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Comparative Study
. 2014 Jan 9;8(1):e2640.
doi: 10.1371/journal.pntd.0002640. eCollection 2014.

Diagnostic accuracy of five serologic tests for Strongyloides stercoralis infection

Affiliations
Comparative Study

Diagnostic accuracy of five serologic tests for Strongyloides stercoralis infection

Zeno Bisoffi et al. PLoS Negl Trop Dis. .

Abstract

Background: The diagnosis of Strongyloides stercoralis (S. stercoralis) infection is hampered by the suboptimal sensitivity of fecal-based tests. Serological methods are believed to be more sensitive, although assessing their accuracy is difficult because of the lack of sensitivity of a fecal-based reference ("gold") standard.

Methods: The sensitivity and specificity of 5 serologic tests for S. stercoralis (in-house IFAT, NIE-ELISA and NIE-LIPS and the commercially available Bordier-ELISA and IVD-ELISA) were assessed on 399 cryopreserved serum samples. Accuracy was measured using fecal results as the primary reference standard, but also using a composite reference standard (based on a combination of tests).

Results: According to the latter standard, the most sensitive test was IFAT, with 94.6% sensitivity (91.2-96.9), followed by IVD-ELISA (92.3%, 87.7-96.9). The most specific test was NIE-LIPS, with specificity 99.6% (98.9-100), followed by IVD-ELISA (97.4%, 95.5-99.3). NIE-LIPS did not cross-react with any of the specimens from subjects with other parasitic infections. NIE-LIPS and the two commercial ELISAs approach 100% specificity at a cut off level that maintains ≥70% sensitivity.

Conclusions: NIE-LIPS is the most accurate serologic test for the diagnosis of S. stercoralis infection. IFAT and each of the ELISA tests are sufficiently accurate, above a given cut off, for diagnosis, prevalence studies and inclusion in clinical trials.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. ROC curve for IVD ELISA (composite reference standard).
Figure 2
Figure 2. ROC curve for Bordier ELISA (composite reference standard).
Figure 3
Figure 3. ROC curve for NIE-LIPS (composite reference standard).
Figure 4
Figure 4. ROC curve for IFAT (composite reference standard) (numbers correspond to titers, 3 = 1/20 to 9 = 1/1280).
Figure 5
Figure 5. ROC curve for NIE-ELISA (composite reference standard).

References

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