Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection—A systematic review and meta-analysis
Top Cited Papers
Open Access
- 9 February 2018
- journal article
- review article
- Published by Public Library of Science (PLoS) in PLoS Neglected Tropical Diseases
- Vol. 12 (2), e0006229
- https://doi.org/10.1371/journal.pntd.0006229
Abstract
Strongyloides stercoralis infection is a neglected tropical disease which can lead to severe symptoms and even death in immunosuppressed people. Unfortunately, its diagnosis is hampered by the lack of a gold standard, as the sensitivity of traditional parasitological tests (including microscopic examination of stool samples and coproculture) is low. Hence, alternative diagnostic methods, such as molecular biology techniques (mostly polymerase chain reaction, PCR) have been implemented. However, there are discrepancies in the reported accuracy of PCR. A systematic review with meta-analysis was conducted in order to evaluate the accuracy of PCR for the diagnosis of S. stercoralis infection. The protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (record: CRD42016054298). Fourteen studies, 12 of which evaluating real-time PCR, were included in the analysis. The specificity of the techniques resulted high (ranging from 93 to 95%, according to the reference test(s) used). When all molecular techniques were compared to parasitological methods, the sensitivity of PCR was assessed at 71.8% (95% CI 52.2–85.5), that decreased to 61.8% (95% CI 42.0–78.4) when serology was added among the reference tests. Similarly, sensitivity of real-time PCR resulted 64.4% (95% CI 46.2–77.7) when compared to parasitological methods only, 56.5% (95% CI 39.2–72.4) including serology. PCR might not be suitable for screening purpose, whereas it might have a role as a confirmatory test. Strongyloides stercoralis is a worm that can potentially kill affected immunosuppressed individuals. The parasite is not easily detected with stool microscopy, hence novel tests have been implemented, such as polymerase chain reaction (PCR), that can detect the DNA of the parasite. This work aims at evaluating the performance of PCR for the diagnosis of S. stercoralis through a revision of diagnostic studies available in literature. According to the results of this work, PCR for S. stercoralis still misses a relevant proportion of infected people, while a positive result confirms the presence of the infection.This publication has 28 references indexed in Scilit:
- Strongyloides stercoralis infectionBMJ, 2013
- Real-Time Polymerase Chain Reaction for Detection of Strongyloides stercoralis in StoolThe American Journal of Tropical Medicine and Hygiene, 2013
- Serological and molecular detection of Strongyloides stercoralis infection among an Orang Asli community in MalaysiaZeitschrift für Parasitenkunde, 2013
- Strongyloides stercoralis: A Plea for ActionPLoS Neglected Tropical Diseases, 2013
- The Laboratory Diagnosis and Follow Up of Strongyloidiasis: A Systematic ReviewPLoS Neglected Tropical Diseases, 2013
- Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralisCurrent Opinion in Infectious Diseases, 2012
- Improved Diagnosis of Strongyloides stercoralis Using Recombinant Antigen-Based Serologies in a Community-Wide Study in Northern ArgentinaClinical and Vaccine Immunology, 2010
- Molecular diagnosis of Strongyloides stercoralis in faecal samples using real-time PCRTransactions of the Royal Society of Tropical Medicine and Hygiene, 2009
- A Luciferase Immunoprecipitation Systems Assay Enhances the Sensitivity and Specificity of Diagnosis ofStrongyloides stercoralisInfectionThe Journal of Infectious Diseases, 2008
- Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviewsJournal of Clinical Epidemiology, 2005