Agar Plate Culture: An Alternative Sensitive Routine Laboratory Detec-tion Method for Strongyloides stercoralis and Hookworm Parasites
Background: Human infection with Strongyloides stercoralis and hookworm parasites is usually under reported due to less sensitive diagnostic methods. Agar plate culture (APC) is the most sensitive technique for parasites having larval stage. However, using APC in routine diagnosis is uncommon. This study aimed to determine the detection rate and sensitivity of APC in comparison with formal ether concentration technique (FECT) and spontaneous tube sedimentation techniques (STSTs) for S. stercoralis and hookworm larvae.
Methods: Stool samples collected from 844 schoolchildren in Amhara Regional State, northwestern Ethiopia in 2019, transported to nearby health institutions and processed by APC, FECT and STSTs. The prevalence of S. stercoralis and hookworm was computed by descriptive statistics and Chi-square. The diagnostic agreement among the three techniques was evaluated using Kappa value.
Results: The overall prevalence of S. stercoralis and hookworm infections by combining the three methods was 13.2% (111/844) and 33.8% (277/844), respectively. Using APC alone, the prevalence of S. stercoralis and hookworm were found to be 10.9% (92/844) and 24.5% (207/844), respectively. Agar plate culture was 5.4 and 2.7 times respectively more sensitive than FECT and STST, with slight and fair agreement in the detection of S. stercoralis. Hookworm diagnostic agreement was moderate between APC and FECT, and APC and STST. The Kappa value between STST and FECT diagnostic methods was substantial.
Conclusion: APC has a better detection rate of S stercoralis and hookworm larvae. Therefore, APC can be used as an alternative routine diagnostic method to S. stercoralis and hookworm co-endemic countries.
2. Bisoffi Z, Buonfrate D, Montresor A, et al. Strongy-loides stercoralis: A plea for action. PLoS Negl Trop Dis. 2013; 7(5):e2214.
3. Global Burden of Disease Study 2013 Collabora-tors. Global, regional, and national incidence, preva-lence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 386(9995):743–800.
4. Utzinger J, Raso G, Brooker S, et al. Schistosomia-sis and neglected tropical diseases: towards integrat-ed and sustainable control and a word of caution. Parasitology. 2009; 136(13):1859–1874.
5. Krolewiecki AJ, Lammie P, Jacobson J, et al. A public health response against Strongyloides stercoralis: time to look at soil-transmitted helminthiasis in full. PLoS Negl Trop Dis. 2013; 7(5):e2165.
6. Schär F, Trostdorf U, Giardina F, et al. Strongyloides stercoralis: Global Distribution and Risk Factors. PLoS Negl Trop Dis. 2013;7(7):e2288.
7. Meurs L, Polderman AM, Vinkeles Melchers NVS, et al. Diagnosing Polyparasitism in a High-Prevalence Setting in Beira, Mozambique: Detec-tion of Intestinal Parasites in Fecal Samples by Mi-croscopy and Real-Time PCR. PLoS Negl Trop Dis. 2017; 11(1):e0005310.
8. Tello R, Terashima A, Marcos LA, et al. Highly effective and inexpensive parasitological technique for diagnosis of intestinal parasites in developing countries: spontaneous sedimentation technique in tube. Int J Infect Dis. 2012; 16(6):e414-416.
9. Jongwutiwes S, Charoenkorn M, Sitthichareonchai P, et al. Increased sensitivity of routine laboratory detection of Strongyloides stercoralis and hookworm by agar-plate culture. Trans R Soc Trop Med Hyg. 1999; 93(4):398-400.
10. Teklemariam Z, Abate D, Mitiku H, et al. Preva-lence of Intestinal Parasitic Infection among HIV Positive Persons Who Are Naive and on Antiretro-viral Treatment in Hiwot Fana Specialized Universi-ty Hospital, Eastern Ethiopia. ISRN AIDS. 2013; 2013:324329.
11. Amor A, Rodriguez E, Saugar JM, et al. High prev-alence of Strongyloides stercoralis in school-aged chil-dren in a rural highland of north-western Ethiopia: the role of intensive diagnostic work-up. Parasit Vec-tors. 2016; 9(1): 617.
12. Masoori L, Meamar AR, Bandehpour M, et al. Fatty acid and retinol-binding protein: A novel antigen for immunodiagnosis of human strongyloidiasis. PLoS One. 2019; 14(7): e0218895.
13. Daniel WW. A foundation for analysis in the health sciences. Biostatistics, 1995; pp 591-598.
14. Inês SJ, Souza JN, Santos RC, et al. Efficacy of parasitological methods for the diagnosis of Strongy-loides stercoralis and hookworm in faecal specimen. Acta Trop. 2011; 120(3): 206– 210.
15. Ritchie L. An ether sedimentation technique for routine stool examinations. Bull U S Army Med Dep. 1948; 8(4):326.
16. Arakaki T, Iwanaga M, Kinjo F, et al. Efficacy of agar-plate culture in detection of Strongyloides stercoralis infection. J Parasitol.1990; 76(3):425–428.
17. Blatt JM, Cantos GA. Evaluation of Techniques for the Diagnosis of Strongyloides stercoralis in Human Immunodeficiency Virus (HIV) Positive and HIV Negative Individuals in the City of Itajaí, Brazil. Braz J Infect Dis. 2003; 7(6):402-408.
18. McHugh ML. Interrater reliability: the kappa statis-tic. Biochem Med (Zagreb). 2012; 22(3): 276–282.
19. Becker SL, Sieto B, Silue´ KD, et al. Diagnosis, Clinical Features, and Self-Reported Morbidity of Strongyloides stercoralis and Hookworm Infection in a Co-Endemic Setting. PLoS Negl Trop Dis. 2011; 5(8):e1292.
20. Forrer A, Khieu V, Schär F, et al. Strongyloides ster-coralis and hookworm co-infection: spatial distribu-tion and determinants in Preah Vihear Province, Cambodia. Parasit Vectors. 2018; 11(1):33.
21. Tadesse H, Bayeh A, Wondemagegn M, et al. Effi-cacy of single dose albendazole and praziquantel drugs among helminths infected school children at Rural Bahir Dar, northwest Ethiopia. Trop Doct. 2018; 48(4):270–272.
22. Tamirat H, Beyene P, Tekola E. Evaluation of Par-asitological Methods for the Detection of Strongyloi-des Stercoralis among Individuals in Selected Health Institutions In Addis Ababa, Ethiopia.Ethiop J Health Sci. 2017; 27(5):515-522.
23. Intapan PM, Maleewong W, Wongsaroj IT, et al. Comparison of the Quantitative Formalin Ethyl Acetate Concentration Technique and Agar Plate Culture for Diagnosis of Human Strongyloidiasis. J Clin Microbiol. 2005; 43(4):1932-3.
24. Singh TS, Chanu NO, Dutta S. Comparative evalu-ation of Harada–Mori and agar plate culture for the identification of hookworm species under limited resources. J Nat Sci Biol Med. 2018; 9:127-31.
25. Anamnart W, Intapan PM, Maleewong W. Modi-fied formalin-ether concentration technique for di-agnosis of human strongyloidiasis. Korean J Parasi-tol. 2013; 51(6):743–745.
26. Glinz D, Silue´ KD, Knopp S, et al. Comparing Diagnostic Accuracy of Kato-Katz, Koga Agar Plate, Ether-Concentration, and FLOTAC for Schis-tosoma mansoni and Soil-Transmitted Helminths. PLoS Negl Trop Dis. 2010; 4(7):e754.
27. Buonfrate D, Formenti F, Perandin F, et al. Novel approaches to the diagnosis of Strongyloides stercoralis infection. Clin Microbiol Infect. 2015; 21(6): 543-552.
|Issue||Vol 16 No 1 (2021)|
|Strongyloides stercoralis Hookworm Agar plate culture Detection rate|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|