Estimation of diagnostic test characteristics and prevalence of Giardia duodenalis in dairy calves in Belgium using a Bayesian approach

Diversity of gastrointestinal parasites and molecular characterization of Giardia duodenalis in free-living and captive howler monkeys (Alouatta guariba clamitans) in southern Brazil

Non-human primates (NHPs) are the group that most share infectious agents with humans due to their close taxonomic relationship. The southern brown howler monkeys (Alouatta guariba clamitans) are endemic primates from Brazil and Argentina's Atlantic Forest. This study aimed to investigate the presence of intestinal parasites in free-living (FL) and captive (CA) southern brown howler monkeys. Thirty-nine stool samples were collected in two areas in southern Brazil, 15 FL and 24 CA. Stool sediments obtained by centrifugal sedimentation technique were used for microscopic analysis and direct immunofluorescence assay and evaluated by molecular analysis through amplification and sequencing of TPI fragments. Intestinal parasites Giardia duodenalis, Cryptosporidium spp., and Trypanoxyuris minutus were detected at coproparasitological analysis. This is the first report of the presence of Cryptosporidium spp. in free-living howlers. The molecular characterization of G. duodenalis isolates indicated assemblage B for the first time found in free-living A. guariba clamitans. The high prevalence of G. duodenalis transmission in CA howler monkeys can be explained by direct contact with humans and frequent soil contact. The presence of a potentially zoonotic assemblage in these animals indicates that the process of fragmentation and cohabitation with humans and livestock affects the wildlife, thus indicating a need for eco-health measures.

Comparative performance evaluation of four different methods for diagnosing Giardia infection in dogs and zoonotic assemblages' identification

Giardia duodenalis (syn. G. intestinalis or G. lamblia) is a parasitic protozoan that infects the upper intestinal tract of a broad range of hosts, including humans and domestic animals. Thus, it has raised concerns about the public health risk due to companion animals. Recently, with the improvement of living standards and increasing contacts between pets and humans, the zoonotic transmission of Giardia has dramatically increased. From a genetic point of view, G. duodenalis should be viewed as a complex species that includes eight different species-specific genetic assemblages. The laboratory diagnosis is mainly based on the finding of microscopic cysts in stool samples by coprological examination. Other methods include the detection of antigens, immunoassays or PCR protocols, which allow the identification of Giardia assemblages. The study aimed to compare the performance of Direct Fluorescence Antibody test (DFA), zinc sulfate flotation technique (ZnSO4), rapid diagnostic test (RDT), end-point PCR amplification (PCR) for the detection of Giardia and to identify the concerning assemblages in a canine population from Central Italy. Direct fluorescence antibody test is the reference standard for laboratory diagnosis of Giardia in fecal samples from dogs, despite the microscopic examination after flotation remains the most useful method in many veterinary diagnostic centers. The present findings demonstrate the high performance of DFA and ZnSO4 in detecting Giardia, while RDT may be useful as alternative or complementary method to the DFA and ZnSO4. PCR performance was low, but it allowed determining Giardia B zoonotic assemblage in 25% of the PCR-positive specimens (15 out of 60), while the remaining PCR-positive isolates belonged to the dog-specific assemblage C. The 26% prevalence of G. duodenalis detected by DFA in owned dogs and the identification of potentially zoonotic assemblages underline the potential risk for public health and indicate frequent cross-species transmission of the parasite between humans and dogs.

Comparison of Giardia duodenalis point-of-care antigen faecal tests to reference laboratory assays in non-symptomatic dogs

Giardia duodenalis is one of the most prevalent enteric parasites of dogs. Point-of-care antigen tests (POC) are rapid and do not require additional equipment, or a specialised diagnostic laboratory. The aim of this study was to compare diagnostic tests available in veterinary practices and in a diagnostic laboratory for the detection of G. duodenalis on a cohort of group-housed dogs from New South Wales, Australia. Two different POC tests were used for the detection of G. duodenalis. Laboratory tests used were the multiplexed-tandem PCR panel (MT-PCR) that includes detection of G. duodenalis DNA, and two reference tests (an in-house TaqMan real-time PCR and a direct immunofluorescence assay, DFA). Canine faecal samples (n = 40) were tested simultaneously for the detection of G. duodenalis. Using either DFA or TaqMan real-time PCR as reference tests, 77.5% (31/40) and 82.5% (33/40) of dogs tested positive, respectively. Agreement (Kappa) between the DFA and TaqMan real-time PCR was 0.84 (95% CI 0.64 to 1.00). There was substantial G. duodenalis test outcome agreement between the two POC tests, Kappa = 0.75. Combining the two POC tests yielded 77% sensitivity and 100% specificity with DFA as reference, and for TaqMan real-time PCR it was 73% sensitivity and 100% specificity. The MT-PCR was in excellent agreement with each reference test, DFA or TaqMan real-time PCR. Due to the high specificity of both POC tests, they can be confidently used as rule-in diagnostics. Confirmatory testing that detects different biological parameters such as DNA, e.g. PCR (inc. MT-PCR), should be implemented before concluding that a dog is negative for the presence of G. duodenalis.

Comparison of Two Bayesian Methods in Evaluation of the Absence of the Gold Standard Diagnostic Tests

Objective

The Bayesian model plays an important role in diagnostic test evaluation in the absence of the gold standard, which used the external prior distribution of a parameter combined with sample data to yield the posterior distribution of the test characteristics. However, the correlation between diagnostic tests has always been a problem that cannot be ignored in the Bayesian model evaluation. This study will discuss how different Bayesian model, correlation scenarios, and prior distribution affect the outcome.

Methods

The data analyzed in this study was gathered during studies of patients presenting to the Nanjing Chest Hospital with suspected tuberculosis. The diagnostic character of T-SPOT.Tb and KD38 tuberculosis antibody test were evaluated in different Bayesian model, and discharge diagnosis as a gold standard was used to verify the model results in the end.

Result

The comparison of four models under the conditional independence situation found that Bayesian probabilistic constraint model was consistent with the Conditional Covariance Bayesian model. The results were mainly affected by prior information. The sensitivity and specificity of the two tests in Conditional Covariance Bayesian model in prior constraint situation were considerably higher than the Bayesian probabilistic constraint model in prior constraint situation. The results of the four models under the conditional dependence situation were similar to the conditional independence situation; p_D was also negative with no prior constraint situation in both model Bayesian probabilistic constraint model and Conditional Covariance Bayesian model. The Deviance Information Criterion of Bayesian probabilistic constraint model was close to model Conditional Covariance Bayesian model, but p_D of Conditional Covariance Bayesian model in Prior constraint situation (p_D=2.40) was higher than the Bayesian probabilistic constraint model in Prior constraint situation (p_D=1.66).

Conclusion

The result of Conditional Covariance Bayesian model in prior constraint with conditional independence situation was closest to the result of gold standard evaluation in our data. Both of the two Bayesian methods are the feasible way for the evaluation of diagnostic test in the absence of the gold standard diagnostic. Prior source, priority number, and conditional dependencies should be considered in the method selection, the accuracy of posterior estimation mainly depending on the prior distribution.

Molecular characterization of Giardia intestinalis and Cryptosporidium parvum from calves with diarrhoea in Austria and evaluation of point-of-care tests

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Giardia intestinalis (48/177) and Cryptosporidium parvum (98/177) occur in Austrian calves.

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C. parvum genotypes IIaA15G2R1, IIaA19G2R2, IIaA21G2R1 and IIaA14G1R1 were found.

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Giardia intestinalis assemblage E and a single sample of assemblage A were found.

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Cryptosporidium was detected mostly in the first two weeks of age (72/102).

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Point-of-care test validity varied greatly for Giardia and Cryptosporidium.

To obtain information about the occurrence and genotype distribution of G. intestinalis and C. parvum in Austrian cattle, faecal samples from diarrhoeic calves younger than 180 days of age originating from 70 farms were examined. Of the 177 faecal samples, 27.1% were positive for Giardia cysts (immunofluorescence microscopy) and 55.4% for Cryptosporidium oocysts (phase-contrast microscopy). Positive samples were characterized by nested PCR for Giardia, 83.3% (triosephosphate isomerase; tpi) and 89.6% (β-giardin; bg) were positive, while the Cryptosporidium nested PCR returned 92.5% (60-kDa glycoprotein) positive results. Sequence analysis revealed one assemblage A-positive sample and 30 (bg) respectively 29 (tpi) assemblage E-positive samples for G. intestinalis. For C. parvum four subtypes within the IIa family (IIaA15G2R1, n = 29; IIaA19G2R2, n = 3; IIaA21G2R1, n = 2; IIaA14G1R1, n = 1) could be differentiated. Validation of two immunochromatographic point-of-care tests resulted in a sensitivity of 29.2% and 77.6%; a specificity of 98.4% and 91.1% for the detection of Giardia intestinalis and Cryptosporidium parvum, respectively. Results confirm the widespread occurrence of both protozoa in diarrhoeic calves in Austria.

Protocol standardization for the detection of Giardia cysts and Cryptosporidium oocysts in Mediterranean mussels (Mytilus galloprovincialis)

Marine bivalve shellfish are of public health interest because they can accumulate pollutants in their tissues. As they are usually consumed raw or lightly cooked, they are considered to be a possible source of foodborne infections, including giardiosis and cryptosporidiosis. Although data indicating contamination of shellfish with Giardia cysts and Cryptosporidium oocysts have been published, comparing results from different studies is difficult, as there is no standardized protocol for the detection and quantification of these parasites in mussels, and different researchers have used different analytical approaches. The aim of this study was to identify and characterize the most sensitive protocol for the detection of Giardia cysts and Cryptosporidium oocysts in shellfish. In an effort to test the sensitivity and the detection limits of the protocol, every step of the process was investigated, from initial preparation of the mussel matrix through detection of the parasites. Comparative studies were conducted, including several methods previously applied by other researchers, on commercial mussels Mytilus galloprovincialis spiked with a known number of (oo)cysts of both parasites. As preparation of the mussel matrix plays an important role in the sensitivity of the method, different techniques were tested. These included: (ia) removal of the coarse particles from the matrix with sieving, (ib) extraction of the lipids with diethyl ether, and (ic) artificial digestion of the matrix with pepsin digestion solution, and (ii) the use or not of immunomagnetic separation (IMS) for the concentration of the (oo)cysts. Pre-treatment of the mussel homogenate with pepsin digestion solution, followed by IMS, then detection with a direct immunofluorescence assay, achieved the highest sensitivity: 32.1% (SD: 21.1) of Giardia cysts and 61.4% (SD: 26.2) Cryptosporidium oocysts were recovered, with a detection limit of 10 (oo)cysts per g of mussel homogenate. The outcome of the current study was the standardization of a protocol, with defined detection limits, for the detection of these two protozoan transmission stages in mussels, in order to be used as a reference technique in future studies. Further advantages of this protocol are that it uses the whole mussel as a starting material and does not require difficult handling procedures. The method has potential to be applied in larger surveys and, potentially, to other species of shellfish for the detection of these parasites. However, the composition (lipid to protein ratio) may be of relevance for detection efficiency for some other species of shellfish.

Investigation of the use of serology and ultrasonography to detect hepatic cystic echinococcosis in Heilongjiang, China, using a Bayesian framework

BACKGROUND

Cystic echinococcosis (CE) is a public health problem in China. However, the prevalence and incidence of CE in Heilongjiang province is still poorly understood. Because there is no perfect gold standard, evaluation of ultrasound (US) and serological methods have been limited. This study evaluated the use of these two diagnostic methods for the diagnosis of CE in suspected cases.

METHODS

A total of 522 suspected hepatic CE patients, as well as their demographic and clinical features were collected and detected by immunoglobulin (IgG)-ELISA and US. The marginal posterior densities of sensitivity and specificity for both tests, and the prevalence of hepatic CE amongst participants, were estimated from the product of the likelihood function of observed and latent data by a Bayesian framework.

RESULTS

Most of the patients were from rural areas. The most common symptom was upper abdominal pain. The antibody-positive proportion determined by IgG-ELISA was 24.33% (127/522), significantly higher than with US examination (17.24%, 90/522). Bayesian analysis indicated that the estimated prevalence of CE amongst suspected cases was 17.70% (95% credible interval: 14.23-21.54%). The sensitivity and specificity of the ELISA test were 92.63% and 90.37%, and that of US were 93.05% and 98.44%, respectively. Among US-confirmed hepatic CE cases, the male to female ratio was 0.46 and the peak age group was 40-49 years.

CONCLUSIONS

The results of the current study demonstrate that CE is present in Heilongjiang province. They also suggest that, whilst ultrasonography appears to be the detection modality of choice, serology may have a use for detection of infection in individuals suspected to be infected. This may have applications for surveillance within the province.

Prevalence and molecular characterisation of Giardia duodenalis in calves with diarrhoea

The aim of this study was to investigate the prevalence of Giardia duodenalis in diarrhoeal faeces from calves that were reared in Korea using PCR and ELISA. Diarrhoeal faecal samples were collected from 590 calves (<3 months old) throughout the country from November 2013 through March 2015. Data were analysed according to the region of collection, season, and type of diarrhoea. Of the 590 collected faecal samples, 77 (13.1 per cent) and 78 (13.2 per cent; true prevalence 9.1 per cent) tested positive by PCR and ELISA, respectively. The results from both testing methods were in agreement in 501 (84.9 per cent) samples, with a κ value of 0.34, which suggests fair agreement. The PCR results showed a higher prevalence in summer and in cases of haemorrhagic diarrhoea (P<0.05), while the ELISA results showed a lower prevalence in cases of pasty diarrhoea (P<0.05). Phylogenetic analysis of the β-giardin gene sequences of G duodenalis showed that the sequences detected in this study belonged to assemblage E, which is specific to cattle and livestock. The higher prevalence of giardiasis in calves with haemorrhagic diarrhoea found in this study differed from previous studies. Therefore, researchers and veterinarians should be aware of the possible involvement of giardiasis in haemorrhagic diarrhoea.

Evaluation of vaccine seroresponse rates and adverse event rates through Bayesian and frequentist methods

In the evaluation of vaccine seroresponse rates and adverse reaction rates, extreme test results often occur, with substantial adverse event rates of 0% and/or seroresponse rates of 100%, which has produced several data challenges. Few studies have used both the Bayesian and frequentist methods on the same sets of data that contain extreme test cases to evaluate vaccine safety and immunogenicity. In this study, Bayesian methods were introduced, and the comparison with frequentist methods was made based on practical cases from randomized controlled vaccine trials and a simulation experiment to examine the rationality of the Bayesian methods. The results demonstrated that the Bayesian non-informative method obtained lower limits (for extreme cases of 100%) and upper limits (for extreme cases of zero), which were similar to the limits that were identified with the frequentist method. The frequentist rate estimates and corresponding confidence intervals (CIs) for extreme cases of 0 or 100% always equaled and included 0 or 100%, respectively, whereas the Bayesian estimations varied depending on the sample size, with none equaling zero or 100%. The Bayesian method obtained more reasonable interval estimates of the rates with extreme data compared with the frequentist method, whereas the frequentist method objectively expressed the outcomes of clinical vaccine trials. The two types of statistical results are complementary, and it is proposed that the Bayesian and frequentist methods should be combined to more comprehensively evaluate clinical vaccine trials.

Assessment of zoonotic transmission of Giardia and Cryptosporidium between cattle and humans in rural villages in Bangladesh

Giardia and Cryptosporidium are important causes of diarrhoea in Bangladesh. The high prevalence of both parasites in humans and cattle in rural Bangladesh and the common use of water ponds by village inhabitants and their animals suggest a potential for zoonotic transmission. Direct transmission of Giardia and Cryptosporidium between cattle and their handlers and indirect transmission through water ponds was investigated. Faecal/stool samples were collected from 623 calves and 125 calf handlers in a cross-sectional survey. In two villages, water samples were collected monthly from water ponds and faecal/stool samples were collected monthly from inhabitants and their cattle. Giardia cysts and Cryptosporidium oocysts were detected in water samples and in faecal/stool samples and positive samples were genotyped, to determine their human or animal origin. The prevalence of Giardia and Cryptosporidium in calves was 22% and 5% respectively. In calf handlers, the prevalence of Giardia and Cryptosporidium was 11.2% and 3.2% respectively. Both in the cross-sectional survey and in the longitudinal study in the villages, G. duodenalis assemblage E was most prevalent in calves, while in humans assemblage AII, BIII and BIV were found. In cattle, Cryptosporidium parvum, C. bovis and C. andersoni were identified, but no Cryptosporidium sequences were obtained from humans. Giardia and Cryptosporidium were detected in 14/24 and 12/24 water samples respectively. G. duodenalis assemblage E and BIV (-like), as well as C. andersoni and C. hominis were identified. Although the presence of Giardia and Cryptosporidium in both water ponds suggests that water-borne transmission of Giardia and Cryptosporidium is possible, the genotyping results indicate that there is no significant direct or indirect (water-borne) transmission of Giardia between cattle and people in this area of rural Bangladesh. No conclusions could be drawn for Cryptosporidium, because of the low number of sequences that were obtained from human and water samples.

Occurrence and potential health risk of Cryptosporidium and Giardia in different water catchments in Belgium

Human wastewater and livestock can contribute to contamination of surface water with Cryptosporidium and Giardia. In countries where a substantial proportion of drinking water is produced from surface water, e.g., Belgium, this poses a constant threat on drinking water safety. Our objective was to monitor the presence of Cryptosporidium and Giardia in different water catchment sites in Belgium and to discriminate between (oo)cysts from human or animal origin using genotyping. Monthly samples were collected from raw water and purified drinking water at four catchment sites. Cryptosporidium and Giardia were detected using USEPA method 1623 and positive samples were genotyped. No contamination was found in purified water at any site. In three catchments, only low numbers of (oo)cysts were recovered from raw water samples (<1/liter), but raw water samples from one catchment site were frequently contaminated with Giardia (92 %) and Cryptosporidium (96 %), especially in winter and spring. Genotyping of Giardia in 38 water samples identified the presence of Giardia duodenalis assemblage AI, AII, BIV, BIV-like, and E. Cryptosporidium andersoni, Cryptosporidium suis, Cryptosporidium horse genotype, Cryptosporidium parvum, and Cryptosporidium hominis were detected. The genotyping results suggest that agriculture may be a more important source of surface water contamination than human waste in this catchment. In catchment sites with contaminated surface water, such as the Blankaart, continuous monitoring of treated water for the presence of Cryptosporidium and Giardia would be justified and (point) sources of surface water contamination should be identified.

Estimation of diagnostic test accuracy without full verification: a review of latent class methods

The performance of a diagnostic test is best evaluated against a reference test that is without error. For many diseases, this is not possible, and an imperfect reference test must be used. However, diagnostic accuracy estimates may be biased if inaccurately verified status is used as the truth. Statistical models have been developed to handle this situation by treating disease as a latent variable. In this paper, we conduct a systematized review of statistical methods using latent class models for estimating test accuracy and disease prevalence in the absence of complete verification.

A combination of the Kato-Katz methods and ELISA to improve the diagnosis of clonorchiasis in an endemic area, China

Background

Examination of feces by light microscopy is widely used for specific parasitological diagnosis of clonorchiasis. However, the true incidence of infection is underestimated owing to the high missing diagnosis rate of this method. The enzyme-linked immunosorbent assay (ELISA) is widely used for the detection and control of clonorchiasis but the practicality of this method is unclear. The purpose of this study was to evaluate the effect of ELISA as a supplementary method for the diagnosis of clonorchiasis.

Methodology/Principal Findings

The present study recruited 2,359 clinically suspected patients from Heilongjiang Province, China. In all, 954 cases were identified as antibody-positive by immunoglobulin (IgG)-ELISA and 495 individuals were diagnosed as egg-positive by the Kato-Katz (KK) method. The seropositive and egg-negative individuals were re-examined by repeated egg counts and/or the number of KK slides and 18 (18.18%) cases were confirmed as clonorchiasis. The 40.44%, antibody-positive rate determined by IgG-ELISA was significantly higher (P<0.05) than the 21.75% egg-positive rate found by examination of feces. A Bayesian approach indicated that the prevalence of clonorchiasis in this region was 22.27% and that the sensitivity, specificity, positive predictive value and negative predictive value of IgG-ELISA were 98.7%, 76.53%, 54.66% and 99.52%, respectively. The agreement between the two methods was moderate (kappa value = 0.564). The clonorchiasis patients lived mainly along the Songhua River. The risk factors, except for ethnic factors, were estimated effectively by both methods.

Conclusions/Significance

The present study suggested that clonorchiasis was widely distributed in Heilongjiang Province, China. The missing diagnosis rate was high using the KK technique alone. The combination of immunological methods and parasitological techniques could improve diagnostic accuracy and reduce the missing diagnosis rate. ELISA used as an auxiliary diagnostic method was realistic and practical for a large-scale screening test, monitoring the prevalence and assessing the risk factors of clonorchiasis.

Estimation of the sensitivity and specificity of assays for screening antibodies to HIV: a comparison between the frequentist and Bayesian approaches

Bayesian and frequentist methods have been applied rarely to the same sets of data for evaluating assays for screening antibodies to HIV, especially for assays with relatively high sensitivities and/or specificities of 100% compared with reference assays. In this study, 95% confidence intervals and 95% Bayesian credible intervals were calculated for sensitivity and specificity for the evaluation of the accuracy of HIV antibody assays using data from China, WHO UNAIDS, USA, Australia, Tanzania, and India. When the sensitivity and/or specificity were 100%, a Bayesian approach obtained reasonable interval estimates of assays for screening antibodies to HIV, whereas frequentist methods express objectively the accuracy of each individual assay. It is suggested that the two types of estimates be reported simultaneously to evaluate more comprehensively a set of highly accurate antibodies for HIV assays.

Microarray analysis of the intestinal host response in Giardia duodenalis assemblage E infected calves

Despite Giardia duodenalis being one of the most commonly found intestinal pathogens in humans and animals, little is known about the host-parasite interactions in its natural hosts. Therefore, the objective of this study was to investigate the intestinal response in calves following a G. duodenalis infection, using a bovine high-density oligo microarray to analyze global gene expression in the small intestine. The resulting microarray data suggested a decrease in inflammation, immune response, and immune cell migration in infected animals. These findings were examined in more detail by histological analyses combined with quantitative real-time PCR on a panel of cytokines. The transcription levels of IL-6, IL-8, IL-13, IL-17, and IFN-γ showed a trend of being downregulated in the jejunum of infected animals compared to the negative controls,.No immune cell recruitment could be seen after infection, and no intestinal pathologies, such as villus shortening or increased levels of apoptosis. Possible regulators of this intestinal response are the nuclear peroxisome proliferator-activated receptors alpha (PPARα), and gamma (PPARγ) and the enzyme adenosine deaminase (ADA), all for which an upregulated expression was found in the microarray and qRT-PCR analyses.

A multicentre prevalence study in Europe on Giardia duodenalis in calves, with molecular identification and risk factor analysis

The present study aimed to obtain data on the occurrence of Giardia duodenalis in calves in four major cattle rearing countries in Europe (Germany, UK, France and Italy), along with genotyping data and risk factors associated with these infections. A total of 2072 calves were sampled on 207 farms. The majority of the animals were Holstein dairy or mixed Holstein calves (n=1565 or 75.5%), and were female (n=1640 or 79.1%). The average age was 7.8 weeks (SD=4.1; median=7; range=2-16 weeks). All fecal samples were tested using a commercially available monoclonal antibody-based ELISA. The overall apparent prevalence of G. duodenalis for the four countries was 45.4% (n=942/2072) and the overall farm prevalence was 89.9% (186/207), with differences in both animal and farm prevalence between the four countries. The prevalence was significantly higher in animals up to 8 weeks (OR=1.88; P<0.001) compared to older calves, and several management factors including contact with the Dam, Frequency of cleaning of the Maternity Pens, and Disinfection of the Calf Housing were found to be associated with infection. Positive samples were withheld for genotyping using the β-giardin and triose phosphate isomerase gene: G. duodenalis assemblage E was most prevalent, although 43% of the isolates were typed as assemblage A, with differences in between countries. Furthermore, 32% of the examined samples was found to be a mixed assemblage A and E infection, which is consistent with previous reports. The results of the present study confirm previous findings in other European countries that G. duodenalis infections are common in calves. The infection especially occurs in animals younger than 2 months, and the proportion of positive animals gradually decreased with increasing age.

Zoonotic potential and molecular epidemiology of Giardia species and giardiasis

Molecular diagnostic tools have been used recently in assessing the taxonomy, zoonotic potential, and transmission of Giardia species and giardiasis in humans and animals. The results of these studies have firmly established giardiasis as a zoonotic disease, although host adaptation at the genotype and subtype levels has reduced the likelihood of zoonotic transmission. These studies have also identified variations in the distribution of Giardia duodenalis genotypes among geographic areas and between domestic and wild ruminants and differences in clinical manifestations and outbreak potentials of assemblages A and B. Nevertheless, our efforts in characterizing the molecular epidemiology of giardiasis and the roles of various animals in the transmission of human giardiasis are compromised by the lack of case-control and longitudinal cohort studies and the sampling and testing of humans and animals living in the same community, the frequent occurrence of infections with mixed genotypes and subtypes, and the apparent heterozygosity at some genetic loci for some G. duodenalis genotypes. With the increased usage of multilocus genotyping tools, the development of next-generation subtyping tools, the integration of molecular analysis in epidemiological studies, and an improved understanding of the population genetics of G. duodenalis in humans and animals, we should soon have a better appreciation of the molecular epidemiology of giardiasis, the disease burden of zoonotic transmission, the taxonomy status and virulences of various G. duodenalis genotypes, and the ecology of environmental contamination.

Bayesian evaluation of the human immunodeficiency virus antibody screening strategy of duplicate enzyme-linked immunosorbent assay in Xuzhou Blood Center, China

BACKGROUND

Accurate estimation of the risk of human immunodeficiency virus (HIV) infection through transfusion is essential for monitoring blood safety. The risk, however, is so low that it can only be estimated by mathematical modeling. With the Bayesian dependence model, this study evaluates the HIV antibody screening strategy of duplicate enzyme-linked immunosorbent assay (ELISA) in Xuzhou Blood Center and therefore estimates part of the total risks of transfusion-transmitted HIV infection.

STUDY DESIGN AND METHODS

Data from Xuzhou Blood Center between 2004 and 2008 were used. Information was obtained on donor profiles and screening and confirmatory test results. The portion of the risks of HIV infection through transfusion concerned was estimated by evaluating the screening algorithm in terms of its accuracy and predictive power with the Bayesian dependence model.

RESULTS

A total of 234,602 donations from voluntary blood donors in Xuzhou Blood Center were screened for HIV antibody. For the study screening algorithm, its sensitivity, specificity, false-positive predictive value (FPPV), and false-negative predictive value (FNPV) were 0.9951 (95% Bayesian credible interval [BCI], 0.9763-0.9997), 0.9991 (95% BCI, 0.9990-0.9992), 0.9647 (95% BCI, 0.9018-0.9923), and 1.52 × 10(-7) (95% BCI, 7.31 × 10(-9) -1.15 × 10(-6) ), respectively. For the positive detection rate (9.60 × 10(-4) ) and FPPV (0.9647), the differences between their own Bayesian median estimates and real values were 2.70 × 10(-5) and -0.0033, respectively.

CONCLUSIONS

The HIV antibody screening algorithm of duplicate ELISA is well evaluated in its accuracy and predictive power with the Bayesian dependence model. The FNPV measures the part of the risks of transfusion-associated HIV transmission concerned.

Evaluation of 30 commercial assays for the detection of antibodies to HIV in China using classical and Bayesian statistics

The purpose of this study was to evaluate the 30 commercial HIV-antibody (HIV-Ab) assays in the nationwide assessment program of China using classical and Bayesian statistical methods. The classical estimates of sensitivity and specificity varied from 95.9% to 100% and from 94.6% to 100%, respectively. The proportions of assays with 100% sensitivity and with 100% specificity reached 63.3% (19/30) and 3.3% (1/30), respectively. Using the Bayesian logit hierarchical model, the overall estimates of sensitivity and specificity were 99.8% (95% Bayesian credible interval [BCI]: 99.4-100%) and 98.1% (95% BCI: 97.4-98.7%), respectively, for the 17 ELISAs under evaluation. For the 13 rapid assays, the corresponding overall estimates were reported to be 99.2% (95% BCI: 98.5-99.8%) and 98.4% (95% BCI: 97.8-98.9%), respectively. In addition, given the prevalences of HIV infection among the general population of China and the intravenous drug user group in China, the positive predictive values were estimated for each individual assay in the framework of the two schools of statistical thought. Furthermore, by comparing the two types of estimates, it is concluded that the two types of statistical methods were complementary for the evaluation of very accurate HIV-Ab assays.

Incidence of and risks associated with Giardia infections in herds on dairy farms in the New York City Watershed

Background

The primary aims of this study were to determine the incidence of Giardia infections in dairy herds on farms in the New York City Watershed region and to evaluate risk factors associated with infections. Because co-infections of Giardia and Cryptosporidium spp. are common in this population, we also evaluated the effect of herd infection status on Giardia infections.

Methods

Farms were grouped into three cohorts based on their prior infection status with Giardia and/or Cryptosporidium spp. The sampling plan included collecting fecal samples from all calves below 30 days of age and proportional sampling of calves, young stock, and adults. A total of 10,672 fecal samples were collected and analyzed for the presence of Giardia cysts using zinc sulfate flotation. Herds enrolled in the study were sampled seasonally for a study period of two years. The probability of shedding cysts past a certain age and the factors that influenced the likelihood of shedding were evaluated using survival analysis. Linear regression was used to evaluate factors that were associated with the intensity of shedding.

Results

The majority of Giardia infections occurred in calves within their first 180 days of age, with the most number of calves shedding Giardia cysts between 11 and 20 days of age. The incidence of shedding of Giardia cysts ranged from 0.0004 per animal day for cattle in the low risk cohort to 0.0011 per animal day for cattle in the high risk cohort. The likelihood of shedding was influenced by the prior infection status of the herd and the season of collection. Infected animals shed on average 9,658 cysts/gram and the intensity of shedding Giardia cysts varied significantly with the age (p < 0.0001) and the season of collection (p = 0.0151 for Spring).

Conclusion

Giardia infections are common in dairy herds in the New York City watershed, particularly in calves less than 6 months of age. Seasonality may be an important factor in the perpetuation of infections based on changes in management practices corresponding to weather patterns of a particular season. A dairy herd's prior infection status with Cryptosporidium influences the likelihood of infection with Giardia.

Transmission cycles of Giardia duodenalis in dogs and humans in Temple communities in Bangkok--a critical evaluation of its prevalence using three diagnostic tests in the field in the absence of a gold standard

The prevalence and associated risk factors for Giardia duodenalis in canine and human populations in Temple communities of Bangkok, Thailand were determined by evaluating three common diagnostic methods utilised to detect Giardia, namely zinc sulphate flotation and microscopy, an immunofluoresence antibody test and nested polymerase chain reaction (PCR) based on the SSU-rDNA gene. The diagnostic sensitivity and specificity together with the negative and positive predictive values of each test were evaluated in the absence of a gold standard using a Bayesian approach. The median estimates of the prevalence of infection with G. duodenalis in dogs and humans in Thailand were 56.8% (95% PCI, 30.4%, 77.7%) and 20.3% (95% PCI, 7.3%, 46.3%) respectively. PCR and immunofluorescence antibody tests (IFAT) were the most accurate tests overall with diagnostic sensitivity and specificity of 97.4% (95% PCI, 88.5%, 99.9%) and 56.2% (95% PCI, 40.4%, 82.9%) for the PCR and 61.8% (95% PCI, 40.8%, 99.1%) and 94.7% (95% PCI, 87.4%, 99.1%) for IFAT respectively Three cycles, anthroponotic, zoonotic and dog-specific cycles of G. duodenalis were shown to be operating among the human and canine populations in these Temple communities in Bangkok, supporting the role of the dog as a potential reservoir for Giardia infections in humans.

Multilocus genotyping of Cryptosporidium and Giardia in non-outbreak related cases of diarrhoea in human patients in Belgium

Stool samples from Belgian patients suffering from abdominal pain and/or diarrhoea were examined for Cryptosporidium and Giardia. Cryptosporidium-positive samples were genotyped using the 70 kDa heat shock protein and the 60 kDa glycoprotein (GP60) genes: C. hominis was identified in 54.2% and C. parvum in 45.8% of the samples. Sequencing at the GP60 locus indicated that subgenotype IbA10G2 of C. hominis and subgenotype IIaA15G2R1 of C. parvum were the most prevalent, although several other subgenotypes were identified. For Giardia, sequencing at the beta-giardin, triose phosphate isomerase (TPI) and glutamate dehydrogenase (GDH) genes revealed assemblage B as the most prevalent (74.4%) in human patients. A high degree of heterogeneity was found, especially on the beta-giardin gene, and to a lesser extent on the GDH gene. Furthermore, using a novel species-specific PCR based on the TPI gene, mixed infections with both assemblage A and B were detected in a large number (32.4%) of human patients, which might have important epidemiological implications.

Giardia duodenalis infection and anthropometric status in preschoolers in Salvador, Bahia State, Brazil

The aim of this study was to estimate the association between Giardia duodenalis infection and anthropometric deficits, as measured by weight-for-age and height-for-age. This cross-sectional study included 629 children from 12 to 48 months of age, selected from 30 geographic areas in the city of Salvador, Bahia State, Brazil. Poisson regression and linear regression were used for the multivariate statistical analyses. G. duodenalis was diagnosed in 13.5% of the children. The children's breastfeeding duration and living conditions (garbage collection and paved streets or sidewalks) modified the effect of G. duodenalis infection on anthropometric status. Among infected children, there were statistically significant associations between weight deficit and shorter breastfeeding (PR=2.22; 95%CI: 1.56-3.14) and inadequate paving of streets and sidewalks (PR=2.00; 95%CI: 1.37-2.92), while height deficit was associated with deficient public garbage collection (PR=2.21; 95%CI: 1.31-2.51). In the linear regression, the association with the anthropometric indicators remained positive and statistically significant. The child's unhealthy living environment aggravated the negative effect of G. duodenalis infection on anthropometric status, and breastfeeding was a protective factor in the outcome.

Occurrence and molecular characterization of Cryptosporidium and Giardia in captive wild ruminants in Belgium

Both Cryptosporidium and Giardia are frequently found in the stool of domestic ruminants, especially young animals. Wild ruminants are also host to these protozoa, but the prevalence of these parasites in both free-ranging and captive nondomesticated ruminants needs to be further investigated. Moreover, the role of wild ruminants serving as reservoirs for these zoonotic parasites remains unclear. Therefore, a cross-sectional survey was conducted to estimate the occurrence of Cryptosporidium and Giardia in captive wild ruminants younger than 6 mo and to determine the potential of these animals to serve as reservoirs for these zoonotic parasites. A total of 67 captive wild ruminants belonging to 21 different animal species at the Antwerp Zoo (Belgium), along with 82 American bison (Bison bison) on a commercial breeding farm, were sampled for the detection of Cryptosporidium and Giardia, using a commercial immunofluoresence assay (Merifluor Cryptosporidium/Giardia IFA). The Cryptosporidium prevalence was 7.5% in the Antwerp Zoo animals and 3.7% in the bison from the breeding farm. All but two of the Cryptosporidium-positive animals were younger than 1 mo of age. Molecular characterization by amplification of the 70-kDa heat-shock protein and the 18S ribosomal DNA gene identified Cryptosporidium parvum in four animals of the Antwerp Zoo. The prevalence of Giardia was 8.9% in the Antwerp Zoo animals and 23.2% in the bison calves. Most Giardia-positive animals were older than 1 mo of age. Molecular characterization on the beta-giardin gene and the triose phosphate isomerase gene identified Giardia duodenalis assemblage A in the Antwerp Zoo and both G. duodenalis assemblage A and assemblage E in the bison calves. These findings indicate that both protozoan parasites are prevalent in captive wild ruminants and that these animals can serve as a potential reservoir for zoonotic transmission.

Is Giardia a significant pathogen in production animals?

Although Giardia duodenalis is recognised worldwide as the most important parasitic cause of gastro-intestinal disorder in human patients, the relevance of infection in production animals is prone to debate. Since the 1980s, clinical disease has been associated with giardiasis in production animals, both in natural conditions and in experimental studies. However, most Giardia research is focussed on the relevance of production animals as a reservoir for zoonotic transmission. In this study, the current knowledge on clinical relevance of giardiasis in production animals is reviewed, along with the diagnosis, treatment and control of infection. Furthermore, future research objectives are discussed.

Using pseudogold standards and latent-class analysis in combination to evaluate the accuracy of three diagnostic tests

We previously reported our use of latent-class models to estimate the sensitivity (Se) and specificity (Sp) for each of three tests used to monitor farmed salmon for infectious salmon anaemia virus (ISAv). Those tests were reverse-transcriptase polymerase chain reaction (RT-PCR), virus isolation (VI), and an indirect immunofluorescent-antibody test (IFAT). We used tissues from 403 salmon from four populations presumed to have different prevalence of ISAv. However, no formal evaluation of the assumptions of conditional independence and constant accuracy had been carried out. In our present study, we "adjusted" that and used two pseudogold standards (a composite reference standard and a study pseudogold), as indicative of the true health status of each fish. The assumption of constant accuracy across populations was evaluated using separate random-effects logistic-regression models for fish classified as D+ or D- (disease positive or negative, according to the pseudogold standards) with study population included in the model to determine if it affected the probability of a positive test result. Where there was evidence of variation in test accuracy across populations, the issue was further investigated using separate latent-class models with informative priors for each study population. Our results suggested that only one PCR test had an accuracy that varied across populations. The assumption of conditional independence among tests was first evaluated using log-linear models of D+ and D- fish with significant interaction between test results indicative of conditional dependence. Latent-class models which incorporated up to two pairs of between-test dependencies were also fit using Bayesian methods. The two approaches showed considerable evidence of dependence between IFAT and VI and some evidence of dependence between one PCR and IFAT. Results obtained from both maximum-likelihood models and from Bayesian analyses of models allowing for conditional dependence between two pairs of tests were consistent with those obtained with the pseudogold standards. The results suggest that pseudogold standards can help in choosing a correct dependence structure and should be used in combination with latent-class models.

Frequentist and Bayesian approaches to prevalence estimation using examples from Johne's disease

Although frequentist approaches to prevalence estimation are simple to apply, there are circumstances where it is difficult to satisfy assumptions of asymptotic normality and nonsensical point estimates (greater than 1 or less than 0) may result. This is particularly true when sample sizes are small, test prevalences are low and imperfect sensitivity and specificity of diagnostic tests need to be incorporated into calculations of true prevalence. Bayesian approaches offer several advantages including direct computation of range-respecting interval estimates (e.g. intervals between 0 and 1 for prevalence) without the requirement of transformations or large-sample approximations. They also allow direct probabilistic interpretation, and the flexibility to model in a straightforward manner the probability of zero prevalence. In this review, we present frequentist and Bayesian methods for animal- and herd-level true prevalence estimation based on individual and pooled samples. We provide statistical methods for detecting differences between population prevalence and frequentist methods for sample size and power calculations. All examples are motivated usingMycobacterium aviumsubspeciesparatuberculosisinfection and we provide WinBUGS code for all examples of Bayesian estimation.

The sensitivity of PCR and serology in different Theileria parva epidemiological situations in Rwanda

Theileria parva is the causative agent of a lethal tick-borne disease of cattle occurring in eastern, central and southern Africa. Variations in the sensitivity of the serological and molecular tests with seasonal vector occurrence and discrepancies between low PCR prevalence and high T. parva vector density are a setback to estimate true prevalences. Therefore, the objectives of the present studies were to evaluate (1) the sensitivity of three serological tests (IFAT, ELISA and SELISA) and one molecular test (PCR) in the diagnosis of chronic T. parva infections in four different agro-ecological zones of Rwanda and (2) the effect of tick challenge and animal's age on the sensitivity of PCR. Blood samples from 635 bovines were collected in four agro-ecological zones of Rwanda. All sera were screened using the IFAT, ELISA, SELISA and PCR. The binary results of the four diagnostic tests were introduced separately for each agro-ecological zone in a Bayesian model to estimate the prevalence of T. parva infections and the sensitivity of the four diagnostic tests. All test specificities were set to 100%. The estimated T. parva prevalence was much higher (83-85%) than estimations based on single diagnostic tests. The estimated sensitivity of serological tests was relatively constant and ranged from 57 to 75% in the various areas. The sensitivity of PCR showed more pronounced variations, ranging from 66% in the low T. parva transmission (high land) zones compared to 24% in the highly vector infested (low land) zones. Calves and adult cattle (n=194) were also sampled in regularly and irregularly dipped herds in the low land region. The apparent T. parva prevalence detected by PCR was significantly higher in calves than in adult cattle and in herds regularly treated with acaricides, while no significant differences were found with IFAT. The conditional probability that a sample was positive at PCR while it was positive at IFAT was significantly lower in adults. The implication of these findings in the use of diagnostic assays for epidemiological studies is discussed.

Parasitic infections in dairy cattle around Hanoi, northern Vietnam

In northern Vietnam, dairy cattle are mainly managed in small-scale farms, where animals are kept confined and feeding occurs by cut and carry methods. In the present study the occurrence of parasitic infections was examined in five provinces around Hanoi. A total of 201 farms were visited, and 334 stool and 239 blood samples were collected from calves younger than 3 months, animals between 3 and 24 months and adult cows. Furthermore, 254 milk samples were collected from lactating animals. Coproscopical examination indicated a high prevalence of nematode eggs (Cooperia spp., Haemonchus and Oesophagostomum spp.) in animals (n=176) between 3 and 24 months (66%) and in adult cows (n=90; 54%). In these age groups the prevalence of Fasciola was 28% and 39%, respectively, and for Paramphistomum the prevalence was 78% and 82%, respectively. Fifty percent of the calves younger than 3 months (n=68) were positive for Giardia, and none for Cryptosporidium. Most Giardia isolates were identified as the non-zoonotic G. duodenalis assemblage E on the beta-giardin gene. The blood samples were examined with commercially available Svanovir((R))Elisa's for the presence of Anaplasma marginale and Babesia bigemina specific antibodies, and a prevalence of 28% and 54% was found, respectively. In the milk samples Neospora caninum specific antibodies (Svanovir((R))Elisa) were detected in 30% of the lactating animals. The present study demonstrates that parasitic infections occur frequently in dairy cattle around Hanoi although animals are mainly kept confined, and indicates that further research on the economic impact of these infections is needed.

Bayes and diagnostic testing

Interpretation of the result of a diagnostic test depends not only on the actual test result(s) but also on information external to this result, namely the test's sensitivity and specificity. This external information (also called prior information) must be combined with the data to yield the so-called updated, posterior estimates of the true prevalence and the test characteristics. The Bayesian approach offers a natural, intuitive framework in which to carry out this estimation process. The influence of the prior information on the final result may not be ignored. Guidance for the choice of prior information not in conflict with the data can be obtained from a set of statistics and indices (DIC, p(D), Bayes-p).

A Bayesian approach for the evaluation of six diagnostic assays and the estimation ofCryptosporidiumprevalence in dairy calves

The prevalence of Cryptosporidium in calves and the test properties of six diagnostic assays (microscopy (ME), an immunofluorescence assay (IFA), two ELISA and two PCR assays) were estimated using Bayesian analysis. In a first Bayesian approach, the test results of the four conventional techniques were used: ME, IFA and two ELISA. This four-test approach estimated that the calf prevalence was 17% (95% Probability Interval (PI): 0.1-0.28) and that the specificity estimates of the IFA and ELISA were high compared to ME. A six-test Bayesian model was developed using the test results of the 4 conventional assays and 2 PCR assays, resulting in a higher calf prevalence estimate (58% with a 95% PI: 0.5-0.66) and in a different test evaluation: the sensitivity estimates of the conventional techniques decreased in the six-test approach, due to the inclusion of two PCR assays with a higher sensitivity compared to the conventional techniques. The specificity estimates of these conventional assays were comparable in the four-test and six-test approach. These results both illustrate the potential and the pitfalls of a Bayesian analysis in estimating prevalence and test characteristics, since posterior estimates are variables depending both on the data at hand and prior information included in the analysis. The need for sensitive diagnostic assays in epidemiological studies is demonstrated, especially for the identification of subclinically infected animals since the PCR assays identify these animals with reduced oocyst excretion, which the conventional techniques fail to identify.

Validation of molecular-diagnostic techniques in the parasitological laboratory

Diagnostic laboratories today often operate according to standard quality management procedures such as ISO/IEC 17025. This requires that only validated methods are used. Validation procedures help to document that a particular protocol used by the accredited laboratory has a guaranteed performance in that particular laboratory. Several study designs exist for validation procedures. Computer programmes are available to help with the statistical analysis of validation results. The agreement beyond chance of results obtained in the protocol that is to be validated can be compared to those achieved in an already established test (agreement). For a method that is used under routine conditions or for epidemiological studies, it is necessary to assess the diagnostic sensitivity and diagnostic specificity of the technique. These parameters can be estimated by comparing the method that needs to be validated with an existing reliable method ('gold standard'). This is done by testing a standard set of well-documented samples using both techniques in parallel. Approaches using Bayes' theorem are used to perform gold standard-free validations. Many PCR-based methods are characterised by an excellent analytical sensitivity and are thus good candidates for diagnostic tools of the required diagnostic sensitivity. However, the high level of analytical sensitivity can also make molecular techniques susceptible to cross-contamination and carry-over problems leading to false-positive results. Moreover, the presence of inhibitors can cause false-negative results. After an initial validation, test performance needs to be continuously monitored, e.g. by using combined Shewhart-CUSUM control routines, and test results compared to those obtained by other laboratories (proficiency testing).

The efficacy of an oral treatment with paromomycin against an experimental infection with Giardia in calves

A controlled and blinded study was conducted to evaluate the efficacy and safety of a treatment with paromomycin sulphate against an experimental Giardia infection in calves. Animals were infected with 10(5)Giardia cysts of cattle origin and were either treated 11 days later with 25, 50 or 75 mg paromomycin/(kg body weight per day) during 5 consecutive days or not treated (control group). Efficacy was evaluated based on reduction in cyst excretion. Furthermore weight gain and diarrhea scores were monitored. In the group treated with 75 mg/kg per day there was a 100% reduction in cyst excretion until 9 days after the start of the treatment (D9) and a very high reduction (> or =98%) until D13. There was a high reduction (> or =93%) until D9 and D13 in the groups treated with 25 and 50 mg/kg, respectively. The cumulative cyst excretion on D13 was significantly (P<0.05) lower in the groups treated with 75 and 50 mg/kg compared to the control group. Although there was a trend towards higher weight gain and less diarrhea in the treated groups, differences between groups were not significant. No adverse reactions to the paromomycin treatment were recorded. Furthermore, the need for reliable parameters for evaluation of treatments against protozoal infections is emphasised.