title: Screening for intestinal helminth infestation in a semi-urban cohort of HIV-infected people in Uganda: a combination of techniques may enhance diagnostic yield in the absence of multiple stool samples.
abstract: Intestinal helminth prevalence is best determined by using multiple stool samples from each subject, but this may be difficult in the clinic or hospital setting. We used a range of well-established parasitological techniques in a study of interactions between helminth infestation and HIV in a cohort of 412 HIV-infected people in Entebbe, Uganda. Analysis of a single stool sample underestimated helminth prevalence, especially of low-intensity infections, but a combination of Kato-Katz smear, formol-ether concentration (FEC), charcoal culture for Strongyloides and a serum enzyme-linked immunosorbent assay for Schistosoma mansoni antigen (CAA) increased diagnostic yield. Helminths were diagnosed in 23% patients by FEC alone, 35% by FEC and Kato-Katz, 39% by FEC, Kato-Katz and charcoal culture and 49% by a combination of all three tests plus CAA. Performing a range of techniques on a single sample may enhance the detection of parasites. Techniques vary in their sensitivity for different helminths so the appropriate choice of techniques depends on which parasite species are being sought.
authors.affiliation: Medical Research Council Research Programme on AIDS in Uganda, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda. michael.brown@lshtm.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
authors.forename: Joseph
authors.initials: J
authors.lastname: Bukusuba
authors.forename: Peter
authors.initials: P
authors.lastname: Hughes
authors.forename: Jessica
authors.initials: J
authors.lastname: Nakiyingi
authors.forename: Christine
authors.initials: C
authors.lastname: Watera
authors.forename: Alison
authors.initials: A
authors.lastname: Elliott
authors.forename: James
authors.initials: J
authors.lastname: Whitworth
mesh_terms: D015331:Cohort Studies; D005243:Feces / Q000469:parasitology; D015658:HIV Infections / Q000150:complications; D006373:Helminthiasis / Q000175:diagnosis*; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis*; D008403:Mass Screening / Q000379:methods; D010274:Parasitology / Q000379:methods*; D014454:Uganda / Q000453:epidemiology; D014505:Urban Population