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The urine circulating cathodic antigen (CCA) dipstick: a valid substitute for microscopy for mapping and point-of-care diagnosis of intestinal schistosomiasis.

Sousa-Figueiredo, J.C., Betson, Martha, Kabatereine, Narcis B and Stothard, Russell (2013) 'The urine circulating cathodic antigen (CCA) dipstick: a valid substitute for microscopy for mapping and point-of-care diagnosis of intestinal schistosomiasis.'. PLoS Neglected Tropical Diseases, Vol 7, Issue 1, e2008.

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Abstract

BACKGROUND

The World Health Organization now recommends the provision of praziquantel treatment to preschool-aged children infected with schistosomiasis. For intestinal schistosomiasis the current operational field diagnostic standard is examination of a thick Kato-Katz smear by microscopy prepared from a single stool specimen, and although pragmatic, this methodology has well-known shortcomings. Here, as a potential alternative, the performance of the urine circulating cathodic antigen (CCA) dipstick test was assessed in terms of disease-mapping and point-of-care diagnosis for intestinal schistosomiasis in preschool-aged children. Our manuscript reports on findings at baseline and at the end of a one-year longitudinal treatment study.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 925 children (mean age 2.8 years) were initially recruited from six lakeshore villages representative of high, moderate and low levels of disease transmission. At baseline, all children were tested for intestinal schistosomiasis by microscopic examination of duplicate Kato-Katz smears prepared from a single stool faecal, by antigen detection with the urine CCA dipstick test and by serology with a commercially available ELISA test (as 'gold-standard') that measures host antibody titres to soluble egg antigens. As a point-of-care diagnosis, the urine CCA dipstick test achieved sensitivity and specificity values ranging from 52.5-63.2% and 57.7-75.6%, respectively, with faecal microscopy achieving very high specificities (>87%) but sensitivities as low as 16.7% in the low transmission setting.

CONCLUSION/SIGNIFICANCE

The urine CCA test was shown to be more effective than faecal microscopy especially in lower transmission settings. The diagnostic performance of this test was not significantly impacted by treatment history or co-infections with other intestinal helminths.

Item Type: Article
Subjects: QX Parasitology > Helminths. Annelida > QX 200 Helminths
QY Clinical Pathology > Diagnostic Tests > QY 160 Feces
QY Clinical Pathology > Diagnostic Tests > QY 185 Urinalysis
WA Public Health > Preventive Medicine > WA 243 Diagnositic services
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 810 Schistosomiasis
Faculty: Department: Biological Sciences > Parasitology Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pntd.0002008
Depositing User: Lynn Roberts-Maloney
Date Deposited: 21 Aug 2013 09:03
Last Modified: 06 Feb 2018 13:06
URI: http://archive.lstmed.ac.uk/id/eprint/3376

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