Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection: Bayesian latent class modeling of test accuracy

Alejandro J. Krolewiecki, Artemis Koukounari, Miryam Romano, Reynaldo N. Caro, Alan Leroy Scott, Pedro Fleitas, Ruben Cimino, Clive Julian Shiff

Research output: Contribution to journalArticle

Abstract

For epidemiological work with soil transmitted helminths the recommended diagnostic approaches are to examine fecal samples for microscopic evidence of the parasite. In addition to several logistical and processing issues, traditional diagnostic approaches have been shown to lack the sensitivity required to reliably identify patients harboring low-level infections such as those associated with effective mass drug intervention programs. In this context, there is a need to rethink the approaches used for helminth diagnostics. Serological methods are now in use, however these tests are indirect and depend on individual immune responses, exposure patterns and the nature of the antigen. However, it has been demonstrated that cell-free DNA from pathogens and cancers can be readily detected in patient’s urine which can be collected in the field, filtered in situ and processed later for analysis. In the work presented here, we employ three diagnostic procedures—stool examination, serology (NIE-ELISA) and PCR-based amplification of parasite transrenal DNA from urine–to determine their relative utility in the diagnosis of S. stercoralis infections from 359 field samples from an endemic area of Argentina. Bayesian Latent Class analysis was used to assess the relative performance of the three diagnostic procedures. The results underscore the low sensitivity of stool examination and support the idea that the use of serology combined with parasite transrenal DNA detection may be a useful strategy for sensitive and specific detection of low-level strongyloidiasis.

Original languageEnglish (US)
Article numbere0006550
JournalPLoS Neglected Tropical Diseases
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Strongyloides stercoralis
Parasites
Helminths
Serology
DNA
Infection
Strongyloidiasis
Argentina
Soil
Enzyme-Linked Immunosorbent Assay
Urine
Antigens
Polymerase Chain Reaction
Pharmaceutical Preparations
Neoplasms

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection : Bayesian latent class modeling of test accuracy. / Krolewiecki, Alejandro J.; Koukounari, Artemis; Romano, Miryam; Caro, Reynaldo N.; Scott, Alan Leroy; Fleitas, Pedro; Cimino, Ruben; Shiff, Clive Julian.

In: PLoS Neglected Tropical Diseases, Vol. 12, No. 6, e0006550, 01.06.2018.

Research output: Contribution to journalArticle

Krolewiecki, Alejandro J. ; Koukounari, Artemis ; Romano, Miryam ; Caro, Reynaldo N. ; Scott, Alan Leroy ; Fleitas, Pedro ; Cimino, Ruben ; Shiff, Clive Julian. / Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection : Bayesian latent class modeling of test accuracy. In: PLoS Neglected Tropical Diseases. 2018 ; Vol. 12, No. 6.
@article{80d64c7fec4b4a63b3da31f887a9c883,
title = "Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection: Bayesian latent class modeling of test accuracy",
abstract = "For epidemiological work with soil transmitted helminths the recommended diagnostic approaches are to examine fecal samples for microscopic evidence of the parasite. In addition to several logistical and processing issues, traditional diagnostic approaches have been shown to lack the sensitivity required to reliably identify patients harboring low-level infections such as those associated with effective mass drug intervention programs. In this context, there is a need to rethink the approaches used for helminth diagnostics. Serological methods are now in use, however these tests are indirect and depend on individual immune responses, exposure patterns and the nature of the antigen. However, it has been demonstrated that cell-free DNA from pathogens and cancers can be readily detected in patient’s urine which can be collected in the field, filtered in situ and processed later for analysis. In the work presented here, we employ three diagnostic procedures—stool examination, serology (NIE-ELISA) and PCR-based amplification of parasite transrenal DNA from urine–to determine their relative utility in the diagnosis of S. stercoralis infections from 359 field samples from an endemic area of Argentina. Bayesian Latent Class analysis was used to assess the relative performance of the three diagnostic procedures. The results underscore the low sensitivity of stool examination and support the idea that the use of serology combined with parasite transrenal DNA detection may be a useful strategy for sensitive and specific detection of low-level strongyloidiasis.",
author = "Krolewiecki, {Alejandro J.} and Artemis Koukounari and Miryam Romano and Caro, {Reynaldo N.} and Scott, {Alan Leroy} and Pedro Fleitas and Ruben Cimino and Shiff, {Clive Julian}",
year = "2018",
month = "6",
day = "1",
doi = "10.1371/journal.pntd.0006550",
language = "English (US)",
volume = "12",
journal = "PLoS Neglected Tropical Diseases",
issn = "1935-2727",
publisher = "Public Library of Science",
number = "6",

}

TY - JOUR

T1 - Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection

T2 - Bayesian latent class modeling of test accuracy

AU - Krolewiecki, Alejandro J.

AU - Koukounari, Artemis

AU - Romano, Miryam

AU - Caro, Reynaldo N.

AU - Scott, Alan Leroy

AU - Fleitas, Pedro

AU - Cimino, Ruben

AU - Shiff, Clive Julian

PY - 2018/6/1

Y1 - 2018/6/1

N2 - For epidemiological work with soil transmitted helminths the recommended diagnostic approaches are to examine fecal samples for microscopic evidence of the parasite. In addition to several logistical and processing issues, traditional diagnostic approaches have been shown to lack the sensitivity required to reliably identify patients harboring low-level infections such as those associated with effective mass drug intervention programs. In this context, there is a need to rethink the approaches used for helminth diagnostics. Serological methods are now in use, however these tests are indirect and depend on individual immune responses, exposure patterns and the nature of the antigen. However, it has been demonstrated that cell-free DNA from pathogens and cancers can be readily detected in patient’s urine which can be collected in the field, filtered in situ and processed later for analysis. In the work presented here, we employ three diagnostic procedures—stool examination, serology (NIE-ELISA) and PCR-based amplification of parasite transrenal DNA from urine–to determine their relative utility in the diagnosis of S. stercoralis infections from 359 field samples from an endemic area of Argentina. Bayesian Latent Class analysis was used to assess the relative performance of the three diagnostic procedures. The results underscore the low sensitivity of stool examination and support the idea that the use of serology combined with parasite transrenal DNA detection may be a useful strategy for sensitive and specific detection of low-level strongyloidiasis.

AB - For epidemiological work with soil transmitted helminths the recommended diagnostic approaches are to examine fecal samples for microscopic evidence of the parasite. In addition to several logistical and processing issues, traditional diagnostic approaches have been shown to lack the sensitivity required to reliably identify patients harboring low-level infections such as those associated with effective mass drug intervention programs. In this context, there is a need to rethink the approaches used for helminth diagnostics. Serological methods are now in use, however these tests are indirect and depend on individual immune responses, exposure patterns and the nature of the antigen. However, it has been demonstrated that cell-free DNA from pathogens and cancers can be readily detected in patient’s urine which can be collected in the field, filtered in situ and processed later for analysis. In the work presented here, we employ three diagnostic procedures—stool examination, serology (NIE-ELISA) and PCR-based amplification of parasite transrenal DNA from urine–to determine their relative utility in the diagnosis of S. stercoralis infections from 359 field samples from an endemic area of Argentina. Bayesian Latent Class analysis was used to assess the relative performance of the three diagnostic procedures. The results underscore the low sensitivity of stool examination and support the idea that the use of serology combined with parasite transrenal DNA detection may be a useful strategy for sensitive and specific detection of low-level strongyloidiasis.

UR - http://www.scopus.com/inward/record.url?scp=85049365541&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049365541&partnerID=8YFLogxK

U2 - 10.1371/journal.pntd.0006550

DO - 10.1371/journal.pntd.0006550

M3 - Article

C2 - 29856738

AN - SCOPUS:85049365541

VL - 12

JO - PLoS Neglected Tropical Diseases

JF - PLoS Neglected Tropical Diseases

SN - 1935-2727

IS - 6

M1 - e0006550

ER -