Antigen-based diagnosis of Schistosoma infection in travellers: a prospective study

Antigen-based diagnosis of Schistosoma infection in travellers: a prospective study

Abstract Background Travellers infected with Schistosoma spp. might be pauci- or even asymptomatic on first presentation. Therefore, schistosomiasis may remain undiagnosed in this population. Active infection, as evidenced by the presence of the tissue-dwelling worm, can be demonstrated via the dete...

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Bibliographic Details
Published in:Journal of travel medicine Vol. 27; no. 4
Main Authors: Casacuberta-Partal, Miriam, Janse, Jacqueline J, van Schuijlenburg, Roos, de Vries, Jutte J C, Erkens, Marianne A A, Suijk, Kitty, van Aalst, Mariëlle, Maas, Jaap J, Grobusch, Martin P, van Genderen, Perry J J, de Dood, Claudia, Corstjens, Paul L A M, van Dam, Govert J, van Lieshout, Lisette, Roestenberg, Meta
Format: Journal Article
Language:English
Published: England Oxford University Press 14-07-2020
Subjects:
Antibodies
Antigens
Assaying
Enzyme-linked immunosorbent assay
Fluorescence
Fresh water
Infections
Medical diagnosis
Original
Praziquantel
Risk analysis
Risk factors
Schistosoma
Schistosomiasis
Sensitivity analysis
Seroconversion
Serology
Signs and symptoms
Soluble egg antigen
Travellers
Schistosomiasis
praziquantel
questionnaire
circulating anodic antigen (CAA)
freshwater contact
serology
Serology
Questionnaire
Freshwater-contact
Praziquantel
Circulating Anodic Antigen (CAA)
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Summary:Abstract Background Travellers infected with Schistosoma spp. might be pauci- or even asymptomatic on first presentation. Therefore, schistosomiasis may remain undiagnosed in this population. Active infection, as evidenced by the presence of the tissue-dwelling worm, can be demonstrated via the detection of adult worm-derived circulating anodic antigen (CAA) utilising a robust well-described lateral flow-(LF) based test applying background-free up-converting reporter particles (UCP). In this prospective study, we assessed the diagnostic value of serum and urine UCP-LF CAA test in comparison with two Schistosoma-specific serological assays detecting antibodies against adult worm antigen-immuno fluorescence assay (AWA-IFA) and against soluble egg antigen–enzyme-linked immunosorbent assay (SEA-ELISA) antigens in travellers. Methods Samples were collected from 106 Dutch travellers who reported freshwater contact in sub-Saharan Africa and who were recruited up to 2 years after return. Subjects were asked to complete a detailed questionnaire on travel history, water contact, signs and symptoms compatible with schistosomiasis. Results Two travellers were positive by serum CAA and an additional one by urine CAA. A total of 22/106 (21%) samples were antibody positive by AWA-IFA and 9/106 (9%) by SEA-ELISA. At follow-up 6 weeks and 6 months after praziquantel treatment, all seropositives remained antibody positive whereas CAA was cleared. Seropositivity could not be predicted by the type of fresh water-related activity, country visited or symptoms reported. Conclusion The low number of UCP-LF CAA positives suggests that in travellers, active infections often do not establish or have very low worm burden. Based on our high seroconversion rates, we conclude that the AWA-IFA assay is the most sensitive test to detect schistosome exposure. Given the lack of predictive symptoms or risk factors, we recommend schistosomiasis screening at least by serology in all travellers with reported freshwater contact in high-endemic areas.
ISSN:1195-1982
1708-8305
DOI:10.1093/jtm/taaa055