Diagnosis of Multiple Enteric Protozoan Infections by Enzyme-Linked Immunosorbent Assay in the Guatemalan Highlands

Julia den Hartog Division of General Medicine, Geriatrics and Palliative Care, Department of Emergency Medicine, and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia; Department of Counseling and Psychological Services, College of Education, Georgia State University, Atlanta, Georgia; Physician Assistant Program, Emory University, Atlanta, Georgia

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Laura Rosenbaum Division of General Medicine, Geriatrics and Palliative Care, Department of Emergency Medicine, and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia; Department of Counseling and Psychological Services, College of Education, Georgia State University, Atlanta, Georgia; Physician Assistant Program, Emory University, Atlanta, Georgia

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Zachary Wood Division of General Medicine, Geriatrics and Palliative Care, Department of Emergency Medicine, and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia; Department of Counseling and Psychological Services, College of Education, Georgia State University, Atlanta, Georgia; Physician Assistant Program, Emory University, Atlanta, Georgia

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David Burt Division of General Medicine, Geriatrics and Palliative Care, Department of Emergency Medicine, and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia; Department of Counseling and Psychological Services, College of Education, Georgia State University, Atlanta, Georgia; Physician Assistant Program, Emory University, Atlanta, Georgia

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William A. Petri Jr. Division of General Medicine, Geriatrics and Palliative Care, Department of Emergency Medicine, and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia; Department of Counseling and Psychological Services, College of Education, Georgia State University, Atlanta, Georgia; Physician Assistant Program, Emory University, Atlanta, Georgia

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We tested a prototype stool enzyme-linked immunosorbent assay (ELISA) (TRI-COMBO) that is simultaneously diagnostic for Giardia lamblia, Cryptosporidium parvum, and Entamoeba histolytica in a rural pediatric clinic in Guatemala. We compared its results to those of three individual ELISAs for these parasites, assessed the prevalence of these parasites, and compared our findings to those found by stool microscopy. We tested 620 non-diarrheal stools. The TRI-COMBO diagnosed 57 positive samples and 52 (91%) had a correlating positive result in an individual assay, giving a kappa coefficient of 0.90. Giardia spp., E. histolytica, and Cryptosporidium spp. were detected in 52 (8.4%), 2 (0.3%), and 3 (0.5%) samples, respectively. Twenty-three (40%) samples positive by ELISA for Giardia spp. were identified by microscopy. This study is the first to test the TRI-COMBO in this setting and, to our knowledge, represents the first assessment of these parasites in Guatemala by stool ELISA.

Author Notes

* Address correspondence to Julia den Hartog, Division of General Medicine, Geriatrics and Palliative Care, University of Virginia Health System, 661 University Lane, Suite B, Orange, VA 22960. E-mail: jrd2t@virginia.edu

Financial support: This study was supported by National Institute of Health AI-43596 to William A. Petri Jr. Support for travel was provided by The Hook Fund of the University of Virginia.

Disclosure: William A. Petri Jr. receives royalty income from TechLab for amebiasis diagnostics. These royalties are donated in their entirety to the American Society of Tropical Medicine and Hygiene without benefit to Dr. Petri. None of the other authors reports a conflict of interest.

Authors' addresses: Julia den Hartog, Division of General Medicine, Geriatrics and Palliative Care, University of Virginia Health System, Charlottesville, VA, E-mail: jrd2t@virginia.edu. Laura Rosenbaum, Department of Counseling and Psychological Services, College of Education, Georgia State University, Atlanta, GA, E-mail: laurarosenbaum@yahoo.com. Zachary Wood, Physician Assistant Program, Emory University, Atlanta, GA, E-mail: zacharytwood@gmail.com. David Burt, University of Virginia Health System, Charlottesville, VA, E-mail: drb5p@virginia.edu. William A. Petri Jr., Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville VA, E-mail: wap3g@virginia.edu.

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