Abstract
BackgroundSoil-transmitted helminths, such as Trichuris trichiura, are of major concern in public health. Current efforts to control these helminth infections involve periodic mass treatment in endemic areas. Since these large-scale interventions are likely to intensify, monitoring the drug efficacy will become indispensible. However, studies comparing detection techniques based on sensitivity, fecal egg counts (FEC), feasibility for mass diagnosis and drug efficacy estimates are scarce.Methodology/Principal FindingsIn the present study, the ether-based concentration, the Parasep Solvent Free (SF), the McMaster and the FLOTAC techniques were compared based on both validity and feasibility for the detection of Trichuris eggs in 100 fecal samples of nonhuman primates. In addition, the drug efficacy estimates of quantitative techniques was examined using a statistical simulation. Trichuris eggs were found in 47% of the samples. FLOTAC was the most sensitive technique (100%), followed by the Parasep SF (83.0% [95% confidence interval (CI): 82.4–83.6%]) and the ether-based concentration technique (76.6% [95% CI: 75.8–77.3%]). McMaster was the least sensitive (61.7% [95% CI: 60.7–62.6%]) and failed to detect low FEC. The quantitative comparison revealed a positive correlation between the four techniques (Rs = 0.85–0.93; p<0.0001). However, the ether-based concentration technique and the Parasep SF detected significantly fewer eggs than both the McMaster and the FLOTAC (p<0.0083). Overall, the McMaster was the most feasible technique (3.9 min/sample for preparing, reading and cleaning of the apparatus), followed by the ether-based concentration technique (7.7 min/sample) and the FLOTAC (9.8 min/sample). Parasep SF was the least feasible (17.7 min/sample). The simulation revealed that the sensitivity is less important for monitoring drug efficacy and that both FLOTAC and McMaster were reliable estimators.Conclusions/SignificanceThe results of this study demonstrated that McMaster is a promising technique when making use of FEC to monitor drug efficacy in Trichuris.
Highlights
Worldwide, infections with soil-transmitted heminths (STHs) such as Trichuris trichiura, Ascaris lumbricoides and hookworms (Ancylostoma duodenale and Necator americanus) are of major importance for public health, in tropical and subtropical countries where climate factors combined with poor environmental, domestic and personal hygiene ease transmission [1,2]
Little attention has been addressed to their feasibility for mass diagnosis under field conditions and their ability to estimate the efficacy of administered drugs, in particular in different settings of pre-drug administration infection intensities
The drop in infection intensity is under examination for monitoring the drug efficacy
Summary
Infections with soil-transmitted heminths (STHs) such as Trichuris trichiura, Ascaris lumbricoides and hookworms (Ancylostoma duodenale and Necator americanus) are of major importance for public health, in tropical and subtropical countries where climate factors combined with poor environmental, domestic and personal hygiene ease transmission [1,2]. Current efforts to control STH infections involve periodic mass drug treatment of people, of school-aged children, in all endemic areas [3]. Since these large-scale interventions are likely to intensify as more attention is addressed to the importance of these neglected diseases [4], monitoring drug efficacy will become indispensable in order to detect the emergence of resistance [5,6] and/or identify confounding factors affecting the drug efficacy [7]. Current efforts to control these helminth infections involve periodic mass treatment in endemic areas Since these large-scale interventions are likely to intensify, monitoring the drug efficacy will become indispensible. Studies comparing detection techniques based on sensitivity, fecal egg counts (FEC), feasibility for mass diagnosis and drug efficacy estimates are scarce
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