Abstract
Diagnostic tools appropriate for undertaking interventions to control helminth infections are key to their success. Many diagnostic tests for helminth infection have unsatisfactory performance characteristics and are not well suited for use in the parasite control programmes that are being increasingly implemented. Although the application of modern laboratory research techniques to improve diagnostics for helminth infection has resulted in some technical advances, uptake has not been uniform. Frequently, pilot or proof of concept studies of promising diagnostic technologies have not been followed by much needed product development, and in many settings diagnosis continues to rely on insensitive and unsatisfactory parasitological or serodiagnostic techniques. In contrast, PCR-based xenomonitoring of arthropod vectors, and use of parasite recombinant proteins as reagents for serodiagnostic tests, have resulted in critical advances in the control of specific helminth parasites. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR) was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, the diagnostic technologies relevant to control of helminth infections, either available or in development, are reviewed. Critical gaps are identified and opportunities to improve needed technologies are discussed.
Highlights
The technical limitations of currently available diagnostic methods for helminth infections impose significant constraints on current initiatives to control these infections, as discussed in other reviews of this collection [1,2]
Assay methodologies have been developed for A. lumbricoides [25], hookworms [26,27] and T. trichiura [25,28], with resistance-associated mutations being found in some populations of these soil-transmitted nematodes
A significant number of obstacles of a technical nature impede the development of diagnostics appropriate to support the ambitious programmes in place to control the neglected tropical diseases (NTDs) in general, and the human helminthiases in particular, there is good evidence that the tools are available to overcome these obstacles
Summary
The technical limitations of currently available diagnostic methods for helminth infections impose significant constraints on current initiatives to control these infections, as discussed in other reviews of this collection [1,2]. Appropriate diagnostic methodologies are required for: a) disease mapping to guide initiation and prioritisation of interventions; b) monitoring and evaluation (M&E) of ongoing interventions, and for the prompt detection of possible emerging anthelmintic resistance; c) assessment of elimination of infection by elimination programmes as these approach termination; and d) case-based diagnosis for surveillance. A product of the discussions held by the Disease Reference Group on Helminth Infections (DRG4) established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), available diagnostic tests for the six helminth human infections, within the remit of the DRG4, are considered in the context of the specific technical requirements of diagnostic tests needed for control of these parasites, and critical gaps in diagnostic technology are identified.
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