• 1.

    Dorris M, Viney ME, Blaxter ML , 2002. Molecular phylogenetic analysis of the genus Strongyloides and related nematodes. Int J Parasitol 32: 15071517.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    World Health Organization , 2018. Strongyloidiasis. Available at: http://www.who.int/intestinal_worms/epidemiology/strongyloidiasis/en/. Accessed December 5, 2018.

  • 3.

    Kearns TM et al.2017. Strongyloides seroprevalence before and after an ivermectin mass drug administration in a remote Australian Aboriginal community. PLoS Negl Trop Dis 11: e0005607.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    de Silva S, Saykao P, Kelly H, MacIntyre CR, Ryan N, Leydon J, Biggs BA , 2002. Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7–20 years after resettlement in Australia. Epidemiol Infect 128: 439444.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Biggs BA, Caruana S, Mihrshahi S, Jolley D, Leydon J, Chea L, Nuon S , 2009. Management of chronic strongyloidiasis in immigrants and refugees: is serologic testing useful? Am J Trop Med Hyg 80: 788791.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Chaves NJ, Gibney KB, Leder K, O’Brien DP, Marshall C, Biggs BA , 2009. Screening practices for infectious diseases among Burmese refugees in Australia. Emerg Infect Dis 15: 17691772.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Rahmanian H, MacFarlane AC, Rowland KE, Einsiedel LJ, Neuhaus SJ , 2015. Seroprevalence of Strongyloides stercoralis in a South Australian Vietnam veteran cohort. Aust N Z J Public Health 39: 331335.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Global Health, Centers for Disease Control and Prevention , 2017, updated December 18, 2018. Strongyloidiasis. Available at: https://www.cdc.gov/dpdx/strongyloidiasis/index.html. Accessed December 5, 2018.

  • 9.

    Keiser PB, Nutman TB , 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17: 208217.

  • 10.

    van Doorn HR, Koelewijn R, Hofwegen H, Gilis H, Wetsteyn JCFM, Wismans PJ, Sarfati C, Vervoort T, van Gool T , 2007. Use of enzyme-linked immunosorbent assay and dipstick assay for detection of Strongyloides stercoralis infection in humans. J Clin Microbiol 45: 438442.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Bisoffi Z et al.2014. Diagnostic accuracy of five serologic tests for Strongyloides stercoralis infection. PLoS Negl Trop Dis 8: e2640.

  • 12.

    Verweij JJ, Canales M, Polman K, Ziem J, Brienen EAT, Polderman AM, van Lieshout L , 2009. Molecular diagnosis of Strongyloides stercoralis in faecal samples using real-time PCR. Trans R Soc Trop Med Hyg 103: 342346.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Phan T , 2016. Strongyloides stercoralis RT PCR validation. In: NSW Health Pathology CM, ed. Sydney, Australia.

  • 14.

    Putland RA, Thomas SM, Grove DI, Johnson AM , 1993. Analysis of the 18S ribosomal RNA gene of Strongyloides stercoralis. Int J Parasitol 23: 149151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Carroll SM, Karthigasu KT, Grove DI , 1981. Serodiagnosis of human strongyloidiasis by an enzyme-linked immunosorbent assay. Trans R Soc Trop Med Hyg 75: 706709.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Buonfrate D, Requena-Mendez A, Angheben A, Cinquini M, Cruciani M, Fittipaldo A, Giorli G, Gobbi F, Piubelli C, Bisoffi Z , 2018. Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection—a systematic review and meta-analysis. PLoS Negl Trop Dis 12: e0006229.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Buonfrate D, Perandin F, Formenti F, Bisoffi Z , 2017. A retrospective study comparing agar plate culture, indirect immunofluorescence and real-time PCR for the diagnosis of Strongyloides stercoralis infection. Parasitology 144: 812816.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Hirata T, Nakamura H, Kinjo N, Yamane N, Fujita J , 2007. Increased detection rate of Strongyloides stercoralis by repeated stool examinations using the agar plate culture method. Am J Trop Med Hyg 77: 683684.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Koosha S, Fesharaki M, Rokni MB , 2004. Comparison of enzyme-linked immunosorbent assay and indirect immunofluorescence assay in the diagnosis of human strongyloidiasis. Indian J Gastroenterol 23: 214216.

    • Search Google Scholar
    • Export Citation
  • 20.

    Requena-Méndez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Muñoz J , 2013. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 7: e2002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Repetto SA et al.2018. Strongyloidiasis outside endemic areas: long-term parasitological and clinical follow-up after ivermectin treatment. Clin Infect Dis 66: 15581565.

    • Crossref
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 350 350 26
Full Text Views 20 20 4
PDF Downloads 35 35 5
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Clinical Performance of Real-Time Polymerase Chain Reaction for Strongyloides stercoralis Compared with Serology in a Nonendemic Setting

View More View Less
  • 1 NSW Health Pathology, Department of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, Concord, Australia;
  • | 2 Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia;
  • | 3 School of Molecular and Biosciences, The University of Sydney, Sydney, Australia
Restricted access

ABSTRACT.

Strongyloides stercoralis is a nematode endemic to subtropical and tropical regions that may cause asymptomatic carriage, peripheral eosinophilia, cutaneous, gastrointestinal, and pulmonary disease, or hyperinfection syndrome. Conventional diagnostic methods for strongyloidiasis include feces microscopy and culture, with low sensitivity in chronic infection due to the low helminth burden, and serology, which may be prone to false-negative results with immunocompromise and false-positive results with other infections and immunological disorders. We evaluated a laboratory-developed real-time polymerase chain reaction (RT-PCR), detecting the 18S SSU ribosomal RNA gene, compared with conventional diagnostic methods, using serology via ELISA as the gold-standard. The population studied included tertiary hospital inpatients and outpatients residing in a nonendemic area. Seven hundred fifty unfixed stool specimens submitted sequentially between 2014 and 2018 were tested for S. stercoralis via microscopy and RT-PCR. Agar plate culture (APC), Harada-Mori culture (HMC), and ELISA were performed in conjunction with 141, 135, and 177 of the specimens, respectively. RT-PCR yielded 13 positive and 730 negative results, with inhibition in seven specimens. ELISA yielded 53 positive, 18 equivocal, and 106 negative results. Results for direct diagnostic methods obtained after treatment with ivermectin were excluded from the performance analysis. Compared with ELISA, RT-PCR, microscopy, APC, and HMC exhibited sensitivities of 38%, 6%, 3%, and 0%, respectively, and specificities of 100%. Given the low sensitivities commensurate with testing a population with remote infection and thus low parasite burden, we recommend a combination of serological and molecular diagnostic testing to achieve the best balance of sensitivity and specificity.

Author Notes

Address correspondence to Genevieve McKew, Department of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, Hospital Rd., Concord NSW, Australia 2139. E-mail: genevieve.mckew@health.nsw.gov.au

Disclosures: Ethical approval was obtained from the Ethics Committee of Sydney Local Health District, Concord office. Approval numbers in the ethics management system REGIS are 2019/ETH08025 and 2019/STE09630.

Authors’ addresses: Christopher Swan, Department of Microbiology, NSW Health Pathology, Royal North Shore Hospital, Herbert St., St. Leonards, NSW, Australia 2065, E-mail: christopher.swan@health.nsw.gov.au. Thuy Phan and Genevieve McKew, Department of Microbiology, NSW Health Pathology, Concord Repatriation and General Hospital, Hospital Rd., Concord, NSW, Australia 2139, E-mails: thuy.phan@health.nsw.gov.au and genevieve.mckew@health.nsw.gov.au.

Save