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Manouana GP, Lorenz E, Mbong Ngwese M, Nguema Moure PA, Maiga Ascofaré O, Akenten CW, Amuasi J, Rakotozandrindrainy N, Rakotozandrindrainy R, Mbwana J, Lusingu J, Byrne N, Melhem S, Zinsou JF, Adegbite RB, Hogan B, Winter D, May J, Kremsner PG, Borrmann S, Eibach D, Adegnika AA. Performance of a rapid diagnostic test for the detection of Cryptosporidium spp. in African children admitted to hospital with diarrhea. PLoS Negl Trop Dis 2020; 14:e0008448. [PMID: 32658930 PMCID: PMC7377516 DOI: 10.1371/journal.pntd.0008448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 07/23/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cryptosporidium is a protozoan parasite that causes mild to severe diarrhoeal disease in humans. To date, several commercial companies have developed rapid immunoassays for the detection of Cryptosporidium infection. However, the challenge is to identify an accurate, simple and rapid diagnostic tool for the estimation of cryptosporidiosis burden. This study aims at evaluating the accuracy of CerTest Crypto, a commercialized rapid diagnostic test (RDT) for the detection of Cryptosporidium antigens in the stool of children presenting with diarrhoea. METHODS A cross-sectional study was conducted in four study sites in Sub-Saharan Africa (Gabon, Ghana, Madagascar, and Tanzania), from May 2017 to April 2018. Stool samples were collected from children under 5 years with diarrhoea or a history of diarrhoea within the last 24 hours. All specimens were processed and analyzed using CerTest Crypto RDT against a composite diagnostic panel involving two polymerase chain reaction (PCR) tests (qPCR and RFLP-PCR,) as the gold standard. RESULTS A total of 596 stool samples were collected. Evaluation of the RDT yielded a very low overall sensitivity of 49.6% (confidence interval (CI) 40.1-59.0), a specificity of 92.5% (CI 89.8-94.7), positive predictive value of 61.3% (CI 50.6-71.2), and negative predictive value of 88.5% (85.3-91.1) when compared to the composite reference standard of qPCR and RFLP-PCR for the detection of Cryptosporidium species. Moreover, the performance of this test varied across different sites. CONCLUSION The weak performance of the studied RDT suggests the need to carefully evaluate available commercial RDTs before their use as standard tools in clinical trials and community survey of Cryptosporidium infections in pediatric cohorts.
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Affiliation(s)
- Gédéon Prince Manouana
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Eva Lorenz
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Mirabeau Mbong Ngwese
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | | | - Oumou Maiga Ascofaré
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | | | - Joyce Mbwana
- National Institute for Medical Research (NIMR) & University of Copenhagen, Denmark
| | - John Lusingu
- National Institute for Medical Research (NIMR) & University of Copenhagen, Denmark
| | - Natalie Byrne
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Sophia Melhem
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Jeannot Frejus Zinsou
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Roméo Bayodé Adegbite
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Benedikt Hogan
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Doris Winter
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Jurgen May
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Peter Gottfried Kremsner
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | - Steffen Borrmann
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Daniel Eibach
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Germany
- * E-mail:
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