Abstract
The diagnosis of strongyloidiasis by coprological methods has a low sensitivity, underestimating the prevalence of Strongyloides stercoralis in endemic areas. Serodiagnostic tests for strongyloidiasis have shown robust diagnostic properties. However, these methods require a blood draw, an invasive and labor-intensive sample collection method, especially in the resource-limited settings where S. stercoralis is endemic. Our study examines a urine-based assay for strongyloidiasis and compares its diagnostic accuracy with coprological and serological methods. Receiver operating characteristic (ROC) curve analyses determined the diagnostic sensitivity (D-Sn) and specificity (D-Sp) of the urine ELISA, as well as estimates its positive predictive value and diagnostic risk. The likelihood ratios of obtaining a positive test result (LR+) or a negative test result (LR-) were calculated for each diagnostic positivity threshold. The urine ELISA assay correlated significantly with the serological ELISA assay for strongyloidiasis, with a D-Sn of 92.7% and a D-Sp of 40.7%, when compared to coprological methods. Moreover, the urine ELISA IgG test had a detection rate of 69%, which far exceeds the coprological method (28%). The likelihood of a positive diagnosis of strongyloidiasis by the urine ELISA IgG test increased significantly with increasing units of IgG detected in urine. The urine ELISA IgG assay for strongyloidiasis assay has a diagnostic accuracy comparable to serological assay, both of which are more sensitive than coprological methods. Since the collection of urine is easy and non-invasive, the urine ELISA IgG assay for strongyloidiasis could be used to screen populations at risk for strongyloidiasis in S. stercoralis endemic areas.
Highlights
Strongyloidiasis is a neglected tropical disease (NTD), with transmission occurring in tropical and subtropical regions of the world, including the subtropical regions of the United States (Southeastern USA) [1,2,3]
People acquire an infection via penetration of the skin by infective larvae whereupon the larvae enter the blood circulation, reaching the lungs and subsequently the gastrointestinal tract where they mature to adult worms
Improved methods for the detection of S. stercoralis infection are urgently needed for people at increased risk from chronic strongyloidiasis [1,4], and people residing in S. stercoralis endemic areas, such as northeast Thailand, where the current study takes place
Summary
Strongyloidiasis is a neglected tropical disease (NTD), with transmission occurring in tropical and subtropical regions of the world, including the subtropical regions of the United States (Southeastern USA) [1,2,3]. The life cycle of S. stercoralis, is unique among soil-transmitted helminths (STHs) in several key respects. Strongyloides stercoralis filariform larvae can autoinfect its human host by re-entering via enteral circulation without shedding larvae into the soil. With both irregular and minimal S. stercoralis larval output in human feces, conventional microscopic methods often fail to detect chronic asymptomatic strongyloidiasis. Improved methods for the detection of S. stercoralis infection are urgently needed for people at increased risk from chronic strongyloidiasis (e.g., candidates for transplantation, people undertaking chemotherapy, or people on systemic corticosteroids) [1,4], and people residing in S. stercoralis endemic areas, such as northeast Thailand, where the current study takes place
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