Performance of three enzyme immunoassays and two direct fluorescence assays for detection of Giardia lamblia in stool specimens preserved in ECOFIX

A Novel Nano Magnetic Beads Dot ELISA Immunoassay and Its Application on the Detection of Giardia lamblia Coproantigen

BACKGROUND

The traditional basis of diagnosis is identification of Giardia lamblia trophozoites or cysts in the stool of infected patients. Recently the advent of more objective techniques like antigen detection methods has led to an increase in their use versus those that rely on subjective microscopic examination of fecal specimens for Giardia cysts may facilitate diagnosis of G. lamblia in stool specimens.

METHODS

This cross-sectional study was carried out from Oct 2015 to Feb 2016 on patients admitted to Benha University Hospitals (Benha, Egypt) and outpatients of Theodor Bilharz Research Institute (TBRI) (Giza, Egypt). Purified G. lamblia cysts antigen was prepared by two-phase sucrose gradient technique. Polyclonal antibody against purified G. lamblia cysts antigen was prepared and labeled with horseradish peroxidase and Nano Magnetic Beads (NMB) to be used as detecting antibody. A total of 72 stool samples, 32 samples positive for giardiasis, 20 samples positive for other parasitic infections in addition to 20 negative samples were examined using dot ELISA and NMB dot-ELISA.

RESULTS

The sensitivity of the traditional dot-ELISA was 81.3 % and it increased by using the NMB-dot-ELISA to be 96.9% in stool samples. Specificity of both techniques was 97.5%.

CONCLUSION

Diagnosis of G. lamblia by NMB-Dot-ELISA technique is sensitive, specific, rapid and easy to perform and interpret. In this study, using the nano-magnetic beads increased the sensitivity of the applied technique.

Screening for Giardia/Cryptosporidium infections using an enzyme immunoassay in a centralized regional microbiology laboratory

CONTEXT

Stool parasitologic testing for Giardia and Cryptosporidium (G/C) previously relied on staining (ie, modified iron hematoxylin-kinyoun), ethyl acetate concentration procedures, and microscopy (the stool ova and parasite method). In April 1999, a microplate enzyme immunoassay (EIA) (ProSpecT G/C, Remel, Inc, Lenexa, Kan) for routine screening of all stool specimens was implemented.

OBJECTIVE

To determine the clinical and laboratory impact of this service change.

DESIGN

Changes were made to the regional microbiology requisition so that physicians could order either a G/ C EIA screen or stool ova and parasite examination. During a 3-year period (May 1999 through April 2002), changes in physician ordering practice, the rate of detection of G/ C infections, and test turnaround times were monitored. The economic outcomes have also been studied and compared annually since implementation and up to the current fiscal year (2004).

RESULTS

The following effects have been noted since G/ C EIA screening was implemented: (1) 70% of all stool parasite tests ordered were converted to G/C EIA screens versus stool ova and parasite tests, (2) stool parasitologic volumes decreased by up to 30% because of physicians ordering a single test per patient, (3) most stool parasite results (70%-80%) were reported within 24 hours of specimen receipt, and (4) the screening assay has improved detection of cryptosporidiosis cases. Although the G/C EIA tests cost more than stool ova and parasite examination, the equivalent of 1.8 full-time employees have been freed up to perform other duties.

CONCLUSIONS

Routine stool G/C EIA screening in our region is not only clinically relevant but also improves the timeliness and efficiency of detection of these important enteric parasite infections.

Detection of Giardia duodenalis antigen in human fecal eluates by enzyme-linked immunosorbent assay using polyclonal antibodies

The present study developed and standardized an enzime-linked immunosorbent assay (ELISA) to detect Giardia antigen in feces using rabbit polyclonal antibodies. Giardia cysts were purified from human fecal samples by sucrose and percoll gradients. Gerbils (Meriones unguiculatus) were infected to obtain trophozoites. Rabbits were inoculated with either cyst or trophozoite antigens of 14 Colombian Giardia isolates to develop antibodies against the respective stages. The IgG anti-Giardia were purified by sequential caprylic acid and ammonium sulfate precipitation. A portion of these polyclonal antibodies was linked to alkaline phosphatase (conjugate). One hundred and ninety six samples of human feces, from different patients, were tested by parasitologic diagnosis: 69 were positive for Giardia cysts, 56 had no Giardia parasites, and 71 revealed parasites other than Giardia. The optimal concentration of polyclonal antibodies for antigen capture was 40 g/ml and the optimal conjugate dilution was 1:100. The absorbance cut-off value was 0.24. The parameters of the ELISA test for Giardia antigen detection were: sensitivity, 100% (95% CI: 93.4-100%); specificity, 95% (95% CI: 88.6-97.6%); positive predictive value, 91% (95% CI: 81.4-95.9%); and negative predictive value, 100% (95% CI: 96.1-100%). This ELISA will improve the diagnosis of Giardia infections in Colombia and will be useful in following patients after treatment.