Abstract
Reliable diagnosis of human helminth infection(s) is essential for ongoing disease surveillance and disease elimination. Current WHO-recommended diagnostic assays are unreliable in low-endemic near-elimination settings and typically involve the invasive, onerous and potentially hazardous sampling of bodily fluids such as stool and blood, as well as tissue via biopsy. In contrast, diagnosis by use of non-invasive urine sampling is generally painless, more convenient and low risk. It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients. In some instances, urine-based diagnostic assays have also been shown to provide a more reliable diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, particularly in low-endemicity settings. Given these relative benefits, we identify and review current research literature to evaluate whether non-invasive urine sampling is currently exploited to its full potential in the development of diagnostic tools for human helminthiases. Though further development, assessment and validation are needed before their routine use in control programmes, low-cost, rapid and reliable assays capable of detecting transrenal helminth-derived antigens and cell-free DNA show excellent promise for future use at the point-of-care in high-, medium- and even low-endemicity elimination settings.
Highlights
Parasitic worms, often referred to as helminths, form the most common human infectious parasites in low- and middle-income countries (LMICs), causing a global burden of disease exceeding that of both malaria and tuberculosis (Hotez et al, 2008; Lustigman et al, 2012)
The rapid, straightforward and reliable diagnosis of helminthiases is essential for ongoing disease surveillance and successful disease control, as control programmes advance towards disease elimination within endemic areas (Fig. 1), (Bergquist et al, 2009; Gordon et al, 2011; McCarthy et al, 2012; Rollinson et al, 2013; Werkman et al, 2018)
Widely considered low-cost, when taking into consideration the cumulative costs of equipment, number of personnel needed and remuneration of specialist staff, the true costs of gold standard assays are being realized and may likely be far more expensive than previously assumed (Turner et al, 2017). Whilst these techniques may be sufficiently sensitive to confirm or refute individual infection status in areas of high disease endemicity or when assessing patients burdened with a high degree of infection, in areas of low-endemicity, for example during control programme near-elimination settings, sensitivity of these techniques can seriously wane (Appendix Fig. A1), (Bergquist et al, 2009; Klepac et al, 2013; Hawkins et al, 2016)
Summary
Often referred to as helminths, form the most common human infectious parasites in low- and middle-income countries (LMICs), causing a global burden of disease exceeding that of both malaria and tuberculosis (Hotez et al, 2008; Lustigman et al, 2012). It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients (Castillo et al, 2009) Further to these clear practical advantages, some urine-based diagnostic assays have been shown to provide a more sensitive diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, in lowendemicity settings (Sousa-Figueiredo et al, 2013; Adriko et al, 2014). To its full potential with regards to the diagnosis of the major human helminth infections and highlight future research needed to further advance helminth urine-diagnostics
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