Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain ≥14 days): Pierrea multi-country, prospective, non-experimental case-control study

Katja Polman, Sören L Becker, Emilie Alirol, Nisha K Bhatta, Narayan R Bhattarai, Emmanuel Bottieau, Martin W Bratschi, Sakib Burza, Jean T Coulibaly, Mama N Doumbia, Ninon S Horié, Jan Jacobs, Basudha Khanal, Aly Landouré, Yodi Mahendradhata, Filip Meheus, Pascal Mertens, Fransiska Meyanti, Elsa H Murhandarwati, Eliézer K N'Goran, Rosanna W Peeling, Raffaella Ravinetto, Suman Rijal, Moussa Sacko, Rénion Saye, Pierre H H Schneeberger, Céline Schurmans, Kigbafori D Silué, Jarir A Thobari, Mamadou S Traoré, Lisette van Lieshout, Harry van Loen, Kristien Verdonck, Lutz von Müller, Cédric P Yansouni, Joel A Yao, Patrick K Yao, Peiling Yap, Marleen Boelaert, François Chappuis, Jürg Utzinger, Katja Polman, Sören L Becker, Emilie Alirol, Nisha K Bhatta, Narayan R Bhattarai, Emmanuel Bottieau, Martin W Bratschi, Sakib Burza, Jean T Coulibaly, Mama N Doumbia, Ninon S Horié, Jan Jacobs, Basudha Khanal, Aly Landouré, Yodi Mahendradhata, Filip Meheus, Pascal Mertens, Fransiska Meyanti, Elsa H Murhandarwati, Eliézer K N'Goran, Rosanna W Peeling, Raffaella Ravinetto, Suman Rijal, Moussa Sacko, Rénion Saye, Pierre H H Schneeberger, Céline Schurmans, Kigbafori D Silué, Jarir A Thobari, Mamadou S Traoré, Lisette van Lieshout, Harry van Loen, Kristien Verdonck, Lutz von Müller, Cédric P Yansouni, Joel A Yao, Patrick K Yao, Peiling Yap, Marleen Boelaert, François Chappuis, Jürg Utzinger

Abstract

Background: Diarrhoea still accounts for considerable mortality and morbidity worldwide. The highest burden is concentrated in tropical areas where populations lack access to clean water, adequate sanitation and hygiene. In contrast to acute diarrhoea (<14 days), the spectrum of pathogens that may give rise to persistent diarrhoea (≥14 days) and persistent abdominal pain is poorly understood. It is conceivable that pathogens causing neglected tropical diseases play a major role, but few studies investigated this issue. Clinical management and diagnostic work-up of persistent digestive disorders in the tropics therefore remain inadequate. Hence, important aspects regarding the pathogenesis, epidemiology, clinical symptomatology and treatment options for patients presenting with persistent diarrhoea and persistent abdominal pain should be investigated in multi-centric clinical studies.

Methods/design: This multi-country, prospective, non-experimental case-control study will assess persistent diarrhoea (≥14 days; in individuals aged ≥1 year) and persistent abdominal pain (≥14 days; in children/adolescents aged 1-18 years) in up to 2000 symptomatic patients and 2000 matched controls. Subjects from Côte d'Ivoire, Indonesia, Mali and Nepal will be clinically examined and interviewed using a detailed case report form. Additionally, each participant will provide a stool sample that will be examined using a suite of diagnostic methods (i.e., microscopic techniques, rapid diagnostic tests, stool culture and polymerase chain reaction) for the presence of bacterial and parasitic pathogens. Treatment will be offered to all infected participants and the clinical treatment response will be recorded. Data obtained will be utilised to develop patient-centred clinical algorithms that will be validated in primary health care centres in the four study countries in subsequent studies.

Discussion: Our research will deepen the understanding of the importance of persistent diarrhoea and related digestive disorders in the tropics. A diversity of intestinal pathogens will be assessed for potential associations with persistent diarrhoea and persistent abdominal pain. Different diagnostic methods will be compared, clinical symptoms investigated and diagnosis-treatment algorithms developed for validation in selected primary health care centres. The findings from this study will improve differential diagnosis and evidence-based clinical management of digestive syndromes in the tropics.

Trial registration: ClinicalTrials.gov; identifier: NCT02105714 .

Figures

Fig. 1
Fig. 1
Synopsis of important definitions and characteristics of diarrhoeal diseases, based on recommendations put forth by the World Health Organization (WHO) and the Infectious Diseases Society of America (IDSA)
Fig. 2
Fig. 2
World map and country-specific maps of Côte d’Ivoire, Indonesia, Mali and Nepal, indicating the sites of patient recruitment for the NIDIAG study on persistent digestive disorders
Fig. 3
Fig. 3
Patient flow of the NIDIAG study on persistent digestive disorders, as outlined in a specific standardised operating procedure (SOP)

References

    1. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–223. doi: 10.1016/S0140-6736(12)61689-4.
    1. Bartram J, Cairncross S. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med. 2010;7:e1000367. doi: 10.1371/journal.pmed.1000367.
    1. Prüss-Ustün A, Bartram J, Clasen T, Colford JM, Cumming O, Curtis V, Bonjour S, Dangour AD, De France J, Fewtrell L, et al. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health. 2014;19:894–905. doi: 10.1111/tmi.12329.
    1. Wolf J, Prüss-Ustün A, Cumming O, Bartram J, Bonjour S, Cairncross S, Clasen T, Colford JM, Curtis V, De France J, et al. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Trop Med Int Health. 2014;19:928–42. doi: 10.1111/tmi.12331.
    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–128. doi: 10.1016/S0140-6736(12)61728-0.
    1. WHO . Diarrhoeal disease. Fact sheet no. 330. August 2009. Geneva: World Health Organization; 2009.
    1. Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, Hennessy T, Griffin PM, DuPont H, Sack RB, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32:331–51. doi: 10.1086/318514.
    1. DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med. 2014;370:1532–40. doi: 10.1056/NEJMra1301069.
    1. Becker SL, Vogt J, Knopp S, Panning M, Warhurst DC, Polman K, Marti H, von Müller L, Yansouni CP, Jacobs J, et al. Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests. BMC Infect Dis. 2013;13:37. doi: 10.1186/1471-2334-13-37.
    1. Fagundes-Neto U. Persistent diarrhea: still a serious public health problem in developing countries. Curr Gastroenterol Rep. 2013;15:345. doi: 10.1007/s11894-013-0345-1.
    1. Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers’ diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg. 2009;80:609–14.
    1. Vernacchio L, Vezina RM, Mitchell AA, Lesko SM, Plaut AG, Acheson DW. Characteristics of persistent diarrhea in a community-based cohort of young US children. J Pediatr Gastroenterol Nutr. 2006;43:52–8. doi: 10.1097/01.mpg.0000228094.74207.39.
    1. Abba K, Sinfield R, Hart CA, Garner P. Antimicrobial drugs for persistent diarrhoea of unknown or non-specific cause in children under six in low and middle income countries: systematic review of randomized controlled trials. BMC Infect Dis. 2009;9:24. doi: 10.1186/1471-2334-9-24.
    1. Kotloff KL, Blackwelder WC, Nasrin D, Nataro JP, Farag TH, van Eijk A, Adegbola RA, Alonso PL, Breiman RF, Faruque AS, et al. The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study. Clin Infect Dis. 2012;55(Suppl 4):S232–45. doi: 10.1093/cid/cis753.
    1. Levine MM, Kotloff KL, Nataro JP, Muhsen K. The Global Enteric Multicenter Study (GEMS): impetus, rationale, and genesis. Clin Infect Dis. 2012;55(Suppl 4):S215–24. doi: 10.1093/cid/cis761.
    1. Abba K, Sinfield R, Hart CA, Garner P. Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review. BMC Infect Dis. 2009;9:88. doi: 10.1186/1471-2334-9-88.
    1. Ross AG, Olds GR, Cripps AW, Farrar JJ, McManus DP. Enteropathogens and chronic illness in returning travelers. N Engl J Med. 2013;368:1817–25. doi: 10.1056/NEJMra1207777.
    1. Utzinger J, Becker SL, Knopp S, Blum J, Neumayr AL, Keiser J, Hatz CF. Neglected tropical diseases: diagnosis, clinical management, treatment and control. Swiss Med Wkly. 2012;142:w13727.
    1. Hotez PJ, Alvarado M, Basáñez MG, Bolliger I, Bourne R, Boussinesq M, Brooker SJ, Brown AS, Buckle G, Budke CM, et al. The Global Burden of Disease Study 2010: interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis. 2014;8:e2865. doi: 10.1371/journal.pntd.0002865.
    1. Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet. 2009;373:1570–5. doi: 10.1016/S0140-6736(09)60233-6.
    1. Conteh L, Engels T, Molyneux DH. Socioeconomic aspects of neglected tropical diseases. Lancet. 2010;375:239–47. doi: 10.1016/S0140-6736(09)61422-7.
    1. King CH. Parasites and poverty: the case of schistosomiasis. Acta Trop. 2010;113:95–104. doi: 10.1016/j.actatropica.2009.11.012.
    1. Pang T, Peeling RW. Diagnostic tests for infectious diseases in the developing world: two sides of the coin. Trans R Soc Trop Med Hyg. 2007;101:856–7. doi: 10.1016/j.trstmh.2007.04.014.
    1. McCarthy JS, Lustigman S, Yang GJ, Barakat RM, García HH, Sripa B, Willingham AL, Prichard RK, Basañez MG. A research agenda for helminth diseases of humans: diagnostics for control and elimination programmes. PLoS Negl Trop Dis. 2012;6:e1601. doi: 10.1371/journal.pntd.0001601.
    1. Kibadi K, Boelaert M, Kayinua M, Minuku JB, Muyembe-Tamfum JJ, Portaels F, Lefevre P. Therapeutic itineraries of patients with ulcerated forms of Mycobacterium ulcerans (Buruli ulcer) disease in a rural health zone in the Democratic Republic of Congo. Trop Med Int Health. 2009;14:1110–6. doi: 10.1111/j.1365-3156.2009.02324.x.
    1. Cavalli A, Bamba SI, Traoré MN, Boelaert M, Coulibaly Y, Polman K, Pirard M, Van Dormael M. Interactions between global health initiatives and country health systems: the case of a neglected tropical diseases control program in Mali. PLoS Negl Trop Dis. 2010;4:e798. doi: 10.1371/journal.pntd.0000798.
    1. Marchal B, Van Dormael M, Pirard M, Cavalli A, Kegels G, Polman K. Neglected tropical disease (NTD) control in health systems: the interface between programmes and general health services. Acta Trop. 2011;120(Suppl 1):S177–85. doi: 10.1016/j.actatropica.2011.02.017.
    1. Amazigo UV, Leak SG, Zoure HG, Njepuome N, Lusamba-Dikassa PS. Community-driven interventions can revolutionise control of neglected tropical diseases. Trends Parasitol. 2012;28:231–8. doi: 10.1016/j.pt.2012.03.002.
    1. Abdullah M, Firmansyah MA. Clinical approach and management of chronic diarrhea. Acta Med Indones. 2013;45:157–65.
    1. Yansouni CP, Bottieau E, Chappuis F, Phoba MF, Lunguya O, Ifeka BB, Jacobs J. Rapid diagnostic tests for a coordinated approach to fever syndromes in low-resource settings. Clin Infect Dis. 2012;55:610–1. doi: 10.1093/cid/cis466.
    1. Chappuis F, Alirol E, d’Acremont V, Bottieau E, Yansouni CP. Rapid diagnostic tests for non-malarial febrile illness in the tropics. Clin Microbiol Infect. 2013;19:422–31. doi: 10.1111/1469-0691.12154.
    1. Yansouni CP, Bottieau E, Lutumba P, Winkler AS, Lynen L, Büscher P, Jacobs J, Gillet P, Lejon V, Alirol E, et al. Rapid diagnostic tests for neurological infections in central Africa. Lancet Infect Dis. 2013;13:546–58. doi: 10.1016/S1473-3099(13)70004-5.
    1. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(Suppl 2):II43–7.
    1. Younas M, Shah S, Talaat A. Frequency of Giardia lamblia infection in children with recurrent abdominal pain. J Pak Med Assoc. 2008;58:171–4.
    1. Dembélé M, Bamani S, Dembélé R, Traoré MO, Goita S, Traoré MN, Sidibe AK, Sam L, Tuinsma M, Toubali E, et al. Implementing preventive chemotherapy through an integrated national neglected tropical disease control program in Mali. PLoS Negl Trop Dis. 2012;6:e1574. doi: 10.1371/journal.pntd.0001574.
    1. Lowe AM, Yansouni CP, Behr MA. Causality and gastrointestinal infections: Koch, Hill, and Crohn’s. Lancet Infect Dis. 2008;8:720–6. doi: 10.1016/S1473-3099(08)70257-3.
    1. Becker SL, Chatigre JK, Gohou J, Coulibaly JT, Leuppi R, Polman K, Chappuis F, Mertens P, Herrmann M, N’Goran EK, et al. Combined stool-based multiplex PCR and microscopy for enhanced pathogen detection in patients with persistent diarrhoea and asymptomatic controls from Côte d’Ivoire. Clin Microbiol Infect. 2015;21:591.
    1. Dubourg G, Fenollar F. Epidemiologic studies need asymptomatic controls. Clin Microbiol Infect. 2015;21:e51–2. doi: 10.1016/j.cmi.2015.04.020.
    1. Becker SL, Chappuis F, Polman K, N’Goran EK, von Müller L, Utzinger J. Reply: Epidemiologic studies need asymptomatic controls. Clin Microbiol Infect. 2015;21:e.53–4. doi: 10.1016/j.cmi.2015.04.024.
    1. Moore SR. Update on prolonged and persistent diarrhea in children. Curr Opin Gastroenterol. 2011;27:19–23. doi: 10.1097/MOG.0b013e32833f215d.
    1. Becker SL, Sieto B, Silué KD, Adjossan L, Koné S, Hatz C, Kern WV, N’Goran EK, Utzinger J. Diagnosis, clinical features, and self-reported morbidity of Strongyloides stercoralis and hookworm infection in a co-endemic setting. PLoS Negl Trop Dis. 2011;5:e1292. doi: 10.1371/journal.pntd.0001292.
    1. Meheus F, Abuzaid AA, Baltussen R, Younis BM, Balasegaram M, Khalil EAG, Boelaert M, Musa AM. The economic burden of visceral leishmaniasis in Sudan: an assessment of provider and household costs. Am J Trop Med Hyg. 2013;89:1146–53. doi: 10.4269/ajtmh.12-0585.
    1. D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B. Beyond malaria – causes of fever in outpatient Tanzanian children. N Engl J Med. 2014;370:809–17. doi: 10.1056/NEJMoa1214482.
    1. Pawlowski SW, Warren CA, Guerrant R. Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology. 2009;136:1874–86. doi: 10.1053/j.gastro.2009.02.072.
    1. Utzinger J. A research and development agenda for the control and elimination of human helminthiases. PLoS Negl Trop Dis. 2012;6:e1646. doi: 10.1371/journal.pntd.0001646.
    1. WHO . Preventive chemotherapy in human helminthiasis: coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers. Geneva: World Health Organization; 2006.
    1. Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Ehrlich Sachs S, Sachs JD, Savioli L. Control of neglected tropical diseases. N Engl J Med. 2007;357:1018–27. doi: 10.1056/NEJMra064142.
    1. Utzinger J, Raso G, Brooker S, de Savigny D, Tanner M, Ørnbjerg N, Singer BH, N’Goran EK. Schistosomiasis and neglected tropical diseases: towards integrated and sustainable control and a word of caution. Parasitology. 2009;136:1859–74. doi: 10.1017/S0031182009991600.
    1. Zhang Y, MacArthur C, Mubila L, Baker S. Control of neglected tropical diseases needs a long-term commitment. BMC Med. 2010;8:67. doi: 10.1186/1741-7015-8-67.
    1. Nakagawa J, Ehrenberg JP, Nealon J, Fürst T, Aratchige P, Gonzales G, Chanthavisouk C, Hernandez LM, Fengthong T, Utzinger J, et al. Towards effective prevention and control of helminth neglected tropical diseases in the Western Pacific Region through multi-disease and multi-sectoral interventions. Acta Trop. 2015;141:407–18. doi: 10.1016/j.actatropica.2013.05.010.
    1. Tambo E, Ai L, Zhou X, Chen JH, Hu W, Bergquist R, Guo JG, Utzinger J, Tanner M, Zhou XN. Surveillance-response systems: the key to elimination of tropical diseases. Infect Dis Poverty. 2014;3:17. doi: 10.1186/2049-9957-3-17.
    1. Mills A. Vertical vs horizontal health programmes in Africa: idealism, pragmatism, resources and efficiency. Soc Sci Med. 1983;17:1971–81. doi: 10.1016/0277-9536(83)90137-5.
    1. Gyapong JO, Gyapong M, Yellu N, Anakwah K, Amofah G, Bockarie M, Adjei S. Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities. Lancet. 2010;375:160–5. doi: 10.1016/S0140-6736(09)61249-6.
    1. Bergquist R, Johansen MV, Utzinger J. Diagnostic dilemmas in helminthology: what tools to use and when? Trends Parasitol. 2009;25:151–6. doi: 10.1016/j.pt.2009.01.004.
    1. Engels D, Nahimana S, Gryseels B. Comparison of the direct faecal smear and two thick smear techniques for the diagnosis of intestinal parasitic infections. Trans R Soc Trop Med Hyg. 1996;90:523–5. doi: 10.1016/S0035-9203(96)90304-1.
    1. Katz N, Chaves A, Pellegrino J. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop São Paulo. 1972;14:397–400.
    1. Davies AP, Chalmers RM. Cryptosporidiosis. BMJ. 2009;339:b4168. doi: 10.1136/bmj.b4168.
    1. Yap P, Fürst T, Müller I, Kriemler S, Utzinger J, Steinmann P. Determining soil-transmitted helminth infection status and physical fitness of school-aged children. J Vis Exp. 2012;66:e3966.
    1. Allen AVH, Ridley DS. Further observations on the formol-ether concentration technique for faecal parasites. J Clin Pathol. 1970;23:545–6. doi: 10.1136/jcp.23.6.545.
    1. Becker SL, Lohourignon LK, Speich B, Rinaldi L, Knopp S, N’Goran EK, Cringoli G, Utzinger J. Comparison of the Flotac-400 dual technique and the formalin-ether concentration technique for diagnosis of human intestinal protozoon infection. J Clin Microbiol. 2011;49:2183–90. doi: 10.1128/JCM.01035-10.
    1. Barda BD, Rinaldi L, Ianniello D, Zepherine H, Salvo F, Sadutshang T, Cringoli G, Clementi M, Albonico M. Mini-FLOTAC, an innovative direct diagnostic technique for intestinal parasitic infections: experience from the field. PLoS Negl Trop Dis. 2013;7:e2344. doi: 10.1371/journal.pntd.0002344.
    1. Barda B, Zepherine H, Rinaldi L, Cringoli G, Burioni R, Clementi M, Albonico M. Mini-FLOTAC and Kato-Katz: helminth eggs watching on the shore of Lake Victoria. Parasit Vectors. 2013;6:220. doi: 10.1186/1756-3305-6-220.
    1. Barda B, Ianniello D, Zepheryne H, Rinaldi L, Cringoli G, Burioni R, Albonico M. Parasitic infections on the shore of Lake Victoria (East Africa) detected by Mini-FLOTAC and standard techniques. Acta Trop. 2014;137:140–6. doi: 10.1016/j.actatropica.2014.05.012.
    1. Koga K, Kasuya S, Khamboonruang C, Sukhavat K, Ieda M, Takatsuka N, Kita K, Ohtomo H. A modified agar plate method for detection of Strongyloides stercoralis. Am J Trop Med Hyg. 1991;45:518–21.
    1. Koga K, Kasuya S, Ohtomo H. How effective is the agar plate method for Strongyloides stercoralis? J Parasitol. 1992;78:155–6. doi: 10.2307/3283707.
    1. Knopp S, Mgeni AF, Khamis IS, Steinmann P, Stothard JR, Rollinson D, Marti H, Utzinger J. Diagnosis of soil-transmitted helminths in the era of preventive chemotherapy: effect of multiple stool sampling and use of different diagnostic techniques. PLoS Negl Trop Dis. 2008;2:e331. doi: 10.1371/journal.pntd.0000331.
    1. Steinmann P, Du ZW, Wang LB, Wang XZ, Jiang JY, Li LH, Marti H, Zhou XN, Utzinger J. Extensive multiparasitism in a village of Yunnan province, People’s Republic of China, revealed by a suite of diagnostic methods. Am J Trop Med Hyg. 2008;78:760–9.
    1. Tchuem Tchuenté LA, Kuete Fouodo CJ, Kamwa Ngassam RI, Sumo L, Dongmo Noumedem C, Kenfack CM, Gipwe NF, Nana ED, Stothard JR, Rollinson D. Evaluation of circulating cathodic antigen (CCA) urine-tests for diagnosis of Schistosoma mansoni infection in Cameroon. PLoS Negl Trop Dis. 2012;6:e1758. doi: 10.1371/journal.pntd.0001758.
    1. Colley DG, Binder S, Campbell C, King CH, Tchuem Tchuenté LA, N’Goran EK, Erko B, Karanja DM, Kabatereine NB, van Lieshout L, et al. A five-country evaluation of a point-of-care circulating cathodic antigen urine assay for the prevalence of Schistosoma mansoni. Am J Trop Med Hyg. 2013;88:426–32. doi: 10.4269/ajtmh.12-0639.
    1. Erko B, Medhin G, Teklehaymanot T, Degarege A, Legesse M. Evaluation of urine-circulating cathodic antigen (Urine-CCA) cassette test for the detection of Schistosoma mansoni infection in areas of moderate prevalence in Ethiopia. Trop Med Int Health. 2013;18:1029–35. doi: 10.1111/tmi.12117.
    1. Adriko M, Standley CJ, Tinkitina B, Tukahebwa EM, Fenwick A, Fleming FM, Sousa-Figueiredo JC, Stothard JR, Kabatereine NB. Evaluation of circulating cathodic antigen (CCA) urine-cassette assay as a survey tool for Schistosoma mansoni in different transmission settings within Bugiri district, Uganda. Acta Trop. 2014;136:50–7. doi: 10.1016/j.actatropica.2014.04.001.
    1. Lamberton PH, Kabatereine NB, Oguttu DW, Fenwick A, Webster JP. Sensitivity and specificity of multiple Kato-Katz thick smears and a circulating cathodic antigen test for Schistosoma mansoni diagnosis pre- and post-repeated-praziquantel treatment. PLoS Negl Trop Dis. 2014;8:e3139. doi: 10.1371/journal.pntd.0003139.
    1. Biswas JS, Al-Ali A, Rajput P, Smith D, Goldenberg SD. A parallel diagnostic accuracy study of three molecular panels for the detection of bacterial gastroenteritis. Eur J Clin Microbiol Infect Dis. 2014;33:2075–81. doi: 10.1007/s10096-014-2177-9.
    1. Drancourt M. Multiplex testing of diarrhoea breaks down microbial barriers. Lancet Infect Dis. 2014;14:663–4. doi: 10.1016/S1473-3099(14)70844-8.
    1. Verweij JJ. Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory. Parasitology. 2014;141:1863–72. doi: 10.1017/S0031182014000419.
    1. Yansouni CP, Merckx J, Libman MD, Ndao M. Recent advances in clinical parasitology diagnostics. Curr Infect Dis Rep. 2014;16:434. doi: 10.1007/s11908-014-0434-9.

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