Latent class analysis to evaluate performance of point-of-care CCA for low-intensity Schistosoma mansoni infections in Burundi.
Latent class analysis to evaluate performance of point-of-care CCA for low-intensity Schistosoma mansoni infections in Burundi.
复制标题
DOI：
10.1186/s13071-018-2700-4
复制
发表时间：
2018-02-23
影响因子：
3.2
通讯作者：
van Dam GJ
中科院分区：
文献类型：
--
作者：
Clements MN;Corstjens PLAM;Binder S;Campbell CH Jr;de Dood CJ;Fenwick A;Harrison W;Kayugi D;King CH;Kornelis D;Ndayishimiye O;Ortu G;Lamine MS;Zivieri A;Colley DG;van Dam GJ
粪便涂片的Kato-Katz检查是检测曼氏血吸虫感染的现场标准方法。然而，Kato-Katz错过了许多活动性感染，特别是光强度。床旁循环阴极抗原（CCA）是一种替代现场诊断，在强度较低时比Kato-Katz更敏感，但CCA示踪结果的解释尚不清楚。为了评估痕量结果，我们测试了来自布隆迪8所学校的398名学生的尿液和粪便标本，采用四种方法：两种在布隆迪，两种在荷兰莱顿的实验室。在布隆迪，我们使用Kato-Katz和床旁CCA（CCAB）。在莱顿，我们重复了CCA（CCAL），也使用了上转换磷循环阳极抗原（CAA）。我们应用贝叶斯潜在类别分析（LCA），首先考虑CCA痕迹为负，然后为正。我们使用LCA输出来估计每个测试的患病率估计值与人群水平感染患病率相比的有效性，并估计可能为真阳性的痕量结果的比例。Kato-Katz的患病率最低（6.8%），而CCAB的微量被认为是阳性的患病率最高（53.5%）。布隆迪（32.4%）的共同国家评估记录的痕量结果比莱顿（2.3%）多得多。CAA的估计患病率为46.5%。LCA表明Kato-Katz的敏感性最低：15.9% [贝叶斯可信区间（BCI）：9.2-23.5%]，CCA-迹线被认为是阴性，15.0%，迹线被认为是阳性（BCI：9.6-21.4%），这意味着Kato-Katz错过了大约85%的感染。当trace被认为是阴性时，CCAB低估了疾病的患病率，当trace被认为是阳性时，CCAB高估了疾病的患病率，每种方式大约12个百分点，CAA在两种模型中高估了患病率。我们的研究结果表明，大约52.2%（BCI：37.8-5.8%）的CCAB跟踪读数是真正的感染。无论是在实验室还是现场测量，在布隆迪的低感染强度下，CCA的表现都优于Kato-Katz。微量为阴性的CCA可能遗漏了许多感染，而微量为阳性的CCA高估了患病率。在缺乏现场友好的金标准诊断方法的情况下，随着计划朝着消除血吸虫病的方向发展，使用具有不同特性的各种诊断方法将变得越来越重要。显然，CCA是检测和定位S.在该领域的曼氏感染和CAA可能是一个有价值的现场工具，在未来。本文的在线版本（10.1186/s13071-018-2700-4）包含补充材料，可供授权用户使用。
Kato-Katz examination of stool smears is the field-standard method for detecting Schistosoma mansoni infection. However, Kato-Katz misses many active infections, especially of light intensity. Point-of-care circulating cathodic antigen (CCA) is an alternative field diagnostic that is more sensitive than Kato-Katz when intensity is low, but interpretation of CCA-trace results is unclear. To evaluate trace results, we tested urine and stool specimens from 398 pupils from eight schools in Burundi using four approaches: two in Burundi and two in a laboratory in Leiden, the Netherlands. In Burundi, we used Kato-Katz and point-of-care CCA (CCAB). In Leiden, we repeated the CCA (CCAL) and also used Up-Converting Phosphor Circulating Anodic Antigen (CAA). We applied Bayesian latent class analyses (LCA), first considering CCA traces as negative and then as positive. We used the LCA output to estimate validity of the prevalence estimates of each test in comparison to the population-level infection prevalence and estimated the proportion of trace results that were likely true positives. Kato-Katz yielded the lowest prevalence (6.8%), and CCAB with trace considered positive yielded the highest (53.5%). There were many more trace results recorded by CCA in Burundi (32.4%) than in Leiden (2.3%). Estimated prevalence with CAA was 46.5%. LCA indicated that Kato-Katz had the lowest sensitivity: 15.9% [Bayesian Credible Interval (BCI): 9.2–23.5%] with CCA-trace considered negative and 15.0% with trace as positive (BCI: 9.6–21.4%), implying that Kato-Katz missed approximately 85% of infections. CCAB underestimated disease prevalence when trace was considered negative and overestimated disease prevalence when trace was considered positive, by approximately 12 percentage points each way, and CAA overestimated prevalence in both models. Our results suggest that approximately 52.2% (BCI: 37.8–5.8%) of the CCAB trace readings were true infections. Whether measured in the laboratory or the field, CCA outperformed Kato-Katz at the low infection intensities in Burundi. CCA with trace as negative likely missed many infections, whereas CCA with trace as positive overestimated prevalence. In the absence of a field-friendly gold standard diagnostic, the use of a variety of diagnostics with differing properties will become increasingly important as programs move towards elimination of schistosomiasis. It is clear that CCA is a valuable tool for the detection and mapping of S. mansoni infection in the field and CAA may be a valuable field tool in the future. The online version of this article (10.1186/s13071-018-2700-4) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
3.2
作者：
Corstjens PL;Nyakundi RK;de Dood CJ;Kariuki TM;Ochola EA;Karanja DM;Mwinzi PN;van Dam GJ
通讯作者：
van Dam GJ
影响因子：
8.4
作者：
Ochodo, Eleanor A.;Gopalakrishna, Gowri;Spek, Bea;Reitsma, Johannes B.;van Lieshout, Lisette;Polman, Katja;Lamberton, Poppy;Bossuyt, Patrick M. M.;Leeflang, Mariska M. G.
通讯作者：
Leeflang, Mariska M. G.
影响因子：
5.2
作者：
Mwinzi, Pauline N. M.;Kittur, Nupur;Colley, Daniel G.
通讯作者：
Colley, Daniel G.
影响因子：
1.9
作者：
Dendukuri, N;Joseph, L
通讯作者：
Joseph, L
影响因子：
3.8
作者：
Knopp, Stefanie;Corstjens, Paul L. A. M.;van Dam, Govert J.
通讯作者：
van Dam, Govert J.