Rapid and Comprehensive Screening for Urogenital and Gastrointestinal Schistosomiasis with Handheld Digital Microscopy Combined with Circulating Cathodic Antigen Testing

Jean T. Coulibaly Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire;
Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire;

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Kigbafori D. Silue Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire;
Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire;

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María Díaz de León Derby Department of Bioengineering, University of California, Berkeley, Berkeley, California;

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Daniel A. Fletcher Department of Bioengineering, University of California, Berkeley, Berkeley, California;
Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, University of California, Berkeley, Berkeley, California;
Chan Zuckerberg Biohub, San Francisco, California;

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Karla N. Fisher Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Canada;
Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada;

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Jason R. Andrews Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California;

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Isaac I. Bogoch Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Canada;
Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada;
Department of Medicine, University of Toronto, Toronto, Canada

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Novel methods are required to aid the monitoring of schistosomiasis control and elimination initiatives through mass drug administration. Portable digital and mobile phone microscopy is a promising tool for this purpose. This cross-sectional study evaluated the diagnostic operating characteristics of a converted mobile phone microscope (the SchistoScope) for the detection of Schistosoma haematobium eggs, as determined by community-based field workers and expert microscopists, compared with a field gold standard of light microscopy. Three hundred sixty-five urine samples were evaluated by conventional light microscopy, with 49 (13.4%) positive for S. haematobium. Compared with light microscopy, the sensitivity and specificity of S. haematobium detection by field microscopists trained to use the SchistoScope were 26.5% (95% CI: 14.9–41.1%) and 98.4% (95% CI: 96.3–99.5%), respectively. The sensitivity and specificity of S. haematobium detection by expert microscopists using the SchistoScope was 74% (95% CI: 59.7–85.4%) and 98.1% (95% CI: 95.9–99.3%), respectively, compared with light microscopy. The sensitivity rose to 96.1% and 100% when evaluating for egg counts greater than five and 10 eggs per 10 mL, respectively. A point-of-care circulating cathodic anion (POC CCA) test was used to evaluate Schistosoma mansoni; however, there were too few positive samples to reliably comment on diagnostic characteristics. This study demonstrated that a “urine-only” approach to rapidly screen for schistosomiasis at the point of sample collection can be conducted with mobile phone microscopy (S. haematobium) coupled with POC CCA (S. mansoni). Such an approach may aid in streamlined schistosomiasis control and elimination initiatives.

Author Notes

Disclosures: I. I. Bogoch consults for the Weapons Threat Reduction Program at Global Affairs Canada. Ethical permission was granted by both the local health district officer, from the Comité National d’Éthique des Sciences de la Vie et de la Santé, Abidjan, Côte d’Ivoire (REB #186-21) and the University Health Network, Toronto, Canada (REB #21-5582).

Financial support: I. I. Bogoch is supported by the Ontario Academic Health Sciences Centre (AHSC) Alternative Funding Plan (AFP) Innovation Fund, New Frontiers in Research Fund (NFRFE-2020-00922), and Canadian Institutes of Health Research (PJT-83575).

Authors’ addresses: Jean T. Coulibaly and Kigbafori D. Silue, Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire, E-mails: jean.coulibaly@csrs.ci and kigbafori.silue@csrs.ci. María Díaz de León Derby, Department of Bioengineering, University of California, Berkeley, Berkeley, CA, E-mail: maria.diaz@berkeley.edu. Daniel A. Fletcher, Department of Bioengineering, University of California, Berkeley, Berkeley, CA, E-mail: fletch@berkeley.edu. Karla N. Fisher, Toronto General Hospital, Toronto, Canada, E-mail: karla.fisher@uhn.ca. Jason R. Andrews, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, E-mail: jandr@stanford.edu. Isaac I. Bogoch, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada, and Division of Infectious Diseases, Toronto General Hospital, Toronto, Canada, E-mail: isaac.bogoch@uhn.ca.

Address correspondence to Isaac I. Bogoch, Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, 14EN 209, 200 Elizabeth St., Toronto, ON, Canada M5G 2C4. E-mail: isaac.bogoch@uhn.ca
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