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Carvalho RGD, Pinheiro MCC, Damasceno Morais FJ, Galvão RLDF, Barbosa L, Souza Sá SLC, Scherr TF, Bezerra FSDM. Immunochromatographic POC-CCA Test for the diagnosis of intestinal schistosomiasis in a high endemic region in Brazil: Differences in the interpretation of results. Acta Trop 2024; 254:107181. [PMID: 38503365 DOI: 10.1016/j.actatropica.2024.107181] [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: 11/22/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
The POC-CCA test is subject to variations in reading interpretations depending on the intensity of its results, and trace test reading have implications for determining prevalence. The aim of this study was to assess whether the readings obtained from the POC-CCA tests, conducted using a semi-quantitative scale (the G-score classification for test determination), exhibited concurrence with the direct visual interpretation (positive, negative, or trace) performed by two distinct analysts, using photographs from previously performed POC-CCA test carried out in the municipality of Maruim, in the state of Sergipe-Brazil, a region of high endemicity. The devices used to read the photographs were smartphones, so as to simulate field usage, and a desktop, a tool with higher image quality that would help the researchers in the evaluation and establishment of the final result at a later. In direct visual interpretation of the POC-CCA photographs, the most discordant results occurred in the identification of the trace response (T). The Kappa index established for the direct visual interpretation between the two analysts, in which T is considered as positive, in the desktop was κ=0.826 and in the smartphone, κ=0.950. When we use the G-score as a reading standardization technique and classify the results according to the manufacturer, with trace being evaluated as positive, the highest level of agreement was obtained. Some disagreement remains between the direct visual interpretation and the G-score when performed on the desktop, with more individuals being classified as negative in the direct visual interpretation, by both analysts. However, this result was not statistically significant. The use of the G-score scale proved to be an excellent tool for standardizing the readings and classifying the results according to the semi-quantitative scale showed greater concordance of results both among analysts and among the different devices used to view the photographs.
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Affiliation(s)
- Roberta Gomes de Carvalho
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil
| | - Marta Cristhiany Cunha Pinheiro
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil
| | - Francisca Janaína Damasceno Morais
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil; Pathology Postgraduate Program, Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n, Fortaleza, Ceará, 60.441-750, Brazil
| | - Rosangela Lima de Freitas Galvão
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil; Pathology Postgraduate Program, Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n, Fortaleza, Ceará, 60.441-750, Brazil
| | - Luciene Barbosa
- Parasitology and Tropical Entomology Laboratory, Department of Morphology, Federal University of Sergipe, Avenida Marechal Rondon Jardim s/n, São Cristóvão, Sergipe, 49.100-000, Brazil
| | - Sidney Lourdes Cesar Souza Sá
- Epidemiological Monitoring. State's Office for Health of Sergipe. Avenida Augusto Franco 3150, Aracaju, Sergipe 49097-670, Brazil
| | - Thomas Foster Scherr
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, Tennessee 37240, USA
| | - Fernando Schemelzer de Moraes Bezerra
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil; Pathology Postgraduate Program, Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n, Fortaleza, Ceará, 60.441-750, Brazil; Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n Fortaleza, Ceará, 60.441-75, Brazil.
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Rivera J, Mu Y, Gordon CA, Jones MK, Cheng G, Cai P. Current and upcoming point-of-care diagnostics for schistosomiasis. Trends Parasitol 2024; 40:60-74. [PMID: 38000956 DOI: 10.1016/j.pt.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Point-of-care (POC) diagnostics are simple and effective portable tools that can be used for fast mapping of helminthic diseases and monitoring control programs. Most POC tests (POCTs) available for schistosomiasis diagnosis are lateral flow immunoassays (LFIAs). The emergence of simple and rapid DNA isolation methods, along with isothermal nucleic acid amplification strategies - for example, loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA) - and recent clustered regularly interspaced short palindromic repeats (CRISPR)-based diagnostic methods facilitate the development of molecular-based POC diagnostics for schistosomiasis. Furthermore, smartphone-based techniques increase real-time connectivity and readout accuracy of POCTs. This review discusses the recent advances in immunological-, molecular-based POCTs and mobile phone microscopes for the diagnosis/screening of schistosomiasis.
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Affiliation(s)
- Jonas Rivera
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Yi Mu
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Catherine A Gordon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Malcolm K Jones
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - Guofeng Cheng
- Shanghai Tenth People's Hospital, Institute for Infectious Diseases and Vaccine Development, Tongji University School of Medicine, Shanghai, China
| | - Pengfei Cai
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Biomedical Sciences, The University of Queensland, Brisbane, Australia.
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Kabbas-Piñango E, Arinaitwe M, van Dam GJ, Moses A, Namukuta A, Nankasi AB, Mwima NK, Besigye F, Prada JM, Lamberton PHL. Reproducibility matters: intra- and inter-sample variation of the point-of-care circulating cathodic antigen test in two Schistosoma mansoni endemic areas in Uganda. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220275. [PMID: 37598698 PMCID: PMC10440168 DOI: 10.1098/rstb.2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Over 240 million people are infected with schistosomiasis. Detecting Schistosoma mansoni eggs in stool using Kato-Katz thick smears (Kato-Katzs) is highly specific but lacks sensitivity. The urine-based point-of-care circulating cathodic antigen test (POC-CCA) has higher sensitivity, but issues include specificity, discrepancy between batches and interpretation of trace results. A semi-quantitative G-score and latent class analyses making no assumptions about trace readings have helped address some of these issues. However, intra-sample and inter-sample variation remains unknown for POC-CCAs. We collected 3 days of stool and urine from 349 and 621 participants, from high- and moderate-endemicity areas, respectively. We performed duplicate Kato-Katzs and one POC-CCA per sample. In the high-endemicity community, we also performed three POC-CCA technical replicates on one urine sample per participant. Latent class analysis was performed to estimate the relative contribution of intra- (test technical reproducibility) and inter-sample (day-to-day) variation on sensitivity and specificity. Within-sample variation for Kato-Katzs was higher than between-sample, with the opposite true for POC-CCAs. A POC-CCA G3 threshold most accurately assesses individual infections. However, to reach the WHO target product profile of the required 95% specificity for prevalence and monitoring and evaluation, a threshold of G4 is needed, but at the cost of reducing sensitivity. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Elías Kabbas-Piñango
- School of Biodiversity, One Health & Veterinary Medicine, Wellcome Centre for Integrative Parasitology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Moses Arinaitwe
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Adriko Moses
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Annet Namukuta
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Andrina Barungi Nankasi
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Nicholas Khayinja Mwima
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Fred Besigye
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Joaquin M. Prada
- Department of Comparative Biomedical Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Poppy H. L. Lamberton
- School of Biodiversity, One Health & Veterinary Medicine, Wellcome Centre for Integrative Parasitology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Mengistu B, Anjulo U, Chernet M, Dunn JC, Mohammed H, Belay H, Gidey B, Tasew G, Tadesse G, Salasibew M, Tollera G, Anderson R. Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis. PLoS Negl Trop Dis 2023; 17:e0011589. [PMID: 37851666 PMCID: PMC10615263 DOI: 10.1371/journal.pntd.0011589] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Geshiyaro project aims to assess the feasibility of interrupting transmission of soil-transmitted helminths (STH) and schistosome (SCH) infection in the Wolaita zone of southern Ethiopia through high coverage community-wide mass drug administration (MDA), in combination with improved water, sanitation, and hygiene services and behaviour change communication delivered through the existing health care infrastructure. To accurately measure treatment coverage a population census was conducted enrolling individuals with biometric fingerprinting and barcoded ID cards. This paper details the baseline census and parasitology surveys conducted before the start of any interventions. METHODS The census was conducted in five of the 15 Wolaita districts between October 2018 and December 2019, enrolling all consenting participants from every household. Simultaneously, a cross-sectional parasitology survey was conducted in 130 out of 361 randomly selected communities from all 15 districts, with 100 individuals across all age groups (infant to adult) per community providing stool and urine for analysis by duplicate Kato-Katz and a point-of-care circulating cathodic antigen (POC-CCA) to test for Schistosoma mansoni and STH, and microhaematuria and urine filtration for Schistosoma haematobium. Of the 130 communities, 30 were randomly selected for annual, longitudinal parasitological monitoring, with 150 randomly selected individuals from infant to adult providing two days of stool and urine samples for analysis by the same diagnostic tests per community. RESULTS In total 97,919 households participated in the baseline census enrolling 466,071 individuals, with parasitological data obtained from 10,785 people. At baseline, 15.5% were infected with at least one STH species, with Ascaris lumbricoides (9.5%), followed by hookworm (7.2%) and Trichuris trichiura (1.8%). Substantial heterogeneity in STH prevalence was observed between communities ranging from 0% to 61% where most infections were low intensity. Schistosoma mansoni infection was the dominant schistosome infection (0.85% by Kato-Katz and 13.3% by POC-CCA trace negative and 21.5% trace positive), with few Schistosoma haematobium infections identified (2.77% haematuria positive and 0.13% positive by urine filtration). CONCLUSIONS While the national control program in Ethiopia has made good progress in reducing prevalence of STH and SCH in Wolaita since it was launched in 2015, there remain areas of persistent infection suggesting the existence of environmental or behavioural risk factors that contribute to ongoing transmission. This project aims to identify the most efficient intervention strategies to reduce community burden and reach interruption of transmission.
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Affiliation(s)
- Anna E. Phillips
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison K. Ower
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Rosie Maddren
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Birhan Mengistu
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Ufaysa Anjulo
- Children’s Investment Fund Foundation, London, United Kingdom
| | - Melkie Chernet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Julia C. Dunn
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | - Habtamu Belay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Roy Anderson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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5
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Mu Y, Rivera J, McManus DP, Weerakoon KG, Ross AG, Olveda RM, Gordon CA, You H, Jones MK, Cai P. Comparative assessment of the SjSAP4-incorporated gold immunochromatographic assay for the diagnosis of human schistosomiasis japonica. Front Public Health 2023; 11:1249637. [PMID: 37736084 PMCID: PMC10509475 DOI: 10.3389/fpubh.2023.1249637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
Background Schistosomiasis, a disease caused by parasites of the genus Schistosoma, remains a global public health threat. This study aimed to validate the diagnostic performance of a recently developed gold immunochromatographic assay (GICA) for the detection of S. japonicum infection in a rural endemic area of the Philippines. Methods Human clinical samples were collected from 412 subjects living in Laoang and Palapag municipalities, Northern Samar, the Philippines. The presence of Schistosoma-specific antibodies in serum samples was tested with the SjSAP4-incorporated GICA strips and the results were converted to fully quantitative data by introducing an R value. The performance of the established GICA was further compared with other diagnostic tools, including the Kato-Katz (KK) technique, point-of-care circulating cathodic antigen (POC-CCA), droplet digital (dd) PCR, and enzyme-linked immunosorbent assays (ELISAs). Results The developed GICA strip was able to detect KK positive individuals with a sensitivity of 83.3% and absolute specificity. When calibrated with the highly sensitive faecal ddPCR assay, the immunochromatographic assay displayed an accuracy of 60.7%. Globally, the GICA assay showed a high concordance with the SjSAP4-ELISA assay. The schistosomiasis positivity rate determined by the GICA test was similar to those obtained with the SjSAP4-ELISA assay and the ddPCR assay performed on serum samples (SR_ddPCR), and was 2.3 times higher than obtained with the KK method. Conclusion The study further confirms that the developed GICA is a valuable diagnostic tool for detecting light S. japonicum infections and implies that this point-of-care assay is a viable solution for surveying endemic areas of low-intensity schistosomiasis and identifying high-priority endemic areas for targeted interventions.
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Affiliation(s)
- Yi Mu
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Jonas Rivera
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kosala G. Weerakoon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Allen G. Ross
- Rural Health and Medical Research Institute, Charles Sturt University, Orange, NSW, Australia
| | - Remigio M. Olveda
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Catherine A. Gordon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Hong You
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Veterinary Science, The University of Queensland, Brisbane, QLD, Australia
| | - Malcolm K. Jones
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Veterinary Science, The University of Queensland, Brisbane, QLD, Australia
| | - Pengfei Cai
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
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MacGregor SR, McManus DP, Sivakumaran H, Egwang TG, Adriko M, Cai P, Gordon CA, Duke MG, French JD, Collinson N, Olveda RM, Hartel G, Graeff-Teixeira C, Jones MK, You H. Development of CRISPR/Cas13a-based assays for the diagnosis of Schistosomiasis. EBioMedicine 2023; 94:104730. [PMID: 37487416 PMCID: PMC10382885 DOI: 10.1016/j.ebiom.2023.104730] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Schistosomiasis is a disease that significantly impacts human health in the developing world. Effective diagnostics are urgently needed for improved control of this disease. CRISPR-based technology has rapidly accelerated the development of a revolutionary and powerful diagnostics platform, resulting in the advancement of a class of ultrasensitive, specific, cost-effective and portable diagnostics, typified by applications in COVID-19/cancer diagnosis. METHODS We developed CRISPR-based diagnostic platform SHERLOCK (Specific High-sensitivity Enzymatic Reporter unLOCKing) for the detection of Schistosoma japonicum and S. mansoni by combining recombinase polymerase amplification (RPA) with CRISPR-Cas13a detection, measured via fluorescent or colorimetric readouts. We evaluated SHERLOCK assays by using 150 faecal/serum samples collected from Schistosoma-infected ARC Swiss mice (female), and 189 human faecal/serum samples obtained from a S. japonicum-endemic area in the Philippines and a S. mansoni-endemic area in Uganda. FINDINGS The S. japonicum SHERLOCK assay achieved 93-100% concordance with gold-standard qPCR detection across all the samples. The S. mansoni SHERLOCK assay demonstrated higher sensitivity than qPCR and was able to detect infection in mouse serum as early as 3 weeks post-infection. In human samples, S. mansoni SHERLOCK had 100% sensitivity when compared to qPCR of faecal and serum samples. INTERPRETATION These schistosomiasis diagnostic assays demonstrate the potential of SHERLOCK/CRISPR-based diagnostics to provide highly accurate and field-friendly point-of-care tests that could provide the next generation of diagnostic and surveillance tools for parasitic neglected tropical diseases. FUNDING Australian Infectious Diseases Research Centre seed grant (2022) and National Health and Medical Research Council (NHMRC) of Australia (APP1194462, APP2008433).
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Affiliation(s)
- Skye R MacGregor
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Donald P McManus
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Haran Sivakumaran
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thomas G Egwang
- Department of Immunology and Parasitology, Med Biotech Laboratories, Kampala, Uganda
| | - Moses Adriko
- Vector Borne and NTD Control Division, Ministry of Health, Kampala, Uganda
| | - Pengfei Cai
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Catherine A Gordon
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mary G Duke
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Juliet D French
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Natasha Collinson
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gunter Hartel
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Statistics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Carlos Graeff-Teixeira
- Department of Pathology, Infectious Diseases Unit, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Malcolm K Jones
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Hong You
- Infection and Inflammation Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.
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7
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Calvo-Urbano B, Léger E, Gabain I, De Dood CJ, Diouf ND, Borlase A, Rudge JW, Corstjens PLAM, Sène M, Van Dam GJ, Walker M, Webster JP. Sensitivity and specificity of human point-of-care circulating cathodic antigen (POC-CCA) test in African livestock for rapid diagnosis of schistosomiasis: A Bayesian latent class analysis. PLoS Negl Trop Dis 2023; 17:e0010739. [PMID: 37216407 DOI: 10.1371/journal.pntd.0010739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
Schistosomiasis is a major neglected tropical disease (NTD) affecting both humans and animals. The morbidity and mortality inflicted upon livestock in the Afrotropical region has been largely overlooked, in part due to a lack of validated sensitive and specific tests, which do not require specialist training or equipment to deliver and interpret. As stressed within the recent WHO NTD 2021-2030 Roadmap and Revised Guideline for schistosomiasis, inexpensive, non-invasive, and sensitive diagnostic tests for livestock-use would also facilitate both prevalence mapping and appropriate intervention programmes. The aim of this study was to assess the sensitivity and specificity of the currently available point-of-care circulating cathodic antigen test (POC-CCA), designed for Schistosoma mansoni detection in humans, for the detection of intestinal livestock schistosomiasis caused by Schistosoma bovis and Schistosoma curassoni. POC-CCA, together with the circulating anodic antigen (CAA) test, miracidial hatching technique (MHT) and organ and mesentery inspection (for animals from abattoirs only), were applied to samples collected from 195 animals (56 cattle and 139 small ruminants (goats and sheep) from abattoirs and living populations) from Senegal. POC-CCA sensitivity was greater in the S. curassoni-dominated Barkedji livestock, both for cattle (median 81%; 95% credible interval (CrI): 55%-98%) and small ruminants (49%; CrI: 29%-87%), than in S. bovis-dominated Richard Toll ruminants (cattle: 62%; CrI: 41%-84%; small ruminants: 12%, CrI: 1%-37%). Overall, sensitivity was greater in cattle than in small ruminants. Small ruminants POC-CCA specificity was similar in both locations (91%; CrI: 77%-99%), whilst cattle POC-CCA specificity could not be assessed owing to the low number of uninfected cattle surveyed. Our results indicate that, whilst the current POC-CCA does represent a potential diagnostic tool for cattle and possibly for predominantly S. curassoni-infected livestock, future work is needed to develop parasite- and/or livestock-specific affordable and field-applicable diagnostic tests to enable determination of the true extent of livestock schistosomiasis.
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Affiliation(s)
- Beatriz Calvo-Urbano
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | - Elsa Léger
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | - Isobel Gabain
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | | | - Nicolas D Diouf
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint Louis, Senegal
| | - Anna Borlase
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - James W Rudge
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | - Mariama Sène
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint Louis, Senegal
| | | | - Martin Walker
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | - Joanne P Webster
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
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Mu Y, McManus DP, Gordon CA, You H, Ross AG, Olveda RM, Cai P. Development and assessment of a novel gold immunochromatographic assay for the diagnosis of schistosomiasis japonica. Front Immunol 2023; 14:1165480. [PMID: 37077910 PMCID: PMC10106775 DOI: 10.3389/fimmu.2023.1165480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThe neglected zoonosis, schistosomiasis japonica, remains a major public health problem in the Philippines. The current study aims to develop a novel gold immunochromatographic assay (GICA) and evaluate its performance in the detection of Schistosoma japonicum infection.MethodsA GICA strip incorporating a S. japonicum saposin protein, SjSAP4 was developed. For each GICA strip test, diluted serum sample (50 µl) was loaded and strips were scanned after 10 min to convert the results into images. ImageJ was used to calculate an R value, which was defined as the signal intensity of the test line divided by the signal intensity of the control line within the cassette. After determination of optimal serum dilution and diluent, the GICA assay was evaluated with sera collected from non-endemic controls (n = 20) and individuals living in schistosomiasis-endemic areas of the Philippines (n = 60), including 40 Kato Katz (KK)-positive participants and 20 subjects confirmed as KK-negative and faecal droplet digital PCR assay (F_ddPCR)-negative at a dilution of 1:20. An ELISA assay evaluating IgG levels against SjSAP4 was also performed on the same panel of sera.ResultsPhosphate-buffered saline (PBS) and 0.9% NaCl were determined as optimal dilution buffer for the GICA assay. The strips tested with serial dilutions of a pooled serum sample from KK-positive individuals (n = 3) suggested that a relatively wide range of dilutions (from 1:10 to 1:320) can be applied for the test. Using the non-endemic donors as controls, the GICA strip showed a sensitivity of 95.0% and absolute specificity; while using the KK-negative and F_ddPCR-negative subjects as controls, the immunochromatographic assay had a sensitivity of 85.0% and a specificity of 80.0%. The SjSAP4-incorperated GICA displayed a high concordance with the SjSAP4-ELISA assay.ConclusionsThe developed GICA assay exhibited a similar diagnostic performance with that of the SjSAP4-ELISA assay, yet the former can be performed by local personnel with minimal training with no requirement for specialised equipment. The GICA assay established here represents a rapid, easy-to-use, accurate and field-friendly diagnostic tool for the on-site surveillance/screening of S. japonicum infection.
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Affiliation(s)
- Yi Mu
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Catherine A. Gordon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Hong You
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Allen G. Ross
- Rural Health and Medical Research Institute, Charles Sturt University, Orange, NSW, Australia
| | - Remigio M. Olveda
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Pengfei Cai
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- *Correspondence: Pengfei Cai,
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Afolabi MO, Sow D, Mbaye I, Diouf MP, Loum MA, Fall EB, Seck A, Manga IA, Cissé C, Camara B, Diouf A, Gaye NA, Colle Lo A, Greenwood B, Ndiaye JLA. Prevalence of malaria-helminth co-infections among children living in a setting of high coverage of standard interventions for malaria and helminths: Two population-based studies in Senegal. Front Public Health 2023; 11:1087044. [PMID: 36935683 PMCID: PMC10018210 DOI: 10.3389/fpubh.2023.1087044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Background Concurrent infections of Plasmodium falciparum with Soil Transmitted Helminths (STH) and Schistosoma spp are still a major public health problem among children living in Sub-Saharan Africa. We conducted two prospective studies among children living in urban and rural settings of Senegal, where control programmes for malaria, STH and schistosomiasis have been sustained, to determine the prevalence of malaria-helminth co-infection. Methods We enrolled 910 children aged 1-14 years from Saraya and Diourbel districts of Senegal in June and November 2021, respectively. We collected finger-prick blood samples from the children for malaria parasite detection using microscopy and PCR methods. Stool samples were also collected and Kato-Katz and PCR methods were used to detect STH and S. mansoni; and Merthiolate-iodine-formalin (MIF) test for other intestinal protozoans. Urine samples were analyzed using a filtration test, Point of Care Circulating Cathodic Antigens (POC-CCA) and PCR methods for detection of S. haematobium. Statistical analyses were performed to compare the continuous and categorical variables across the two study sites and age groups, as well as using the adjusted Odds ratios (aOR) to explore risk factors for malaria-helminth co-infections. Results The overall prevalence of polyparasitism with P. falciparum, STH, S. haematobium and S. mansoni among children in the two study sites was 2.2% (20/910) while prevalence of P. falciparum-S. haematobium co-infection was 1.1% (10/910); P. falciparum-S. mansoni 0.7% (6/910) and P. falciparum with any intestinal protozoan 2.4% (22/910). Co-infection was slightly higher among 5-14 year old children (17/629, 2.7%; 95% CI: 1.43-3.97) than 1-4 years (3/281, 1.1%; 95% CI: -0.12-2.32) and, in boys (13/567, 2.3%; 95% CI: 1.27-3.96) than girls (7/343, 2.1%; 95% CI: 0.52-3.48). Children aged 5-14 years (aOR = 3.37; 95% CI: 0.82-13.77, p = 0.09), who were boys (aOR = 1.44; 95% CI: 0.48-4.36, p = 0.51) and lived in Saraya (aOR = 1.27; 95% CI: 0.24-6.69, p = 0.77) had a higher risk of malaria-helminth co-infection than other age group, in girls and those who lived in Diourbel. Living in houses with spaces between the walls and roofs as well as frequent contacts with water during swimming were statistically significant risk factors for malaria-helminth co-infection. Conclusions The prevalence of malaria-helminth co-infection is low in two districts in Senegal, possibly due to sustained implementation of effective control measures for malaria and NTDs. These findings could help to develop and implement strategies that would lead to elimination of malaria and helminths in the study areas.
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Affiliation(s)
- Muhammed O. Afolabi
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Muhammed O. Afolabi
| | - Doudou Sow
- Service de Parasitologie-Mycologie, Université Gaston Berger de Saint-Louis, Saint-Louis, Senegal
| | - Ibrahima Mbaye
- Service de Parasitologie-Mycologie, Université de Thies, Thies, Senegal
| | | | - Mor Absa Loum
- Service de Parasitologie-Mycologie, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Amadou Seck
- Service de Parasitologie-Mycologie, Université de Thies, Thies, Senegal
| | - Isaac A. Manga
- Service de Parasitologie-Mycologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Cheikh Cissé
- Service de Parasitologie-Mycologie, Université de Thies, Thies, Senegal
| | | | - Awa Diouf
- Service de Parasitologie-Mycologie, Université de Thies, Thies, Senegal
| | - Ndéye Aida Gaye
- Service de Parasitologie-Mycologie, Université de Thies, Thies, Senegal
| | - Aminata Colle Lo
- Service de Parasitologie-Mycologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Coulibaly JT, Silue KD, Armstrong M, Díaz de León Derby M, D’Ambrosio MV, Fletcher DA, Keiser J, Fisher K, Andrews JR, Bogoch II. High Sensitivity of Mobile Phone Microscopy Screening for Schistosoma haematobium in Azaguié, Côte d'Ivoire. Am J Trop Med Hyg 2023; 108:41-43. [PMID: 36509050 PMCID: PMC9833070 DOI: 10.4269/ajtmh.22-0527] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 12/15/2022] Open
Abstract
Schistosomiasis infections continue to impact African settings disproportionately, and there is an urgent need for novel tools to evaluate infection control and elimination strategies at the community level. Mobile phone microscopes are portable and semiautomated devices with multiple applications for screening neglected tropical diseases. In a community-based schistosomiasis screening program in Azaguié, Côte d'Ivoire, mobile phone microscopy demonstrated a sensitivity of 85.7% (95% CI: 69.7-95.2%) and specificity of 93.3% (95% CI: 87.7-96.9%) for Schistosoma haematobium identification compared with conventional light microscopy, and 95% sensitivity (95% CI: 74.1-99.8%) with egg concentrations of five or more per 10 mL of urine. Mobile phone microscopy is a promising tool for schistosomiasis control and elimination efforts.
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Affiliation(s)
- Jean T. Coulibaly
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire;,Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Kigbafori D. Silue
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire;,Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Maxim Armstrong
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | | | - Michael V. D’Ambrosio
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | - Daniel A. Fletcher
- Department of Bioengineering, University of California, Berkeley, Berkeley, California;,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, University of California, Berkeley, Berkeley, California;,Chan Zuckerberg Biohub, San Francisco, California
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland;,University of Basel, Basel, Switzerland
| | - Karla Fisher
- Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California
| | - Isaac I. Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada;,Department of Medicine, University of Toronto, Toronto, Canada,Address correspondence to Isaac I. Bogoch, Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, 14EN 209, 200 Elizabeth St., Toronto M5G 2C4, ON, Canada. E-mail:
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Identification of a linear B-cell epitope on the Schistosoma japonicum saposin protein, SjSAP4: Potential as a component of a multi-epitope diagnostic assay. PLoS Negl Trop Dis 2022; 16:e0010619. [PMID: 35816547 PMCID: PMC9302751 DOI: 10.1371/journal.pntd.0010619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/21/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background Schistosoma japonicum is one of three major species of blood flukes causing schistosomiasis, a disease, which continues to be a major public health issue in the Philippines. SjSAP4, a member of a multigene family of saposin-like proteins, is a recognized immunodiagnostic biomarker for schistosomiasis japonica. This study aimed to identify linear B-cell epitopes on SjSAP4 and to validate their potential as components of a multi-epitope assay for the serological diagnosis of schistosomiasis japonica. Methodology SjSAP4-derived peptides were expressed as GST-peptide-fused proteins and these were Western blot probed with human serum samples from S. japonicum Kato-Katz (KK)-positive individuals and uninfected controls. A core epitope was further identified by Western blotting through probing a series of truncated peptides with the schistosomiasis patient sera. The diagnostic performance of the core epitope-containing peptides and the full-length SjSAP4 was evaluated by enzyme-linked immunosorbent assay (ELISA) using a panel of sera collected from subjects resident in a schistosomiasis-endemic area of the Philippines. Main findings As a result of the peptide mapping, one peptide (P15) was found to be highly immunogenic in the KK-positive individuals. We subsequently showed that -S163QCSLVGDIFVDKYLD178- is a core B-cell epitope of P15. Subsequent ELISAs incorporating SjSAP4, SjSAP4-Peptide and SjSP-13V2-Peptide showed a sensitivity of 94.0%, 46.0% and 74.0%, respectively, and a specificity of 97.1%, 100% and 100%, respectively. Notably, complementary recognition of the B-cell epitopes (SjSAP4-Peptide and SjSP-13V2-Peptide) was observed in a subset of the KK-positive individuals. A dual epitope-ELISA (SjSAP4-Peptide + SjSP-13V2-Peptide-ELISA) showed a diagnostic sensitivity of 84.0% and a specificity of 100%. Conclusions/Significance In this study, -S163QCSLVGDIFVDKYLD178- was identified as a dominant linear B-cell epitope on SjSAP4. This peptide and the complementary recognition of other B-cell epitopes using sera from different KK-positive individuals can provide the basis of developing a multi-epitope assay for the serological diagnosis of schistosomiasis. The recent road map (2021–2030) released by WHO for controlling or eliminating neglected tropical diseases (NTDs) highlights diagnostics as a major focus. Development and deployment of accurate, affordable and field-friendly diagnostics/surveillance tools will be crucial for the control and elimination of schistosomiasis. Multi-epitope chimeric antigens, constructed based on linear B-cell epitopes identified from highly antigenic antigens, may achieve not only an equivalent or superior diagnostic performance compared to the parent immunogens but also exhibit more optimal physicochemical properties. However, to date, only a limited number of linear B-cell epitopes have been identified for the serological diagnosis of schistosomiasis. In this study, we identified a linear B-cell epitope (-S163QCSLVGDIFVDKYLD178-) on SjSAP4, a recognized immunodiagnostic biomarker for schistosomiasis japonica, and validated its potential as a component of a multi-epitope assay for the serological diagnosis of schistosomiasis japonica. Notably, differential recognition of B-cell epitopes (SjSAP4-Peptide and SjSP-13V2-Peptide) was observed in a subset of subjects positive by the Kato-Katz technique for the disease. A dual epitope-ELISA (SjSAP4-Peptide + SjSP-13V2-Peptide-ELISA) showed a superior diagnostic performance (84.0% sensitivity and 100% specificity) than individual-epitope ELISAs. The findings in this study provide support for the development of multi-epitope antigen-based diagnostics for schistosomiasis.
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Mulindwa J, Namulondo J, Kitibwa A, Nassuuna J, Nyangiri OA, Kimuda MP, Boobo A, Nerima B, Busingye F, Candia R, Namukuta A, Ssenyonga R, Ukumu N, Ajal P, Adriko M, Noyes H, de Dood CJ, Corstjens PLAM, van Dam GJ, Elliott AM, Matovu E. High prevalence of Schistosoma mansoni infection and stunting among school age children in communities along the Albert-Nile, Northern Uganda: A cross sectional study. PLoS Negl Trop Dis 2022; 16:e0010570. [PMID: 35895705 PMCID: PMC9359559 DOI: 10.1371/journal.pntd.0010570] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/08/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Knowing the prevalence of schistosomiasis is key to informing programmes to control and eliminate the disease as a public health problem. It is also important to understand the impact of infection on child growth and development in order to allocate appropriate resources and effort to the control of the disease. METHODS We conducted a survey to estimate the prevalence of schistosomiasis among school aged children in villages along the Albert-Nile shore line in the district of Pakwach, North Western Uganda. A total of 914 children aged between 10-15 years were screened for Schistosoma mansoni using the POC-CCA and Kato Katz (KK) techniques. The infection intensities were assessed by POC-CCA and KK as well as CAA tests. The KK intensities were also correlated with POC-CCA and with CAA intensity. Anthropometric measurements were also taken and multivariate analysis was carried out to investigate their association with infection status. RESULTS The prevalence of schistosomiasis using the POC-CCA diagnostic test was estimated at 85% (95% CI: 83-87), being highest amongst children living closer to the Albert-Nile shoreline. Visual scoring of the POC-CCA results was more sensitive than the Kato Katz test and was positively correlated with the quantified infection intensities by the CAA test. The majority of the children were underweight (BMI<18.5), and most notably, boys had significantly lower height for age (stunting) than girls in the same age range (p < 0.0001), but this was not directly associated with S. mansoni infection. CONCLUSION High prevalence of S. mansoni infection in the region calls for more frequent mass drug administration with praziquantel. We observed high levels of stunting which was not associated with schistosomiasis. There is a need for improved nutrition among the children in the area.
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Affiliation(s)
- Julius Mulindwa
- Department of Biochemistry and Sports Sciences, College of Natural Sciences, Makerere University, Kampala, Uganda
| | - Joyce Namulondo
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Anna Kitibwa
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Jacent Nassuuna
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Oscar Asanya Nyangiri
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Magambo Phillip Kimuda
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Alex Boobo
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Barbara Nerima
- Department of Biochemistry and Sports Sciences, College of Natural Sciences, Makerere University, Kampala, Uganda
| | - Fred Busingye
- Vector Borne & NTD Control Division, Ministry of Health, Kampala, Uganda
| | - Rowel Candia
- Vector Borne & NTD Control Division, Ministry of Health, Kampala, Uganda
| | - Annet Namukuta
- Vector Borne & NTD Control Division, Ministry of Health, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Noah Ukumu
- Pakwach District Local Government, District Health Office, Pakwach, Uganda
| | - Paul Ajal
- Pakwach District Local Government, District Health Office, Pakwach, Uganda
| | - Moses Adriko
- Vector Borne & NTD Control Division, Ministry of Health, Kampala, Uganda
| | - Harry Noyes
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - Claudia J. de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Enock Matovu
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
- * E-mail:
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Performance of loop-mediated isothermal amplification (LAMP) for detection of Schistosoma mansoni infection compared with Kato–Katz and real-time PCR. J Helminthol 2022; 96:e28. [DOI: 10.1017/s0022149x22000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The performance of loop-mediated isothermal amplification (LAMP) for detection of Schistosoma mansoni DNA from stool and urine samples in comparison with Kato–Katz and real-time polymerase chain reaction (PCR) was studied. After obtaining informed consent, 50 children participated in the present study and agreed to submit stool and urine samples. Stool samples were examined by Kato–Katz. Both real-time PCR and LAMP techniques were applied on stool and urine samples. The overall prevalence of S. mansoni was 46% in stool and urine samples as detected by the employed techniques, and 90% of cases had light infection intensity. The highest percentage of infection was diagnosed by real-time PCR (44%), followed by Kato–Katz (42%) and LAMP in the stool (36%), while the lowest percentages of infection were diagnosed by real-time PCR and LAMP in urine samples (24% and 14%, respectively). Kato–Katz, real-time PCR and LAMP showed 100% specificity where the sensitivity was 91.3%, 95.7% and 78.3%, respectively, in stool samples. Real-time PCR and LAMP showed lower sensitivity in urine samples. The LAMP assay is a promising technique for S. mansoni diagnosis in endemic countries of moderate and high-intensity infection. Yet, it needs further optimization, particularly in urine samples.
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Favre TC, Beck LCNH, Bezerra FSM, Graeff-Teixeira C, Coelho PMZ, Enk MJ, Katz N, Oliveira RR, Reis MGD, Pieri OS. Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius. Rev Soc Bras Med Trop 2022; 55:e0389. [PMID: 35239906 PMCID: PMC8909435 DOI: 10.1590/0037-8682-0389-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer’s claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen’s kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.
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Affiliation(s)
| | | | | | - Carlos Graeff-Teixeira
- Universidade Federal do Espírito Santo, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | | | | | | | - Mitermayer Galvão dos Reis
- Fundação Oswaldo Cruz, Brasil; Universidade Federal da Bahia, Brasil; Yale University, United States of America
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Rogers MJ, McManus DP, Muhi S, Gordon CA. Membrane Technology for Rapid Point-of-Care Diagnostics for Parasitic Neglected Tropical Diseases. Clin Microbiol Rev 2021; 34:e0032920. [PMID: 34378956 PMCID: PMC8404699 DOI: 10.1128/cmr.00329-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Parasitic neglected tropical diseases (NTDs) affect over one billion people worldwide, with individuals from communities in low-socioeconomic areas being most at risk and suffering the most. Disease management programs are hindered by the lack of infrastructure and resources for clinical sample collection, storage, and transport and a dearth of sensitive diagnostic methods that are inexpensive as well as accurate. Many diagnostic tests and tools have been developed for the parasitic NTDs, but the collection and storage of clinical samples for molecular and immunological diagnosis can be expensive due to storage, transport, and reagent costs, making these procedures untenable in most areas of endemicity. The application of membrane technology, which involves the use of specific membranes for either sample collection and storage or diagnostic procedures, can streamline this process, allowing for long-term sample storage at room temperature. Membrane technology can be used in serology-based diagnostic assays and for nucleic acid purification prior to molecular analysis. This facilitates the development of relatively simple and rapid procedures, although some of these methods, mainly due to costs, lack accessibility in low-socioeconomic regions of endemicity. New immunological procedures and nucleic acid storage, purification, and diagnostics protocols that are simple, rapid, accurate, and cost-effective must be developed as countries progress control efforts toward the elimination of the parasitic NTDs.
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Affiliation(s)
- Madeleine J. Rogers
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine A. Gordon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Application of a POCCCA rapid diagnostic test and serology for detection of schistosomiasis in HIV-positive individuals in urban Malawi. Acta Trop 2021; 224:106142. [PMID: 34562420 DOI: 10.1016/j.actatropica.2021.106142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/07/2021] [Accepted: 09/12/2021] [Indexed: 11/20/2022]
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Cai P, Mu Y, Weerakoon KG, Olveda RM, Ross AG, McManus DP. Performance of the point-of-care circulating cathodic antigen test in the diagnosis of schistosomiasis japonica in a human cohort from Northern Samar, the Philippines. Infect Dis Poverty 2021; 10:121. [PMID: 34556183 PMCID: PMC8460201 DOI: 10.1186/s40249-021-00905-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Zoonotic schistosomiasis, caused by Schistosoma japonicum, remains a major public health problem in the Philippines. This study aimed to evaluate the commercially available rapid diagnostic point-of-care circulating cathodic antigen (POC-CCA) test in detecting individuals infected with S. japonicum in a human cohort from an endemic area for schistosomiasis japonica in the Philippines. METHODS Clinical samples were collectedin 18 barangays endemic for S. japonicum infection in Laoang and Palapag municipalities, Northern Samar, the Philippines, in 2015. The presence of CCA in filter-concentrated urine samples (n = 412) was evaluated using the commercial kits and the results were converted to images, which were further analyzed by ImageJ software to calculate R values. The diagnostic performance of the immunochromatographic POC-CCA test was compared using the Kato-Katz (KK) procedure, in-house enzyme-linked immunosorbent assays (ELISAs) and droplet digital (dd) PCR assays as reference. RESULTS The POC-CCA test was able to detect S. japonicum-infected individuals in the cohort with an eggs per gram of faeces (EPG) more than or equal to 10 with sensitivity/specificity values of 63.3%/93.3%. However, the assay showed an inability to diagnose schistosomiasis japonica infections in all cohort KK-positive individuals, of which the majority had an extremely low egg burden (EPG: 1-9). The prevalence of S. japonicum infection in the total cohort determined by the POC-CCA test was 12.4%, only half of that determined by the KK method (26.2%). When compared with the ELISAs and ddPCR assays as a reference, the POC-CCA assay was further shown to be a test with low sensitivity. Nevertheless, the assay exhibited significant positive correlations with egg burden determined by the KK technique and the target gene copy number index values determined by the ddPCR assays within the entire cohort. CONCLUSIONS By using in silico image analysis, the POC-CCA cassette test could be converted to a quantitative assay to avoid reader-variability. Because of its low sensitivity, the commercially available POC-CCA assay had limited potential for determining the status of a S. japonicum infection in the target cohort. The assay should be applied with caution in populations where schistosome parasites (especially S. japonicum) are present at low infection intensity.
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Affiliation(s)
- Pengfei Cai
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Yi Mu
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kosala G Weerakoon
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Roucher C, Brosius I, Mbow M, Faye BT, De Hondt A, Smekens B, Arango D, Burm C, Tsoumanis A, Paredis L, van Herrewege Y, Potters I, Cisse B, Mboup S, Polman K, Bottieau E. Evaluation of Artesunate-mefloquine as a Novel Alternative Treatment for Schistosomiasis in African Children (SchistoSAM): protocol of a proof-of-concept, open-label, two-arm, individually-randomised controlled trial. BMJ Open 2021; 11:e047147. [PMID: 34168029 PMCID: PMC8231067 DOI: 10.1136/bmjopen-2020-047147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Alternative drugs and diagnostics are needed for the treatment and control of schistosomiasis. The exclusive use of praziquantel (PZQ) in mass drug administration programmes may result in the emergence of drug resistance. PZQ has little activity against Schistosoma larvae, thus reinfection remains a problem in high-risk communities. Furthermore, the insufficient sensitivity of conventional microscopy hinders therapeutic response assessment. Evaluation of artesunate-mefloquine (AM) as a Novel Alternative Treatment for Schistosomiasis in African Children (SchistoSAM) aims to evaluate the safety and efficacy of the antimalarial combination artesunate-mefloquine, re-purposed for the treatment of schistosomiasis, and to assess the performance of highly sensitive novel antigen-based and DNA-based assays as tools for monitoring treatment response. METHODS AND ANALYSIS The SchistoSAM study is an open-label, two-arm, individually randomised controlled non-inferiority trial, with a follow-up of 48 weeks. Primary school-aged children from the Richard Toll district in northern Senegal, an area endemic for Schistosoma mansoni and Schistosoma haematobium, are allocated to the AM intervention arm (3-day courses at 6-week intervals) or the PZQ control arm (single dose of 40 mg/kg). The trial's primary endpoints are the efficacy (cure rate (CR), assessed by microscopy) and safety (frequency and pattern of drug-related adverse events) of one AM course versus PZQ at 4 weeks after treatment. Secondary endpoints include (1) cumulative CR, egg reduction rate and safety after each additional course of AM, and at weeks 24 and 48, (2) prevalence and severity of schistosomiasis-related morbidity and (3) malaria prevalence, incidence and morbidity, both after 24 and 48 weeks. CRs and intensity reduction rates are also assessed by antigen-based and DNA-based diagnostic assays, for which performance for treatment monitoring is evaluated. ETHICS AND DISSEMINATION Ethics approval was obtained both in Belgium and Senegal. Oral assent from the children and signed informed consent from their legal representatives was obtained, prior to enrolment. The results will be disseminated in peer-reviewed journals and at international conferences. TRIAL REGISTRATION NUMBER NCT03893097; pre-results.
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Affiliation(s)
- Clémentine Roucher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Moustapha Mbow
- Department of Immunology, Cheikh Anta Diop University, Dakar, Senegal
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | | | - Annelies De Hondt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bart Smekens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Diana Arango
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Christophe Burm
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Linda Paredis
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Yven van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Idzi Potters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Badara Cisse
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Souleymane Mboup
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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19
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Cavalcanti MG, Engel DC, de Araujo Cunha AF, Peralta JM. Case Report: Diagnosis and Assessment of Cure Approaches for Acute Schistosomiasis in Pre-School Children. Front Immunol 2021; 12:624736. [PMID: 34054799 PMCID: PMC8149760 DOI: 10.3389/fimmu.2021.624736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/27/2021] [Indexed: 02/02/2023] Open
Abstract
Acute schistosomiasis (AS) manifests with a broad spectrum of clinical features in pediatric populations. Diagnosis may be difficult in the absence of detectable numbers of eggs. As a result, new approaches may be required to achieve an accurate diagnosis. Optimal praziquantel (PZQ) treatment regimen for young children is debatable. Also, the post-treatment response is still poorly evaluated due to the lack of reliable markers. A group of 6 children (a toddler and 5 pre-school children) and one pre-adolescent were investigated for AS clinical manifestations and followed-up for two years after treatment. Ova detection was performed by Kato-Katz (KK) and presence of Schistosoma mansoni DNA was assessed by real-time PCR (rt-PCR) in stool samples. IgG and IgE anti-Schistosoma levels and urinary antigen were detected by ELISA and point-of-care circulating cathodic antigen (POC-CCA) testing in serum and urine, respectively. AS clinical symptoms were present in 5/7 (71.4%) of the infected children, and hypereosinophilia was detected in all of them. Ova detection and serology were positive in only 3/7 (44.9%) and 4/7 (57.1%), respectively. However, real-time PCR (rt-PCR) showed the presence of Schistosoma DNA in 6/7 (85.7%) of the cases, and urinary antigen was detected in all infected children. The long-term follow-up after treatment with three doses of PZQ (80mg/kg/dose), showed high cure rates (CR) as demonstrated by the DNA-based assay as well as reduced levels of side effects. CR based on urinary antigen detection ranged from 28.6 to 100%, being the highest CR due to double testing the 2-year post-treatment samples. The results suggest that high dose and repeated treatment with PZQ might be effective for AS in young children. Also, new laboratory markers should be considered to diagnosis and monitor the drug response.
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Affiliation(s)
- Marta G Cavalcanti
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Délia Celser Engel
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Fernandes de Araujo Cunha
- Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Mauro Peralta
- Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Graeff-Teixeira C, Favero V, Pascoal VF, de Souza RP, Rigo FDV, Agnese LHD, Bezerra FSM, Coelho PMZ, Enk MJ, Favre TC, Katz N, Oliveira RR, Dos Reis MG, Pieri OS. Low specificity of point-of-care circulating cathodic antigen (POCCCA) diagnostic test in a non-endemic area for schistosomiasis mansoni in Brazil. Acta Trop 2021; 217:105863. [PMID: 33587944 DOI: 10.1016/j.actatropica.2021.105863] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 02/08/2023]
Abstract
A point-of-care test for detecting schistosome circulating cathodic antigen in urine (POCCCA) has been proposed for mapping infection and defining prevalence thresholds for mass drug administration (MDA). However, there is increasing evidence that POCCCA may yield false-positive results, which requires rigorous specificity evaluation in non-endemic areas. POCCCA was applied in an area known to be free from infection and devoid of any condition for schistosomiasis transmission as part of a multicentre study to evaluate the performance of POCCCA in Brazil's low or potentially endemic settings. Besides POCCCA detection in urine, a search for eggs in stool was performed by Kato-Katz (KK) and Helmintex (HTX) methods. One-hundred-and-seventy-four participants returned urine samples, 140 of which delivered stool samples. All these were HTX-negative for Schistosoma mansoni, and all 118 tested with KK were negative for both S. mansoni and soil-transmitted helminths. POCCCA results from freshly collected urine yielded a specificity of 62.1% (95% CI: 53.6% - 70.2%), taking trace outcomes as positive according to the manufacturer's instructions. Retesting urine from the 140 HTX-negatives after one-year storage at -20 °C with two new POCCCA batches simultaneously yielded significantly different specificities (34.3%; 95%CI: 26.5% - 42.8% and 75.0%; 95% CI: 67.0% - 81.9%). These two batches had a weak agreement (Cohen's kappa: 0.56; 95%CI: 0.44-0.68) among the 174 urine samples retested. At present, POCCCA cannot be recommended either as a cut-off point for MDA or a reliable diagnostic tool for treatment of the infection carriers (selective chemotherapy) in low endemic areas and at final stages of transmission interruption. Manufacturers should be required to optimize production standardization and to assure quality and reproducibility of the test. Extended rigorous performance evaluations by different users from different regions are needed before POCCCA is widely recommended.
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Affiliation(s)
- Carlos Graeff-Teixeira
- Infectious Diseases Unit (NDI), Center for Health Sciences, Universidade Federal do Espírito Santo, Vitória, ES, Brazil; Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vivian Favero
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vanessa Fey Pascoal
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Renata Perotto de Souza
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Francine de Vargas Rigo
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luize Hoffmann Dall Agnese
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | - Tereza Cristina Favre
- Oswaldo Cruz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
| | - Naftale Katz
- René Rachou Institute, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, MG, Brazil
| | | | - Mitermayer Galvão Dos Reis
- Gonçalo Muniz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, BA, Brazil; Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, BA, Brazil; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, United States of America.
| | - Otavio Sarmento Pieri
- Oswaldo Cruz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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21
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Cisse M, Sangare I, Djibougou AD, Tahita MC, Gnissi S, Bassinga JKW, Konda S, Diallo AH. Prevalence and risk factors of Schistosoma mansoni infection among preschool-aged children from Panamasso village, Burkina Faso. Parasit Vectors 2021; 14:185. [PMID: 33794961 PMCID: PMC8017716 DOI: 10.1186/s13071-021-04692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Schistosomiasis remains a major public health concern in sub-Saharan Africa. Although schistosomiasis is well documented in school-aged children in Burkina Faso, prevalence data among preschool-aged children (PSAC) are limited and outdated, and its risk factors in this group remain poorly documented. The main objective of this study was to assess the prevalence and risk factors associated with Schistosoma (S.) mansoni infection among PSAC from Panamasso village, western Burkina Faso. Methodology A cross-sectional study was carried out among 228 children under 6 years old from Panamasso village. Sociodemographic and water contact data were collected using a structured questionnaire. Kato-Katz and formol-ether concentration techniques were used to detect S. mansoni eggs in stool samples. Urine samples were subjected to a point-of-care circulating cathodic antigen (POC-CCA) cassette test and a centrifugation method to check for both S. mansoni and S. haematobium infection, respectively. Potential risk factors for S. mansoni infection were explored using multivariable logistic regression. Results The mean age of children was 40.2 ± 15.0 months. The prevalence of S. mansoni infection as determined by Kato-Katz, formol-ether concentration and POC-CCA was 42.1%, 39.5% and 80.7%, respectively. Based on the combined results of the three methods, the overall prevalence of S. mansoni infection was 81.1%. No case of S. haematobium infection was found. The geometric mean intensity of S. mansoni infection was 107.2 eggs per gram of feces with 54.2%, 33.3% and 12.5% of the children having light, moderate and heavy infections, respectively. Girls (AOR = 2.9, 95% CI 1.3–6.1), a household located within 500 m from the pond (AOR = 3.0, 95% CI 1.0–8.6) or between 500 and 1000 m from the pond (AOR = 3.0, 95% CI 1.2–7.2), and the child’s history of going to the pond (AOR = 5.0, 95% CI 1.7–14.3) were the variables significantly associated with S. mansoni infection. Conclusion S. mansoni was the sole species infecting a high proportion of PSAC in the study area. A mass drug administration program with praziquantel is therefore urgently required for those below 6 years old. Other control strategies should include increased community-awareness and provision of safe water.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04692-8.
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Affiliation(s)
- Mamoudou Cisse
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso. .,Institut Supérieur des sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso.
| | - Ibrahim Sangare
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.,Institut Supérieur des sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Arthur D Djibougou
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Marc C Tahita
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Souleymane Gnissi
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | | | - Salifou Konda
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye H Diallo
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.,Unité de Formation et de Recherche en Sciences De la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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22
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El Saftawy EA. Validity of urine-CCA cassette test and indirect haem-agglutination assay (IHA) in the detection of schistosomiasis- mansoni infection relative to microscopic examination. J Parasit Dis 2021; 45:285-292. [PMID: 33746416 DOI: 10.1007/s12639-020-01303-8] [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: 08/25/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
Several immunodiagnostic assays have been commercially presented over the last years as easy diagnostic methods for schistosomiasis using serum or urine samples. The performance of immunochromatographic test (ICT) and indirect hemagglutination assay (IHA) was validated in the identification of active schistosomiasis infection. Detection of circulating cathodic antigen (CCA) of the parasite in urine samples and anti-Schistosoma antibodies in serum using ICT (Urine-CCA Cassette test) and IHA respectively. Proved diagnosis of Schistosoma mansoni infection was defined by the sum of positive results from microscopic examination (Gold standard) and Kato-Katz method. Out of 173 (mean age, 45 ± 10 years; 70 from Giza, 103 from different Egyptian governorates), 9 4 adult patients were infected. Urine-CCA cassette test despite showing high specificity (91.14%) it was of low sensitivity (23.40%). PPVs was 75.86% and NPV was 50.00% and diagnostic accuracy of 54.34%. The IHA showed a sensitivity of 57.45% and specificity of 48.10%. PPVs was 56.84% whereas NPVs was 48.72%. As for diagnostic accuracy, it was 53.18%. Urine-CCA Cassette test had lower sensitivity than expected for detection of circulating antigen and the IHA kit is generally more expensive than microscopic examination and Urine-CCA cassette test with low sensitivity and specificity. On the basis of this diagnostic performance none of the two tested immune-assays can be a sole tool in the principal diagnosis of active schistosomiasis infections.
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Affiliation(s)
- Enas A El Saftawy
- Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.,Medical Parasitology Department, Faculty of Medicine, Armed Forces College of Medicine, Cairo, Egypt
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23
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Graeff-Teixeira C, Favero V, de Souza RP, Pascoal VF, Bittencourt HR, Fukushige M, Geiger SM, Negrão-Corrêa D. Use of Schistosoma mansoni soluble egg antigen (SEA) for antibody detection and diagnosis of schistosomiasis: The need for improved accuracy evaluations of diagnostic tools. Acta Trop 2021; 215:105800. [PMID: 33352167 DOI: 10.1016/j.actatropica.2020.105800] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
Many antigens for use in antibody-detection systems for schistosomiasis have been investigated over the past 40 years. In particular, soluble egg antigens (SEA) are still widely used in enzyme-linked immunosorbent assays (ELISAs) for detection of immunoglobulin classes and subclasses. Here, we conducted a literature review to examine accuracy evaluations of SEA-Immunoglobulin G (IgG)-ELISAs performed to detect Schistosoma mansoni infections and published between 1979 and 2019. S. mansoni is the main causative agent for intestinal schistosomiasis in many countries in Africa and Central and South America. After retrieving 214 relevant abstracts from the PubMed database, we selected 15 publications to undergo a full review. Sensitivity and specificity values varied from 71 to 99%, and from 6 to 100%, respectively. In addition, 11/15 studies did not state confidence intervals. Therefore, the findings from this review indicate that after four decades, we still do not have consistent evaluation estimates of SEA-IgG-ELISAs. Antigen mass per well and dilution of test sera in these articles varied from 0.018 µg to 1.5 µg, and from 1:50 to 1:500, respectively. Most of the reported accuracy evaluations used control sera which were selected based on parasitological examinations for egg detection, although ill-defined criteria were also noted. The number and composition of control serum panels was considered not adequate in approximately half of the studies. It is also noteworthy that among more than 30 diagnostic antigen preparations under development since the 1970s, most were not validated in the field and they failed to reach populations in need. Thus, attention to guidelines for standardization, estimations of accuracy, and reporting of results is needed to facilitate coordinated efforts aimed at schistosomiasis control and elimination.
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24
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Mehta SD, Okal D, Otieno F, Green SJ, Nordgren RK, Huibner S, Bailey RC, Bhaumik DK, Landay A, Kaul R. Schistosomiasis is associated with rectal mucosal inflammation among Kenyan men who have sex with men. Int J STD AIDS 2021; 32:694-703. [PMID: 33533314 DOI: 10.1177/0956462420985973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Schistosoma mansoni infection is hyperendemic in Lake Victoria communities and associated with cervicovaginal immune alterations and HIV acquisition. We assessed the hypothesis that schistosomiasis correlates with greater rectal inflammation in men who have sex with men (MSM) in Kisumu, Kenya. Methods: In this cross-sectional study of 38 HIV-negative MSM aged 18-35 years, schistosomiasis was diagnosed by urine circulating cathodic antigen (CCA). Microbiome was assessed in rectal swabs by 16S rRNA gene amplicon sequencing, and rectal inflammation by quartile normalized summative score of inflammatory cytokines (IL-1α, IL-1β, IL-8, and TNF-α). Elastic net (EN) regression identified taxa associated with inflammation. Multivariable linear regression estimated the association between inflammation score and schistosomiasis and bacteria identified in EN. Results: Most men were CCA positive (24/38; 63%), and median rectal inflammation score was significantly higher in these participants (11 vs. 8, p = 0.04). In multivariable regression, CCA-positive men had 2.85-point greater inflammation score (p = 0.009). The relative abundance of Succinivibrio (coefficient = -1.13, p = 0.002) and Pseudomonas (coefficient = -1.04, p = 0.001) were negatively associated with inflammation. Discussion: CCA positivity was associated with rectal mucosal inflammation, controlling for rectal microbiome composition. Given its high prevalence and contribution to inflammation, schistosomiasis may have important implications for HIV transmission in this vulnerable population.
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Affiliation(s)
- Supriya D Mehta
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Duncan Okal
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | - Stefan J Green
- Sequencing Core, Research Resources Center, 14681University of Illinois at Chicago, Chicago, USA
| | - Rachel K Nordgren
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Sanja Huibner
- Division of Infectious Diseases, University of Toronto School of Medicine, Toronto, Canada
| | - Robert C Bailey
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Dulal K Bhaumik
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Alan Landay
- Department of Internal Medicine, 2468Rush University, Chicago, USA
| | - Rupert Kaul
- Division of Infectious Diseases, University of Toronto School of Medicine, Toronto, Canada
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Hoekstra PT, Schwarz NG, Adegnika AA, Andrianarivelo MR, Corstjens PLAM, Rakotoarivelo RA, Rakotozandrindrainy R, Sicuri E, Kreidenweiss A, van Dam GJ. Fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers: An introduction to the freeBILy project. Acta Trop 2020; 211:105631. [PMID: 32679109 DOI: 10.1016/j.actatropica.2020.105631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Schistosoma antigen detection tests have a large potential for schistosomiasis control programs due to their ability to detect active and ongoing Schistosoma infections, their much higher sensitivity compared to microscopical methods, and the possibility to use non-invasive urine samples. Pregnant women and young children could especially benefit from affordable and easy-to-use antigen tests as inclusion of these vulnerable groups in mass drug administration campaigns will always require higher justification hurdles, especially in low to middle endemic regions with a higher proportion of individuals who are not infected and thus unnecessarily exposed to praziquantel. The overall objective of the 'fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers' (freeBILy, www.freeBILy.eu) project is to thoroughly evaluate the point-of-care circulating cathodic antigen (POC-CCA) and the up-converting phosphor reporter particle, lateral flow circulating anodic antigen (UCP-LF CAA) urine strip tests to diagnose Schistosoma infections in pregnant women and young children and to assess their potential as a schistosomiasis control tool in test-and-treat strategies. The freeBILy project will generate valuable, evidence-based findings on improved tools and test-and-treat strategies to reduce the burden of schistosomiasis in pregnant women and young children.
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Affiliation(s)
- Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Norbert G Schwarz
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany; German Center for Infection Research, Germany
| | - Ayola A Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; German Center for Infection Research, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Andrea Kreidenweiss
- German Center for Infection Research, Germany; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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Ramírez ADP, Favero V, Lindholz CG, Veríssimo CDM, Pascoal VF, Candido RRF, Morassutti AL, Graeff-Teixeira C. Schistosomiasis: an epidemiological update on Brazil's southernmost low endemic area in Esteio. Rev Soc Bras Med Trop 2020; 53:e20200411. [PMID: 33027417 PMCID: PMC7534964 DOI: 10.1590/0037-8682-0411-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Brazil's southernmost state, Rio Grande do Sul (RGS), was considered schistosomiasis-free until 1998 when a low endemic focus was identified in Esteio, a city located next to the capital of RGS. In the last two decades, the control interventions applied in the region have been apparently successful, and the absence of new cases indicated the possibility of interrupted schistosomiasis transmission. The objective of this study was to update the clinical and epidemiological data of schistosomiasis in Esteio. METHODS We reviewed all 28 individuals diagnosed with the infection since 1997 and a survey was applied to a group of 29 school-aged children residing in Vila Pedreira, one of the most affected neighborhoods. RESULTS No eggs were detected in fecal samples using the Helmintex method, and all samples were negative for serum antibodies on examination by the western blot technique using the Schistosoma mansoni microsomal antigen (MAMA- WB). In contrast, 23 individuals (79%) tested positive for the cathodic circulating antigen with the point-of-care immunochromatographic test (POC-CCA) on urine samples. Of the 28 formerly infected individuals, only eight were located, of which four tested positive, and four tested negative for serum antibodies using the MAMA-WB technique. CONCLUSIONS Current adverse conditions for S. mansoni transmission in Esteio and the absence of a confirmed diagnosis suggests that there is (i) a lack of specificity of the POC-CCA test in low endemic settings, and (ii) a high probability that interruption of schistosomiasis has been achieved in Esteio.
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Affiliation(s)
- Angélica da Paz Ramírez
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil
| | - Vivian Favero
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil
| | - Catieli Gobetti Lindholz
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil
| | - Carolina de Marco Veríssimo
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil
| | - Vanessa Fey Pascoal
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil
| | - Renata Russo Frasca Candido
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil.,University of Western Australia, Department of Physics, Perth, Australia
| | - Alessandra Loureiro Morassutti
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil
| | - Carlos Graeff-Teixeira
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências, Departamento de Ecologia e Biodiversidade, Porto Alegre, RS, Brasil.,Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Departamento de Patologia e Núcleo de Doenças Infecciosas, Vitória, ES, Brasil
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Analytical and Clinical Assessment of a Portable, Isothermal Recombinase Polymerase Amplification (RPA) Assay for the Molecular Diagnosis of Urogenital Schistosomiasis. Molecules 2020; 25:molecules25184175. [PMID: 32933094 PMCID: PMC7570534 DOI: 10.3390/molecules25184175] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
Accurate diagnosis of urogenital schistosomiasis is crucial for disease surveillance and control. Routine diagnostic methods, however, lack sensitivity when assessing patients with low levels of infection still able to maintain pathogen transmission. Therefore, there is a need for highly sensitive diagnostic tools that can be used at the point-of-care in endemic areas. Recombinase polymerase amplification (RPA) is a rapid and sensitive diagnostic tool that has been used to diagnose several pathogens at the point-of-care. Here, the analytical performance of a previously developed RPA assay (RT-ShDra1-RPA) targeting the Schistosoma haematobium Dra1 genomic region was assessed using commercially synthesised S. haematobium Dra1 copies and laboratory-prepared samples spiked with S. haematobium eggs. Clinical performance was also assessed by comparing diagnostic outcomes with that of a reference diagnostic standard, urine-egg microscopy. The RT-ShDra1-RPA was able to detect 1 × 101 copies of commercially synthesised Dra1 DNA as well as one S. haematobium egg within laboratory-spiked ddH2O samples. When compared with urine-egg microscopy, the overall sensitivity and specificity of the RT-ShDra1-RPA assay was 93.7% (±88.7–96.9) and 100% (±69.1–100), respectively. Positive and negative predictive values were 100% (±97.5–100) and 50% (±27.2–72.8), respectively. The RT-ShDra1-RPA therefore shows promise as a rapid and highly sensitive diagnostic tool able to diagnose urogenital schistosomiasis at the point-of-care.
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Mduluza T, Jones C, Osakunor DNM, Lim R, Kuebel JK, Phiri I, Manangazira P, Tagwireyi P, Mutapi F. Six rounds of annual praziquantel treatment during a national helminth control program significantly reduced schistosome infection and morbidity levels in a cohort of schoolchildren in Zimbabwe. PLoS Negl Trop Dis 2020; 14:e0008388. [PMID: 32569278 PMCID: PMC7332090 DOI: 10.1371/journal.pntd.0008388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 07/02/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends that schistosomiasis be treated through Mass Drug Administration (MDA). In line with this recommendation, Zimbabwe commenced a national helminth control program in 2012 targeting schoolchildren throughout the country for 6 years. This study, part of a larger investigation of the impact of helminth treatment on the overall health of the children, determined the effect of annual praziquantel treatment on schistosome infection and morbidity in a cohort of children during Zimbabwe's 6-year national helminth control program. METHODOLOGY/PRINCIPAL FINDINGS A school-based longitudinal study was carried out in 35 sentinel sites across Zimbabwe from September 2012 to November 2017. The sentinel sites were selected following a countrywide survey conducted in 280 primary schools. Schistosoma haematobium was diagnosed using the urine filtration technique. Schistosoma mansoni was diagnosed using both the Kato-Katz and formol-ether concentration techniques. S. haematobium morbidity was determined through detection of macro and microhaematuria. A cohort of children aged 6-15 years old was surveyed annually before MDA and 6 weeks post treatment. Maximum treatment coverage reached 90% over the 6 rounds of MDA. At baseline S. haematobium infection prevalence and intensity were 31.7% (95% CI = 31.1-32.2) and 28.75 eggs/10ml urine (SEM = 0.81) respectively, while S. mansoni prevalence and intensity were 4.6% (95% CI = 4.4-4.8) and 0.28 eggs/25mg (SEM = 0.02). Prior to the 6th round of MDA, S. haematobium infection prevalence had reduced to 1.56% (p<0.001) and infection intensity to 0.07 (SEM 0.02). Six weeks later after the 6th MDA, both were 0. Similarly the prevalence of S. haematobium morbidity as indicated by haematuria also fell significantly from 32.3% (95% CI = 29.9-34.6) to 0% (p< 0.0001) prior to the final MDA. For S.mansoni, both prevalence and intensity had decreased to 0 prior to the 6th MDA. After 6 rounds of annual MDA, prevalence and intensity of both schistosome species decreased significantly to 0% (p< 0.0001). CONCLUSION Zimbabwe's helminth control program significantly reduced schistosome infection intensity and prevalence and urogenital schistosomiasis morbidity prevalence in a cohort of school-aged children, moving the schistosome prevalence in the children from moderate to low by WHO classification. These findings will inform the design of the country's next stage interventions for helminth control and eventual elimination.
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Affiliation(s)
- Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe.,TIBA Zimbabwe, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Edinburgh, United Kingdom
| | - Caitlin Jones
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Derick N M Osakunor
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Rivka Lim
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Julius K Kuebel
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Isaac Phiri
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Portia Manangazira
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Paradzayi Tagwireyi
- Department of Geography and Environmental Science, Geo-information and Earth Observation Centre, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Francisca Mutapi
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
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Detecting Schistosoma mansoni infections among pre-school-aged children in southern Ghana: a diagnostic comparison of urine-CCA, real-time PCR and Kato-Katz assays. BMC Infect Dis 2020; 20:301. [PMID: 32321418 PMCID: PMC7178570 DOI: 10.1186/s12879-020-05034-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Background In Ghana, pre-school-aged children (PSAC) are at risk of intestinal schistosomiasis and are living in need of praziquantel treatment. To better assess the infection burden within this vulnerable demographic group, we have provided a comparative assessment of the prevalence of Schistosoma mansoni in pre-school-aged children by urine circulating cathodic antigen (CCA) dipsticks, real-time PCR Taqman® faecal assays and Kato-Katz coproscopy. Methods In all, 190 pre-school-aged children were sampled from three endemic communities (viz. Tomefa, Torgahkope/Adakope, and Manheam) around Weija dam, Southern Ghana. Fresh stool and urine samples were collected from all participants for diagnosis. Results Among all the three communities, the urine-CCA assay recorded the highest prevalence values of 90.5% (95% CI 80.4–96.4), 87.9% (95% CI 76.7–95), and 81.2% (95% CI 69.9–89.6) in Tomefa, Torgahkope/Adakope, and Manheam respectively. Prevalence by real-time PCR was 50% (95% CI 35.5–64.5), 8% (95% CI 2.2–19.2) and 16.7% (95% CI 8.3–28.5), while by Kato-Katz was 55.6% (95% CI 42.5–68.1), 8.6% (95% CI 2.9–19) and 11.6% (95% CI 5.1–21.6) respectively. Children aged 1 year and over were found to be positive with the urine-CCA assay; by the ages of 3–4, over 50% were urine-CCA patent. The sensitivity and specificity of the POC-CCA dipsticks, when compared against the combined results of Kato-Katz/TaqMan results was found to be 84.1% (95% CI = 72.7–92.1) and 12.9% (95% CI = 6.6–22) respectively. Conclusions We propose that the urine-CCA dipstick may be a useful rapid diagnostic tool to estimate the prevalence of intestinal schistosomiasis in PSAC, particularly in rapid identification of at-risk areas. However, our assessment has shown that it possible to record false positives when compared to combined Kato-Katz and qPCR results. To guide PSAC praziquantel treatment needs, we propose the urine CCA assay should be included in routine surveillance of intestinal schistosomiasis alongside other diagnostics such as Kato-Katz and urine filtration.
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Odeniran PO, Omolabi KF, Ademola IO. Epidemiological dynamics and associated risk factors of S. haematobium in humans and its snail vectors in Nigeria: a meta-analysis (1983-2018). Pathog Glob Health 2020; 114:76-90. [PMID: 32182201 DOI: 10.1080/20477724.2020.1728164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Schistosoma haematobium, a major pathogen of urogenital schistosomiasis, has been reported to be affecting an estimated 30 million people in Nigeria. Current national estimates of S. haematobium and its cercariae, in humans and snail vectors respectively, are lacking in Nigeria, hence systematic meta-analyses were conducted to understand the disease dynamics in the endemic country over a period of 35 years based on publications from five databases (AJOL, Ovid MEDLINE, Google Scholar, PubMed and Web of Science). The preferred reporting items for systematic reviews and meta-analyses (PRIMSA) checklist were used as the standard guide for the analyses. The prevalence of S. haematobium in human hosts in Nigeria using quality effects model was 32.1% (27.3-37.2), while schistosome cercariae were observed at 3.5% (0.0-11.9), 18.2% (4.7-36.8) and 18.7% (0.0-46.1) and for B. forskalii, Bulinus globosus and B. truncatus, respectively. The high report of schistosome cercariae indicates the continuous transmission of S. haematobium in humans especially with individuals who have frequent contact with freshwater. Heterogeneity of subgroup analyses (regions, zones, sex, age groups, diagnostic techniques) and risk factors (pathological signs, occupation, water sources, anthropogenic activities, treatment) were determined. The result showed prevalence of an endemic moderate class infection that has been linked to several risk factors. Therefore, there is need for increased awareness on the prevalence, transmission routes and treatment strategies to mitigate the disease in this endemic area.
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Affiliation(s)
- Paul Olalekan Odeniran
- Department of Veterinary Parasitology and Entomology, University of Ibadan, Ibadan, Nigeria
| | - Kehinde Foluke Omolabi
- Molecular Bio-computation and Drug Design Laboratory, University of KwaZulu Natal, Durban, South Africa
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An update on non-invasive urine diagnostics for human-infecting parasitic helminths: what more could be done and how? Parasitology 2019; 147:873-888. [PMID: 31831084 PMCID: PMC7284843 DOI: 10.1017/s0031182019001732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Reliable diagnosis of human helminth infection(s) is essential for ongoing disease surveillance and disease elimination. Current WHO-recommended diagnostic assays are unreliable in low-endemic near-elimination settings and typically involve the invasive, onerous and potentially hazardous sampling of bodily fluids such as stool and blood, as well as tissue via biopsy. In contrast, diagnosis by use of non-invasive urine sampling is generally painless, more convenient and low risk. It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients. In some instances, urine-based diagnostic assays have also been shown to provide a more reliable diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, particularly in low-endemicity settings. Given these relative benefits, we identify and review current research literature to evaluate whether non-invasive urine sampling is currently exploited to its full potential in the development of diagnostic tools for human helminthiases. Though further development, assessment and validation are needed before their routine use in control programmes, low-cost, rapid and reliable assays capable of detecting transrenal helminth-derived antigens and cell-free DNA show excellent promise for future use at the point-of-care in high-, medium- and even low-endemicity elimination settings.
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Exum NG, Kibira SPS, Ssenyonga R, Nobili J, Shannon AK, Ssempebwa JC, Tukahebwa EM, Radloff S, Schwab KJ, Makumbi FE. The prevalence of schistosomiasis in Uganda: A nationally representative population estimate to inform control programs and water and sanitation interventions. PLoS Negl Trop Dis 2019; 13:e0007617. [PMID: 31412023 PMCID: PMC6709927 DOI: 10.1371/journal.pntd.0007617] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 08/26/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background To improve schistosomiasis control programs in Uganda, where intestinal schistosomiasis is a widespread public health problem, a country-wide assessment of the disease prevalence among all age ranges is needed. Few studies have aimed to quantify the relationships between disease prevalence and water and sanitation characteristics across Uganda to understand the potential to interrupt disease transmission with an integrated package of interventions. Methodology/Principal findings A nationally representative survey was undertaken that included a household and individual questionnaire followed by disease testing based on detection of worm antigens (circulating cathodic antigen–CCA), diagnosis and treatment. A comprehensive set of questions was asked of randomly sampled individuals, two years of age and above, to understand their water and sanitation infrastructure, open defecation behaviors, exposure to surface water bodies, and knowledge of schistosomiasis. From a set of 170 randomly sampled, geographically diverse enumeration areas, a total of 9,183 study participants were included. After adjustment with sample weights, the national prevalence of schistosomiasis was 25.6% (95% confidence interval (CI): 22.3, 29.0) with children ages two to four most at risk for the disease with 36.1% infected (95% CI: 30.1, 42.2). The defecation behaviors of an individual were more strongly associated with infection status than the household water and sanitation infrastructure, indicating the importance of incorporating behavior change into community-led total sanitation coverage. Conclusions/Significance Our results highlight the importance of incorporating monitoring and evaluation data into control programs in Uganda to understand the geographic distribution of schistosomiasis prevalence outside of communities where endemicity is known to be high. The high prevalence of schistosomiasis among the youngest age group, ineligible to receive drug treatment, shows the imperative to develop a child-appropriate drug protocol that can be safely administered to preschool-aged children. Water and sanitation interventions should be considered an essential investment for elimination alongside drug treatment. Schistosomiasis is a neglected tropical disease in sub-Saharan Africa that has remained intractable despite efforts to eliminate it through mass drug administration. The transmission cycle is perpetuated when sanitation infrastructure does not adequately capture infected urine or feces and local water bodies, with snail vectors, are contaminated. Schistosomiasis has been linked with stunting and cognitive deficits and there is particular concern for the most vulnerable age group under five years old who are undergoing critical intestinal development but are ineligible to receive drug treatment. Efforts to reduce the disease have focused on children and young adolescents in endemic areas, near water bodies where transmission is known to be high. In Uganda, where fresh water bodies are abundant and intestinal schistosomiasis is endemic, very little is understood about the disease prevalence at a national level. We conducted a large, nationally representative survey and found a national prevalence of 25.6% where the 2–4 year old children had the highest prevalence for schistosomiasis with 36.1% infected. The most significant risk-factor for the disease was an individual’s open defecation behaviors in surface waters. This emphasizes the need to include water and sanitation investments alongside drug treatment and behavior change to control schistosomiasis in Uganda.
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Affiliation(s)
- Natalie G. Exum
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Simon P. S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Julien Nobili
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Alexandra K. Shannon
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - John C. Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Kellogg J. Schwab
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Fredrick E. Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
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Silva-Moraes V, Shollenberger LM, Siqueira LMV, Castro-Borges W, Harn DA, Grenfell RFQE, Rabello ALT, Coelho PMZ. Diagnosis of Schistosoma mansoni infections: what are the choices in Brazilian low-endemic areas? Mem Inst Oswaldo Cruz 2019; 114:e180478. [PMID: 30942278 PMCID: PMC6440364 DOI: 10.1590/0074-02760180478] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/21/2019] [Indexed: 12/25/2022] Open
Abstract
The population of Brazil is currently characterised by many individuals harbouring low-intensity Schistosoma mansoni infections. The Kato-Katz technique is the diagnostic method recommended by the World Health Organization (WHO) to assess these infections, but this method is not sensitive enough in the context of low egg excretion. In this regard, potential alternatives are being employed to overcome the limits of the Kato-Katz technique. In the present review, we evaluated the performance of parasitological and immunological approaches adopted in Brazilian areas. Currently, the diagnostic choices involve a combination of strategies, including the utilisation of antibody methods to screen individuals and then subsequent confirmation of positive cases by intensive parasitological investigations.
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Affiliation(s)
- Vanessa Silva-Moraes
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Belo Horizonte, MG, Brasil
- University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases, Athens, GA, United States of America
| | - Lisa M Shollenberger
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Belo Horizonte, MG, Brasil
- Old Dominion University, Department of Biological Sciences, Norfolk, VA, United States of America
| | - Liliane Maria Vidal Siqueira
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Belo Horizonte, MG, Brasil
| | - William Castro-Borges
- Universidade Federal de Ouro Preto, Laboratório de Enzimologia e Proteômica, Ouro Preto, MG, Brasil
| | - Donald A Harn
- University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases, Athens, GA, United States of America
| | - Rafaella Fortini Queiroz e Grenfell
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Belo Horizonte, MG, Brasil
- University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases, Athens, GA, United States of America
| | - Ana Lucia Teles Rabello
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Pesquisas Clínicas e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Paulo Marcos Zech Coelho
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Belo Horizonte, MG, Brasil
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Silva-Moraes V, Shollenberger LM, Castro-Borges W, Rabello ALT, Harn DA, Medeiros LCS, Jeremias WDJ, Siqueira LMV, Pereira CSS, Pedrosa MLC, Almeida NBF, Almeida A, Lambertucci JR, Carneiro NFDF, Coelho PMZ, Grenfell RFQ. Serological proteomic screening and evaluation of a recombinant egg antigen for the diagnosis of low-intensity Schistosoma mansoni infections in endemic area in Brazil. PLoS Negl Trop Dis 2019; 13:e0006974. [PMID: 30870412 PMCID: PMC6472831 DOI: 10.1371/journal.pntd.0006974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/18/2019] [Accepted: 02/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background Despite decades of use of control programs, schistosomiasis remains a global public health problem. To further reduce prevalence and intensity of infection, or to achieve the goal of elimination in low-endemic areas, there needs to be better diagnostic tools to detect low-intensity infections in low-endemic areas in Brazil. The rationale for development of new diagnostic tools is that the current standard test Kato-Katz (KK) is not sensitive enough to detect low-intensity infections in low-endemic areas. In order to develop new diagnostic tools, we employed a proteomics approach to identify biomarkers associated with schistosome-specific immune responses in hopes of developing sensitive and specific new methods for immunodiagnosis. Methods and findings Immunoproteomic analyses were performed on egg extracts of Schistosoma mansoni using pooled sera from infected or non-infected individuals from a low-endemic area of Brazil. Cross reactivity with other soil-transmitted helminths (STH) was determined using pooled sera from individuals uniquely infected with different helminths. Using this approach, we identified 23 targets recognized by schistosome acute and chronic sera samples. To identify immunoreactive targets that were likely glycan epitopes, we compared these targets to the immunoreactivity of spots treated with sodium metaperiodate oxidation of egg extract. This treatment yielded 12/23 spots maintaining immunoreactivity, suggesting that they were protein epitopes. From these 12 spots, 11 spots cross-reacted with sera from individuals infected with other STH and 10 spots cross-reacted with the negative control group. Spot number 5 was exclusively immunoreactive with sera from S. mansoni-infected groups in native and deglycosylated conditions and corresponds to Major Egg Antigen (MEA). We expressed MEA as a recombinant protein and showed a similar recognition pattern to that of the native protein via western blot. IgG-ELISA gave a sensitivity of 87.10% and specificity of 89.09% represented by area under the ROC curve of 0.95. IgG-ELISA performed better than the conventional KK (2 slides), identifying 56/64 cases harboring 1–10 eggs per gram of feces that were undiagnosed by KK parasitological technique. Conclusions The serological proteome approach was able to identify a new diagnostic candidate. The recombinant egg antigen provided good performance in IgG-ELISA to detect individuals with extreme low-intensity infections (1 egg per gram of feces). Therefore, the IgG-ELISA using this newly identified recombinant MEA can be a useful tool combined with other techniques in low-endemic areas to determine the true prevalence of schistosome infection that is underestimated by the KK method. Further, to overcome the complexity of ELISA in the field, a second generation of antibody-based rapid diagnostic tests (RDT) can be developed. Schistosomiasis remains a serious global public health problem. Detecting parasite eggs in patient stool samples using the KK method is the standard diagnostic recommended by the World Health Organization (WHO) for infection by S. mansoni. As a result of intensive control strategies, many previously high-endemic areas are now considered low-endemic areas and the KK method does not function well in low-endemic areas and therefore cannot be considered the gold standard. Thus, a new emphasis on strategies to accurately diagnose low-intensity infections was outlined in a plan from the WHO focusing on elimination of disease as a public health problem. Successful diagnoses and treatment of infected individuals may result in eradication of low-burden transmitters and consequently contribute to interruption of disease transmission. In this regard, immunological techniques have proven to be more sensitive and promising for identifying low-intensity infections where KK may be negative. The identification of antigens is the initial step for developing new immunodiagnostic assays. In this study, we used sets of pooled human sera samples from controls with acute and chronic infections to identify new target antigens via proteomic screening. Using these approaches, we initially identified 12 different egg proteins in S. mansoni-infected individuals (acute and chronic phase). A single antigen, identified as MEA, was shown to be highly specific as this antigen was not recognized by sera from negative patients or patients infected with other STH. The recombinant MEA protein functioned in an ELISA as a highly sensitive and specific antigen to detect patient IgG-antibodies. Recombinant MEA performed significantly better to detect low-intensity infections (1 egg per gram of feces) than the KK method using 2 slides. Therefore, we were able to use a proteomic screening approach to identify a potential new candidate antigen for development of far more sensitive diagnostic assays. Further diagnostic assays employing the MEA could be useful tools on their own or in combination with other methods for diagnosis of schistosome infection in populations living in extreme low-intensity endemic areas of Brazil.
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Affiliation(s)
- Vanessa Silva-Moraes
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Lisa Marie Shollenberger
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - William Castro-Borges
- Laboratório de Enzimologia e Proteomica, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Ana Lucia Teles Rabello
- Grupo de Pesquisas Clínicas e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Donald A. Harn
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | | | - Wander de Jesus Jeremias
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Liliane Maria Vidal Siqueira
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Caroline Stephane Salviano Pereira
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Luysa Camargos Pedrosa
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Nathalie Bonatti Franco Almeida
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Aureo Almeida
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Paulo Marcos Zech Coelho
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Rafaella Fortini Queiroz Grenfell
- Biologia do Schistosoma mansoni e sua interação com o hospedeiro, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
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