Schistosomiasis other diagnostic studies: Difference between revisions
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There are no other diagnostic studies associated with schistosomiasis. | There are no other diagnostic studies associated with schistosomiasis. | ||
==Other diagnostic studies== | ==Other diagnostic studies== | ||
'''Formalin-ethyl acetate sedimentation''' | |||
*Five grammes of stool is mixed, strained, diluted with normal [[saline]] solution and centrifuged | |||
*The sediment is collected and treated with formalin-ethyl acetate and subsequently used for slide preparation | |||
*A single formalin-ethyl acetate sedimentation test is not as sensitive for detection of low-intensity infection as multiple [[Kato-Katz technique|Kato-Katz]] smears | |||
'''Urine testing for schistosome eggs''' | |||
*The classic method used for identification of ''[[Schistosoma haematobium|S.haematobium]]'' eggs is filter concentration of a [[urine]] sample collected over 4 hours (ending around noon) into a jug with formalin preservative | |||
*10 mL of [[urine]] is filtered through a 12-μm pore membrane that traps the eggs, and the membrane surface then is examined under a microscope. | |||
*Standard microscopic urinalysis will not identify low-intensity Schistosoma infections. | |||
*Each separate microscopic urinalysis has a sensitivity of 55% to 62% for detection of low-intensity infection; therefore, at least three different urine samples need to be evaluated to achieve diagnostic accuracy. | |||
'''Schistosomal antigen testing (urine or serum)''' | |||
*Urine sample is taken for measurement of circulating cathodic [[antigen]] released by schistosomes or serum sample for measurement of both circulating cathodic and anodic antigen.<ref name="pmid7814474">{{cite journal |vauthors=van Etten L, Folman CC, Eggelte TA, Kremsner PG, Deelder AM |title=Rapid diagnosis of schistosomiasis by antigen detection in urine with a reagent strip |journal=J. Clin. Microbiol. |volume=32 |issue=10 |pages=2404–6 |year=1994 |pmid=7814474 |pmc=264074 |doi= |url=}}</ref> | |||
*Identifies active infection rather than past infection | |||
*May not be sufficiently sensitive for detection of low-intensity infection | |||
'''Serologic testing''' | |||
*Serologic testing help in detection of Schistosoma-specific antibodies in serum. These tests include: | |||
**[[Enzyme-linked immunosorbent assay]] | |||
**[[Indirect antiglobulin test|Indirect hemagglutination assay]] | |||
**Indirect [[immunofluorescent]] antibody testing | |||
*More useful for evaluating recent travelers than immigrants, as it is not possible to distinguish between active infection and past infection. | |||
*Due to the long life of schistosomes, positive test results cannot be discounted simply because exposure was historically distant. | |||
*Sensitivity is highest when the assay is targeted to the suspected species (''[[Schistosoma mansoni|S.mansoni]]'', ''[[Schistosoma japonicum|S.japonicum]], or [[Schistosoma haematobium|S.haematobium]]'') | |||
'''Biopsy of tissue''' | |||
*A biopsy specimen is obtained from the rectum during [[anoscopy]], [[Genital|genital tissues]], or the [[urinary bladder]] wall during [[cystoscopy]] and then crushed and examined under a microscope | |||
*[[Schistosoma mansoni|''S.mansoni'']] and ''[[Schistosoma japonicum|S.japonicum]]'' eggs can be identified in crushed random [[Biopsy|rectal biopsy]] specimens. | |||
*[[Schistosoma haematobium|''S.haematobium'']] eggs can be identified in crushed biopsy specimens from genital tissues or the [[urinary bladder]] wall | |||
*[[Sensitivity]] of microscopic analysis of six crushed rectal biopsies is similar to that of two [[Kato-Katz thick smear|Kato-Katz thick smears]]. | |||
*[[Liver]] biopsy is notoriously insensitive for diagnosis of schistosomiasis; a negative liver biopsy result does not exclude infection | |||
*Standard sectioned intestinal biopsies are not sufficiently sensitive for diagnosis of intestinal schistosomiasis. | |||
'''PCR to detect schistosomal DNA''' | |||
*[[Gene amplification]] technique used to detect schistosomal [[DNA]]. | |||
'''Other laboratory tests''' | |||
Other diagnostic tests that are helpful in diagnosis of schistosomiasis include: | |||
*Urinalysis, including dipstick testing and microscopic analysis for [[leukocytes]], [[erythrocytes]], and [[Urinary casts|casts]]. | |||
**If obstruction is causing a [[urinary tract infection]], [[leukocyte esterase]] or [[nitrites]] may be present. | |||
**[[Erythrocytes]] are seen in the urine of patients with glomerulonephritis. | |||
**Urinary casts, which are aggregates of [[protein]], [[blood cells]], tubular epithelial cell constituents, or all three, develop secondary to urinary stasis in renal tubules and significant [[proteinuria]]. | |||
*Measurement of blood urea nitrogen ([[Blood urea nitrogen|BUN]]) and [[serum creatinine]] to test renal function. | |||
*[[Liver function tests]] | |||
**[[Aspartate transaminase|AST]] and [[Alanine transaminase|ALT]] levels usually remain normal, even in patients with hepatosplenic disease. | |||
**[[Albumin]] levels may be low due to [[malnutrition]] or nephrotic forms of schistosomiasis. | |||
*[[Complete blood count|Complete blood count (]]CBC) | |||
**[[Anemia]] may be seen in patients with chronic blood loss due to intestinal or urinary schistosomiasis and in those with glomerular disease. | |||
**[[Eosinophilia]] may be prominent early in the disease course but may be minimal in patients with longstanding disease. | |||
[[Image:Schistosoma bladder histopathology.jpeg|thumb|center|Photomicrography of bladder in ''S. hematobium'' infection, showing clusters of the parasite eggs with intense eosinophilia, Source: CDC]] | |||
==References== | ==References== | ||
Revision as of 11:56, 23 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
There are no other diagnostic studies associated with schistosomiasis.
Other diagnostic studies
Formalin-ethyl acetate sedimentation
- Five grammes of stool is mixed, strained, diluted with normal saline solution and centrifuged
- The sediment is collected and treated with formalin-ethyl acetate and subsequently used for slide preparation
- A single formalin-ethyl acetate sedimentation test is not as sensitive for detection of low-intensity infection as multiple Kato-Katz smears
Urine testing for schistosome eggs
- The classic method used for identification of S.haematobium eggs is filter concentration of a urine sample collected over 4 hours (ending around noon) into a jug with formalin preservative
- 10 mL of urine is filtered through a 12-μm pore membrane that traps the eggs, and the membrane surface then is examined under a microscope.
- Standard microscopic urinalysis will not identify low-intensity Schistosoma infections.
- Each separate microscopic urinalysis has a sensitivity of 55% to 62% for detection of low-intensity infection; therefore, at least three different urine samples need to be evaluated to achieve diagnostic accuracy.
Schistosomal antigen testing (urine or serum)
- Urine sample is taken for measurement of circulating cathodic antigen released by schistosomes or serum sample for measurement of both circulating cathodic and anodic antigen.[1]
- Identifies active infection rather than past infection
- May not be sufficiently sensitive for detection of low-intensity infection
Serologic testing
- Serologic testing help in detection of Schistosoma-specific antibodies in serum. These tests include:
- Enzyme-linked immunosorbent assay
- Indirect hemagglutination assay
- Indirect immunofluorescent antibody testing
- More useful for evaluating recent travelers than immigrants, as it is not possible to distinguish between active infection and past infection.
- Due to the long life of schistosomes, positive test results cannot be discounted simply because exposure was historically distant.
- Sensitivity is highest when the assay is targeted to the suspected species (S.mansoni, S.japonicum, or S.haematobium)
Biopsy of tissue
- A biopsy specimen is obtained from the rectum during anoscopy, genital tissues, or the urinary bladder wall during cystoscopy and then crushed and examined under a microscope
- S.mansoni and S.japonicum eggs can be identified in crushed random rectal biopsy specimens.
- S.haematobium eggs can be identified in crushed biopsy specimens from genital tissues or the urinary bladder wall
- Sensitivity of microscopic analysis of six crushed rectal biopsies is similar to that of two Kato-Katz thick smears.
- Liver biopsy is notoriously insensitive for diagnosis of schistosomiasis; a negative liver biopsy result does not exclude infection
- Standard sectioned intestinal biopsies are not sufficiently sensitive for diagnosis of intestinal schistosomiasis.
PCR to detect schistosomal DNA
- Gene amplification technique used to detect schistosomal DNA.
Other laboratory tests Other diagnostic tests that are helpful in diagnosis of schistosomiasis include:
- Urinalysis, including dipstick testing and microscopic analysis for leukocytes, erythrocytes, and casts.
- If obstruction is causing a urinary tract infection, leukocyte esterase or nitrites may be present.
- Erythrocytes are seen in the urine of patients with glomerulonephritis.
- Urinary casts, which are aggregates of protein, blood cells, tubular epithelial cell constituents, or all three, develop secondary to urinary stasis in renal tubules and significant proteinuria.
- Measurement of blood urea nitrogen (BUN) and serum creatinine to test renal function.
- Liver function tests
- AST and ALT levels usually remain normal, even in patients with hepatosplenic disease.
- Albumin levels may be low due to malnutrition or nephrotic forms of schistosomiasis.
- Complete blood count (CBC)
- Anemia may be seen in patients with chronic blood loss due to intestinal or urinary schistosomiasis and in those with glomerular disease.
- Eosinophilia may be prominent early in the disease course but may be minimal in patients with longstanding disease.
