Intestinal schistosomiasis: Can a urine sample decide the infection?

Intestinal schistosomiasis, one of the neglected tropical diseases whose control depends on accurate diagnosis of the disease prevalence. The use of low sensitive Kato Katz (KK) fecal egg detection method as a reference gold standard is not an accurate indication especially in low transmission areas...

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Veröffentlicht in:Parasitology international 2021-02, Vol.80, p.102201-102201, Article 102201
Hauptverfasser: Diab, Radwa Galal, Tolba, Mona Mohamed, Ghazala, Rasha Abdelmawla, Abu-Sheasha, Ghada Ahmed, Webster, Bonnie L., Mady, Rasha Fadly
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container_end_page 102201
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container_start_page 102201
container_title Parasitology international
container_volume 80
creator Diab, Radwa Galal
Tolba, Mona Mohamed
Ghazala, Rasha Abdelmawla
Abu-Sheasha, Ghada Ahmed
Webster, Bonnie L.
Mady, Rasha Fadly
description Intestinal schistosomiasis, one of the neglected tropical diseases whose control depends on accurate diagnosis of the disease prevalence. The use of low sensitive Kato Katz (KK) fecal egg detection method as a reference gold standard is not an accurate indication especially in low transmission areas. Latent class analysis frameworks especially the Bayesian could be used instead to compare between different diagnostic tests without the use of a gold standard method as a reference. Thus, this study compared two urine-based tests for the detection of circulating antigen and cell free DNA of Schistosoma mansoni versus KK method using the Bayesian latent class analytical framework and in two models where the trace results of point of contact - assay of circulating cathodic antigen (POC-CCA) were once estimated as positive, and as negative in the other model. The Bayesian framework in the trace CCA positive model showed an estimate of disease prevalence of 26% (95% BCI:0 to 60%). POC-CCA showed the highest sensitivity (74% with BCI: 9 to 91%) and lowest specificity for (20% with BCI: 0% to 37%) and the reverse for KK. For POC-CCA with traces considered negative, it was found that results between the three tests were moderated where the positivity for infection by Schistosoma antigen detection and PCR for cell free DNA approached that estimated by the Bayesian framework (44%), and the specificity for point of contact assay(81%; 95%BCI: 59% to 100%) rose in hand with its sensitivity(77%, 95% BCI:53% to 100%) and with results for PCR test (sensitivity = 80%; 95% BCI: 61% to 100%, specificity = 69%; 95% BIC: 47% to 100%). KK remains with the highest specificity while its sensitivity in the two models never exceeded 22%. Thus, we conclude that the use of a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the trace negative model of point of contact assay, or conventional PCR, when compared to the fecal egg detection using duplicate KK. However, the use of a single tool restricts the management of the disease in areas of low endemicity. Conclusion Theuseoflatentclassanalysis(LCA) foranalysis of thepresentresults in the Bayesian framework proved that a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the POC CCA assay with traces considered negative, or conventional PCR, when compared to the fecal egg detection using dupl
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The use of low sensitive Kato Katz (KK) fecal egg detection method as a reference gold standard is not an accurate indication especially in low transmission areas. Latent class analysis frameworks especially the Bayesian could be used instead to compare between different diagnostic tests without the use of a gold standard method as a reference. Thus, this study compared two urine-based tests for the detection of circulating antigen and cell free DNA of Schistosoma mansoni versus KK method using the Bayesian latent class analytical framework and in two models where the trace results of point of contact - assay of circulating cathodic antigen (POC-CCA) were once estimated as positive, and as negative in the other model. The Bayesian framework in the trace CCA positive model showed an estimate of disease prevalence of 26% (95% BCI:0 to 60%). POC-CCA showed the highest sensitivity (74% with BCI: 9 to 91%) and lowest specificity for (20% with BCI: 0% to 37%) and the reverse for KK. For POC-CCA with traces considered negative, it was found that results between the three tests were moderated where the positivity for infection by Schistosoma antigen detection and PCR for cell free DNA approached that estimated by the Bayesian framework (44%), and the specificity for point of contact assay(81%; 95%BCI: 59% to 100%) rose in hand with its sensitivity(77%, 95% BCI:53% to 100%) and with results for PCR test (sensitivity = 80%; 95% BCI: 61% to 100%, specificity = 69%; 95% BIC: 47% to 100%). KK remains with the highest specificity while its sensitivity in the two models never exceeded 22%. Thus, we conclude that the use of a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the trace negative model of point of contact assay, or conventional PCR, when compared to the fecal egg detection using duplicate KK. However, the use of a single tool restricts the management of the disease in areas of low endemicity. Conclusion Theuseoflatentclassanalysis(LCA) foranalysis of thepresentresults in the Bayesian framework proved that a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the POC CCA assay with traces considered negative, or conventional PCR, when compared to the fecal egg detection using duplicate KKsmears. [Display omitted] •The detection of cell-free Schistosoma DNA in urine provides a potential screening tool for intestinal schistosomiasis.•PCR failed to detect any cell-free Schistosoma DNA from urine samples preserved on FTA® cards.•Compared to Kato Katz, PCR for cell free DNA from urine samples has reasonable accuracy, and affordable financial and technical expenses.•POC CCA in the trace negative model shows comprehensive sensitivity and specificity, yet, the traces might be positive and hence missing true cases.</description><identifier>ISSN: 1383-5769</identifier><identifier>EISSN: 1873-0329</identifier><identifier>DOI: 10.1016/j.parint.2020.102201</identifier><language>eng</language><publisher>Elsevier B.V</publisher><subject>Cell free DNA ; Circulating antigen ; Kato Katz ; Latent class analysis ; Point-of contact cassette assay</subject><ispartof>Parasitology international, 2021-02, Vol.80, p.102201-102201, Article 102201</ispartof><rights>2020 Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c339t-92e6f718e04ac0a82793bd8b02fb1789813976a2c25e9c535dc85f9a46610b673</citedby><cites>FETCH-LOGICAL-c339t-92e6f718e04ac0a82793bd8b02fb1789813976a2c25e9c535dc85f9a46610b673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.parint.2020.102201$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids></links><search><creatorcontrib>Diab, Radwa Galal</creatorcontrib><creatorcontrib>Tolba, Mona Mohamed</creatorcontrib><creatorcontrib>Ghazala, Rasha Abdelmawla</creatorcontrib><creatorcontrib>Abu-Sheasha, Ghada Ahmed</creatorcontrib><creatorcontrib>Webster, Bonnie L.</creatorcontrib><creatorcontrib>Mady, Rasha Fadly</creatorcontrib><title>Intestinal schistosomiasis: Can a urine sample decide the infection?</title><title>Parasitology international</title><description>Intestinal schistosomiasis, one of the neglected tropical diseases whose control depends on accurate diagnosis of the disease prevalence. The use of low sensitive Kato Katz (KK) fecal egg detection method as a reference gold standard is not an accurate indication especially in low transmission areas. Latent class analysis frameworks especially the Bayesian could be used instead to compare between different diagnostic tests without the use of a gold standard method as a reference. Thus, this study compared two urine-based tests for the detection of circulating antigen and cell free DNA of Schistosoma mansoni versus KK method using the Bayesian latent class analytical framework and in two models where the trace results of point of contact - assay of circulating cathodic antigen (POC-CCA) were once estimated as positive, and as negative in the other model. The Bayesian framework in the trace CCA positive model showed an estimate of disease prevalence of 26% (95% BCI:0 to 60%). POC-CCA showed the highest sensitivity (74% with BCI: 9 to 91%) and lowest specificity for (20% with BCI: 0% to 37%) and the reverse for KK. For POC-CCA with traces considered negative, it was found that results between the three tests were moderated where the positivity for infection by Schistosoma antigen detection and PCR for cell free DNA approached that estimated by the Bayesian framework (44%), and the specificity for point of contact assay(81%; 95%BCI: 59% to 100%) rose in hand with its sensitivity(77%, 95% BCI:53% to 100%) and with results for PCR test (sensitivity = 80%; 95% BCI: 61% to 100%, specificity = 69%; 95% BIC: 47% to 100%). KK remains with the highest specificity while its sensitivity in the two models never exceeded 22%. Thus, we conclude that the use of a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the trace negative model of point of contact assay, or conventional PCR, when compared to the fecal egg detection using duplicate KK. However, the use of a single tool restricts the management of the disease in areas of low endemicity. Conclusion Theuseoflatentclassanalysis(LCA) foranalysis of thepresentresults in the Bayesian framework proved that a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the POC CCA assay with traces considered negative, or conventional PCR, when compared to the fecal egg detection using duplicate KKsmears. [Display omitted] •The detection of cell-free Schistosoma DNA in urine provides a potential screening tool for intestinal schistosomiasis.•PCR failed to detect any cell-free Schistosoma DNA from urine samples preserved on FTA® cards.•Compared to Kato Katz, PCR for cell free DNA from urine samples has reasonable accuracy, and affordable financial and technical expenses.•POC CCA in the trace negative model shows comprehensive sensitivity and specificity, yet, the traces might be positive and hence missing true cases.</description><subject>Cell free DNA</subject><subject>Circulating antigen</subject><subject>Kato Katz</subject><subject>Latent class analysis</subject><subject>Point-of contact cassette assay</subject><issn>1383-5769</issn><issn>1873-0329</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kEtPwzAQhC0EEqXwDzj4yCXFjyS2OYBQeVWqxAXOluNsVFeJE7wpEv-eVOHMaVermdHOR8g1ZyvOeHm7Xw0uhTiuBBPHkxCMn5AF10pmTApzOu1Sy6xQpTknF4h7xnihFF-Qp00cAccQXUvR7wKOPfZdcBjwjq5dpI4epmig6LqhBVqDDzXQcQc0xAb8GPr4cEnOGtciXP3NJfl8ef5Yv2Xb99fN-nGbeSnNmBkBZaO4BpY7z5wWysiq1hUTTcWVNppLo0onvCjA-EIWtddFY1xelpxVpZJLcjPnDqn_Okxv2y6gh7Z1EfoDWpHnOmdaFPkkzWepTz1igsYOKXQu_VjO7BGa3dsZmj1CszO0yXY_22Cq8R0gWfQBooc6pKmsrfvwf8Avnrt2MQ</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Diab, Radwa Galal</creator><creator>Tolba, Mona Mohamed</creator><creator>Ghazala, Rasha Abdelmawla</creator><creator>Abu-Sheasha, Ghada Ahmed</creator><creator>Webster, Bonnie L.</creator><creator>Mady, Rasha Fadly</creator><general>Elsevier B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202102</creationdate><title>Intestinal schistosomiasis: Can a urine sample decide the infection?</title><author>Diab, Radwa Galal ; Tolba, Mona Mohamed ; Ghazala, Rasha Abdelmawla ; Abu-Sheasha, Ghada Ahmed ; Webster, Bonnie L. ; Mady, Rasha Fadly</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c339t-92e6f718e04ac0a82793bd8b02fb1789813976a2c25e9c535dc85f9a46610b673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cell free DNA</topic><topic>Circulating antigen</topic><topic>Kato Katz</topic><topic>Latent class analysis</topic><topic>Point-of contact cassette assay</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Diab, Radwa Galal</creatorcontrib><creatorcontrib>Tolba, Mona Mohamed</creatorcontrib><creatorcontrib>Ghazala, Rasha Abdelmawla</creatorcontrib><creatorcontrib>Abu-Sheasha, Ghada Ahmed</creatorcontrib><creatorcontrib>Webster, Bonnie L.</creatorcontrib><creatorcontrib>Mady, Rasha Fadly</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Parasitology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Diab, Radwa Galal</au><au>Tolba, Mona Mohamed</au><au>Ghazala, Rasha Abdelmawla</au><au>Abu-Sheasha, Ghada Ahmed</au><au>Webster, Bonnie L.</au><au>Mady, Rasha Fadly</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intestinal schistosomiasis: Can a urine sample decide the infection?</atitle><jtitle>Parasitology international</jtitle><date>2021-02</date><risdate>2021</risdate><volume>80</volume><spage>102201</spage><epage>102201</epage><pages>102201-102201</pages><artnum>102201</artnum><issn>1383-5769</issn><eissn>1873-0329</eissn><abstract>Intestinal schistosomiasis, one of the neglected tropical diseases whose control depends on accurate diagnosis of the disease prevalence. The use of low sensitive Kato Katz (KK) fecal egg detection method as a reference gold standard is not an accurate indication especially in low transmission areas. Latent class analysis frameworks especially the Bayesian could be used instead to compare between different diagnostic tests without the use of a gold standard method as a reference. Thus, this study compared two urine-based tests for the detection of circulating antigen and cell free DNA of Schistosoma mansoni versus KK method using the Bayesian latent class analytical framework and in two models where the trace results of point of contact - assay of circulating cathodic antigen (POC-CCA) were once estimated as positive, and as negative in the other model. The Bayesian framework in the trace CCA positive model showed an estimate of disease prevalence of 26% (95% BCI:0 to 60%). POC-CCA showed the highest sensitivity (74% with BCI: 9 to 91%) and lowest specificity for (20% with BCI: 0% to 37%) and the reverse for KK. For POC-CCA with traces considered negative, it was found that results between the three tests were moderated where the positivity for infection by Schistosoma antigen detection and PCR for cell free DNA approached that estimated by the Bayesian framework (44%), and the specificity for point of contact assay(81%; 95%BCI: 59% to 100%) rose in hand with its sensitivity(77%, 95% BCI:53% to 100%) and with results for PCR test (sensitivity = 80%; 95% BCI: 61% to 100%, specificity = 69%; 95% BIC: 47% to 100%). KK remains with the highest specificity while its sensitivity in the two models never exceeded 22%. Thus, we conclude that the use of a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the trace negative model of point of contact assay, or conventional PCR, when compared to the fecal egg detection using duplicate KK. However, the use of a single tool restricts the management of the disease in areas of low endemicity. Conclusion Theuseoflatentclassanalysis(LCA) foranalysis of thepresentresults in the Bayesian framework proved that a single urine sample could be very sensitive and highly specific in the diagnosis of intestinal schistosomiasis using either the POC CCA assay with traces considered negative, or conventional PCR, when compared to the fecal egg detection using duplicate KKsmears. [Display omitted] •The detection of cell-free Schistosoma DNA in urine provides a potential screening tool for intestinal schistosomiasis.•PCR failed to detect any cell-free Schistosoma DNA from urine samples preserved on FTA® cards.•Compared to Kato Katz, PCR for cell free DNA from urine samples has reasonable accuracy, and affordable financial and technical expenses.•POC CCA in the trace negative model shows comprehensive sensitivity and specificity, yet, the traces might be positive and hence missing true cases.</abstract><pub>Elsevier B.V</pub><doi>10.1016/j.parint.2020.102201</doi><tpages>1</tpages></addata></record>
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subjects Cell free DNA
Circulating antigen
Kato Katz
Latent class analysis
Point-of contact cassette assay
title Intestinal schistosomiasis: Can a urine sample decide the infection?
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