Comparing diagnostic accuracy of Kato-Katz, Koga agar plate, ether-concentration, and FLOTAC for Schistosoma mansoni and soil-transmitted helminths

• Published in: PLoS neglected tropical diseases Vol. 4; no. 7; p. e754
• Main Authors: Glinz, Dominik, Silué, Kigbafori D, Knopp, Stefanie, Lohourignon, Laurent K, Yao, Kouassi P, Steinmann, Peter, Rinaldi, Laura, Cringoli, Giuseppe, N'Goran, Eliézer K, Utzinger, Jürg
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20-07-2010; Public Library of Science (PLoS)
• Subjects: Accuracy; Adolescent; Animals; Child; Cote d'Ivoire; Epidemiology; Feces - parasitology; Helminthiasis - diagnosis; Helminthiasis - epidemiology; Helminths - isolation & purification; Humans; Infections; Methods; Microscopy - methods; Parasites; Parasitology - methods; Prevalence; Public health; Public Health and Epidemiology; Sensitivity and Specificity; Tropical diseases; Cote d'Ivoire; Parasitology; Animals; Prevalence; Microscopy; Sensitivity & Specificity; Humans; Adolescent; Cote d'Ivoire; Feces; Child; Helminthiasis; Helminths
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0000754

Infections with schistosomes and soil-transmitted helminths exert a considerable yet underappreciated economic and public health burden on afflicted populations. Accurate diagnosis is crucial for patient management, drug efficacy evaluations, and monitoring of large-scale community-based control programs.
The diagnostic accuracy of four copromicroscopic techniques (i.e., Kato-Katz, Koga agar plate, ether-concentration, and FLOTAC) for the detection of Schistosoma mansoni and soil-transmitted helminth eggs was compared using stool samples from 112 school children in Côte d'Ivoire. Combined results of all four methods served as a diagnostic 'gold' standard and revealed prevalences of S. mansoni, hookworm, Trichuris trichiura, Strongyloides stercoralis and Ascaris lumbricoides of 83.0%, 55.4%, 40.2%, 33.9% and 28.6%, respectively. A single FLOTAC from stool samples preserved in sodium acetate-acetic acid-formalin for 30 or 83 days showed a higher sensitivity for S. mansoni diagnosis (91.4%) than the ether-concentration method on stool samples preserved for 40 days (85.0%) or triplicate Kato-Katz using fresh stool samples (77.4%). Moreover, a single FLOTAC detected hookworm, A. lumbricoides and T. trichiura infections with a higher sensitivity than any of the other methods used, but resulted in lower egg counts. The Koga agar plate method was the most accurate diagnostic assay for S. stercoralis.
We have shown that the FLOTAC method holds promise for the diagnosis of S. mansoni. Moreover, our study confirms that FLOTAC is a sensitive technique for detection of common soil-transmitted helminths. For the diagnosis of S. stercoralis, the Koga agar plate method remains the method of choice.