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Open Access Highly Accessed Research article

Prospective European-wide multicentre study on a blood based real-time PCR for the diagnosis of acute schistosomiasis

Dominic Wichmann1*, Sven Poppert2, Heidrun Von Thien2, Joannes Clerinx3, Sebastian Dieckmann4, Mogens Jensenius5, Philippe Parola6, Joachim Richter7, Mirjam Schunk8, August Stich9, Philipp Zanger10, Gerd D Burchard112 and Egbert Tannich2

Author affiliations

1 Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany

2 Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

3 Department of Clinical Sciences, Institute for Tropical Medicine Antwerp, Antwerp, Belgium

4 Institute of Tropical Medicine & International Health, Charité Universitätsmedizin Berlin, Berlin, Germany

5 Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway

6 Department of Infectious Diseases an Tropical Medicine, Hôpital Nord, Marseille, France

7 Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University Duesseldorf, Duesseldorf, Germany

8 Department for Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Munich, Munich, Germany

9 Missionsaerztliche Klinik, Wuerzburg, Germany

10 Institute of Tropical Medicine, Eberhard Karls University, Tuebingen, Germany

11 Department of Tropical Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

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Citation and License

BMC Infectious Diseases 2013, 13:55  doi:10.1186/1471-2334-13-55

Published: 30 January 2013

Abstract

Background

Acute schistosomiasis constitutes a rare but serious condition in individuals experiencing their first prepatent Schistosoma infection. To circumvent costly and time-consuming diagnostics, an early and rapid diagnosis is required. So far, classic diagnostic tools such as parasite microscopy or serology lack considerable sensitivity at this early stage of Schistosoma infection. To validate the use of a blood based real-time polymerase chain reaction (PCR) test for the detection of Schistosoma DNA in patients with acute schistosomiasis who acquired their infection in various endemic regions we conducted a European-wide prospective study in 11 centres specialized in travel medicine and tropical medicine.

Methods

Patients with a history of recent travelling to schistosomiasis endemic regions and freshwater contacts, an episode of fever (body temperature ≥38.5°C) and an absolute or relative eosinophil count of ≥700/μl or 10%, were eligible for participation. PCR testing with DNA extracted from serum was compared with results from serology and microscopy.

Results

Of the 38 patients with acute schistosomiasis included into the study, PCR detected Schistosoma DNA in 35 patients at initial presentation (sensitivity 92%). In contrast, sensitivity of serology (enzyme immunoassay and/or immunofluorescence assay) or parasite microscopy was only 70% and 24%, respectively.

Conclusion

For the early diagnosis of acute schistosomiasis, real-time PCR for the detection of schistosoma DNA in serum is more sensitive than classic diagnostic tools such as serology or microscopy, irrespective of the region of infection. Generalization of the results to all Schistosoma species may be difficult as in the study presented here only eggs of S. mansoni were detected by microscopy. A minimum amount of two millilitre of serum is required for sufficient diagnostic accuracy.