• Zeno Bisoffi, Dora Buonfrate, Marco Sequi, Rojelio Mejia, Ruben O Cimino, Alejandro J Krolewiecki, Marco Albonico, Maria Gobbo, Stefania Bonafini, Andrea Angheben, Ana Requena-Mendez, José Muñoz, and Thomas B Nutman.
• 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).
• PLoS Negl Trop Dis. 2014 Jan 1;8(1):e2640.

BackgroundThe 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.MethodsThe 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).ResultsAccording 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.ConclusionsNIE-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.

26 keywords...

hide…