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Real-time PCR for detection of Strongyloides stercoralis in human stool samples from Côte d'Ivoire : diagnostic accuracy, inter-laboratory comparison and patterns of hookworm co-infection

Becker, Sören L. and Piraisoody, Nivetha and Kramme, Stefanie and Marti, Hanspeter and Silué, Kigbafori D. and Panning, Marcus and Nickel, Beatrice and Kern, Winfried V. and Herrmann, Mathias and Hatz, Christoph F. and N'Goran, Eliézer K. and Utzinger, Jürg and von Müller, Lutz. (2015) Real-time PCR for detection of Strongyloides stercoralis in human stool samples from Côte d'Ivoire : diagnostic accuracy, inter-laboratory comparison and patterns of hookworm co-infection. Acta tropica, 150. pp. 210-217.

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Official URL: http://edoc.unibas.ch/39871/

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Abstract

Human infections with the helminth species Strongyloides stercoralis encompass a wide clinical spectrum, ranging from asymptomatic carriage to life-threatening disease. The diagnosis of S. stercoralis is cumbersome and the sensitivity of conventional stool microscopy is low. New molecular tools have been developed to increase sensitivity. We compared the diagnostic accuracy of real-time PCR with microscopy for the detection of S. stercoralis and hookworm in human stool samples, and investigated the inter-laboratory agreement of S. stercoralis-specific real-time PCR in two European laboratories. Stool specimens from 256 randomly selected individuals in rural Côte d'Ivoire were examined using three microscopic techniques (i.e. Kato-Katz, Koga agar plate (KAP) and Baermann (BM)). Additionally, ethanol-fixed stool aliquots were subjected to molecular diagnosis. The prevalence of S. stercoralis and hookworm infection was 21.9% and 52.0%, respectively, whilst co-infections were detected in 35 (13.7%) participants. The diagnostic agreement between real-time PCR and microscopy was excellent when both KAP and BM tested positive for S. stercoralis, but was considerably lower when only one microscopic technique was positive. The sensitivity of KAP, BM and real-time PCR for detection of S. stercoralis as compared to a combination of all diagnostic techniques was 21.4%, 37.5% and 76.8%, respectively. The inter-laboratory agreement of S. stercoralis-specific PCR was substantial (κ=0.63, p<0.001). We conclude that a combination of real-time PCR and stool microscopy shows high accuracy for S. stercoralis diagnosis. Besides high sensitivity, PCR may also enhance specificity by reducing microscopic misdiagnosis of morphologically similar helminth larvae (i.e. hookworm and S. stercoralis) in settings where both helminth species co-exist.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Eco System Health Sciences > Health Impact Assessment (Utzinger)
03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Travel Clinic (Neumayr)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Medicine > Travel Clinic (Neumayr)
UniBasel Contributors:Becker, Sören Leif and Marti, Hanspeter and Hatz, Christoph and Utzinger, Jürg
Item Type:Article, refereed
Publisher:Elsevier Science Publ.
ISSN:0001-706X
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:30 Jun 2016 11:00
Deposited On:27 Jan 2016 14:21

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