Recombinase Polymerase Amplification Compared to Real-Time Polymerase Chain Reaction Test for the Detection of Fasciola hepatica in Human Stool

Miguel M. Cabada Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
Department of Medicine, Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Lima, Peru.
Universidad Peruana Cayetano Heredia-University of Texas Medical Branch Collaborative Research Center-Cusco, Cusco, Peru.

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Jose L. Malaga Department of Medicine, Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Lima, Peru.
Universidad Peruana Cayetano Heredia-University of Texas Medical Branch Collaborative Research Center-Cusco, Cusco, Peru.

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Alejandro Castellanos-Gonzalez Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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Kelli A. Bagwell Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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Patrick A. Naeger Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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Hayley K. Rogers Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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Safa Maharsi Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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Maryann Mbaka Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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A. Clinton White Jr. Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

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Fasciola hepatica is the most widely distributed trematode infection in the world. Control efforts may be hindered by the lack of diagnostic capacity especially in remote endemic areas. Polymerase chain reaction (PCR)–based methods offer high sensitivity and specificity but require expensive technology. However, the recombinase polymerase amplification (RPA) is an efficient isothermal method that eliminates the need for a thermal cycler and has a high deployment potential to resource-limited settings. We report on the characterization of RPA and PCR tests to detect Fasciola infection in clinical stool samples with low egg burdens. The sensitivity of the RPA and PCR were 87% and 66%, respectively. Both tests were 100% specific showing no cross-reactivity with trematode, cestode, or nematode parasites. In addition, RPA and PCR were able to detect 47% and 26% of infections not detected by microscopy, respectively. The RPA adapted to a lateral flow platform was more sensitive than gel-based detection of the reaction products. In conclusion, the Fasciola RPA is a highly sensitive and specific test to diagnose chronic infection using stool samples. The Fasciola RPA lateral flow has the potential for deployment to endemic areas after further characterization.

Author Notes

* Address correspondence to Miguel M. Cabada, Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas and Universidad Peruana Cayetano Heredia-University of Texas Medical Branch Collaborative Research Center-Cusco, Cusco, Peru. E-mail: micabada@utmb.edu

Financial support: This study was funded by the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences, National Institutes of Health. Specimen collection was performed through a study funded by the National Institute for Allergy and Infectious Diseases at the National Institutes of Health grant 1R01AI104820-01.

Authors' addresses: Miguel M. Cabada, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, UPCH-UTMB Collaborative Research Center, Cusco, Peru, E-mail: micabada@utmb.edu. Jose L. Malaga, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, UPCH-UTMB Collaborative Research Center, Cusco, Peru, E-mail: joseluis8@hotmail.com. Alejandro Castellanos-Gonzalez, Kelli A. Bagwell, Patrick A. Naeger, Hayley K. Rogers, Safa Maharsi, Maryann Mbaka, and A. Clinton White Jr., Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, E-mails: alcastel@utmb.edu, kabagwel@utmb.edu, panaeger@utmb.edu, hkrogers@utmb.edu, samahars@utmb.edu, maryann.mbaka@gmail.com, and acwhite@utmb.edu.

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