Antigen-based diagnosis of Schistosoma infection in travellers: a prospective study

Miriam Casacuberta-Partal, Jacqueline J Janse, Roos van Schuijlenburg, Jutte J C de Vries, Marianne A A Erkens, Kitty Suijk, Mariëlle van Aalst, Jaap J Maas, Martin P Grobusch, Perry J J van Genderen, Claudia de Dood, Paul L A M Corstjens, Govert J van Dam, Lisette van Lieshout, Meta Roestenberg, Miriam Casacuberta-Partal, Jacqueline J Janse, Roos van Schuijlenburg, Jutte J C de Vries, Marianne A A Erkens, Kitty Suijk, Mariëlle van Aalst, Jaap J Maas, Martin P Grobusch, Perry J J van Genderen, Claudia de Dood, Paul L A M Corstjens, Govert J van Dam, Lisette van Lieshout, Meta Roestenberg

Abstract

Background: Travellers infected with Schistosoma spp. might be pauci- or even asymptomatic on first presentation. Therefore, schistosomiasis may remain undiagnosed in this population. Active infection, as evidenced by the presence of the tissue-dwelling worm, can be demonstrated via the detection of adult worm-derived circulating anodic antigen (CAA) utilising a robust well-described lateral flow-(LF) based test applying background-free up-converting reporter particles (UCP). In this prospective study, we assessed the diagnostic value of serum and urine UCP-LF CAA test in comparison with two Schistosoma-specific serological assays detecting antibodies against adult worm antigen-immuno fluorescence assay (AWA-IFA) and against soluble egg antigen-enzyme-linked immunosorbent assay (SEA-ELISA) antigens in travellers.

Methods: Samples were collected from 106 Dutch travellers who reported freshwater contact in sub-Saharan Africa and who were recruited up to 2 years after return. Subjects were asked to complete a detailed questionnaire on travel history, water contact, signs and symptoms compatible with schistosomiasis.

Results: Two travellers were positive by serum CAA and an additional one by urine CAA. A total of 22/106 (21%) samples were antibody positive by AWA-IFA and 9/106 (9%) by SEA-ELISA. At follow-up 6 weeks and 6 months after praziquantel treatment, all seropositives remained antibody positive whereas CAA was cleared. Seropositivity could not be predicted by the type of fresh water-related activity, country visited or symptoms reported.

Conclusion: The low number of UCP-LF CAA positives suggests that in travellers, active infections often do not establish or have very low worm burden. Based on our high seroconversion rates, we conclude that the AWA-IFA assay is the most sensitive test to detect schistosome exposure. Given the lack of predictive symptoms or risk factors, we recommend schistosomiasis screening at least by serology in all travellers with reported freshwater contact in high-endemic areas.

Keywords: Schistosomiasis; circulating anodic antigen (CAA); freshwater contact; praziquantel; questionnaire; serology.

© International Society of Travel Medicine 2020.

Figures

Figure 1
Figure 1
Study flowchart detailing study participation of Dutch travellers for submitting serum and urine samples for the diagnosis of schistosomiasis before and after administration of PZQ during 2014–2019. Asterisk represents schistosomiasis Ab diagnostics via AWA-IFA and SEA-ELISA
Figure 2
Figure 2
Antibody titres as measures by AWA-IFA (a) and SEA-ELISA (b) at baseline, 6 weeks after PZQ treatment and 6 months after PZQ treatment. The red line indicates threshold value for the test (AWA-IFA > 1:8 titre, SEA-ELISA > 1:16 titre)

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Source: PubMed

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