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Comparison of Two Serological Assays in Detecting Strongyloides Infection in Immunocompromised Patients

Emelia OsmanDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Nur Azma AminUniversiti Kuala Lumpur Institute of Medical Science Technology Selangor, Malaysia;

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Thieeraporn Phraseart Ma NoonDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Siti Nuratiqah Hanani LahatDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Mohamad Syairazi RosliDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Shazia Farhana ShamDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Petrick Ramesh PeriyasamyDepartment of Medical, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Nuraffini GhazaliDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Siti Nor Azreen Abd ManapDepartment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;

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Rahmah NoordinInstitute for Research in Molecular Medicine, Universiti Sains Malaysia (USM), Penang, Malaysia

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ABSTRACT.

Strongyloides infection may develop into fatal hyperinfection and dissemination syndrome in immunocompromised hosts. Despite suboptimal specificity issues, the detection of IgG antibodies by ELISA has been central in the serodiagnosis of Strongyloides infection. Recently, an IgG4-based lateral-flow test (SsRapid) using recombinant NIE (rNIE) protein with good diagnostic performance has been reported. This study assessed the result concordance between a commercial IgG-ELISA and the SsRapid. Additionally, we determined the Strongyloides seroprevalence and its association with clinical manifestations. Immunocompromised patients (N = 200) were from Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia, and were diagnosed with HIV/AIDS, hematological malignancy, and solid organ cancers. Their plasma samples were tested using a commercial IgG-ELISA and SsRapid. A fair concordance (κ = 0.27–0.33; P < 0.05) between the tests was demonstrated. The SsRapid exhibited a significantly higher (P < 0.05) seroprevalence (10.5% [21/200]) compared with IgG-ELISA (7.5% [15/200]). After adsorption with rNIE, all SsRapid-positive samples tested negative with the rapid test, thus showing binding specificity. There was no significant association with clinical manifestations. This study revealed that SsRapid is a useful diagnostic tool for Strongyloides infection, and there is a notable seroprevalence among the immunocompromised patients.

Author Notes

Address correspondence to Emelia Osman, Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia. E-mail: emelia.osman@ukm.edu.my

Financial support: This study was funded by the fundamental grant of the Faculty of Medicine, Universiti Kebangsaan Malaysia (FF-2021-102). We would like to thank Miss Putri Sabrina Mohamed Yusoff and Mrs. Noor Wanie Hassan for their technical assistance, and MyLAB 1/2018 for financial assistance in producing the rapid tests.

Authors’ addresses: Emelia Osman, Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, E-mail: emelia.osman@ukm.edu.my. Nur Azma Amin, Universiti Kuala Lumpur Institute of Medical Science Technology Kajang, Malaysia, E-mail: nurazma@unikl.edu.my. Thieeraporn Phraseart Ma Noon, Siti Nuratiqah Hanani Lahat, Mohamad Syairazi Rosli, and Shazia Farhana Sham, Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, E-mails: a162674@siswa.ukm.edu.my, a162941@siswa.ukm.edu.my, a157803@siswa.ukm.edu.my, and a166744@siswa.ukm.edu.my. Petrick Ramesh Periyasamy, Department of Medical, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, E-mail: petrick.periyasamy@gmail.com. Nuraffini Ghazali and Siti Nor Azreen Abd Manap, Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, E-mails: nuraffini.ghazali@gmail.com and sitinorazreen@ukm.edu. Rahmah Noordin, Institute for Research in Molecular Medicine, Universiti Sains Malaysia (USM), Penang, Malaysia, E-mail: rahmah8485@gmail.com.

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