PLoS Neglected Tropical Diseases
There is growing interest in local elimination of soil-transmitted helminth (STH) infection in endemic settings. In such settings, highly sensitive diagnostics are needed to detect STH infection. We compared double-slide Kato-Katz, the most commonly used copromicroscopic detection method, to multi-parallel quantitative polymerase chain reaction (qPCR) in 2,799 stool samples from children aged 2–12 years in a setting in rural Bangladesh with predominantly low STH infection intensity. We estimated the sensitivity and specificity of each diagnostic using Bayesian latent class analysis. Compared to double-slide Kato-Katz, STH prevalence using qPCR was almost 3-fold higher for hookworm species and nearly 2-fold higher for Trichuris trichiura. Ascaris lumbricoides prevalence was lower using qPCR, and 26% of samples classified as A. lumbricoides positive by Kato-Katz were negative by qPCR. Amplicon sequencing of the 18S rDNA from 10 samples confirmed that A. lumbricoides was absent in samples classified as positive by Kato-Katz and negative by qPCR. The sensitivity of Kato-Katz was 49% for A. lumbricoides, 32% for hookworm, and 52% for T. trichiura; the sensitivity of qPCR was 79% for A. lumbricoides, 93% for hookworm, and 90% for T. tri-chiura. Specificity was ≥97% for both tests for all STH except for Kato-Katz for A. lumbri-coides (specificity = 68%). There were moderate negative, monotonic correlations between qPCR cycle quantification values and eggs per gram quantified by Kato-Katz. While it is widely assumed that double-slide Kato-Katz has few false positives, our results indicate otherwise and highlight inherent limitations of the Kato-Katz technique. qPCR had higher sensitivity than Kato-Katz in this low intensity infection setting.
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© 2020 Benjamin-Chung et al.
Benjamin-Chung, Jade; Pilotte, Nils; Ercumen, Ayse; Grant, Jessica R.; Maasch, Jacqueline R.M.A.; Gonzalez, Andrew M.; Ester, Ashanta C.; Arnold, Benjamin F.; Rahman, Mahbubur; Haque, Rashidul; Hubbard, Alan E.; Luby, Stephen P.; Williams, Steven A.; and Colford, John M., "Comparison of Multi-Parallel qPCR and Double-Slide Kato-Katz for Detection of Soil-Transmitted Helminth Infection Among Children in Rural Bangladesh" (2020). Biological Sciences: Faculty Publications, Smith College, Northampton, MA.