1
|
Nacife MBPESL, Siqueira LMV, Barbosa KF, Vianna VN, Masioli CZ, da Silva JC, Zicker F, Coelho PMZ, Katz N, Machado-Coelho GLL. Prevalence of helmintic infections in Brazilian Maxakali indigenous: a repeated cross-sectional design. Int J Equity Health 2024; 23:18. [PMID: 38302951 PMCID: PMC10832216 DOI: 10.1186/s12939-024-02105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The prevalence of intestinal parasites is known to be high among Amerindian populations; further, there are serious problems in the healthcare of these populations in Brazil. The Maxakali, located in the northeastern region of Minas Gerais, Brazil, is an indigenous group that still preserves many of its cultural aspects. This study aimed to compare the positivity rate of schistosomiasis and soil-transmitted helminths in this ethnic group in epidemiological surveys conducted in 1972 and 2014. METHODS Stool parasitological examinations were performed by the Kato-Katz technique during both periods in this population. In 2014, the parasitological diagnosis was also realized with the TF-Test® technique. RESULTS In 1972, 270 inhabitants were examined. The positivity rates were 67.4% for Schistosoma mansoni, 72.9% for hookworms, 43.7% for Ascaris lumbricoides, and 23.7% for Trichuris trichiura. In 2014, 545 individuals were examined, and the positivity rates obtained were 45.7% for S. mansoni, 22.8% for hookworms, 0.6% for A. lumbricoides, and 2.8% for T. trichiura. CONCLUSIONS The comparison of the parasitological surveys conducted in 1972 and 2014, indicates that the indigenous Maxakali remained neglected by the health and indigenous protection authorities during these four decades. The infection rate observed in 2014 for schistosomiasis and hookworm remains high, considering the current epidemiological view of these diseases in the Brazilian population.
Collapse
Affiliation(s)
- Maria Beatriz Pena E Silva Leite Nacife
- Universidade Federal de Ouro Preto, Escola de Medicina, Laboratório de Epidemiologia, Rua Dois s/n, sala 203, Campus Universitário Morro do Cruzeiro, Ouro Preto, Minas Gerais, CEP 35402-145, Brasil
| | | | - Keila Furbino Barbosa
- Universidade Federal de Ouro Preto, Escola de Medicina, Laboratório de Epidemiologia, Rua Dois s/n, sala 203, Campus Universitário Morro do Cruzeiro, Ouro Preto, Minas Gerais, CEP 35402-145, Brasil
| | - Valeska Natiely Vianna
- Universidade Federal de Ouro Preto, Escola de Medicina, Laboratório de Epidemiologia, Rua Dois s/n, sala 203, Campus Universitário Morro do Cruzeiro, Ouro Preto, Minas Gerais, CEP 35402-145, Brasil
| | - Cássio Zumerle Masioli
- Universidade Federal de Ouro Preto, Escola de Medicina, Laboratório de Epidemiologia, Rua Dois s/n, sala 203, Campus Universitário Morro do Cruzeiro, Ouro Preto, Minas Gerais, CEP 35402-145, Brasil
| | - Jaime Costa da Silva
- Ministério da Saúde, Distrito Sanitário Especial Indígena/Minas Gerais-Espírito Santo, Belo Horizonte, Minas Gerais, Brasil
| | | | | | - Naftale Katz
- Fundação Oswaldo Cruz, Instituto René Rachou, Belo Horizonte, Minas Gerais, Brasil
| | - George Luiz Lins Machado-Coelho
- Universidade Federal de Ouro Preto, Escola de Medicina, Laboratório de Epidemiologia, Rua Dois s/n, sala 203, Campus Universitário Morro do Cruzeiro, Ouro Preto, Minas Gerais, CEP 35402-145, Brasil.
| |
Collapse
|
2
|
Siqueira LMV, Senra C, de Oliveira ÁA, Carneiro NFDF, Gomes LI, Rabello A, Coelho PMZ, Oliveira E. A Real-Time PCR Assay for the Diagnosis of Intestinal Schistosomiasis and Cure Assessment After the Treatment of Individuals With Low Parasite Burden. Front Immunol 2021; 11:620417. [PMID: 33815351 PMCID: PMC8010660 DOI: 10.3389/fimmu.2020.620417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/24/2020] [Indexed: 01/02/2023] Open
Abstract
The laboratorial diagnosis of the intestinal schistosomiasis is always performed using Kato-Katz technique. However, this technique presents low sensitivity for diagnosis of individuals with low parasite burden, which constitutes the majority in low endemicity Brazilian locations for the disease. The objective of this study was developed and to validate a real-time PCR assay (qPCR) targeting 121 bp sequence to detect Schistosoma spp. DNA for the diagnosis of intestinal schistosomiasis and a sequence of the human β-actin gene as internal control. Firstly, the qPCR was standardized and next it was evaluated for diagnosis and cure assessment of intestinal schistosomiasis in the resident individuals in Tabuas and Estreito de Miralta, two locations in Brazil endemic for intestinal schistosomiasis. The qPCR assay results were compared with those of the Kato-Katz (KK) test, examining 2 or 24 slides, Saline Gradient (SG) and “reference test” (24 KK slides + SG). The cure assessment was measured by these diagnostic techniques at 30, 90, and 180 days post-treatment. In Tabuas, the positivity rates obtained by the qPCR was 30.4% (45/148) and by “reference test” was of 31.0% (46/148), with no statistical difference (p = 0.91). The presumed cure rates at 30, 90, and 180 days post-treatment were 100, 94.4, and 78.4% by the analysis of 24 KK slides, 100, 94.4, and 78.4% by the SG, and 100, 83.3, and 62.1% by the qPCR assay. In Estreito de Miralta, the positivity obtained by qPCR was 18.3% (26/142) and with “reference test” was 24.6% (35/142), with no statistical difference (p = 0.20). The presumed cure rates were 93.3, 96.9, and 96.5% by the KK, 93.3, 96.9, and 100% by the SG, and 93.3, 93.9, and 96.5% by the qPCR at 30, 90, and 180 days post-treatment, respectively. This study showed that the diagnostic techniques presented different performance in the populations from the two districts (Tabuas and Estreito de Miralta) and reinforces the need of combining techniques to improve diagnosis accuracy, increasing the detection of individuals with low parasite burden. This combination of techniques consists an important strategy for controlling the disease transmission.
Collapse
Affiliation(s)
- Liliane Maria Vidal Siqueira
- Diagnosis and Therapy of Infectious and Oncologic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Carolina Senra
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Áureo Almeida de Oliveira
- Diagnosis and Therapy of Infectious and Oncologic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | | | - Luciana Inácia Gomes
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Ana Rabello
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Paulo Marcos Zech Coelho
- Diagnosis and Therapy of Infectious and Oncologic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Edward Oliveira
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| |
Collapse
|
3
|
Carneiro NFDF, Caldeira AP, Katz N, de Oliveira ÁA, Siqueira LMV, Oliveira E, Silveira MF, Enk MJ, Coelho PMZ. Transmission control of schistosomiasis mansoni in a low endemicity area through a single intervention with rigorous prospection of infected cases treated with praziquantel: evaluation after 7 years of intervention. Rev Inst Med Trop Sao Paulo 2019; 61:e64. [PMID: 31859841 PMCID: PMC6907418 DOI: 10.1590/s1678-9946201961064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/22/2019] [Indexed: 11/22/2022] Open
Abstract
A prospective cohort study with rigorous searching for schistosomiasis cases was conducted among residents of Pedra Preta, Montes Claros, Minas Gerais State, Brazil, seven years after an intervention. Kato-Katz (KK), Saline Gradient, Miracidia Hatch and Polymerase Chain Reaction (PCR) were used as the diagnostic methods in 2008. In the period of 2013-2016, 175 patients remaining in the area were examined using the diagnostic methods Kato-Katz (24 slides, 1 g of feces) and Saline Gradient (2 procedures, 1 g of feces). Sixty-eight out of the 69 infected and treated individuals in 2008 tested negative. The percentage of new cases was 2.29% (4/175), and the 4 infected individuals presented low parasitic load [1, 6, 7 and 19 eggs per gram (EPG)]. All the participants answered epidemiological questionnaires on risky behavior. All residences had pit latrines and domiciliary water supply. The primary transmission focus (lake) was dry for several months. Malacological surveys showed a few non-infected specimens of Biomphalaria glabrata . A clear dominance of Biomphalaria straminea was observed. It can be inferred that a significant decrease in the disease transmission occurred after a single action through an intense search for infected and treated cases under the ecoepidemiological conditions of this area.
Collapse
Affiliation(s)
| | | | - Naftale Katz
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| | - Áureo Almeida de Oliveira
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| | - Liliane Maria Vidal Siqueira
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| | - Edward Oliveira
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Pesquisa Clínica, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Paulo Marcos Zech Coelho
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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.
Collapse
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
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
6
|
Senra C, Gomes LI, Siqueira LMV, Coelho PMZ, Rabello A, Oliveira E. Development of a laboratorial platform for diagnosis of schistosomiasis mansoni by PCR-ELISA. BMC Res Notes 2018; 11:455. [PMID: 29996913 PMCID: PMC6042422 DOI: 10.1186/s13104-018-3571-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
Objective We developed a laboratorial platform to release a commercial platform used in the PCR-ELISA for the molecular diagnosis of schistosomiasis mansoni. On following, PCR-ELISA platform laboratorial was evaluated in 206 feces samples collected of individual living in a Brazilian low endemicity area. Results The PCR-ELISA laboratorial platform indicated a prevalence rate of 25.2%, which was higher than the Kato-Katz technique (18.4%) and lower than the commercial platform (30.1%). Considering Kato-Katz technique as the reference, there were 97.4% and 91.1% of relative sensitivity and specificity rates, respectively. The laboratorial platform presented good precision, performance diagnostic, and can be used in replacement to the commercial platform for diagnosis of schistosomiasis by PCR-ELISA. Electronic supplementary material The online version of this article (10.1186/s13104-018-3571-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Carolina Senra
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Av. Augusto de Lima, 1715, Belo Horizonte, MG, 30190-002, Brazil
| | - Luciana Inácia Gomes
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Av. Augusto de Lima, 1715, Belo Horizonte, MG, 30190-002, Brazil
| | - Liliane Maria Vidal Siqueira
- Biology of the Schistosoma mansoni and its Interaction with Host, Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Av. Augusto de Lima, 1715, Belo Horizonte, MG, 30190-002, Brazil
| | - Paulo Marcos Zech Coelho
- Biology of the Schistosoma mansoni and its Interaction with Host, Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Av. Augusto de Lima, 1715, Belo Horizonte, MG, 30190-002, Brazil
| | - Ana Rabello
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Av. Augusto de Lima, 1715, Belo Horizonte, MG, 30190-002, Brazil
| | - Edward Oliveira
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Av. Augusto de Lima, 1715, Belo Horizonte, MG, 30190-002, Brazil.
| |
Collapse
|
7
|
Nacife MBPESL, Siqueira LMV, Martins R, Vianna VN, Barbosa KF, Masioli CZ, Silva JCD, Machado-Coelho GLL. Prevalence of schistosomiasis mansoni in indigenous Maxakali villages, Minas Gerais, Brazil. Rev Inst Med Trop Sao Paulo 2018; 60:e26. [PMID: 29972467 PMCID: PMC6029851 DOI: 10.1590/s1678-9946201860026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/26/2018] [Indexed: 11/21/2022] Open
Abstract
Intestinal parasitic infections are a common health problem among Amerindian populations and schistosomiasis represents one of the most prevalent diseases in Maxakali people. The Kato-Katz is the diagnostic method recommended by WHO for epidemiological studies; however, one of the technique's limitations is the failure to detect parasites in individuals with low parasite load. The aim of this study was to establish the prevalence of Schistosoma mansoni in indigenous Maxakali villages, evaluating the TF-Test® performance for diagnosis compared to the Kato-Katz technique. Stool samples from 545 individuals were processed by the TF-Test® (1 sample) and Kato-Katz (1 slide). The positivity rate for S. mansoni by Kato-Katz was 45.7%. The rate by the TF-Test® was 33.2%, and 51.9% by the combined parasitological techniques. The amplitude of parasite load was 24 to 4,056 eggs per gram of feces (epg), with a geometric mean of 139 epg. The co-positivity, co-negativity, and accuracy values by TF-Test® in relation to Kato-Katz were 59.0%, 88.5%, and 75.0%, respectively. The agreement between these techniques was moderate (k=0.486) as determined by the kappa index. Thus, the results of this study demonstrated that the performance of Kato-Katz was superior (p <0.05) to that of TF-Test® in the detection of S. mansoni. The combination of TF-Test® and Kato-Katz resulted in an increased positivity rate of S. mansoni, demonstrating the high risk of infection to which indigenous populations are exposed and the importance of the implementation of control strategies in Maxakali villages.
Collapse
Affiliation(s)
| | - Liliane Maria Vidal Siqueira
- Laboratório de Esquistossomose, Instituto de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael Martins
- Laboratório de Epidemiologia, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Valeska Natiely Vianna
- Laboratório de Epidemiologia, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Keila Furbino Barbosa
- Laboratório de Epidemiologia, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Cássio Zumerle Masioli
- Laboratório de Epidemiologia, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | | | | |
Collapse
|
8
|
Coelho PMZ, Siqueira LMV, Grenfell RFQ, Almeida NBF, Katz N, Almeida Á, Carneiro NFDF, Oliveira E. Improvement of POC-CCA Interpretation by Using Lyophilization of Urine from Patients with Schistosoma mansoni Low Worm Burden: Towards an Elimination of Doubts about the Concept of Trace. PLoS Negl Trop Dis 2016; 10:e0004778. [PMID: 27326453 PMCID: PMC4915691 DOI: 10.1371/journal.pntd.0004778] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/23/2016] [Indexed: 12/05/2022] Open
Abstract
Background Accurate diagnostic techniques for schistosomiasis are essential for prevalence determination and identification of positive patients. A point-of-care test for detecting schistosome circulating cathodic antigen (POC-CCA) has been evaluated for its accuracy in different endemic regions. This reagent strip/dipstick based assay has showed high sensitivity for individuals with high or moderate worm burden, but the interpretation of light infections is less clear, especially for trace readings. Methodology/Principal Findings We introduced a urine lyophilization step to the POC-CCA assay to improve its sensitivity and clarify the interpretation of traces. We evaluated POC-CCA sensitivity and specificity within individuals with low parasite burdens in a Brazilian endemic area where a high number of traces were detected. Patients that were positive for other helminths were also evaluated for cross reactions. In all cases, a combined parasitological diagnosis using Kato-Katz (24 slides) and Saline Gradient (1 g of feces) were used as reference. At baseline, diagnosis by POC-CCA (1–2 cassettes) showed 6% sensitivity, inaccurately predicting a low prevalence of Schistosoma mansoni infections (2 POC-CCA positives/32 egg positives). After urine lyophilization, the sensitivity was increased significantly (p < 0.05). Prevalence rates changed from 2% to 32% (27 POC-CCA positives/32 egg positives), equivalent to parasitological techniques. Most of the trace readings changed to positive after lyophilization while some negatives turned into traces. Cross reaction analysis confirmed the specificity of POC-CCA. Conclusions/Significance Trace readings cannot be primarily defined as positive or negative cases. It is critical to verify case-by-case by concentrating urine 10 fold by lyophilization for the diagnosis. Following lyophilization, persistent trace readings should be read as negatives. No trained technician is needed and cost is restricted to the cost of a lyophilizer and the electricity to run it. Schistosomiasis mansoni is a relevant disease affecting millions of individuals in different countries, in particular countries in Africa, and Brazil. Diagnosis performed by Kato-Katz technique for the detection of eggs in stool and a point-of-care test for circulating cathodic antigen detection in urine (POC-CCA) has been evaluated. Both methods have decreased sensitivity when diagnosing patients with low parasite burdens, which can lead to infected individuals not receiving treatment. Here, we focused on interpretation of POC-CCA results in persons with low parasite burdens. We noted a high number (49%) of indeterminate results, including false negatives and trace readings. A urine concentration step was included to improve the test’s sensitivity. Important differences on sensitivity and prevalence rates were noted when comparing diagnosis by POC-CCA before and after urine concentration. Notably, indeterminate results were easily defined after introduction of this step. Cross reaction analysis confirmed the specificity of POC-CCA, with exceptions noted for individuals with hookworm infection. In conclusion, trace readings cannot be primarily defined as positive or negative cases. It is imperative to analyze each case individually by concentrating urine prior to the introduction of treatment, instead of relying on a point-of-care test with indeterminate results.
Collapse
Affiliation(s)
- Paulo Marcos Zech Coelho
- Schistosomiasis Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Liliane Maria Vidal Siqueira
- Schistosomiasis Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Rafaella Fortini Queiroz Grenfell
- Schistosomiasis Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Nathalie Bonatti Franco Almeida
- Schistosomiasis Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Naftale Katz
- Schistosomiasis Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Áureo Almeida
- Schistosomiasis Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | | | - Edward Oliveira
- Clinical Research Laboratory, Rene Rachou Research Center, Oswaldo Cruz Foundation (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
9
|
Siqueira LMV, Couto FFB, Taboada D, Oliveira ÁAD, Carneiro NFDF, Oliveira E, Coelho PMZ, Katz N. Performance of POC-CCA® in diagnosis of schistosomiasis mansoni in individuals with low parasite burden. Rev Soc Bras Med Trop 2016; 49:341-7. [DOI: 10.1590/0037-8682-0070-2016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 01/19/2023] Open
|
10
|
Siqueira LMV, Gomes LI, Oliveira E, Oliveira ERD, Oliveira ÁAD, Enk MJ, Carneiro NF, Rabello A, Coelho PMZ. Evaluation of parasitological and molecular techniques for the diagnosis and assessment of cure of schistosomiasis mansoni in a low transmission area. Mem Inst Oswaldo Cruz 2015; 110:209-14. [PMID: 25946244 PMCID: PMC4489451 DOI: 10.1590/0074-02760140375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/26/2015] [Indexed: 11/22/2022] Open
Abstract
This study evaluated parasitological and molecular techniques for the diagnosis and
assessment of cure of schistosomiasis mansoni. A population-based study was performed
in 201 inhabitants from a low transmission locality named Pedra Preta, municipality
of Montes Claros, state of Minas Gerais, Brazil. Four stool samples were analysed
using two techniques, the Kato-Katz® (KK) technique (18 slides) and the
TF-Test®, to establish the infection rate. The positivity rate of 18 KK
slides of four stool samples was 28.9% (58/201) and the combined parasitological
techniques (KK+TF-Test®) produced a 35.8% positivity rate (72/201).
Furthermore, a polymerase chain reaction (PCR)-ELISA assay produced a positivity rate
of 23.4% (47/201) using the first sample. All 72 patients with positive
parasitological exams were treated with a single dose of Praziquantel® and
these patients were followed-up 30, 90 and 180 days after treatment to establish the
cure rate. Cure rates obtained by the analysis of 12 KK slides were 100%, 100% and
98.4% at 30, 90 and 180 days after treatment, respectively. PCR-ELISA revealed cure
rates of 98.5%, 95.5% and 96.5%, respectively. The diagnostic and assessment of cure
for schistosomiasis may require an increased number of KK slides or a test with
higher sensitivity, such as PCR-ELISA, in situations of very low parasite load, such
as after therapeutic interventions.
Collapse
Affiliation(s)
| | - Luciana Inácia Gomes
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil
| | - Edward Oliveira
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil
| | | | | | | | | | - Ana Rabello
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil
| | | |
Collapse
|
11
|
Mayrink W, Mendonça-Mendes A, de Paula JC, Siqueira LMV, de Resende Marrocos S, Dias ES, de Andrade HM, Machado-Coelho GLL. Cluster randomised trial to evaluate the effectiveness of a vaccine against cutaneous leishmaniasis in the Caratinga microregion, south-east Brazil. Trans R Soc Trop Med Hyg 2013. [DOI: 10.1093/trstmh/trt048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
12
|
Siqueira LMV, Coelho PMZ, Oliveira ÁAD, Massara CL, Carneiro NFDF, Lima ACL, Enk MJ. Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2012; 106:844-50. [PMID: 22124557 DOI: 10.1590/s0074-02762011000700010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 09/20/2011] [Indexed: 11/21/2022] Open
Abstract
This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test®, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test®. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8% compared to 35.8% from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.
Collapse
Affiliation(s)
- Liliane Maria Vidal Siqueira
- Laboratório de Esquistossomose, Instituto de Pesquisas René Rachou-Fiocruz, Belo Horizonte, MG, Brasil, 30190-002
| | | | | | | | | | | | | |
Collapse
|