Specificity of the POC-CCA urine test for diagnosing S. mansoni schistosomiasis

Marti, Hanspeter; Halbeisen, Sarah; Bausch, Kathrin; Nickel, Beatrice; Neumayr, Andreas

doi:10.1016/j.tmaid.2019.101473

Cited by 15 publications

(8 citation statements)

References 3 publications

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“…Previous studies found that POC-CCA tests yield false positive results in patients with urine infections, hematuria, and proteinuria [13]. In our study, we found only partial evidence of these associations.…”

Section: Discussioncontrasting

confidence: 63%

“…Still, evidence from other studies give rise to concerns about POC-CCA test specificity and possible interactions with other conditions, such as urinary tract infection, hematuria [13], and pregnancy [25]. Our previous study of S. mekongi-endemic areas in Lao PDR and Cambodia showed an exceedingly high positivity rate with POC-CCA testing, suggesting that other, closely related helminth infections, such as O. viverrini, might lead to positive POC-CCA test results [11].…”

Section: Discussionmentioning

confidence: 92%

“…One 2016 study found that two pregnant women from Switzerland, with no history of S. mansoni infection, tested positive with POC-CCA [25]. Similarly, a 2019 study from Switzerland [13] showed that 3 out of 15 pregnant women residing in Switzerland tested positive for S. mansoni infection with POC-CCA.…”

Section: Discussionmentioning

confidence: 99%

“…A further study to validate the POC-CCA urine test in asymptomatic Eritrean refugees from S. mansoni-affected areas confirmed the high sensitivity of 90%, but showed a relatively low specificity of 73.6% [12]. A follow-up study of individuals who had never visited a Schistosoma-endemic area (residents of Switzerland), indicated a considerable amount of false positive (low specificity) cases among healthy adults (80% specificity), infants under three years (83% specificity), pregnant women (80% specificity), patients with urinary tract infections (73% specificity), patients with hematuria (93% specificity) and patients with bladder malignancies (80% specificity) [13]. This raised a concern about the use of POC-CCA in Southeast Asian settings where many other parasitic diseases are coendemic, especially those caused by trematode species, which might cross-react with POC-CCA.…”

Section: Introductionmentioning

confidence: 99%

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Cross-reaction of POC-CCA urine test for detection of Schistosoma mekongi in Lao PDR: a cross-sectional study

et al. 2020

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Background: The point-of-care circulating cathodic antigen (POC-CCA) test is increasingly used as a rapid diagnostic method for Schistosoma mansoni infection. The test has good sensitivity, although false positive results have been reported among pregnant women and patients with urine infections and hematuria. We validated the POC-CCA test's ability to diagnose Schistosoma mekongi infection in Lao People's Democratic Republic (Lao PDR), where S. mekongi is endemic. Of particular interest was the test's specificity and possible cross-reactivity with other helminth infections. Methods: We conducted a cross-sectional study of children and adults in the provinces of Champasack (Schistosoma mekongi and Opisthorchis viverrini endemic), Savannakhet (O. viverrini endemic) and Luang Prabang (soil-transmitted helminths endemic) between October 2018 and April 2019. POC-CCA and urine dipstick tests were administered to all study participants, while an additional pregnancy test was offered to women. Two stool samples were collected from participants and examined with a Kato-Katz test (two smears per stool). Logistic regression was used to associate potential confounding factors (predictors) with POC-CCA test results (outcome). Results: In S. mekongi-endemic Champasack, 11.5% (n = 366) and 0.5% (n = 2) of study participants had positive POC-CCA and Kato-Katz test results, respectively. Only one of the two Kato-Katz positive patients was also POC-CCA positive. In Champasack and Luang Prabang, where S. mekongi is not endemic, the POC-CCA test yielded (presumably) false positive results for 6.0% (n = 22) and 2.5% (n = 9) of study participants, respectively, while all of the Kato-Katz tests were negative. POC-CCA positive test results were significantly associated with O. viverrini infection (1.69, 95% confidence interval (CI): 1.02-2.77, P = 0.042), increased leukocytes (adjusted Odds Ratio (aOR) = 1.58, 95% CI: 1.15-2.17, P = 0.005) and hematuria (aOR = 1.50, 95% CI: 1.07-2.10, P = 0.019) if the observed trace was counted as a positive test result. Two pregnant women from Champasack province had POC-CCA positive tests. Conclusions: We observed a cross-reaction between the POC-CCA test and O. viverrini infection. To some extent, we can confirm previous observations asserting that POC-CCA provides false positive results among patients with urinary tract infections and hematuria. In S. mekongi-endemic areas, POC-CCA can be applied cautiously for surveillance purposes, keeping in mind the considerable risk of false positive results and its unknown sensitivity.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cross-reaction of POC-CCA urine test for detection of Schistosoma mekongi in Lao PDR: a cross-sectional study

et al. 2020

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“…Several individuals had stool microscopy, serology, and POC-CCA test results that were negative at baseline but positive only according to the POC-CCA test during follow-up; the reason for this is difficult to explain. 48,49 Furthermore, it was recently documented that there is significant variability between POC-CCA test batches. 50 A recent study by Graeff-Teixeira et al demonstrated unacceptably high rates of positive POC-CCA results in a nonendemic area.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Point-of-Care Circulating Cathodic Antigen Assay for Monitoring Mass Drug Administration in a Schistosoma mansoni Control Program in Western Kenya

Straily

Kavere²,

Wanja³

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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The WHO guidelines for monitoring and evaluating Schistosoma mansoni control programs are based on the Kato-Katz (KK) fecal examination method; however, there are limitations to its use, particularly in low prevalence areas. The point-of-care urine circulating cathodic antigen (POC-CCA) assay has emerged as a useful tool for mapping schistosomiasis prevalence, but its use in monitoring and evaluating control programs has not been evaluated. Before POC-CCA can be used for these programs, it must be determined how previous guidance based on the KK method can be translated to the POC-CCA assay; furthermore, its performance in different endemicity settings must be evaluated. Urine and stool specimens were collected from students attending public primary schools in western Kenya before mass treatment with praziquantel at baseline (51 schools), year 1 (45 schools), year 2 (34 schools), and year 3 (20 schools). Prevalence and infection intensity were determined by the KK method and POC-CCA assay. Changes in prevalence and intensity were compared within the strata of schools grouped according to the baseline prevalence determined by the KK method (0–10%, > 10–20%, > 20%). The prevalence determined by the POC-CCA assay was higher than that determined by the KK method at all time points for all strata. The prevalence determined by the KK method decreased from baseline to 2 and 3 years, as did infection intensity (with one exception). A corresponding decrease was not always replicated by the POC-CCA assay results. The POC-CCA assay did not perform as expected, and the concordance of results of the two tests was poor. Furthermore, there are emerging concerns regarding the specificity of the POC-CCA assay. Therefore, it is impossible to translate historical data and programmatic guidelines based on the KK method results to the POC-CCA assay.

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Blood Trematodes

Montgomery¹,

Straily²

2023

Principles and Practice of Pediatric Infectious Diseases

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Specificity of the POC-CCA urine test for diagnosing S. mansoni schistosomiasis

Cited by 15 publications

References 3 publications

Cross-reaction of POC-CCA urine test for detection of Schistosoma mekongi in Lao PDR: a cross-sectional study

Cross-reaction of POC-CCA urine test for detection of Schistosoma mekongi in Lao PDR: a cross-sectional study

Evaluation of the Point-of-Care Circulating Cathodic Antigen Assay for Monitoring Mass Drug Administration in a Schistosoma mansoni Control Program in Western Kenya

Blood Trematodes

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