Mini-FLOTAC, an Innovative Direct Diagnostic Technique for Intestinal Parasitic Infections: Experience from the Field

Abstract

BackgroundSoil-transmitted helminths and intestinal protozoa infection are widespread in developing countries, yet an accurate diagnosis is rarely performed. The aim of this study was to evaluate the recently developed mini–FLOTAC method and to compare with currently more widely used techniques for the diagnosis of intestinal parasitic infections in different settings.Methodology/Principal FindingsThe study was carried out in Dharamsala, Himachal Pradesh, India, and in Bukumbi, Tanzania. A total of 180 pupils from two primary schools had their stool analyzed (n = 80 in Dharamsala and n = 100 in Bukumbi) for intestinal parasitic infections with three diagnostic methods: direct fecal smear, formol-ether concentration method (FECM) and mini-FLOTAC. Overall, 72% of the pupils were positive for any intestinal parasitic infection, 24% carried dual infections and 11% three infections or more. The most frequently encountered intestinal parasites were Entamoeba coli, Entamoeba histolytica/dispar, Giardia intestinalis, hookworm, (and Schistosoma mansoni, in Tanzania). Statistically significant differences were found in the detection of parasitic infections among the three methods: mini-FLOTAC was the most sensitive method for helminth infections (90% mini-FLOTAC, 60% FECM, and 30% direct fecal smear), whereas FECM was most sensitive for intestinal protozoa infections (88% FECM, 70% direct fecal smear, and 68% mini-FLOTAC).Conclusion/SignificanceWe present the first experiences with the mini-FLOTAC for the diagnosis of intestinal helminths and protozoa. Our results suggest that it is a valid, sensitive and potentially low-cost alternative technique that could be used in resource-limited settings — particularly for helminth diagnosis.

Intestinal Parasite Infections and Accuracy of Direct Thin and Thick Smear, Formol-Ether Sedimentation, Centrifugal Flotation, and Mini-FLOTAC Techniques Among Patients with Gastrointestinal Tract Disorders from the Greater Cairo Region, Egypt

“…However, mini-FLOTAC-ZnSO 4 was the most accurate for diagnosis of helminthic infection, and FEC was more accurate in the diagnosis of protozoal infection (accuracy = 100%, CI = 1.0-1.0, and perfect agreement with the gold standard, κ index = 1), a result that corresponds to that of Barda and others. 41 Quantitative diagnosis of H. nana infections showed that the Kato-Katz technique significantly detected more eggs than mini-FLOTAC techniques (P < 0.001). However, no significant difference was found in quantitative diagnosis of E. vermicularis egg count (P = 4).…”

Integrated School-Based Surveillance for Soil-Transmitted Helminth Infections and Lymphatic Filariasis in Gampaha District, Sri Lanka

“…However, our study has shown that integration is feasible in the Sri Lankan context. Improved tests like mini-FLOTAC that can test preserved stools 26 and involvement of additional university parasitology laboratories might be necessary if this program were to be expanded to cover the entire country. Unpublished draft WHO guidelines for integrating STH screening with TAS call for~300 children to be tested for STH per EU, because this is sufficient for classifying areas for further treatment after cessation of MDA for filariasis.…”

Mini-FLOTAC for counting Toxoplasma gondii oocysts from cat feces – Comparison with cell counting plates

“…Recent studies have shown that Mini-FLOTAC is more sensitive than the formol-ether concentration method and direct smear for the diagnosis of soil-transmitted helminths in humans, than the McMaster technique for the diagnosis of Eimeria in goats (Barda et al, 2013a(Barda et al, , 2013b(Barda et al, , 2013cSilva et al, 2013).…”