List of Titles

Application of a universal parasite diagnostic test to biological specimens collected from animals

- Lane, Meredith, Kashani, Mitra, Barratt, Joel, Qvarnstrom, Yvonne, Yabsley, Michael, Garrett, Kayla, Bradbury, Richard

Authors: Lane, Meredith , Kashani, Mitra , Barratt, Joel , Qvarnstrom, Yvonne , Yabsley, Michael , Garrett, Kayla , Bradbury, Richard
Date: 2023
Type: Text , Journal article
Relation: International Journal for Parasitology: Parasites and Wildlife Vol. 20, no. (2023), p. 20-30
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Description: A previously described universal parasite diagnostic (nUPDx) based on PCR amplification of the 18S rDNA and deep-amplicon sequencing, can detect human blood parasites with a sensitivity comparable to real-time PCR. To date, the efficacy of this assay has only been assessed on human blood. This study assessed the utility of nUPDx for the detection of parasitic infections in animals using blood, tissues, and other biological sample types from mammals, birds, and reptiles, known to be infected with helminth, apicomplexan, or pentastomid parasites (confirmed by microscopy or PCR), as well as negative samples. nUPDx confirmed apicomplexan and/or nematode infections in 24 of 32 parasite-positive mammals, while also identifying several undetected coinfections. nUPDx detected infections in 6 of 13 positive bird and 1 of 2 positive reptile samples. When applied to 10 whole parasite specimens (worms and arthropods), nUPDx identified all to the genus or family level, and detected one incorrect identification made by morphology. Babesia sp. infections were detected in 5 of the 13 samples that were negative by other diagnostic approaches. While nUPDx did not detect PCR/microscopy-confirmed trichomonads or amoebae in cloacal swabs/tissue from 8 birds and 2 reptiles due to primer template mismatches, 4 previously undetected apicomplexans were detected in these samples. Future efforts to improve the utility of the assay should focus on validation against a larger panel of tissue types and animal species. Overall, nUPDx shows promise for use in both veterinary diagnostics and wildlife surveillance, especially because species-specific PCRs can miss unknown or unexpected pathogens. © 2022

Infection of Western Gray Kangaroos (Macropus fuliginosus) with Australian arboviruses associated with human infection

- Gyawali, Narayan, Taylor-Robinson, Andrew, Bradbury, Richard, Potter, Abbey, Aaskov, John

Authors: Gyawali, Narayan , Taylor-Robinson, Andrew , Bradbury, Richard , Potter, Abbey , Aaskov, John
Date: 2020
Type: Text , Journal article
Relation: Vector-Borne and Zoonotic Diseases Vol. 20, no. 1 (2020), p. 33-39
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Description: More than 75 arboviruses (arthropod-borne viruses) have been identified in Australia. While Alfuy virus (ALFV), Barmah Forest virus (BFV), Edge Hill virus (EHV), Kokobera virus (KOKV), Murray Valley encephalitis virus (MVEV), Sindbis virus (SINV), Ross River virus (RRV), Stratford virus (STRV), and West Nile virus strain Kunjin (KUNV) have been associated with human infection, there remains a paucity of data regarding their respective transmission cycles and any potential nonhuman vertebrate hosts. It is likely that these viruses are maintained in zoonotic cycles involving native animals rather than solely by human-to-human transmission. A serosurvey (n = 100) was undertaken to determine the prevalence of neutralizing antibodies against a panel of Australian arboviruses in western gray kangaroos (Macropus fuliginosus) obtained from 11 locations in the midwest to southwest of Western Australia. Neutralizing antibodies against RRV were detected in 25%, against BFV in 14%, and antibodies to both viruses in 34% of serum samples. The prevalence of antibodies against these two viruses was the same in males and females, but higher in adult than in subadult kangaroos (p < 0.05). Twenty-one percent of samples had neutralizing antibodies against any one or more of the flaviviruses ALFV, EHV, KOKV, MVEV, and STRV. No neutralizing antibodies against SINV and KUNV were detected. If this sample of kangaroo sera was representative of the broader Australian population of macropods, it suggests that they are common hosts for RRV and BFV. The absence or low seroprevalence of antibodies against the remaining arboviruses suggests that they are not prevalent in the region or that kangaroos are not commonly infected with them. The detection of neutralizing antibodies to MVEV requires further investigation as this virus has not been identified previously so far south in Western Australia. © Copyright 2020, Mary Ann Liebert, Inc.

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Pathogen genomics in public health

- Armstrong, Gregory, MacCannell, Duncan, Taylor, Jill, Carleton, Heather, Neuhaus, Elizabeth, Bradbury, Richard, Posey, James, Gwinn, Marta

Authors: Armstrong, Gregory , MacCannell, Duncan , Taylor, Jill , Carleton, Heather , Neuhaus, Elizabeth , Bradbury, Richard , Posey, James , Gwinn, Marta
Date: 2019
Type: Text , Journal article
Relation: New England Journal of Medicine Vol. 381, no. 26 (2019), p. 2569-2580
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Cross-sectional study of soil-transmitted helminthiases in black belt region of Alabama, USA

- Poole, Claudette, Barker, Troy, Bradbury, Richard, Capone, Drew, Chatham, Amy, Handali, Sukwan, Rodriguez, Eduardo, Qvarnstrom, Yvonne, Brown, Joe

Authors: Poole, Claudette , Barker, Troy , Bradbury, Richard , Capone, Drew , Chatham, Amy , Handali, Sukwan , Rodriguez, Eduardo , Qvarnstrom, Yvonne , Brown, Joe
Date: 2023
Type: Text , Journal article
Relation: Emerging Infectious Diseases Vol. 29, no. 12 (2023), p. 2461-2470
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Description: We conducted a cross-sectional study to determine the prevalence of soil-transmitted helminthiases (STH) in areas of rural Alabama, USA, that have sanitation deficits. We enrolled 777 children; 704 submitted stool specimens and 227 a dried blood spot sample. We microscopically examined stool specimens from all 704 children by using Mini-FLOTAC for helminth eggs. We tested a subset by using molecular techniques: real-time PCR analysis for 5 STH species, TaqMan Array Cards for enteric helminths, and digital PCR for Necator americanus hookworm. We analyzed dried blood spots for Strongyloides stercoralis and Toxocara spp. roundworms by using serologic testing. Despite 12% of our cohort reporting living in homes that directly discharge untreated domestic wastewater, stool testing for STH was negative; however, 5% of dried blood spots were positive for Toxocara spp. roundworms. Survey data suggests substantial numbers of children in this region may be exposed to raw sewage, which is itself a major public health concern. © 2023 Centers for Disease Control and Prevention (CDC). All rights reserved.

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The forgotten exotic tapeworms : a review of uncommon zoonotic cyclophyllidea

- Sapp, Sarah, Bradbury, Richard

Authors: Sapp, Sarah , Bradbury, Richard
Date: 2020
Type: Text , Journal article , Review
Relation: Parasitology Vol. 147, no. 5 (2020), p. 533-558
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Description: As training in helminthology has declined in the medical microbiology curriculum, many rare species of zoonotic cestodes have fallen into obscurity. Even among specialist practitioners, knowledge of human intestinal cestode infections is often limited to three genera, Taenia, Hymenolepis and Dibothriocephalus. However, five genera of uncommonly encountered zoonotic Cyclophyllidea (Bertiella, Dipylidium, Raillietina, Inermicapsifer and Mesocestoides) may also cause patent intestinal infections in humans worldwide. Due to the limited availability of summarized and taxonomically accurate data, such cases may present a diagnostic dilemma to clinicians and laboratories alike. In this review, historical literature on these cestodes is synthesized and knowledge gaps are highlighted. Clinically relevant taxonomy, nomenclature, life cycles, morphology of human-infecting species are discussed and clarified, along with the clinical presentation, diagnostic features and molecular advances, where available. Due to the limited awareness of these agents and identifying features, it is difficult to assess the true incidence of these 'forgotten' cestodiases as clinical misidentifications are likely to occur. Also, the taxonomic status of many of the human-infecting species of these tapeworms is unclear, hampering accurate species identification. Further studies combining molecular data and morphological observations are necessary to resolve these long-standing taxonomic issues and to elucidate other unknown aspects of transmission and ecology. Copyright © The Author(s), US Government, 2020.

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Sensitive universal detection of blood parasites by selective pathogen-DNA enrichment and deep amplicon sequencing

- Flaherty, Briana, Barratt, Joel, Lane, Meredith, Talundzic, Eldin, Bradbury, Richard

Authors: Flaherty, Briana , Barratt, Joel , Lane, Meredith , Talundzic, Eldin , Bradbury, Richard
Date: 2021
Type: Text , Journal article
Relation: Microbiome Vol. 9, no. 1 (2021), p.
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Description: Background: Targeted amplicon deep sequencing (TADS) has enabled characterization of diverse bacterial communities, yet the application of TADS to communities of parasites has been relatively slow to advance. The greatest obstacle to this has been the genetic diversity of parasitic agents, which include helminths, protozoa, arthropods, and some acanthocephalans. Meanwhile, universal amplification of conserved loci from all parasites without amplifying host DNA has proven challenging. Pan-eukaryotic PCRs preferentially amplify the more abundant host DNA, obscuring parasite-derived reads following TADS. Flaherty et al. (2018) described a pan-parasitic TADS method involving amplification of eukaryotic 18S rDNA regions possessing restriction sites only in vertebrates. Using this method, host DNA in total DNA extracts could be selectively digested prior to PCR using restriction enzymes, thereby increasing the number of parasite-derived reads obtained following NGS. This approach showed promise though was only as sensitive as conventional PCR. Results: Here, we expand on this work by designing a second set of pan-eukaryotic primers flanking the priming sites already described, enabling nested PCR amplification of the established 18S rDNA target. This nested approach facilitated introduction of a second restriction digestion between the first and second PCR, reducing the proportional mass of amplifiable host-derived DNA while increasing the number of PCR amplification cycles. We applied this method to blood specimens containing Babesia, Plasmodium, various kinetoplastids, and filarial nematodes and confirmed its limit of detection (LOD) to be approximately 10-fold lower than previously described, falling within the range of most qPCR methods. Conclusions: The assay detects and differentiates the major malaria parasites of humans, along with several other clinically important blood parasites. This represents an important step towards a TADS-based universal parasite diagnostic (UPDx) test with a sufficient LOD for routine applications. [MediaObject not available: see fulltext.]. © 2021, The Author(s).

Hospitalizations associated with Strongyloidiasis in the United States, 2003-2018

- Inagaki, Kengo, Bradbury, Richard, Hobbs, Charlotte

Authors: Inagaki, Kengo , Bradbury, Richard , Hobbs, Charlotte
Date: 2022
Type: Text , Journal article
Relation: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Vol. 75, no. 9 (2022), p. 1548-1555
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Description: BACKGROUND: Strongyloides stercoralis is considered to be historically endemic in Appalachia and the American South, but recent surveillance data, especially data evaluating strongyloidiasis associated with hospitalization, are lacking in most parts of the United States. METHODS: We performed a population-based retrospective analysis on strongyloidiasis using the National Inpatient Sample from 2003 to 2018. Geographic distribution of strongyloidiasis associated hospitalization was assessed. Logistic regression was used to identify risk factors associated with strongyloidiasis. RESULTS: We identified 6931 hospitalizations associated with strongyloidiasis during the study period (11.8 per million hospitalizations). The rate of strongyloidiasis was highest in the Northeast US region, including the Middle Atlantic division (47.1 cases per million population; adjusted odds ratio, 2.00 [95% confidence interval: 1.58-2.53]), and the East South Central division (27.5 cases per million; adjusted odds ratio, 2.77 [2.02-3.80]). Older age, male sex, nonwhite race/ethnicity (particularly Hispanic and Asian), nonprivate insurance, and residence in neighborhoods with low median income were also associated with strongyloidiasis. Immunocompromising conditions, particularly human immunodeficiency virus infection, were present in 41.3% of hospitalizations with strongyloidiasis. In-hospital death occurred in 7.8% of patients with strongyloidiasis-associated hospitalization. CONCLUSIONS: Strongyloidiasis-associated hospitalization is rare in the United States but can be associated with increased mortality rate/mortality risk . It occurs more frequently in poor and marginalized populations. Immunocompromised conditions were common among hospitalized patients with strongyloidiasis. Enhanced surveillance efforts are needed to inform health policies for improving the health of at-risk populations. © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

A molecular survey of tick-borne pathogens from ticks collected in Central Queensland

- Chalada, Melissa, Stenos, John, Vincent, Gemma, Barker, Dayana, Bradbury, Richard

Authors: Chalada, Melissa , Stenos, John , Vincent, Gemma , Barker, Dayana , Bradbury, Richard
Date: 2018
Type: Text , Journal article
Relation: Vector-borne and zoonotic diseases Vol. 18, no. 3 (2018), p. 151-163
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Description: Central Queensland (CQ) is a large and isolated, low population density, remote tropical region of Australia with a varied environment. The region has a diverse fauna and several species of ticks that feed upon that fauna. This study examined 518 individual ticks: 177 Rhipicephalus sanguineus (brown dog tick), 123 Haemaphysalis bancrofti (wallaby tick), 102 Rhipicephalus australis (Australian cattle tick), 47 Amblyomma triguttatum (ornate kangaroo tick), 57 Ixodes holocyclus (paralysis tick), 9 Bothriocroton tachyglossi (CQ short-beaked echidna tick), and 3 Ornithodoros capensis (seabird soft tick). Tick midguts were pooled by common host or environment and screened for four genera of tick-borne zoonoses by PCR and sequencing. The study examined a total of 157 midgut pools of which 3 contained DNA of Coxiella burnetii, 13 Rickettsia gravesii, 1 Rickettsia felis, and 4 other Rickettsia spp. No Borrelia spp. or Babesia spp. DNA were recovered.

HTLV-I and strongyloides in Australia : the worm lurking beneath

- Gordon, Catherine, Shield, Jennifer, Bradbury, Richard, Muhi, Stephen, Page, Wendy

Authors: Gordon, Catherine , Shield, Jennifer , Bradbury, Richard , Muhi, Stephen , Page, Wendy
Date: 2021
Type: Text , Book chapter
Relation: Advances in Parasitology p. 119-201
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Description: Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5–10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well. © 2021 Elsevier Ltd. *Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Richard Bradbury" is provided in this record**

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Human strongyloidiasis : complexities and pathways forward

- Buonfrate, Dora, Bradbury, Richard, Watts, Matthew, Bisoffi, Zeno

Authors: Buonfrate, Dora , Bradbury, Richard , Watts, Matthew , Bisoffi, Zeno
Date: 2023
Type: Text , Journal article , Review
Relation: Clinical Microbiology Reviews Vol. 36, no. 4 (2023), p.
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Description: Strongyloidiasis is a World Health Organization neglected tropical disease usually caused by Strongyloides stercoralis, a parasitic worm with a complex life cycle. Globally, 300-600 million people are infected through contact with fecally contaminated soil. An autoinfective component of the life cycle can lead to chronic infection that may be asymptomatic or cause long-term symptoms, including malnourishment in children. Low larval output can limit the sensitivity of detection in stool, with serology being effectivebut less sensitive in immunocompromise. Host immunosuppression can trigger catastrophic, fatal hyperinfection/dissemination, where large numbers of larvae pierce the bowel wall and disseminate throughout the organs. Stable disease is effectivelytreated by single-dose ivermectin, with disease in immunocompromised patients treated with multiple doses. Strategies for management include raising awareness, clarifying zoonotic potential, the development and use of effectivediagnostic tests for epidemiological studies and individual diagnosis, and the implementation of treatment programs with research into therapeutic alternatives and medication safety. © 2023 American Society for Microbiology. All rights reserved.

Parasitic infections of the central nervous system

- Mathison, Blaine, Bradbury, Richard

Authors: Mathison, Blaine , Bradbury, Richard
Date: 2023
Type: Text , Book chapter
Relation: Molecular Medical Microbiology, Third Edition Chapter 159 p. 3135-3177
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Description: Parasites are an uncommon cause of infections of the human central nervous system (CNS). When they do cause CNS infections; however, the results can be detrimental and as such, an accurate diagnosis needs to be made as soon as possible so treatment can be initiated. This chapter covers the taxonomy, biology, epidemiology, clinical presentation, pathology, treatment, and diagnosis of parasites of the CNS, with an emphasis on molecular detection and identification. © 2024 Elsevier Ltd. All rights reserved.

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An atypical case of autochthonous cutaneous leishmaniasis associated with naturally infected phlebotomine sand flies in Texas, United States

- Kipp, Evan, de Almeida, Marcos, Marcet, Paula, Bradbury, Richard, Benedict, Theresa, Lin, Wuling, Dotson, Ellen, Hergert, Melinda

Authors: Kipp, Evan , de Almeida, Marcos , Marcet, Paula , Bradbury, Richard , Benedict, Theresa , Lin, Wuling , Dotson, Ellen , Hergert, Melinda
Date: 2020
Type: Text , Journal article
Relation: American Journal of Tropical Medicine and Hygiene Vol. 103, no. 4 (2020), p. 1496-1501
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Description: In the United States, phlebotomine sand flies carrying Leishmania (Leishmania) mexicana are endemic along the southern border. However, relatively little is known about the enzootic and zoonotic transmission of L. (L.) mexicana within the United States, and autochthonous cases of the consequent disease are rarely reported. We investigated an atypical case of cutaneous leishmaniasis (CL) caused by L. (L.) mexicana in a patient from central Texas which did not respond to a typical antileishmanial chemotherapy. We also investigated sand fly vectors around the patient's residence. PCR followed by DNA sequencing was used for determination of Leishmania spp., sand fly species, and host blood meal source. The L. (L.) mexicana genotype from the patient was identical to one found in a positive sand fly. Moreover, this genotype presented the same single-nucleotide polymorphisms as other historical CL cases acquired in Texas over the last 10 years, but distinct from those originating in Mexico and Central America. Three sand fly species were identified among the samples analyzed (n = 194), the majority of which were Lutzomyia (Dampfomyia) anthophora (n = 190), of which four specimens tested positive for Leishmania and two blood-fed specimens showed the presence of a human blood meal. This study highlights the complexity of clinical management of CL in a setting where the disease is infrequently encountered. The detection of human blood in Lu. (D.) anthophora is the first documentation of anthropophagy in this species. This is the first report of wild-caught, naturally infected sand flies found in association with an autochthonous case of human leishmaniasis and the specific strain of Leishmania (Leishmania) mexicana in the United States. Copyright © 2020 by The American Society of Tropical Medicine and Hygiene

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Inactivating effects of common laboratory disinfectants, fixatives, and temperatures on the eggs of soil transmitted helminths

- Kines, Kristine, Fox, Mark, Ndubuisi, MacKevin, Verocai, Guilherme, Cama, Vitaliano, Bradbury, Richard

Authors: Kines, Kristine , Fox, Mark , Ndubuisi, MacKevin , Verocai, Guilherme , Cama, Vitaliano , Bradbury, Richard
Date: 2021
Type: Text , Journal article
Relation: Microbiology Spectrum Vol. 9, no. 3 (2021), p.
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Description: Soil-transmitted helminths (STH) are important and widespread intestinal pathogens of humans and animals. It is presently unknown which inactivating procedures may be universally effective for safe transport, preservation, and disinfection of STH-contaminated specimens, and this lack of knowledge may expose laboratory staff to higher risk of laboratory-acquired infections (LAI’s). There are limited data on the efficacy of commonly used disinfectants and fecal fixatives for inactivating the eggs of STH. This work tested five disinfectants for surface cleanup, four storage temperature conditions, and six transport/storage fixatives, to inactivate eggs of three species of STH of animal origin (Ascaris suum “roundworm,” Trichuris vulpis “whipworm” and Ancylostoma caninum “hookworm”) as surrogates for human STH. Among disinfectants, exposure to 10% povidone-iodine for $5 min inactivated 100% of the three species tested, while 5 min exposure to 95% ethanol inactivated T. vulpis and A. caninum eggs. All of the fixatives tested had inactivation effects on A. caninum hookworm eggs within 24 h of exposure, except potassium dichromate, which required 48 h. 95% ethanol for $48 h inactivated eggs from all three STH species. Freezing at #220°C for $24 h inactivated eggs of T. vulpis and A. caninum, but only freezing at 280°C for $24 h inactivated .99% eggs, including A. suum. This work provides an evidence base for health and safety guidelines and mitigation strategies for the handling, storage, and disposal of stool samples containing STH eggs in laboratory, health care, childcare, or veterinary settings. IMPORTANCE This study systematically evaluates common laboratory disinfectants and storage conditions for their effectiveness in inactivating the infective stages of soil-transmitted helminths (STH). Animal-infecting proxy species were chosen to represent three major groups of STH that infect humans: roundworms, whipworms, and hookworms. Previously published work in this area typically focuses on a particular inactivation method, either for a single STH species, or on a subset of closely related species. Because prediagnostic fecal specimens must be regarded as potentially infectious with a mix of species, such information may be of limited utility in a working laboratory. We provide a straightforward summary of storage and disinfection methods that can achieve complete inactivation across a range of STH species, which represents a significant advance for clinical, veterinary and research laboratory biosafety. Copyright © 2021 Kines et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

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Strongyloides fuelleborni kellyi in New Guinea : neglected, ignored and unexplored

- Bradbury, Richard

Authors: Bradbury, Richard
Date: 2021
Type: Text , Journal article
Relation: Microbiology Australia Vol. 42, no. 4 (2021), p. 169-172
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Description: Strongyloidiasis remains endemic throughout the Island of New Guinea. While many infections are caused by Strongyloides stercoralis, a second human-infecting Strongyloides species, Strongyloides fuelleborni kellyi, is also present. S. f. kellyi infections are most common in infants and young children, and those with high-intensity infections might develop a potentially fatal protein-losing enteropathy, swollen belly syndrome. Surprisingly little work has been performed on S. f. kellyi. Unlike S. stercoralis, S. f. kellyi is passed in faeces as eggs rather than rhabditiform larvae. There is no specific diagnostic test. This review summarises what is currently known about the biology, epidemiology, and clinical impact of S. f. kellyi infections. Features that might be used to differentiate S. f. kellyi from hookworm and S. stercoralis are also discussed. S. f. kellyi remains a neglected, ignored, and unexplored human helminth infection, worthy of further research. © 2021 Journal Compilation

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First international external quality assessment scheme of nucleic acid amplification tests for the detection of schistosoma and soil-transmitted helminths, including strongyloides : A pilot study

- Cools, Piet, van Lieshout, Lisette, Koelewijn, Rob, Addiss, David, Ajjampur, Sitara, Ayana, Mio, Bradbury, Richard, Cantera, Jason, Dana, Daniel, Fischer, Kerstin, Imtiaz, Rubina, Kabagenyi, Joyce, Lok, James, McCarthy, James, Mejia, Rojelio, Mekonnen, Zeleke, Njenga, Sammy, Othman, Nurulhasanah, Shao, Hongguang, Traub, Rebecca, Van Esbroeck, Marjan, Vercruysse, Jozef, Vlaminck, Johnny, Williams, Steven, Verweij, Jaco, van Hellemond, Jaap, Levecke, Bruno

Authors: Cools, Piet , van Lieshout, Lisette , Koelewijn, Rob , Addiss, David , Ajjampur, Sitara , Ayana, Mio , Bradbury, Richard , Cantera, Jason , Dana, Daniel , Fischer, Kerstin , Imtiaz, Rubina , Kabagenyi, Joyce , Lok, James , McCarthy, James , Mejia, Rojelio , Mekonnen, Zeleke , Njenga, Sammy , Othman, Nurulhasanah , Shao, Hongguang , Traub, Rebecca , Van Esbroeck, Marjan , Vercruysse, Jozef , Vlaminck, Johnny , Williams, Steven , Verweij, Jaco , van Hellemond, Jaap , Levecke, Bruno
Date: 2020
Type: Text , Journal article
Relation: PLoS Neglected Tropical Diseases Vol. 14, no. 6 (2020), p. 1-19
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Description: Background Nucleic acid amplification tests (NAATs) are increasingly being used as diagnostic tools for soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, Necator ameri-canus, Ancylostoma duodenale and A. ceylanicum), Strongyloides stercoralis and Schisto-soma in human stool. Currently, there is a large diversity of NAATs being applied, but an external quality assessment scheme (EQAS) for these diagnostics is lacking. An EQAS involves a blinded process where test results reported by a laboratory are compared to those reported by reference or expert laboratories, allowing for an objective assessment of the diagnostic performance of a laboratory. In the current study, we piloted an international EQAS for these helminths (i) to investigate the feasibility of designing and delivering an EQAS; (ii) to assess the diagnostic performance of laboratories; and (iii) to gain insights into the different NAAT protocols used. Methods and principal findings A panel of twelve stool samples and eight DNA samples was validated by six expert laboratories for the presence of six helminths (Ascaris, Trichuris, N. americanus, Ancylostoma, Strongyloides and Schistosoma). Subsequently this panel was sent to 15 globally dispersed laboratories. We found a high degree of diversity among the different DNA extraction and NAAT protocols. Although most laboratories performed well, we could clearly identify the laboratories that were poorly performing. Conclusions/Significance We showed the technical feasibility of an international EQAS for the NAAT of STHs, Stron-gyloides and Schistosoma. In addition, we documented that there are clear benefits for par-ticipating laboratories, as they can confirm and/or improve the diagnostic performance of their NAATs. Further research should aim to identify factors that explain poor performance of NAATs. © 2020 Cools et al.

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