Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection: Bayesian latent class modeling of test accuracy

ARTEMIS KOUKOUNARI; ALAN L. SCOTT; CLIVE J. SHIFF; MIRYAM ROMANO; PEDRO FLEITAS; ALEJANDRO J. KROLEWIECKI; REYNALDO N. CARO; RUBEN CIMINO; ARTEMIS KOUKOUNARI; ALAN L. SCOTT; CLIVE J. SHIFF; MIRYAM ROMANO; PEDRO FLEITAS; ALEJANDRO J. KROLEWIECKI; REYNALDO N. CARO; RUBEN CIMINO

PLoS Neglected Tropical Diseases

Public Library of Science

Lugar: San Francisco; Año: 2018

1935-2727

For epidemiological work with soil transmitted helminths the recommended diagnosticapproaches are to examine fecal samples for microscopic evidence of the parasite. In addition to several logistical and processing issues, traditional diagnostic approaches have been shown to lack the sensitivity required to reliably identify patients harboring low-level infections such as those associated with effective mass drug intervention programs. In this context, there is a need to rethink the approaches used for helminth diagnostics. Serologicalmethods are now in use, however these tests are indirect and depend on individual immuneresponses, exposure patterns and the nature of the antigen. However, it has been demonstrated that cell-free DNA from pathogens and cancers can be readily detected in patient´s urine which can be collected in the field, filtered in situ and processed later for analysis. In the work presented here, we employ three diagnostic proceduresÐstool examination, serology (NIE-ELISA) and PCR-based amplification of parasite transrenal DNA from urine±to determine their relative utility in the diagnosis of S. stercoralis infections from 359 field samples from an endemic area of Argentina. Bayesian Latent Class analysis was used to assess the relative performance of the three diagnostic procedures. The results underscore the low sensitivity of stool examination and support the idea that the use of serology combined with parasite transrenal DNA detection may be a useful strategy for sensitive and specific detection of low-level strongyloidiasis.