Detecting Schistosoma mansoni infections among pre-school-aged children in southern Ghana: a diagnostic comparison of urine-CCA, real-time PCR and Kato-Katz assays
Open Access
- 22 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 20 (1), 1-10
- https://doi.org/10.1186/s12879-020-05034-2
Abstract
In Ghana, pre-school-aged children (PSAC) are at risk of intestinal schistosomiasis and are living in need of praziquantel treatment. To better assess the infection burden within this vulnerable demographic group, we have provided a comparative assessment of the prevalence of Schistosoma mansoni in pre-school-aged children by urine circulating cathodic antigen (CCA) dipsticks, real-time PCR Taqman® faecal assays and Kato-Katz coproscopy. In all, 190 pre-school-aged children were sampled from three endemic communities (viz. Tomefa, Torgahkope/Adakope, and Manheam) around Weija dam, Southern Ghana. Fresh stool and urine samples were collected from all participants for diagnosis. Among all the three communities, the urine-CCA assay recorded the highest prevalence values of 90.5% (95% CI 80.4–96.4), 87.9% (95% CI 76.7–95), and 81.2% (95% CI 69.9–89.6) in Tomefa, Torgahkope/Adakope, and Manheam respectively. Prevalence by real-time PCR was 50% (95% CI 35.5–64.5), 8% (95% CI 2.2–19.2) and 16.7% (95% CI 8.3–28.5), while by Kato-Katz was 55.6% (95% CI 42.5–68.1), 8.6% (95% CI 2.9–19) and 11.6% (95% CI 5.1–21.6) respectively. Children aged 1 year and over were found to be positive with the urine-CCA assay; by the ages of 3–4, over 50% were urine-CCA patent. The sensitivity and specificity of the POC-CCA dipsticks, when compared against the combined results of Kato-Katz/TaqMan results was found to be 84.1% (95% CI = 72.7–92.1) and 12.9% (95% CI = 6.6–22) respectively. We propose that the urine-CCA dipstick may be a useful rapid diagnostic tool to estimate the prevalence of intestinal schistosomiasis in PSAC, particularly in rapid identification of at-risk areas. However, our assessment has shown that it possible to record false positives when compared to combined Kato-Katz and qPCR results. To guide PSAC praziquantel treatment needs, we propose the urine CCA assay should be included in routine surveillance of intestinal schistosomiasis alongside other diagnostics such as Kato-Katz and urine filtration.Keywords
Funding Information
- Department for International Development, UK Government (PO 6407, PO 6407, PO 6407, PO 6407, PO 6407, PO 6407)
This publication has 36 references indexed in Scilit:
- Is POC-CCA a truly reliable test for schistosomiasis diagnosis in low endemic areas? The trace results controversyPLoS Neglected Tropical Diseases, 2018
- Evaluation of diagnostic methods for the detection of intestinal schistosomiasis in endemic areas with low parasite loads: Saline gradient, Helmintex, Kato-Katz and rapid urine testPLoS Neglected Tropical Diseases, 2018
- The COUNTDOWN Study Protocol for Expansion of Mass Drug Administration Strategies against Schistosomiasis and Soil-Transmitted Helminthiasis in GhanaTropical Medicine and Infectious Disease, 2018
- Schistosomiasis is more prevalent than previously thought: what does it mean for public health goals, policies, strategies, guidelines and intervention programs?Infectious Diseases of Poverty, 2017
- Evaluation and optimization of the Circulating Cathodic Antigen (POC-CCA) cassette test for detecting Schistosoma mansoni infection by using image analysis in school children in Mwanza Region, TanzaniaParasite Epidemiology and Control, 2016
- What is required in terms of mass drug administration to interrupt the transmission of schistosome parasites in regions of endemic infection?Parasites & Vectors, 2015
- Schistosomiasis in African infants and preschool children: let them now be treated!Trends in Parasitology, 2013
- Schistosomiasis and neglected tropical diseases: towards integrated and sustainable control and a word of cautionParasitology, 2009
- Multiplex real-time PCR for the detection and quantification of Schistosoma mansoni and S. haematobium infection in stool samples collected in northern SenegalTransactions of the Royal Society of Tropical Medicine and Hygiene, 2008
- Utility of Composite Reference Standards and Latent Class Analysis in Evaluating the Clinical Accuracy of Diagnostic Tests for PertussisClinical and Vaccine Immunology, 2008