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Real-Time Polymerase Chain Reaction for Detection of Low-Intensity Schistosoma japonicum Infections in China

More sensitive methods for diagnosing infection with Schistosoma japonicum are needed as control becomes more effective. We compared a real-time polymerase chain reaction (PCR) for stool samples with conventional diagnostic methods in a study of 1,727 persons from Anhui Province, China. Seroprevalence determined by using an indirect hemagglutination assay (IHA) was much higher (26.1%) than the prevalence in stool-based tests, which were 5.3%, 3.2%, and 3.0% for PCR, hatching test, and Kato-Katz thick smear, respectively. A large proportion of the positive stool samples were only positive in one or two tests. The PCR showed better agreement with IHA than the other two stool-based tests. A commonly used diagnostic algorithm with initial screening for antibodies and subsequent testing with the Kato-Katz thick smear of the seropositive results would have resulted in treatment of 22 people compared with 50 people if the PCR replaced the Kato-Katz thick smear. As prevalence and intensity decrease, the benefit of increased sensitivity using the PCR must be weighed against additional costs.

Received May 8, 2009. Accepted for publication June 10, 2009.

Acknowledgments: We thank Wu Weiduo, Chao Zhiguo, Xiao Xiang, Wang Qizhi, Zhang Gonghua, Liu Xiaoming, Chen Dalin, Pan Xinping, and the staff at Anhui Provincial Institute of Parasitic Diseases and Tongling Station of Schistosomiasis Control for collecting and processing samples.

Financial support: This study was supported by University Hospital of North Norway, Tromsø, Norway.

^* Address correspondence to Tore Lier, Department of Microbiology and Infection Control, University Hospital of North Norway, PO Box 56, N-9038 Tromsø, Norway. E-mail: tore.lier{at}unn.no

Authors’ addresses: Tore Lier, Gunnar S. Simonsen, Hanne H. Haukland, and Joachim Hegstad, Department of Microbiology and Infection Control, University Hospital of North Norway, PO Box 56, N-9038 Tromsø, Norway, E-mails: tore.lier{at}unn.no, gunnar.skov.simonsen{at}unn.no, hanne.husom.haukland{at}unn.no, and joachim.hegstad{at}unn.no. Tianping Wang, Anhui Institute of Parasitic Diseases, 207 Dongjiao Road, Wuhu 241000, Anhui, Peoples Republic of China, E-mail: wangtianping{at}hotmail.com. Dabing Lu, Department of Infectious Diseases, Faculty of Medicine, Imperial College, London SW7 2AZ, United Kingdom, E-mail: dabing2001wyz{at}yahoo.com.cn. Birgitte J. Vennervald and Maria V. Johansen, DBL–Centre for Health Research and Development, Faculty of Life Sciences, Thorvaldsensvej 57, University of Copenhagen, DK-1871 Fredriksberg C, Denmark, E-mails: bjv{at}life.ku.dk and mvj{at}life.ku.dk.