title: Accuracy of urine circulating cathodic antigen (CCA) test for Schistosoma mansoni diagnosis in different settings of Côte d'Ivoire.
abstract: BACKGROUND
  Promising results have been reported for a urine circulating cathodic antigen (CCA) test for the diagnosis of Schistosoma mansoni. We assessed the accuracy of a commercially available CCA cassette test (designated CCA-A) and an experimental formulation (CCA-B) for S. mansoni diagnosis.
  
  
  METHODS
  We conducted a cross-sectional survey in three settings of Côte d'Ivoire: settings A and B are endemic for S. mansoni, whereas S. haematobium co-exists in setting C. Overall, 446 children, aged 8-12 years, submitted multiple stool and urine samples. For S. mansoni diagnosis, stool samples were examined with triplicate Kato-Katz, whereas urine samples were tested with CCA-A. The first stool and urine samples were additionally subjected to an ether-concentration technique and CCA-B, respectively. Urine samples were examined for S. haematobium using a filtration method, and for microhematuria using Hemastix dipsticks.
  
  
  RESULTS
  Considering nine Kato-Katz as diagnostic 'gold' standard, the prevalence of S. mansoni in setting A, B and C was 32.9%, 53.1% and 91.8%, respectively. The sensitivity of triplicate Kato-Katz from the first stool and a single CCA-A test was 47.9% and 56.3% (setting A), 73.9% and 69.6% (setting B), and 94.2% and 89.6% (setting C). The respective sensitivity of a single CCA-B was 10.4%, 29.9% and 75.0%. The ether-concentration technique showed a low sensitivity for S. mansoni diagnosis (8.3-41.0%). The specificity of CCA-A was moderate (76.9-84.2%); CCA-B was high (96.7-100%). The likelihood of a CCA-A color reaction increased with higher S. mansoni fecal egg counts (odds ratio: 1.07, p<0.001). A concurrent S. haematobium infection or the presence of microhematuria did not influence the CCA-A test results for S. mansoni diagnosis.
  
  
  CONCLUSIONS
  CCA-A showed similar sensitivity than triplicate Kato-Katz for S. mansoni diagnosis with no cross-reactivity to S. haematobium and microhematuria. The low sensitivity of CCA-B in our study area precludes its use for S. mansoni diagnosis.
authors: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors: Jean T
authors: JT
authors: Coulibaly
authors: Stefanie
authors: S
authors: Knopp
authors: Nicaise A
authors: NA
authors: N'Guessan
authors: Kigbafori D
authors: KD
authors: Silué
authors: Thomas
authors: T
authors: Fürst
authors: Laurent K
authors: LK
authors: Lohourignon
authors: Jean K
authors: JK
authors: Brou
authors: Yve K
authors: YK
authors: N'Gbesso
authors: Penelope
authors: P
authors: Vounatsou
authors: Eliézer K
authors: EK
authors: N'Goran
authors: Jürg
authors: J
authors: Utzinger
mesh_terms: D000818:Animals; D000947:Antigens, Helminth / Q000652:urine*; D002648:Child; D019411:Clinical Laboratory Techniques / Q000379:methods*; D007560:Cote d'Ivoire; D003430:Cross-Sectional Studies; D005243:Feces / Q000737:chemistry; D005260:Female; D006023:Glycoproteins / Q000652:urine*; D015801:Helminth Proteins / Q000652:urine*; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008297:Male; D010274:Parasitology / Q000379:methods*; D015995:Prevalence; D012555:Schistosomiasis mansoni / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014556:Urine / Q000737:chemistry
chemical_list: D000947:Antigens, Helminth; C091532:CCA protein, Schistosoma mansoni; D006023:Glycoproteins; D015801:Helminth Proteins