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Moon M, Wu HW, Jiz M, Maldonado S, Kurtis JD, Friedman JF, Jarilla B, Park S. Evaluation of sensitivity and specificity of Kato-Katz and circulating cathodic antigen in terms of Schistosoma japonicum using latent class analysis. Sci Rep 2024; 14:8164. [PMID: 38589377 PMCID: PMC11001968 DOI: 10.1038/s41598-024-57863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024] Open
Abstract
Schistosoma japonicum is endemic in the Philippines. The Kato-Katz (KK) method was used to diagnose S. japonicum. This is impractical, particularly when the sample size is limited. Knowledge on point-of-care circulating cathodic antigen (CCA) test performance for S. japonicum is limited. Determining the sensitivity and specificity of new diagnostics is difficult when the gold standard test is less effective or absent. Latent class analysis (LCA) can address some limitations. A total of 484 children and 572 adults from the Philippines were screened for S. japonicum. We performed Bayesian LCA to estimate the infection prevalence, sensitivity and specificity of each test by stratifying them into two age groups. Observed prevalence assessed by KK was 50.2% and 31.8%, and by CCA was 89.9% and 66.8%, respectively. Using Bayesian LCA, among children, the sensitivity and specificity of CCA were 94.8% (88.7-99.4) and 21.5% (10.5-36.1) while those of KK were 66.0% (54.2-83.3) and 78.1% (61.1-91.3). Among adults, the sensitivity and specificity of CCA were 86.4% (76.6-96.9) and 62.8% (49.1-81.1) while those of KK were 43.6% (35.1-53.9) and 85.5% (75.8-94.6). Overall, CCA was more sensitive than KK, regardless of the age group at diagnosis, as KK was more specific. KK and CCA have different diagnostic performance, which should inform their use in the planning and implementation of S. japonicum control programs.
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Affiliation(s)
- Mugyeom Moon
- Food and Agriculture Organization of the United Nations, Regional Office for Asia and Pacific, Bangkok, Thailand
| | - Hannah W Wu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mario Jiz
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Jonathan D Kurtis
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer F Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Blanca Jarilla
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea.
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Tamarozzi F, Mazzi C, Antinori S, Arsuaga M, Becker SL, Bottieau E, Camprubi-Ferrer D, Caumes E, Duvignaud A, Grobusch MP, Jaureguiberry S, Jordan S, Mueller A, Neumayr A, Perez-Molina JA, Salas-Coronas J, Salvador F, Tomasoni LR, van Hellemond JJ, Vaughan SD, Wammes LJ, Zammarchi L, Buonfrate D, Huits R, van Lieshout L, Gobbi F. Consensus definitions in imported human schistosomiasis: a GeoSentinel and TropNet Delphi study. Lancet Infect Dis 2024:S1473-3099(24)00080-X. [PMID: 38467128 DOI: 10.1016/s1473-3099(24)00080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 03/13/2024]
Abstract
Terminology in schistosomiasis is not harmonised, generating misunderstanding in data interpretation and clinical descriptions. This study aimed to achieve consensus on definitions of clinical aspects of schistosomiasis in migrants and returning travellers. We applied the Delphi method. Experts from institutions affiliated with GeoSentinel and TropNet, identified through clinical and scientific criteria, were invited to participate. Five external reviewers revised and pilot-tested the statements. Statements focusing on the definitions of acute or chronic; possible, probable, or confirmed; active; and complicated schistosomiasis were managed through REDCap and replies managed in a blinded manner. Round 1 mapped the definitions used by experts; subsequent rounds were done to reach consensus, or quantify disagreement, on the proposed statements. Data were analysed with percentages, medians, and IQRs of a 5-point Likert scale. The study was terminated on the basis of consensus or stability-related and time-related criteria. 28 clinicians and scientists met the criteria for experts. 25 (89%) of 28 experts replied to Round 1, 18 (64%) of 28 to Round 2, 19 (68%) of 28 to Round 3, and 21 (75%) of 28 to at least two rounds. High-level consensus (79-100% agreement and IQRs ≤1) was reached for all definitions. Consensus definitions will foster harmonised scientific and clinical communication and support future research and development of management guidelines for schistosomiasis.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Cristina Mazzi
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Marta Arsuaga
- National Referral for Imported Diseases Unit, Hospital La Paz-Carlos III, Madrid, Spain
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Eric Caumes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; University of Bordeaux, INSERM UMR 1219, IRD EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, Netherlands
| | - Stephane Jaureguiberry
- Université de Paris Saclay, AP-HP, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Service des Maladies Infectieuses et Tropicales, Hôpital de Bicêtre, Paris, France
| | - Sabine Jordan
- Division of Infectious Diseases, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Mueller
- Department of Tropical Medicine, Klinikum Würzburg Mitte (Medical Mission Hospital), Würzburg, Germany
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Jose A Perez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, University Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquin Salas-Coronas
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Tropical Medicine Unit, Hospital Universitario Poniente, El Ejido, Almería, Spain; Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, Universidad de Almería, Almería, Spain
| | - Fernando Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Lina R Tomasoni
- Department of Infectious and Tropical Diseases, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Jaap J van Hellemond
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Stephen D Vaughan
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Linda J Wammes
- Department of Medical Microbiology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ralph Huits
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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3
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Ramos LMS, Pereira DSCA, Oliveira LOV, Graeff-Teixeira C. Accuracy of commercial ELISA and ICT for screening schistosomiasis infections at a low endemicity area in Brazil. Trans R Soc Trop Med Hyg 2024:trae005. [PMID: 38401052 DOI: 10.1093/trstmh/trae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Control interventions recommended by the World Health Organization have successfully resulted in low-intensity schistosomiasis transmission areas. To achieve elimination of transmission, new diagnostic screening tools are needed to overcome less than adequate sensitivity of the currently used Kato-Katz faecal thick smear method. Ideally, in-house serological tests should be avoided due to not having a continuous supply of kits as would be necessary for large population studies. Quality assurance provided by manufacturers and proper performance evaluations are also needed. We evaluated the accuracy of two commercially available serology tests as screening methods for detecting light schistosomiasis infections. METHODS Serum samples were collected in 2015 from individuals living in a low-endemicity locality in northeastern Brazil and deposited in a biorepository. We evaluated immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) and an immunochromatographic test (ICT). The Helmintex method was used to define true-positive samples. RESULTS Overall sensitivity was close to 90% for both the IgG ELISA and ICT, yet specificity was 28% and 18%, respectively. For the IgM ELISA, the values were estimated to be 55% and 43%, respectively. CONCLUSIONS Poor specificity and positive predictive values prevent these tests from being recommended for screening populations in low-intensity schistosomiasis-endemic areas.
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Affiliation(s)
- Lida M S Ramos
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória 29043-910, Brazil
| | - Danielle S C A Pereira
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória 29043-910, Brazil
| | - Laila O V Oliveira
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória 29043-910, Brazil
| | - Carlos Graeff-Teixeira
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória 29043-910, Brazil
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Oyeyemi OT, Ogundahunsi O, Schunk M, Fatem RG, Shollenberger LM. Neglected tropical disease (NTD) diagnostics: current development and operations to advance control. Pathog Glob Health 2024; 118:1-24. [PMID: 37872790 PMCID: PMC10769148 DOI: 10.1080/20477724.2023.2272095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
Neglected tropical diseases (NTDs) have become important public health threats that require multi-faceted control interventions. As late treatment and management of NTDs contribute significantly to the associated burdens, early diagnosis becomes an important component for surveillance and planning effective interventions. This review identifies common NTDs and highlights the progress in the development of diagnostics for these NTDs. Leveraging existing technologies to improve NTD diagnosis and improving current operational approaches for deployment of developed diagnostics are crucial to achieving the 2030 NTD elimination target. Point-of-care NTD (POC-NTD) diagnostic tools are recommended preferred diagnostic options in resource-constrained areas for mapping risk zones and monitoring treatment efficacy. However, few are currently available commercially. Technical training of remote health care workers on the use of POC-NTD diagnostics, and training of health workers on the psychosocial consequences of these diagnostics are critical in harnessing POC-NTD diagnostic potential. While the COVID-19 pandemic has challenged the possibility of achieving NTD elimination in 2030 due to the disruption of healthcare services and dwindling financial support for NTDs, the possible contribution of NTDs in exacerbating COVID-19 pandemic should motivate NTD health system strengthening.
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Affiliation(s)
- Oyetunde T. Oyeyemi
- Department of Biosciences and Biotechnology, University of Medical Sciences, Ondo, Nigeria
- Department of Biological Sciences, Old Dominion University, Virginia, USA
| | - Olumide Ogundahunsi
- The Central Office for Research and Development (CORD), University of Medical Sciences, Ondo, Nigeria
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU) institution, Munich, Germany
| | - Ramzy G. Fatem
- Schistosome Biological Supply Center, Theodor Bilharz Research Institute, Giza, Egypt
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Kabbas-Piñango E, Arinaitwe M, van Dam GJ, Moses A, Namukuta A, Nankasi AB, Mwima NK, Besigye F, Prada JM, Lamberton PHL. Reproducibility matters: intra- and inter-sample variation of the point-of-care circulating cathodic antigen test in two Schistosoma mansoni endemic areas in Uganda. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220275. [PMID: 37598698 PMCID: PMC10440168 DOI: 10.1098/rstb.2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Over 240 million people are infected with schistosomiasis. Detecting Schistosoma mansoni eggs in stool using Kato-Katz thick smears (Kato-Katzs) is highly specific but lacks sensitivity. The urine-based point-of-care circulating cathodic antigen test (POC-CCA) has higher sensitivity, but issues include specificity, discrepancy between batches and interpretation of trace results. A semi-quantitative G-score and latent class analyses making no assumptions about trace readings have helped address some of these issues. However, intra-sample and inter-sample variation remains unknown for POC-CCAs. We collected 3 days of stool and urine from 349 and 621 participants, from high- and moderate-endemicity areas, respectively. We performed duplicate Kato-Katzs and one POC-CCA per sample. In the high-endemicity community, we also performed three POC-CCA technical replicates on one urine sample per participant. Latent class analysis was performed to estimate the relative contribution of intra- (test technical reproducibility) and inter-sample (day-to-day) variation on sensitivity and specificity. Within-sample variation for Kato-Katzs was higher than between-sample, with the opposite true for POC-CCAs. A POC-CCA G3 threshold most accurately assesses individual infections. However, to reach the WHO target product profile of the required 95% specificity for prevalence and monitoring and evaluation, a threshold of G4 is needed, but at the cost of reducing sensitivity. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Elías Kabbas-Piñango
- School of Biodiversity, One Health & Veterinary Medicine, Wellcome Centre for Integrative Parasitology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Moses Arinaitwe
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Adriko Moses
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Annet Namukuta
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Andrina Barungi Nankasi
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Nicholas Khayinja Mwima
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Fred Besigye
- Vector Borne and NTD Control Division, Bilharzia and Worm Control Program Uganda, Ministry of Health, PO Box 1661, Kampala, Uganda
| | - Joaquin M. Prada
- Department of Comparative Biomedical Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Poppy H. L. Lamberton
- School of Biodiversity, One Health & Veterinary Medicine, Wellcome Centre for Integrative Parasitology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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Calvo-Urbano B, Léger E, Gabain I, De Dood CJ, Diouf ND, Borlase A, Rudge JW, Corstjens PLAM, Sène M, Van Dam GJ, Walker M, Webster JP. Sensitivity and specificity of human point-of-care circulating cathodic antigen (POC-CCA) test in African livestock for rapid diagnosis of schistosomiasis: A Bayesian latent class analysis. PLoS Negl Trop Dis 2023; 17:e0010739. [PMID: 37216407 DOI: 10.1371/journal.pntd.0010739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
Schistosomiasis is a major neglected tropical disease (NTD) affecting both humans and animals. The morbidity and mortality inflicted upon livestock in the Afrotropical region has been largely overlooked, in part due to a lack of validated sensitive and specific tests, which do not require specialist training or equipment to deliver and interpret. As stressed within the recent WHO NTD 2021-2030 Roadmap and Revised Guideline for schistosomiasis, inexpensive, non-invasive, and sensitive diagnostic tests for livestock-use would also facilitate both prevalence mapping and appropriate intervention programmes. The aim of this study was to assess the sensitivity and specificity of the currently available point-of-care circulating cathodic antigen test (POC-CCA), designed for Schistosoma mansoni detection in humans, for the detection of intestinal livestock schistosomiasis caused by Schistosoma bovis and Schistosoma curassoni. POC-CCA, together with the circulating anodic antigen (CAA) test, miracidial hatching technique (MHT) and organ and mesentery inspection (for animals from abattoirs only), were applied to samples collected from 195 animals (56 cattle and 139 small ruminants (goats and sheep) from abattoirs and living populations) from Senegal. POC-CCA sensitivity was greater in the S. curassoni-dominated Barkedji livestock, both for cattle (median 81%; 95% credible interval (CrI): 55%-98%) and small ruminants (49%; CrI: 29%-87%), than in S. bovis-dominated Richard Toll ruminants (cattle: 62%; CrI: 41%-84%; small ruminants: 12%, CrI: 1%-37%). Overall, sensitivity was greater in cattle than in small ruminants. Small ruminants POC-CCA specificity was similar in both locations (91%; CrI: 77%-99%), whilst cattle POC-CCA specificity could not be assessed owing to the low number of uninfected cattle surveyed. Our results indicate that, whilst the current POC-CCA does represent a potential diagnostic tool for cattle and possibly for predominantly S. curassoni-infected livestock, future work is needed to develop parasite- and/or livestock-specific affordable and field-applicable diagnostic tests to enable determination of the true extent of livestock schistosomiasis.
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Affiliation(s)
- Beatriz Calvo-Urbano
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | - Elsa Léger
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | - Isobel Gabain
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | | | - Nicolas D Diouf
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint Louis, Senegal
| | - Anna Borlase
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - James W Rudge
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | - Mariama Sène
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint Louis, Senegal
| | | | - Martin Walker
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
| | - Joanne P Webster
- Royal Veterinary College, Department of Pathobiology and Population Sciences, University of London, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom
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7
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Ramos LMDS, da Silva-Pereira RA, Oliveira E, Fonseca CT, Graeff-Teixeira C. A review of serological tests available in Brazil for intestinal schistosomiasis diagnosis. Mem Inst Oswaldo Cruz 2023; 118:e230236. [PMID: 36921190 PMCID: PMC10003949 DOI: 10.1590/0074-02760220236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/02/2023] [Indexed: 03/12/2023] Open
Abstract
The World Health Organization (WHO) roadmap and recommendations for elimination of schistosomiasis were recently updated. With significant reductions in the prevalence and intensity of schistosomiasis infections worldwide, there is a need for more sensitive diagnostic methods. There are a few remaining transmission hotspots in Brazil, although low endemicity settings comprise most of the endemic localities. For the latter, serology may represent a tool for population screening which could help eliminate transmission of schistosomiasis. Here, we review serology tests currently available in Brazil from both public health and private laboratories: immunofluorescent antibody tests (IFATs) on adult worm sections and enzyme-linked immunosorbent assays (ELISAs) with soluble egg and adult worm antigens. Both in-house and commercially available tests have received less than adequate performance evaluations. Our review of immediate basic and operational research goals may help identify local adjustments that can be made to improve control interventions aimed at elimination of schistosomiasis as a public health problem.
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Affiliation(s)
- Lidia Mara da Silva Ramos
- Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Núcleo de Doenças Infecciosas, Vitória, ES, Brasil
| | - Rosiane A da Silva-Pereira
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Pesquisa em Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Edward Oliveira
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Genômica Funcional de Parasitos, Belo Horizonte, MG, Brasil
| | - Cristina Toscano Fonseca
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Pesquisa em Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Carlos Graeff-Teixeira
- Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Núcleo de Doenças Infecciosas, Vitória, ES, Brasil
- + Corresponding author:
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8
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Hoekstra PT, Madinga J, Lutumba P, van Grootveld R, Brienen EAT, Corstjens PLAM, van Dam GJ, Polman K, van Lieshout L. Diagnosis of Schistosomiasis without a Microscope: Evaluating Circulating Antigen (CCA, CAA) and DNA Detection Methods on Banked Samples of a Community-Based Survey from DR Congo. Trop Med Infect Dis 2022; 7:tropicalmed7100315. [PMID: 36288056 PMCID: PMC9608707 DOI: 10.3390/tropicalmed7100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Detection of Schistosoma eggs in stool or urine is known for its low sensitivity in diagnosing light infections. Alternative diagnostics with better sensitivity while remaining highly specific, such as real-time PCR and circulating antigen detection, are progressively used as complementary diagnostic procedures but have not yet replaced microscopy. This study evaluates these alternative methods for the detection of Schistosoma infections in the absence of microscopy. Schistosomiasis presence was determined retrospectively in 314 banked stool and urine samples, available from a previous survey on the prevalence of taeniasis in a community in the Democratic Republic of the Congo, using real-time PCR, the point-of-care circulating cathodic antigen (POC-CCA) test, as well as the up-converting particle lateral flow circulating anodic antigen (UCP-LF CAA) test. Schistosoma DNA was present in urine (3%) and stool (28%) samples, while CCA (28%) and CAA (69%) were detected in urine. Further analysis of the generated data indicated stool-based PCR and the POC-CCA test to be suitable diagnostics for screening of S. mansoni infections, even in the absence of microscopy. A substantial proportion (60%) of the 215 CAA-positive cases showed low antigen concentrations, suggesting that even PCR and POC-CCA underestimated the “true” number of schistosome positives.
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Affiliation(s)
- Pytsje T. Hoekstra
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
| | - Joule Madinga
- Institute of Health and Society, Université Catholique de Louvain, 1348 Brussels, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa 1197, Democratic Republic of the Congo
- Department of Tropical Medicine, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo
| | - Rebecca van Grootveld
- Department of Clinical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eric A. T. Brienen
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Department of Health Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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9
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Summers S, Bhattacharyya T, Allan F, Stothard JR, Edielu A, Webster BL, Miles MA, Bustinduy AL. A review of the genetic determinants of praziquantel resistance in Schistosoma mansoni: Is praziquantel and intestinal schistosomiasis a perfect match? Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.933097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Schistosomiasis is a neglected tropical disease (NTD) caused by parasitic trematodes belonging to the Schistosoma genus. The mainstay of schistosomiasis control is the delivery of a single dose of praziquantel (PZQ) through mass drug administration (MDA) programs. These programs have been successful in reducing the prevalence and intensity of infections. Due to the success of MDA programs, the disease has recently been targeted for elimination as a public health problem in some endemic settings. The new World Health Organization (WHO) treatment guidelines aim to provide equitable access to PZQ for individuals above two years old in targeted areas. The scale up of MDA programs may heighten the drug selection pressures on Schistosoma parasites, which could lead to the emergence of PZQ resistant schistosomes. The reliance on a single drug to treat a disease of this magnitude is worrying should drug resistance develop. Therefore, there is a need to detect and track resistant schistosomes to counteract the threat of drug resistance to the WHO 2030 NTD roadmap targets. Until recently, drug resistance studies have been hindered by the lack of molecular markers associated with PZQ resistance. This review discusses recent significant advances in understanding the molecular basis of PZQ action in S. mansoni and proposes additional genetic determinants associated with PZQ resistance. PZQ resistance will also be analyzed in the context of alternative factors that may decrease efficacy within endemic field settings, and the most recent treatment guidelines recommended by the WHO.
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10
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Hoermann J, Kuenzli E, Schaefer C, Paris DH, Bühler S, Odermatt P, Sayasone S, Neumayr A, Nickel B. Performance of a rapid immuno-chromatographic test (Schistosoma ICT IgG-IgM) for detecting Schistosoma-specific antibodies in sera of endemic and non-endemic populations. PLoS Negl Trop Dis 2022; 16:e0010463. [PMID: 35622871 PMCID: PMC9212132 DOI: 10.1371/journal.pntd.0010463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/21/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Schistosomiasis, an acute and chronic parasitic disease caused by human pathogenic Schistosoma species, is a neglected tropical disease affecting more than 220 million people worldwide.
For diagnosis of schistosomiasis, stool and urine microscopy for egg detection is still the recommended method, however sensitivity of these methods is limited. Therefore, other methods like molecular detection of DNA in stool, detection of circulating cathodic antigen in urine or circulating anodic antigen in urine and serum, as well as serological tests have gained more attention. This study examines the sensitivity and specificity of a rapid diagnostic test based on immunochromatography (Schistosoma ICT IgG-IgM, LD Bio, Lyon, France) for simultaneous detection of specific IgG and IgM antibodies in serum, against Schistosoma spp. in endemic and non-endemic populations.
Methodology/Principal findings
Frozen banked serum samples from patients with confirmed schistosomiasis, patients with other helminth infections, patients with seropositive rheumatoid arthritis and healthy blood donors were used to assess the sensitivity and the specificity of the Schistosoma ICT IgG-IgM rapid diagnostic test.
The test showed a sensitivity of 100% in patients with parasitologically confirmed schistosomiasis, irrespective of the species (S. mansoni, S. haematobium, S. japonicum, S. mekongi). In healthy blood donors and patients with rheumatoid factor positive rheumatoid arthritis from Europe, specificity was 100%. However, in serum samples of patients with other tissue invasive helminth infections, the test showed some cross-reactivity, resulting in a specificity of 85%.
Conclusion/Significance
With its high sensitivity, the Schistosoma ICT IgG-IgM rapid diagnostic test is a suitable screening test for detection of Schistosoma specific antibodies, including S. mekongi. However, in populations with a high prevalence of co-infection with other tissue invasive helminths, positive results should be confirmed with other diagnostic assays due to the test’s imperfect specificity.
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Affiliation(s)
- Julie Hoermann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Esther Kuenzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Carmen Schaefer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel H. Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Silja Bühler
- Division of Hygiene and Infectious Diseases, Institute for Hygiene and Environment, Hamburg, Germany
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
| | - Beatrice Nickel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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11
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Clark J, Moses A, Nankasi A, Faust CL, Adriko M, Ajambo D, Besigye F, Atuhaire A, Wamboko A, Rowel C, Carruthers LV, Francoeur R, Tukahebwa EM, Lamberton PHL, Prada JM. Translating From Egg- to Antigen-Based Indicators for Schistosoma mansoni Elimination Targets: A Bayesian Latent Class Analysis Study. Front Trop Dis 2022; 3:825721. [PMID: 35784267 PMCID: PMC7612949 DOI: 10.3389/fitd.2022.825721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Schistosomiasis is a parasitic disease affecting over 240-million people. World Health Organization (WHO) targets for Schistosoma mansoni elimination are based on Kato-Katz egg counts, without translation to the widely used, urine-based, point-of-care circulating cathodic antigen diagnostic (POC-CCA). We aimed to standardize POC-CCA score interpretation and translate them to Kato-Katz-based standards, broadening diagnostic utility in progress towards elimination. A Bayesian latent-class model was fit to data from 210 school-aged-children over four timepoints pre- to six-months-post-treatment. We used 1) Kato-Katz and established POC-CCA scoring (Negative, Trace, +, ++ and +++), and 2) Kato-Katz and G-Scores (a new, alternative POC-CCA scoring (G1 to G10)). We established the functional relationship between Kato-Katz counts and POC-CCA scores, and the score-associated probability of true infection. This was combined with measures of sensitivity, specificity, and the area under the curve to determine the optimal POC-CCA scoring system and positivity threshold. A simulation parametrized with model estimates established antigen-based elimination targets. True infection was associated with POC-CCA scores of ≥ + or ≥G3. POC-CCA scores cannot predict Kato-Katz counts because low infection intensities saturate the POC-CCA cassettes. Post-treatment POC-CCA sensitivity/specificity fluctuations indicate a changing relationship between egg excretion and antigen levels (living worms). Elimination targets can be identified by the POC-CCA score distribution in a population. A population with ≤2% ++/+++, or ≤0.5% G7 and above, indicates achieving current WHO Kato-Katz-based elimination targets. Population-level POC-CCA scores can be used to access WHO elimination targets prior to treatment. Caution should be exercised on an individual level and following treatment, as POC-CCAs lack resolution to discern between WHO Kato-Katz-based moderate- and high-intensity-infection categories, with limited use in certain settings and evaluations.
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Affiliation(s)
- Jessica Clark
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Arinaitwe Moses
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Andrina Nankasi
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Christina L. Faust
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Diana Ajambo
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Fred Besigye
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Arron Atuhaire
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Aidah Wamboko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Candia Rowel
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Lauren V. Carruthers
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Rachel Francoeur
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
- Faculty of Science and Engineering, University of Chester, Chester, United Kingdom
| | | | - Poppy H. L. Lamberton
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Joaquin M. Prada
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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12
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Hoekstra PT, van Dam GJ, van Lieshout L. Context-Specific Procedures for the Diagnosis of Human Schistosomiasis – A Mini Review. Front Trop Dis 2021. [DOI: 10.3389/fitd.2021.722438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Schistosomiasis is a parasitic disease caused by trematode blood flukes of the genus Schistosoma, affecting over 250 million people mainly in the tropics. Clinically, the disease can present itself with acute symptoms, a stage which is relatively more common in naive travellers originating from non-endemic regions. It can also develop into chronic disease, with the outcome depending on the Schistosoma species involved, the duration and intensity of infection and several host-related factors. A range of diagnostic tests is available to determine Schistosoma infection, including microscopy, antibody detection, antigen detection using the Point-Of-Care Circulating Cathodic Antigen (POC-CCA) test and the Up-Converting Particle Lateral Flow Circulating Anodic Antigen (UCP-LF CAA) test, as well as Nucleic Acid Amplification Tests (NAATs) such as real-time PCR. In this mini review, we discuss these different diagnostic procedures and explore their most appropriate use in context-specific settings. With regard to endemic settings, diagnostic approaches are described based on their suitability for individual diagnosis, monitoring control programs, determining elimination as a public health problem and eventual interruption of transmission. For non-endemic settings, we summarize the most suitable diagnostic approaches for imported cases, either acute or chronic. Additionally, diagnostic options for disease-specific clinical presentations such as genital schistosomiasis and neuro-schistosomiasis are included. Finally, the specific role of diagnostic tests within research settings is described, including a controlled human schistosomiasis infection model and several clinical studies. In conclusion, context-specific settings have different requirements for a diagnostic test, stressing the importance of a well-considered decision of the most suitable diagnostic procedure.
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Tamarozzi F, Ursini T, Hoekstra PT, Silva R, Costa C, Gobbi F, Monteiro GB, Motta L, van Dam GJ, Corstjens PL, van Lieshout L, Buonfrate D. Evaluation of microscopy, serology, circulating anodic antigen (CAA), and eosinophil counts for the follow-up of migrants with chronic schistosomiasis: a prospective cohort study. Parasit Vectors 2021; 14:149. [PMID: 33750443 PMCID: PMC7941883 DOI: 10.1186/s13071-021-04655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background An accurate test for the diagnosis and post-treatment follow-up of patients with schistosomiasis is needed. We assessed the performance of different laboratory parameters, including the up-converting reporter particle technology lateral flow assay to detect circulating anodic antigen (UCP-LF CAA), for the post-treatment follow-up of schistosomiasis in migrants attending a dedicated outpatient clinic in a non-endemic country. Methods Routine anti-Schistosoma serology results and eosinophil counts were obtained of patients with positive urine/stool microscopy and/or PCR (confirmed cases) or only positive serology (possible cases), and at least one follow-up visit at 6 (T6) or 12 (T12) months after praziquantel treatment. All sera samples were tested with the UCP-LF CAA assay. Results Forty-eight patients were included, 23 confirmed and 25 possible cases. The percentage seropositivity and median antibody titers did not change significantly during follow-up. UCP-LF CAA was positive in 86.9% of confirmed and 20% of possible cases. The percentage positivity and median CAA levels decreased significantly post-treatment, with only two patients having positive CAA levels at T12. Conclusions The UCP-LF CAA assay proved useful for the diagnosis of active infection with Schistosoma spp. and highly valuable for post-treatment monitoring in migrants, encouraging the development of a commercial test.![]()
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Tamara Ursini
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ronaldo Silva
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Cecilia Costa
- Dipartimento medico di malattie infettive, Ospedale Maggiore della Carità, Novara, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Gerardo B Monteiro
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Leonardo Motta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul L Corstjens
- Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy.
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