Accuracy of molecular biology techniques for the diagnosis of <i>Strongyloides stercoralis</i> infection—A systematic review and meta-analysis

<div><p>Background</p><p><i>Strongyloides stercoralis</i> 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.</p><p>Methodology</p><p>A systematic review with meta-analysis was conducted in order to evaluate the accuracy of PCR for the diagnosis of <i>S</i>. <i>stercoralis</i> 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.</p><p>Conclusions</p><p>PCR might not be suitable for screening purpose, whereas it might have a role as a confirmatory test.</p></div

Forest plot showing the accuracy of the molecular techniques according to the single study sets.

<p>Forest plot showing the accuracy of the molecular techniques according to the single study sets.</p

Accuracy of all PCR techniques (comparison with both fecal and serological tests): ROC curve.

<p>Accuracy of all PCR techniques (comparison with both fecal and serological tests): ROC curve.</p

Summary estimates of diagnostic accuracy of PCR techniques for the diagnosis of <i>Strongyloides stercoralis</i> infection.

<p>Summary estimates of diagnostic accuracy of PCR techniques for the diagnosis of <i>Strongyloides stercoralis</i> infection.</p

Risk of bias and applicability concerns summary.

<p>Risk of bias and applicability concerns summary.</p

Summary of findings table for the review of PCR techniques for the diagnosis of <i>Strongyloides stercoralis</i> infection.

<p>Summary of findings table for the review of PCR techniques for the diagnosis of <i>Strongyloides stercoralis</i> infection.</p

Accuracy of real-time PCR (comparison with fecal tests): ROC curve.

<p>Of note, the only study using a CRS (including serology) to assess the accuracy of real-time PCR demonstrated a sensitivity of 56.8%[<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006229#pntd.0006229.ref020" target="_blank">20</a>], which is almost the same value found with the meta-analysis. On the other hand, the only study using a Bayesian approach [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006229#pntd.0006229.ref011" target="_blank">11</a>] demonstrated an extremely low sensitivity (11.6%) of real-time PCR.</p

Risk of bias and applicability concerns graph.

<p>Risk of bias and applicability concerns graph.</p

Main characteristics of the study sets included in the analysis.

<p>Main characteristics of the study sets included in the analysis.</p

Additional file 2: of The arrhythmogenic cardiomyopathy-specific coding and non-coding transcriptome in human cardiac stromal cells

Supplementary information. Contains supplementary information, tables and figures. (PDF 1224 kb