of health Carlos III, Madrid, Spain
| | - Zaida Herrador
- National Center of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Melaku Anegagrie
- National Center of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain.,Mundo Sano Foundation, Madrid, Spain
| | - Agustín Benito
- National Center of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
40
|
Pacheco-Tenza MI, Ruiz-Maciá JA, Navarro-Cots M, Gregori-Colomé J, Cepeda-Rodrigo JM, Llenas-García J. Strongyloides stercoralis infection in a Spanish regional hospital: Not just an imported disease. Enferm Infecc Microbiol Clin 2016; 36:24-28. [PMID: 27743682 DOI: 10.1016/j.eimc.2016.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Strongyloides stercoralis infection is more prevalent in tropical regions but autochthonous cases have been reported in Spain, mainly in La Safor (Valencia). The objective is to describe the strongyloidiasis cases registered in a regional hospital of Alicante province (Spain) and to determine if they were autochthonous cases. METHODS Retrospective study of all diagnosed cases of strongyloidiasis in Vega Baja Hospital (Orihuela, Alicante) between January 1999 and March 2016. RESULTS A total of 10 cases were found, four of which were autochthonous cases. Two of them presented with a hyper-infection syndrome, with a fatal outcome. All autochthonous cases were in patients ≥69years old with gastrointestinal, cutaneous, and/or respiratory symptoms. Serology was positive in the 8 cases studied. Larvae were found in histopathological samples of the gastrointestinal tract of three patients. CONCLUSIONS We communicate the first autochthonous cases of strongyloidiasis in the region of Vega Baja. Screening programs should be implemented, especially in immunosuppressed patients or patients under chronic corticosteroid treatment.
Collapse
Affiliation(s)
| | | | - María Navarro-Cots
- Servicio de Microbiología, Hospital Vega Baja, San Bartolomé, Alicante, España
| | - Joan Gregori-Colomé
- Servicio de Medicina Interna, Hospital Vega Baja, San Bartolomé, Alicante, España
| | | | - Jara Llenas-García
- Servicio de Medicina Interna, Hospital Vega Baja, San Bartolomé, Alicante, España; Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, España.
| |
Collapse
|
41
|
StrongNet: An International Network to Improve Diagnostics and Access to Treatment for Strongyloidiasis Control. PLoS Negl Trop Dis 2016; 10:e0004898. [PMID: 27607192 PMCID: PMC5015896 DOI: 10.1371/journal.pntd.0004898] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
42
|
O'Connell EM, Nutman TB. Molecular Diagnostics for Soil-Transmitted Helminths. Am J Trop Med Hyg 2016; 95:508-513. [PMID: 27481053 PMCID: PMC5014250 DOI: 10.4269/ajtmh.16-0266] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/29/2016] [Indexed: 12/18/2022] Open
Abstract
Historically, the diagnosis of soil-transmitted helminths (STHs) (e.g., Strongyloides stercoralis, Trichuris trichiura, Ancylostoma duodenale, Necator americanus, and Ascaris lumbricoides) has relied on often-insensitive microscopy techniques. Over the past several years, there has been an effort to use molecular diagnostics, particularly quantitative polymerase chain reaction (qPCR), to detect intestinal pathogens. While some platforms have been approved by regulatory bodies (e.g., Food and Drug Administration) to detect intestinal bacteria, viruses, and protozoa, there are no approved tests currently available for STH. Although studies comparing qPCR to microscopy methods for STH are imperfect, due in large part to a lack of a sufficient gold standard, they do show a significant increase in sensitivity and specificity of qPCR compared with microscopic techniques. These studies, as well as the advantages and disadvantages of using qPCR for STH diagnosis, are discussed. Guidelines for those designing future studies utilizing qPCR are proposed for optimizing results, as is the proposition for using standardized molecular diagnostics routinely for STH in clinical laboratories and for field-based studies when possible.
Collapse
Affiliation(s)
- Elise M O'Connell
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
43
|
Fernández-Soto P, Sánchez-Hernández A, Gandasegui J, Bajo Santos C, López-Abán J, Saugar JM, Rodríguez E, Vicente B, Muro A. Strong-LAMP: A LAMP Assay for Strongyloides spp. Detection in Stool and Urine Samples. Towards the Diagnosis of Human Strongyloidiasis Starting from a Rodent Model. PLoS Negl Trop Dis 2016; 10:e0004836. [PMID: 27415764 PMCID: PMC4945066 DOI: 10.1371/journal.pntd.0004836] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 06/19/2016] [Indexed: 11/28/2022] Open
Abstract
Background Strongyloides stercoralis, the chief causative agent of human strongyloidiasis, is a nematode globally distributed but mainly endemic in tropical and subtropical regions. Chronic infection is often clinically asymptomatic but it can result in severe hyperinfection syndrome or disseminated strongyloidiasis in immunocompromised patients. There is a great diversity of techniques used in diagnosing the disease, but definitive diagnosis is accomplished by parasitological examination of stool samples for morphological identification of parasite. Until now, no molecular method has been tested in urine samples as an alternative to stool samples for diagnosing strongyloidiasis. This study aimed to evaluate the use of a new molecular LAMP assay in a well-established Wistar rat experimental infection model using both stool and, for the first time, urine samples. The LAMP assay was also clinically evaluated in patients´ stool samples. Methodology/Principal Findings Stool and urine samples were obtained daily during a 28-day period from rats infected subcutaneously with different infective third-stage larvae doses of S. venezuelensis. The dynamics of parasite infection was determined by daily counting the number of eggs per gram of feces from day 1 to 28 post-infection. A set of primers for LAMP assay based on a DNA partial sequence in the 18S rRNA gene from S. venezuelensis was designed. The set up LAMP assay (namely, Strong-LAMP) allowed the sensitive detection of S. venezuelensis DNA in both stool and urine samples obtained from each infection group of rats and was also effective in S. stercoralis DNA amplification in patients´ stool samples with previously confirmed strongyloidiasis by parasitological and real-time PCR tests. Conclusions/Significance Our Strong-LAMP assay is an useful molecular tool in research of a strongyloidiasis experimental infection model in both stool and urine samples. After further validation, the Strong-LAMP could also be potentially applied for effective diagnosis of strongyloidiasis in a clinical setting. Human strongyloidiasis, a soil-transmitted infection mainly caused by Strongyloides stercoralis, is one of the most neglected among the so-called neglected tropical diseases (NTDs). The difficult diagnosis lead to an underreporting of infection rates. Strongyloidiasis can easily be misdiagnosed because many infections remain asymptomatic and the lack of sensitivity of the conventional fecal-based techniques for morphologically identification of infective larvae in feces. Although serologic tests are useful, a limitation in standardization to avoid cross-reactions still remains. There is an urgent need to improve more sensitive and specific diagnostic tests, particularly in immunocompromised patients or candidates to immunosuppressive treatments. Several molecular approaches for Strongyloides spp. DNA detection have already been assayed, but they have a very limited use in routine diagnostic, particularly in endemic areas. In addition, all molecular approaches for Strongyloides spp. DNA detection have always been mainly assayed for stool samples and no other more advantageous biological samples, such as urine, have been investigated for molecular purposes. In this study we have developed, for the first time, a molecular assay using LAMP methodology as a simple, sensible and robust method for the detection of S. venezuelensis DNA in a well-established Wistar rats experimental infection in both stool and urine samples. The LAMP assay was also successfully evaluated in patients´ stool samples. Our LAMP assay (Strong-LAMP) is an useful molecular tool in a strongyloidiasis experimental infection model and could be a potential field-friendly diagnostic test in a clinical setting, following further validation.
Collapse
Affiliation(s)
- Pedro Fernández-Soto
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Alicia Sánchez-Hernández
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Javier Gandasegui
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Cristina Bajo Santos
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Julio López-Abán
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - José María Saugar
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Esperanza Rodríguez
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Vicente
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Antonio Muro
- Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
44
|
Repetto SA, Ruybal P, Solana ME, López C, Berini CA, Alba Soto CD, Cappa SMG. Comparison between PCR and larvae visualization methods for diagnosis of Strongyloides stercoralis out of endemic area: A proposed algorithm. Acta Trop 2016; 157:169-77. [PMID: 26868702 DOI: 10.1016/j.actatropica.2016.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
Underdiagnosis of chronic infection with the nematode Strongyloides stercoralis may lead to severe disease in the immunosuppressed. Thus, we have set-up a specific and highly sensitive molecular diagnosis in stool samples. Here, we compared the accuracy of our polymerase chain reaction (PCR)-based method with that of conventional diagnostic methods for chronic infection. We also analyzed clinical and epidemiological predictors of infection to propose an algorithm for the diagnosis of strongyloidiasis useful for the clinician. Molecular and gold standard methods were performed to evaluate a cohort of 237 individuals recruited in Buenos Aires, Argentina. Subjects were assigned according to their immunological status, eosinophilia and/or history of residence in endemic areas. Diagnosis of strongyloidiasis by PCR on the first stool sample was achieved in 71/237 (29.9%) individuals whereas only 35/237(27.4%) were positive by conventional methods, requiring up to four serial stool samples at weekly intervals. Eosinophilia and history of residence in endemic areas have been revealed as independent factors as they increase the likelihood of detecting the parasite according to our study population. Our results underscore the usefulness of robust molecular tools aimed to diagnose chronic S. stercoralis infection. Evidence also highlights the need to survey patients with eosinophilia even when history of an endemic area is absent.
Collapse
|
45
|
Contreras SN, Barreiro Alonso E, Liguori Ljoka ME, Díaz Trapiella A. [Strongyloidiasis native to Asturias]. Semergen 2016; 43:e6-e8. [PMID: 27151772 DOI: 10.1016/j.semerg.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- S N Contreras
- Atención Primaria, Centro de Salud El Coto, Gijón, Asturias, España
| | - E Barreiro Alonso
- Sección de Aparato Digestivo, Hospital de Cabueñes, Gijón, Asturias, España.
| | - M E Liguori Ljoka
- Atención Primaria, Área I, Hospital de Jarrio, Coaña, Asturias, España
| | - A Díaz Trapiella
- Servicio de Hematología y Hemoterapia, Hospital de Cabueñes, Gijón, Asturias, España
| |
Collapse
|
46
|
Gómez-Junyent J, Paredes-Zapata D, de las Parras ER, González-Costello J, Ruiz-Arranz Á, Cañizares R, Saugar JM, Muñoz J. Real-Time Polymerase Chain Reaction in Stool Detects Transmission of Strongyloides stercoralis from an Infected Donor to Solid Organ Transplant Recipients. Am J Trop Med Hyg 2016; 94:897-9. [PMID: 26880781 DOI: 10.4269/ajtmh.15-0610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/09/2015] [Indexed: 11/07/2022] Open
Abstract
Solid organ transplant recipients can acquire Strongyloides stercoralis from an infected donor. The diagnosis of S. stercoralis in immunocompromised individuals may be challenging due to a lower sensitivity of available parasitological and serological methods, compared with immunocompetent individuals. Recently, a real-time polymerase chain reaction (RT-PCR) in stool has been developed for S. stercoralis diagnosis. We report two cases of S. stercoralis infection transmitted by a donor to two solid organ transplant recipients, who were diagnosed with RT-PCR in stool. This test could play an important role inS. stercoralis diagnosis in immunosuppressed patients, facilitating rapid treatment initiation and reducing the risk of severe strongyloidiasis. Adherence to current recommendations of screening among donors and recipients from endemic areas is also urgently needed.
Collapse
Affiliation(s)
- Joan Gómez-Junyent
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - David Paredes-Zapata
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Esperanza Rodríguez de las Parras
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - José González-Costello
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Ángel Ruiz-Arranz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Rosario Cañizares
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - José María Saugar
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - José Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Donation and Transplant Coordination Section, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain; Department of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (CNM-ISCIII), Majadahonda, Madrid, Spain; Department of Cardiology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain; Department of Intensive Care, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
47
|
Watts MR, Robertson G, Bradbury R. The laboratory diagnosis of Strongyloides stercoralis. MICROBIOLOGY AUSTRALIA 2016. [DOI: 10.1071/ma16003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It is estimated that over 30million people worldwide are infected by the nematode, Strongyloides stercoralis1. It is endemic in sub-tropical and tropical parts of Australia, with high rates of infection documented in some indigenous communities2. Due to the potential for chronic autoinfection, that may persist for decades, migration leads to the presence of the infection in non-endemic areas1. Transmission to humans is generally through the penetration of larvae through the skin, following contact with faecally contaminated soil1. Disease severity ranges from asymptomatic chronic carriage to an overwhelming illness, where large numbers spread throughout the body, usually triggered by immunosuppression1.
Collapse
|
48
|
Comparison of parasitological, immunological and molecular methods for evaluation of fecal samples of immunosuppressed rats experimentally infected with Strongyloides venezuelensis. Parasitology 2015; 142:1715-21. [PMID: 26442899 DOI: 10.1017/s0031182015001298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Definitive diagnosis of strongyloidiasis in humans is typically achieved by detection of larvae in fecal samples. However, limitations on sensitivity of parasitological methods emphasize the need for more robust diagnostic methods. The aim of this study was to compare the diagnostic value of three methods: eggs per gram of feces (EPG), coproantigen detection by enzyme linked immunosorbent assay (ELISA), and DNA detection by conventional polymerase chain reaction (PCR). The assays were performed at 0 and 5, 8, 13, 21 and 39 days post-infection (dpi) using fecal samples from experimentally infected immunocompetent and immunosuppressed rats. In immunocompetent rats, eggs were detected in feces on days 5, 8 and 13 dpi; coproantigen detection and PCR amplification were successful at all post-infection time points (5, 8, 13, 21 and 39 dpi). In immunosuppressed rats, eggs were detected at 5, 8, 13 and 21; coproantigen detection and PCR amplification were successful at all post-infection time points. In conclusion, these results suggest that coproantigen detection and PCR may be more sensitive alternatives to traditional methods such as EPG for diagnosis of Strongyloides venezuelensis infection.
Collapse
|
49
|
Becker SL, Piraisoody N, Kramme S, Marti H, Silué KD, Panning M, Nickel B, Kern WV, Herrmann M, Hatz CF, N’Goran EK, Utzinger J, von Müller L. Real-time PCR for detection of Strongyloides stercoralis in human stool samples from Côte d'Ivoire: diagnostic accuracy, inter-laboratory comparison and patterns of hookworm co-infection. Acta Trop 2015. [PMID: 26215130 DOI: 10.1016/j.actatropica.2015.07.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Human infections with the helminth species Strongyloides stercoralis encompass a wide clinical spectrum, ranging from asymptomatic carriage to life-threatening disease. The diagnosis of S. stercoralis is cumbersome and the sensitivity of conventional stool microscopy is low. New molecular tools have been developed to increase sensitivity. We compared the diagnostic accuracy of real-time PCR with microscopy for the detection of S. stercoralis and hookworm in human stool samples, and investigated the inter-laboratory agreement of S. stercoralis-specific real-time PCR in two European laboratories. Stool specimens from 256 randomly selected individuals in rural Côte d'Ivoire were examined using three microscopic techniques (i.e. Kato-Katz, Koga agar plate (KAP) and Baermann (BM)). Additionally, ethanol-fixed stool aliquots were subjected to molecular diagnosis. The prevalence of S. stercoralis and hookworm infection was 21.9% and 52.0%, respectively, whilst co-infections were detected in 35 (13.7%) participants. The diagnostic agreement between real-time PCR and microscopy was excellent when both KAP and BM tested positive for S. stercoralis, but was considerably lower when only one microscopic technique was positive. The sensitivity of KAP, BM and real-time PCR for detection of S. stercoralis as compared to a combination of all diagnostic techniques was 21.4%, 37.5% and 76.8%, respectively. The inter-laboratory agreement of S. stercoralis-specific PCR was substantial (κ=0.63, p<0.001). We conclude that a combination of real-time PCR and stool microscopy shows high accuracy for S. stercoralis diagnosis. Besides high sensitivity, PCR may also enhance specificity by reducing microscopic misdiagnosis of morphologically similar helminth larvae (i.e. hookworm and S. stercoralis) in settings where both helminth species co-exist.
Collapse
|
50
|
de Souza JN, Inês EDJ, Santiago M, Teixeira MCA, Soares NM. Strongyloides stercoralisinfection in patients with systemic lupus erythematosus: diagnosis and prevention of severe strongyloidiasis. Int J Rheum Dis 2015; 19:700-5. [DOI: 10.1111/1756-185x.12644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joelma Nascimento de Souza
- Departamento de Análises Clínicas e Toxicológicas; Faculdade de Farmácia; Universidade Federal da Bahia; Salvador Brazil
| | - Elizabete De Jesus Inês
- Departamento de Análises Clínicas e Toxicológicas; Faculdade de Farmácia; Universidade Federal da Bahia; Salvador Brazil
| | | | | | - Neci Matos Soares
- Departamento de Análises Clínicas e Toxicológicas; Faculdade de Farmácia; Universidade Federal da Bahia; Salvador Brazil
| |
Collapse
|