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PLoS Negl Trop Dis. 2014 Jan 9;8(1):e2640. doi: 10.1371/journal.pntd.0002640. eCollection 2014.

Diagnostic accuracy of five serologic tests for Strongyloides stercoralis infection.

Author information

1
Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy ; Coordinating Resources to Assess and Improve Health Status of Migrants from Latin America (COHEMI) Project Study Group, European Commission, Health Cooperation Work Programme, FP7 (GA-261495).
2
Department of Public Health, IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy.
3
National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, United States of America.
4
Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina.
5
Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy.
6
Coordinating Resources to Assess and Improve Health Status of Migrants from Latin America (COHEMI) Project Study Group, European Commission, Health Cooperation Work Programme, FP7 (GA-261495) ; Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.

Abstract

BACKGROUND:

The diagnosis of Strongyloides stercoralis (S. stercoralis) infection is hampered by the suboptimal sensitivity of fecal-based tests. Serological methods are believed to be more sensitive, although assessing their accuracy is difficult because of the lack of sensitivity of a fecal-based reference ("gold") standard.

METHODS:

The sensitivity and specificity of 5 serologic tests for S. stercoralis (in-house IFAT, NIE-ELISA and NIE-LIPS and the commercially available Bordier-ELISA and IVD-ELISA) were assessed on 399 cryopreserved serum samples. Accuracy was measured using fecal results as the primary reference standard, but also using a composite reference standard (based on a combination of tests).

RESULTS:

According to the latter standard, the most sensitive test was IFAT, with 94.6% sensitivity (91.2-96.9), followed by IVD-ELISA (92.3%, 87.7-96.9). The most specific test was NIE-LIPS, with specificity 99.6% (98.9-100), followed by IVD-ELISA (97.4%, 95.5-99.3). NIE-LIPS did not cross-react with any of the specimens from subjects with other parasitic infections. NIE-LIPS and the two commercial ELISAs approach 100% specificity at a cut off level that maintains ≥70% sensitivity.

CONCLUSIONS:

NIE-LIPS is the most accurate serologic test for the diagnosis of S. stercoralis infection. IFAT and each of the ELISA tests are sufficiently accurate, above a given cut off, for diagnosis, prevalence studies and inclusion in clinical trials.

PMID:
24427320
PMCID:
PMC3890421
DOI:
10.1371/journal.pntd.0002640
[Indexed for MEDLINE]
Free PMC Article

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