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Acta Trop. 2014 Jun;134:89-94. doi: 10.1016/j.actatropica.2014.03.003. Epub 2014 Mar 19.

Schistosoma mansoni in schoolchildren in a Madagascan highland school assessed by PCR and sedimentation microscopy and Bayesian estimation of sensitivities and specificities.

Author information

1
Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht street 74, D-20359 Hamburg, Germany. Electronic address: schwarznorbert@bni-hamburg.de.
2
Department of Microbiology and Parasitology, University of Antananarivo, B.P.175, Antananarivo, Madagascar. Electronic address: rakrapha13@yahoo.fr.
3
Department of Microbiology and Parasitology, University of Antananarivo, B.P.175, Antananarivo, Madagascar. Electronic address: herijean007@yahoo.fr.
4
Department of Microbiology and Parasitology, University of Antananarivo, B.P.175, Antananarivo, Madagascar. Electronic address: njariharinjaka@yahoo.fr.
5
Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht street 74, D-20359 Hamburg, Germany. Electronic address: hahn@bnitm.de.
6
Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht street 74, D-20359 Hamburg, Germany; Department of Microbiology and Parasitology, University of Antananarivo, B.P.175, Antananarivo, Madagascar. Electronic address: hogan@bni-hamburg.de.
7
Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard Nocht Street 74, D-20359 Hamburg, Germany; Institute for Medical Microbiology, Virology and Hygiene, University Hospital of Rostock, Schillingallee 70, D-18057 Rostock, Germany. Electronic address: Frickmann@bni-hamburg.de.
8
Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht street 74, D-20359 Hamburg, Germany. Electronic address: dekker@bni-hamburg.de.
9
Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht street 74, D-20359 Hamburg, Germany. Electronic address: poppert@bni-hamburg.de.
10
Department of Microbiology and Parasitology, University of Antananarivo, B.P.175, Antananarivo, Madagascar. Electronic address: rakouttsa@yahoo.fr.
11
Department of Microbiology and Parasitology, University of Antananarivo, B.P.175, Antananarivo, Madagascar. Electronic address: rakotophilibert@yahoo.fr.
12
Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht street 74, D-20359 Hamburg, Germany. Electronic address: may@bni-hamburg.de.
13
Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard Nocht Street 74, D-20359 Hamburg, Germany. Electronic address: hagen@bni-hamburg.de.

Abstract

Madagascar is an endemic area for schistosomiasis, but recent prevalence data are scarce. We investigated stool samples of 410 children aged 4-18 years from a combined primary and secondary school in a Madagascan highland village near Ambositra in order to assess the prevalence of Schistosoma mansoni using microscopy and real-time polymerase chain reaction (PCR). A high prevalence of S. mansoni of 77.1% was detected by PCR, while only 15.2% of microscopic examinations of sedimentation-enriched stools were positive. We estimated the sensitivity and specificity of stool sedimentation microscopy (19.7% and 98.8%) and of PCR (98.9% and 89.3%) using a Bayesian approach for two dependant tests in one population without a reference standard. Our Bayesian posterior estimate of the prevalence is 80.2%. Simple sedimentation technique misses about 4/5 of all PCR-confirmed infections and is insufficient to determine the prevalence of S. mansoni. A survey comparing PCR with a classical standard technique (KatoKatz) is desirable.

KEYWORDS:

Madagascar; Microscopy; PCR; Prevalence; Schistosomiasis; Sensitivity and specificity

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