All that is blood is not schistosomiasis: experiences with reagent strip testing for urogenital schistosomiasis with special consideration to very-low prevalence settings.
All that is blood is not schistosomiasis: experiences with reagent strip testing for urogenital schistosomiasis with special consideration to very-low prevalence settings.
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DOI：
10.1186/s13071-015-1165-y
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发表时间：
2015-11-10
影响因子：
3.2
通讯作者：
Utzinger J
中科院分区：
文献类型：
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作者：
Krauth SJ;Greter H;Stete K;Coulibaly JT;Traoré SI;Ngandolo BN;Achi LY;Zinsstag J;N'Goran EK;Utzinger J
微量血尿的试纸试验长期以来一直被用于血吸虫的社区诊断。敏感性和特异性是合理的，因此，微量血尿可以作为血瘤链球菌感染的替代指标。然而，在潜在的血吸虫流行的背景下对检测性能的评估是罕见的，除了敏感性和特异性之外的检测参数一直被忽视。对来自三项研究的有关微量血尿和尿滤过结果之间关系的数据进行了比较，并将其与最近Cochrane综述的结果联系起来。数据按嗜血杆菌流行率分层，以确定检测结果中与流行率相关的差异。使用Kappa协议和回归模型来比较不同血吸虫流行类别的数据。我们发现，无论血吸虫病的流行程度如何，在大多数情况下，微量血尿的“背景”患病率(平均为13%)似乎与血吸虫病无关。这种背景水平的微量血尿可能是由于尿液过滤遗漏的病例，或除血结核杆菌外的其他原因所致。特别是在患病率极低的情况下，微量血尿的阳性结果可能不能准确地描述血瘤链球菌的范围，而阴性结果则是没有感染的可靠指标。微量血尿试剂条检测仍然是尿路血吸虫病的一个很好的替代方法，但检测结果的含义和适用范围因使用试剂条的环境而异。在发病率极低的情况下，微量血尿不能作为泌尿生殖系统血吸虫病的代用指标，治疗决定不应仅基于试剂条检测结果。我们的发现强调了针对消灭泌尿生殖系统血吸虫病的环境需要高度准确的诊断工具。
Reagent strip testing for microhaematuria has long been used for community diagnosis of Schistosoma haematobium. Sensitivities and specificities are reasonable, and hence, microhaematuria can serve as a proxy for S. haematobium infection. However, assessment of test performance in the context of the underlying S. haematobium prevalence is rare and test parameters other than sensitivity and specificity have been neglected. Data about the association between microhaematuria and urine filtration results from three studies were compared and put into context with findings from a recent Cochrane review. Data were stratified by S. haematobium prevalence to identify prevalence-related differences in test performance. Kappa agreement and regression models were employed to compare data for different S. haematobium prevalence categories. We found a “background” prevalence of microhaematuria (13 %, on average) which does not seem to be associated with schistosomiasis in most settings, irrespective of the prevalence of S. haematobium. This background level of microhaematuria might be due to cases missed with urine filtration, or alternative causes apart from S. haematobium. Especially in very-low prevalence settings, positive results for microhaematuria likely give an inaccurate picture of the extent of S. haematobium, whereas negative results are a sound indicator for the absence of infection. Reagent strip testing for microhaematuria remains a good proxy for urogenital schistosomiasis, but implications of test results and scope of application differ depending on the setting in which reagent strips are employed. In very-low prevalence settings, microhaematuria is an unstable proxy for urogenital schistosomiasis and treatment decision should not be based on reagent strip test results alone. Our findings underscore the need for highly accurate diagnostic tools for settings targeted for elimination of urogenital schistosomiasis.