Proportion of positive results, interquartile range (IQR), minimum-maximum range, and median per diagnostic test at three different time points (baseline) of 24 <i>S. haematobium</i>-positive subjects.

<p>Proportion of positive results, interquartile range (IQR), minimum-maximum range, and median per diagnostic test at three different time points (baseline) of 24 <i>S. haematobium</i>-positive subjects.</p

Infection prevalence and intensity group as measured by real-time PCR (Ct-values) and microscopy (egg output) at the different examination time points.

<p>Infection prevalence and intensity group as measured by real-time PCR (Ct-values) and microscopy (egg output) at the different examination time points.</p

Spearman's correlation coefficients between values of each diagnostic tool before treatment, and two and 18 months post-treatment (N = 114).

<p>* <i>Note</i>: P-values <0.0001.</p><p>^** Values of real-time PCR are negative as low PCR Ct-values reflect high parasite-specific DNA loads and vice versa.</p

Cumulative percentages and median (IQR) of positive results for each diagnostic test, based on measurement of single urine samples, at three different examination time points of 114 selected <i>Schistosomiasis haematobium</i>-positive schoolchildren.

<p>* <i>Note</i>: missing data cSEA at two months post-treatment (N = 26).</p

PCR-detected hookworm infection and its association with severe anemia.

<p>Displayed are the adjusted Odds Ratios and 95% confidence intervals for hookworm infection and its association with severe anemia. Hookworm infection is defined as an <i>A. duodenale</i> and/or <i>a N. americanus</i> infection; infection load is defined by the following cycle thresholds (Ct): low 35</p

Baseline characteristics of sub population (severely anemic cases) stratified per iron status.

†<p>Iron deficiency was defined as a bone marrow iron grade of none (grade 0) or very slight (grade 1).</p>§<p>Iron replete means sufficient iron (≥grade 2).</p

Baseline characteristics of 830 hookworm-PCR tested children stratified per study group.

*<p>n = 826.</p

PCR-detected hookworm infection and its association with iron deficiency.

<p>Displayed are the adjusted Odds Ratios and 95% confidence intervals for hookworm infection and its association with iron deficiency. Hookworm infection is defined as an <i>A. duodenale</i> and/or <i>a N. americanus</i> infection; infection load is defined by the following cycle thresholds (Ct): low 35[29]. The multivariate model was adjusted for age, sex, study location, HIV (human immunodeficiency virus) infection and wasting (defined as a Z-score of weight for height <−2). These analyses include only children with severe anemia (hemoglobin of <5.0 g per decilitre).</p

PCR-determined hookworm distribution stratified per study group.

<p>Infection load is defined by the following cycle thresholds (Ct): low 35*</p><p>P<0.05.</p>**<p>P<0.01;</p>***<p>P<0.001.</p

Diagnosing Polyparasitism in a High-Prevalence Setting in Beira, Mozambique: Detection of Intestinal Parasites in Fecal Samples by Microscopy and Real-Time PCR

<div><p>Background</p><p>Many different intestinal parasite species can co-occur in the same population. However, classic diagnostic tools can only frame a particular group of intestinal parasite species. Hence, one or two tests do not suffice to provide a complete picture of infecting parasite species in a given population. The present study investigated intestinal parasitic infections in Beira, Mozambique, i.e. in the informal settlement of Inhamudima. Diagnostic accuracy of five classical microscopy techniques and real-time PCR for the detection of a broad spectrum of parasites was compared.</p><p>Methodology/Principal Findings</p><p>A cross-sectional population-based survey was performed. One stool sample per participant (n = 303) was examined by direct smear, formal-ether concentration (FEC), Kato smear, Baermann method, coproculture and real-time PCR. We found that virtually all people (96%) harbored at least one helminth, and that almost half (49%) harbored three helminths or more. Remarkably, <i>Strongyloides stercoralis</i> infections were widespread with a prevalence of 48%, and <i>Ancylostoma</i> spp. prevalence was higher than that of <i>Necator americanus</i> (25% <i>versus</i> 15%), the hookworm species that is often assumed to prevail in East-Africa. Among the microscopic techniques, FEC was able to detect the broadest spectrum of parasite species. However, FEC also missed a considerable number of infections, notably <i>S</i>. <i>stercoralis</i>, <i>Schistosoma mansoni</i> and <i>G</i>. <i>intestinalis</i>. PCR outperformed microscopy in terms of sensitivity and range of parasite species detected.</p><p>Conclusions/Significance</p><p>We showed intestinal parasites—especially helminths—to be omnipresent in Inhamudima, Beira. However, it is a challenge to achieve high diagnostic sensitivity for all species. Classical techniques such as FEC are useful for the detection of some intestinal helminth species, but they lack sensitivity for other parasite species. PCR can detect intestinal parasites more accurately but is generally not feasible in resource-poor settings, at least not in peripheral labs. Hence, there is a need for a more field-friendly, sensitive approach for on-the-spot diagnosis of parasitic infections.</p></div