Validity of urine-CCA cassette test and indirect haem-agglutination assay (IHA) in the detection of schistosomiasis- man
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ORIGINAL ARTICLE
Validity of urine-CCA cassette test and indirect haemagglutination assay (IHA) in the detection of schistosomiasismansoni infection relative to microscopic examination Enas A. El Saftawy1,2
Received: 25 August 2020 / Accepted: 27 October 2020 Ó Indian Society for Parasitology 2020
Abstract Several immunodiagnostic assays have been commercially presented over the last years as easy diagnostic methods for schistosomiasis using serum or urine samples. The performance of immunochromatographic test (ICT) and indirect hemagglutination assay (IHA) was validated in the identification of active schistosomiasis infection. Detection of circulating cathodic antigen (CCA) of the parasite in urine samples and anti-Schistosoma antibodies in serum using ICT (Urine-CCA Cassette test) and IHA respectively. Proved diagnosis of Schistosoma mansoni infection was defined by the sum of positive results from microscopic examination (Gold standard) and Kato–Katz method. Out of 173 (mean age, 45 ± 10 years; 70 from Giza, 103 from different Egyptian governorates), 94 adult patients were infected. Urine-CCA cassette test despite showing high specificity (91.14%) it was of low sensitivity (23.40%). PPVs was 75.86% and NPV was 50.00% and diagnostic accuracy of 54.34%. The IHA showed a sensitivity of 57.45% and specificity of 48.10%. PPVs was 56.84% whereas NPVs was 48.72%. As for diagnostic accuracy, it was 53.18%. Urine-CCA Cassette test had lower sensitivity than expected for detection of circulating antigen and the IHA kit is generally more expensive than microscopic examination and Urine-CCA cassette test with low sensitivity and specificity. On the basis of this diagnostic performance none of the two tested
& Enas A. El Saftawy [email protected] 1
Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
2
Medical Parasitology Department, Faculty of Medicine, Armed Forces College of Medicine, Cairo, Egypt
immune-assays can be a sole tool in the principal diagnosis of active schistosomiasis infections. Keywords Immunochromatographic test Indirect hemagglutination assay Schistosoma mansoni
Introduction Schistosomiasis is one of the major parasitic diseases in the world following malaria, affects more than 250 million people worldwide and caused by blood-dwelling flukes (Engels et al. 1996; Asundi et al. 2019). Humans have been involved in the life cycle of five species of the Schistosomes, but 90% of all infections are produced by just three: S. mansoni (mostly in Africa and South America) and S. japonicum (predominantly in China, Indonesia, and the Philippines) produce intestinal schistosmiasis, while S. haematobium (in Africa and Middle East) causes urinary disease (Alemayehu et al. 2017; Mutapi et al. 2017; Tchuente´ et al. 2017; WHO 2017). In the definitive host (humans and other mammals), the parasite is distinguished into males and females and reproduces sexually where huge amounts of eggs are produced by adult females, that almost causes all symptoms. Asexual repro
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