Abstract
BackgroundPromising results have been reported for a urine circulating cathodic antigen (CCA) test for the diagnosis of Schistosoma mansoni. We assessed the accuracy of a commercially available CCA cassette test (designated CCA-A) and an experimental formulation (CCA-B) for S. mansoni diagnosis.MethodologyWe conducted a cross-sectional survey in three settings of Côte d'Ivoire: settings A and B are endemic for S. mansoni, whereas S. haematobium co-exists in setting C. Overall, 446 children, aged 8–12 years, submitted multiple stool and urine samples. For S. mansoni diagnosis, stool samples were examined with triplicate Kato-Katz, whereas urine samples were tested with CCA-A. The first stool and urine samples were additionally subjected to an ether-concentration technique and CCA-B, respectively. Urine samples were examined for S. haematobium using a filtration method, and for microhematuria using Hemastix dipsticks.Principal FindingsConsidering nine Kato-Katz as diagnostic ‘gold’ standard, the prevalence of S. mansoni in setting A, B and C was 32.9%, 53.1% and 91.8%, respectively. The sensitivity of triplicate Kato-Katz from the first stool and a single CCA-A test was 47.9% and 56.3% (setting A), 73.9% and 69.6% (setting B), and 94.2% and 89.6% (setting C). The respective sensitivity of a single CCA-B was 10.4%, 29.9% and 75.0%. The ether-concentration technique showed a low sensitivity for S. mansoni diagnosis (8.3–41.0%). The specificity of CCA-A was moderate (76.9–84.2%); CCA-B was high (96.7–100%). The likelihood of a CCA-A color reaction increased with higher S. mansoni fecal egg counts (odds ratio: 1.07, p<0.001). A concurrent S. haematobium infection or the presence of microhematuria did not influence the CCA-A test results for S. mansoni diagnosis.Conclusion/SignificanceCCA-A showed similar sensitivity than triplicate Kato-Katz for S. mansoni diagnosis with no cross-reactivity to S. haematobium and microhematuria. The low sensitivity of CCA-B in our study area precludes its use for S. mansoni diagnosis.
Highlights
There is growing awareness, political commitment, and financial resources to control neglected tropical diseases (NTDs) [1,2,3]
Urine samples were examined with a filtration method for S. haematobium eggs and with a rapid diagnostic test for S. mansoni that is based on detecting circulating cathodic antigens (CCA)
The sensitivity of triplicate Kato-Katz from the first stool sample was comparable to a single CCA-A (47.9– 94.2% vs. 56.3–89.6%), and significantly higher than the sensitivity of a single CCA-B test (10.4–75.0%)
Summary
There is growing awareness, political commitment, and financial resources to control neglected tropical diseases (NTDs) [1,2,3]. Preventive chemotherapy, that is the repeated large-scale administration of drugs to at-risk populations, has become the key strategy for the control of several NTDs, including schistosomiasis [3,4,5]. The issue of diagnosis has received only token attention in the current era of preventive chemotherapy, its importance must be emphasized for rapid identification of highrisk communities warranting regular treatment, appraisal of drug efficacy, monitoring progress of control interventions, and improved patient management [6,7,8]. With regard to intestinal schistosomiasis due to Schistosoma mansoni and S. japonicum, the Kato-Katz technique is the most widely used diagnostic approach in epidemiological surveys [8,9]. Accuracy of CCA Test for S. mansoni Diagnosis. Promising results have been reported for a urine circulating cathodic antigen (CCA) test for the diagnosis of Schistosoma mansoni. We assessed the accuracy of a commercially available CCA cassette test (designated CCA-A) and an experimental formulation (CCA-B) for S. mansoni diagnosis
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