Autor/a:
|
Buonfrate, Dora; Requena-Méndez, Ana; Angheben, Andrea; Cinquini, Michela; Cruciani, Mario; Fittipaldo, Andrea; Giorli, Giovanni; Gobbi, Federico; Piubelli, Chiara; Bisoffi, Zeno
|
Abstract:
|
BACKGROUND: Strongyloides stercoralis
infection is a neglected tropical disease which can lead to
severe symptoms and even death in immunosuppressed people.
Unfortunately, its diagnosis is hampered by the lack of a gold
standard, as the sensitivity of traditional parasitological
tests (including microscopic examination of stool samples and
coproculture) is low. Hence, alternative diagnostic methods,
such as molecular biology techniques (mostly polymerase chain
reaction, PCR) have been implemented. However, there are
discrepancies in the reported accuracy of PCR.
METHODOLOGY: A systematic review with meta-analysis was
conducted in order to evaluate the accuracy of PCR for the
diagnosis of S. stercoralis infection. The protocol was
registered with PROSPERO International Prospective Register of
Systematic Reviews (record: CRD42016054298). Fourteen studies,
12 of which evaluating real-time PCR, were included in the
analysis. The specificity of the techniques resulted high
(ranging from 93 to 95%, according to the reference test(s)
used). When all molecular techniques were compared to
parasitological methods, the sensitivity of PCR was assessed at
71.8% (95% CI 52.2-85.5), that decreased to 61.8% (95% CI
42.0-78.4) when serology was added among the reference tests.
Similarly, sensitivity of real-time PCR resulted 64.4% (95% CI
46.2-77.7) when compared to parasitological methods only, 56.5%
(95% CI 39.2-72.4) including serology. CONCLUSIONS: PCR might not be suitable for screening purpose,
whereas it might have a role as a confirmatory test. |