Abstract
BackgroundCopro-parasitological diagnosis is still a challenge in management of helminth infections at individual and community levels in resource-limited settings.The aim of our study was to compare the performance of three quantitative techniques: Kato-Katz, McMaster and Mini-FLOTAC methids. The study was carried out in Oran, Northern Argentina.Methods200 schoolchildren were enrolled to provide a single stool sample, which was tested for helminth infections with Kato-Katz, McMaster and Mini-FLOTAC methods. The Mini-FLOTAC was performed with two flotation solutions (FS2 saturated saline and FS7 zinc sulphate). Preparation and reading time for each of the three methods was calculated both when processing single and multiple samples.ResultsOut of 193 schoolchildren examined, 40% were positive for any helminth infection by any method; the most prevalent was Hymenolepis nana (23%) followed by Ascaris lumbricoides (17%) and a third group of less prevalent helminths: Enterobius vermicularis, Trichuris trichiura and hookworms (11% all together). Mini-FLOTAC FS2 was more sensitive than FS7 for H. nana (93% vs 78%) and for other helminths (85% vs 80%), whereas FS7 was more sensitive for A. lumbricoides (87% vs 61%). Kato-Katz method was more sensitive than McMaster method for A. lumbricoides (84% vs 48%) and for other helminths (48% vs 43%) except for H. nana (49% vs 61%). As for egg counts, Mini-FLOTAC FS2 reported 904 eggs per gram of faeces (EPG) for H. nana (vs 457 with McMaster and 111 with Kato-Katz) and 1177 EPG for A. lumbricoides (vs 1315 with Kato-Katz and 995 with McMaster); FS2 detected the highest EPG for both H.nana and A.lumbricoides (904 vs 568 and 1177 vs 643 respectively), the differences were not statistically significant. The technique feasibility was calculated: Kato-Katz mean time was 48 minutes/sample, Mini-FLOTAC 13 minutes/sample and McMaster 7 minutes/sample. However, especially for Kato-Katz and Mini-FLOTAC, the mean time (min/sample) decreased significantly when processing multiple samples.ConclusionsMini-FLOTAC is a promising technique for helminth diagnosis, it is more sensitive than Kato-Katz and McMaster for H. nana and as sensitive as Kato-Katz and more sensitive than McMaster for A. lumbricoides identification. Egg counts differences although relevant, did not reach statistical significance.
Highlights
Copro-parasitological diagnosis is still a challenge in management of helminth infections at individual and community levels in resource-limited settings
In addition to comparing diagnostic accuracy, this study focused on the affordability of this innovative technique and on its transferability to peripheral laboratories, in order to improve diagnosis and facilitate parasitological monitoring of Soil-transmitted helminths (STH) control programmes
Forty five (23%) children were found positive for Hymenolepis nana, 32 (16.6%) were positive for Ascaris lumbricoides, few others were found positive for other helminths: Enterobius vermicularis, Trichuris trichiura and hookworms (6%, 3% and 1.5%, respectively)
Summary
Copro-parasitological diagnosis is still a challenge in management of helminth infections at individual and community levels in resource-limited settings. In 2007 Menghi et al [5] conducted a survey in Tartagal, Salta Province, on STH and protozoa detecting a prevalence of 94.6% in the aboriginal community and the most common helminths were hookworms (58%), Hymenolepis nana (31%) and Strongyloides stercoralis (24%). These data were confirmed in a recent review by Socias et al [6]. One of the greatest limitations in parasite detection is the lack of a standard, sensitive and low-cost technique This hinders different researchers from adopting the same method and comparing results. Efforts have been recently made in order to find a parasitological method that meets these features, and WHO is presently evaluating standard methods both for mapping and for monitoring efficacy of anthelminthic drugs and the impact of preventive chemotherapy in STH control programmes [7]
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