Abstract
BackgroundMicroscopy-based identification of eggs in stool offers simple, reliable and economical options for assessing the prevalence and intensity of hookworm infections, and for monitoring the success of helminth control programs. This study was conducted to evaluate and compare the diagnostic parameters of the Kato-Katz (KK) and simple sodium nitrate flotation technique (SNF) in terms of detection and quantification of hookworm eggs, with PCR as an additional reference test in stool, collected as part of a baseline cross-sectional study in Cambodia.Methods/Principle FindingsFecal samples collected from 205 people in Dong village, Rovieng district, Preah Vihear province, Cambodia were subjected to KK, SNF and PCR for the detection (and in case of microscopy-based methods, quantification) of hookworm eggs in stool. The prevalence of hookworm detected using a combination of three techniques (gold standard) was 61.0%. PCR displayed a highest sensitivity for hookworm detection (92.0%) followed by SNF (44.0%) and quadruple KK smears (36.0%) compared to the gold standard. The overall eggs per gram feces from SNF tended to be higher than for quadruple KK and the SNF proved superior for detecting low egg burdens.Conclusion/SignificanceAs a reference, PCR demonstrated the higher sensitivity compared to SNF and the quadruple KK method for detection of hookworm in human stool. For microscopic-based quantification, a single SNF proved superior to the quadruple KK for the detection of hookworm eggs in stool, in particular for low egg burdens. In addition, the SNF is cost-effective and easily accessible in resource poor countries.
Highlights
Human hookworms are estimated to infect between 576–740 million people globally and are responsible for a global burden of 3.2 million disability-adjusted life years [1,2]
Detection of hookworm eggs in human feces can be done by the Kato Katz technique (KK), sodium nitrate flotation technique (SNF) or polymerase chain reaction (PCR)
SNF of a single stool sample proved superior for the detection of hookworm eggs in feces than quadruple Kato Katz smears
Summary
Human hookworms are estimated to infect between 576–740 million people globally and are responsible for a global burden of 3.2 million disability-adjusted life years [1,2]. Diagnosis of soil-transmitted helminth (STH) infections, including hookworm has largely relied on copromicroscopy techniques based on the detection and quantification of eggs in feces. These tests aim to offer simple, reliable and economical options for assessing the prevalence and intensity of STH infections and monitoring the success of drug efficacy trials and helminth control programs. Microscopy-based identification of eggs in stool offers simple, reliable and economical options for assessing the prevalence and intensity of hookworm infections, and for monitoring the success of helminth control programs. This study was conducted to evaluate and compare the diagnostic parameters of the Kato-Katz (KK) and simple sodium nitrate flotation technique (SNF) in terms of detection and quantification of hookworm eggs, with PCR as an additional reference test in stool, collected as part of a baseline cross-sectional study in Cambodia
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