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
[Display omitted] •Strongyloides stercoralis is endemic in rural Côte d’Ivoire (prevalence: 21.9%).•Real-time PCR reveals higher prevalence than stool microscopy (16.8% vs. 10.9%).•The diagnostic agreement of PCR for S. stercoralis in two laboratories is substantial.•S. stercoralis-hookworm co-infec...
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| creator | Becker, Sören L. Piraisoody, Nivetha Kramme, Stefanie Marti, Hanspeter Silué, Kigbafori D. Panning, Marcus Nickel, Beatrice Kern, Winfried V. Herrmann, Mathias Hatz, Christoph F. N’Goran, Eliézer K. Utzinger, Jürg von Müller, Lutz |
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•Strongyloides stercoralis is endemic in rural Côte d’Ivoire (prevalence: 21.9%).•Real-time PCR reveals higher prevalence than stool microscopy (16.8% vs. 10.9%).•The diagnostic agreement of PCR for S. stercoralis in two laboratories is substantial.•S. stercoralis-hookworm co-infection was observed in 13.7% of study participants.•PCR may prevent misidentification of morphologically similar helminth species.
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 |
| doi_str_mv | 10.1016/j.actatropica.2015.07.019 |
| format | Article |
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•Strongyloides stercoralis is endemic in rural Côte d’Ivoire (prevalence: 21.9%).•Real-time PCR reveals higher prevalence than stool microscopy (16.8% vs. 10.9%).•The diagnostic agreement of PCR for S. stercoralis in two laboratories is substantial.•S. stercoralis-hookworm co-infection was observed in 13.7% of study participants.•PCR may prevent misidentification of morphologically similar helminth species.
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.</description><identifier>ISSN: 0001-706X</identifier><identifier>EISSN: 1873-6254</identifier><identifier>DOI: 10.1016/j.actatropica.2015.07.019</identifier><identifier>PMID: 26215130</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adolescent ; Adult ; Aged ; Ancylostomatoidea - genetics ; Ancylostomatoidea - isolation & purification ; Animals ; Baermann technique ; Child ; Child, Preschool ; Coinfection ; Cote d'Ivoire - epidemiology ; Cross-Sectional Studies ; Diagnostic accuracy ; Feces - parasitology ; Female ; Hookworm ; Hookworm Infections - complications ; Hookworm Infections - diagnosis ; Hookworm Infections - epidemiology ; Humans ; Infant ; Infant, Newborn ; Koga agar plate culture ; Male ; Middle Aged ; Prevalence ; Real-time PCR ; Real-Time Polymerase Chain Reaction ; Rural Population ; Sensitivity and Specificity ; Strongyloides stercoralis ; Strongyloides stercoralis - genetics ; Strongyloides stercoralis - isolation & purification ; Strongyloidiasis - complications ; Strongyloidiasis - diagnosis ; Strongyloidiasis - epidemiology ; Young Adult</subject><ispartof>Acta tropica, 2015-10, Vol.150, p.210-217</ispartof><rights>2015 Elsevier B.V.</rights><rights>Copyright © 2015 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-dede843e8f5c0b342d7ae3b5541dbe71962bb8e403fc09804736ae1cda4aea993</citedby><cites>FETCH-LOGICAL-c377t-dede843e8f5c0b342d7ae3b5541dbe71962bb8e403fc09804736ae1cda4aea993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.actatropica.2015.07.019$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26215130$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Becker, Sören L.</creatorcontrib><creatorcontrib>Piraisoody, Nivetha</creatorcontrib><creatorcontrib>Kramme, Stefanie</creatorcontrib><creatorcontrib>Marti, Hanspeter</creatorcontrib><creatorcontrib>Silué, Kigbafori D.</creatorcontrib><creatorcontrib>Panning, Marcus</creatorcontrib><creatorcontrib>Nickel, Beatrice</creatorcontrib><creatorcontrib>Kern, Winfried V.</creatorcontrib><creatorcontrib>Herrmann, Mathias</creatorcontrib><creatorcontrib>Hatz, Christoph F.</creatorcontrib><creatorcontrib>N’Goran, Eliézer K.</creatorcontrib><creatorcontrib>Utzinger, Jürg</creatorcontrib><creatorcontrib>von Müller, Lutz</creatorcontrib><title>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</title><title>Acta tropica</title><addtitle>Acta Trop</addtitle><description>[Display omitted]
•Strongyloides stercoralis is endemic in rural Côte d’Ivoire (prevalence: 21.9%).•Real-time PCR reveals higher prevalence than stool microscopy (16.8% vs. 10.9%).•The diagnostic agreement of PCR for S. stercoralis in two laboratories is substantial.•S. stercoralis-hookworm co-infection was observed in 13.7% of study participants.•PCR may prevent misidentification of morphologically similar helminth species.
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Ancylostomatoidea - genetics</subject><subject>Ancylostomatoidea - isolation & purification</subject><subject>Animals</subject><subject>Baermann technique</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Coinfection</subject><subject>Cote d'Ivoire - epidemiology</subject><subject>Cross-Sectional Studies</subject><subject>Diagnostic accuracy</subject><subject>Feces - parasitology</subject><subject>Female</subject><subject>Hookworm</subject><subject>Hookworm Infections - complications</subject><subject>Hookworm Infections - diagnosis</subject><subject>Hookworm Infections - epidemiology</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Koga agar plate culture</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prevalence</subject><subject>Real-time PCR</subject><subject>Real-Time Polymerase Chain Reaction</subject><subject>Rural Population</subject><subject>Sensitivity and Specificity</subject><subject>Strongyloides stercoralis</subject><subject>Strongyloides stercoralis - genetics</subject><subject>Strongyloides stercoralis - isolation & purification</subject><subject>Strongyloidiasis - complications</subject><subject>Strongyloidiasis - diagnosis</subject><subject>Strongyloidiasis - epidemiology</subject><subject>Young Adult</subject><issn>0001-706X</issn><issn>1873-6254</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUFu1TAQhiMEoq-FKyCzY0GCHSdxwg4FCpUqgQpI7KyJPWn9SOzUdorejmtwD7asuAknwU-vIJasRh598_8z_rPsMaMFo6x5ti1ARYjeLUZBUVJWF1QUlHV3sg1rBc-bsq7uZhtKKcsFbT4dZcchbNOrFHV5Pzsqm5LVjNNN9uMCYcqjmZG86y_I6DzRGFFF4yxxI3mfXOzlbnJGYyAholfOw2QCMZZcrTPY1HRuIgHmZUrI6N1M-p_fIxL96-u3sxtnPD4nLw1cWheiUQSUWj2o3dMkkfTyCYYkGZ3fEeXmBbwJyRusJgvEBNiwX-TKuc9fnJ8Tkxs7HjZ8kN0bYQr48LaeZB9PX33o3-Tnb1-f9S_Oc8WFiLlGjW3FsR1rRQdelVoA8qGuK6YHFKxrymFosaJ8VLRraSV4A8iUhgoQuo6fZE8Ouot31yuGKGcTFE4TWHRrkEywtmMVb3lCuwOqvAvB4ygXb2bwO8mo3Kcnt_Kf9OQ-PUmFTOml2Ue3Nuswo_47-SeuBPQHANOxNwa9DMqgVajTJ6sotTP_YfMbAnS5Ag</recordid><startdate>201510</startdate><enddate>201510</enddate><creator>Becker, Sören L.</creator><creator>Piraisoody, Nivetha</creator><creator>Kramme, Stefanie</creator><creator>Marti, Hanspeter</creator><creator>Silué, Kigbafori D.</creator><creator>Panning, Marcus</creator><creator>Nickel, Beatrice</creator><creator>Kern, Winfried V.</creator><creator>Herrmann, Mathias</creator><creator>Hatz, Christoph F.</creator><creator>N’Goran, Eliézer K.</creator><creator>Utzinger, Jürg</creator><creator>von Müller, Lutz</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201510</creationdate><title>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</title><author>Becker, Sören L. ; Piraisoody, Nivetha ; Kramme, Stefanie ; Marti, Hanspeter ; Silué, Kigbafori D. ; Panning, Marcus ; Nickel, Beatrice ; Kern, Winfried V. ; Herrmann, Mathias ; Hatz, Christoph F. ; N’Goran, Eliézer K. ; Utzinger, Jürg ; von Müller, Lutz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-dede843e8f5c0b342d7ae3b5541dbe71962bb8e403fc09804736ae1cda4aea993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Ancylostomatoidea - genetics</topic><topic>Ancylostomatoidea - isolation & purification</topic><topic>Animals</topic><topic>Baermann technique</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Coinfection</topic><topic>Cote d'Ivoire - epidemiology</topic><topic>Cross-Sectional Studies</topic><topic>Diagnostic accuracy</topic><topic>Feces - parasitology</topic><topic>Female</topic><topic>Hookworm</topic><topic>Hookworm Infections - complications</topic><topic>Hookworm Infections - diagnosis</topic><topic>Hookworm Infections - epidemiology</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Koga agar plate culture</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prevalence</topic><topic>Real-time PCR</topic><topic>Real-Time Polymerase Chain Reaction</topic><topic>Rural Population</topic><topic>Sensitivity and Specificity</topic><topic>Strongyloides stercoralis</topic><topic>Strongyloides stercoralis - genetics</topic><topic>Strongyloides stercoralis - isolation & purification</topic><topic>Strongyloidiasis - complications</topic><topic>Strongyloidiasis - diagnosis</topic><topic>Strongyloidiasis - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Becker, Sören L.</creatorcontrib><creatorcontrib>Piraisoody, Nivetha</creatorcontrib><creatorcontrib>Kramme, Stefanie</creatorcontrib><creatorcontrib>Marti, Hanspeter</creatorcontrib><creatorcontrib>Silué, Kigbafori D.</creatorcontrib><creatorcontrib>Panning, Marcus</creatorcontrib><creatorcontrib>Nickel, Beatrice</creatorcontrib><creatorcontrib>Kern, Winfried V.</creatorcontrib><creatorcontrib>Herrmann, Mathias</creatorcontrib><creatorcontrib>Hatz, Christoph F.</creatorcontrib><creatorcontrib>N’Goran, Eliézer K.</creatorcontrib><creatorcontrib>Utzinger, Jürg</creatorcontrib><creatorcontrib>von Müller, Lutz</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Acta tropica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Becker, Sören L.</au><au>Piraisoody, Nivetha</au><au>Kramme, Stefanie</au><au>Marti, Hanspeter</au><au>Silué, Kigbafori D.</au><au>Panning, Marcus</au><au>Nickel, Beatrice</au><au>Kern, Winfried V.</au><au>Herrmann, Mathias</au><au>Hatz, Christoph F.</au><au>N’Goran, Eliézer K.</au><au>Utzinger, Jürg</au><au>von Müller, Lutz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Acta tropica</jtitle><addtitle>Acta Trop</addtitle><date>2015-10</date><risdate>2015</risdate><volume>150</volume><spage>210</spage><epage>217</epage><pages>210-217</pages><issn>0001-706X</issn><eissn>1873-6254</eissn><abstract>[Display omitted]
•Strongyloides stercoralis is endemic in rural Côte d’Ivoire (prevalence: 21.9%).•Real-time PCR reveals higher prevalence than stool microscopy (16.8% vs. 10.9%).•The diagnostic agreement of PCR for S. stercoralis in two laboratories is substantial.•S. stercoralis-hookworm co-infection was observed in 13.7% of study participants.•PCR may prevent misidentification of morphologically similar helminth species.
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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>26215130</pmid><doi>10.1016/j.actatropica.2015.07.019</doi><tpages>8</tpages></addata></record> |
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| ispartof | Acta tropica, 2015-10, Vol.150, p.210-217 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adolescent Adult Aged Ancylostomatoidea - genetics Ancylostomatoidea - isolation & purification Animals Baermann technique Child Child, Preschool Coinfection Cote d'Ivoire - epidemiology Cross-Sectional Studies Diagnostic accuracy Feces - parasitology Female Hookworm Hookworm Infections - complications Hookworm Infections - diagnosis Hookworm Infections - epidemiology Humans Infant Infant, Newborn Koga agar plate culture Male Middle Aged Prevalence Real-time PCR Real-Time Polymerase Chain Reaction Rural Population Sensitivity and Specificity Strongyloides stercoralis Strongyloides stercoralis - genetics Strongyloides stercoralis - isolation & purification Strongyloidiasis - complications Strongyloidiasis - diagnosis Strongyloidiasis - epidemiology Young Adult |
| title | 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 |
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