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Evaluation of ImmunoCard STAT test and ELISA versus light microscopy in diagnosis of giardiasis and cryptosporidiosis

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Abstract

This study was designed to evaluate ImmunoCard STAT Cryptosporidium/Giardia rapid assay and ELISA copro-antigen assays in detecting Giardia lamblia and Cryptosporidium species in fecal samples in comparison to microscopy. Both ImmunoCard STAT and ELISA assays were evaluated with 90 stool specimens that were tested by the standard ova and parasite examination including staining with both iron hematoxylin stain and modified Ziehl Neelson stains. Counting the number of Giardia cysts and Cryptosporidia oocysts in the positive stool samples was done in order to quantify the lower limit of parasite number that was able to be detected by all included assays. Both ImmunoCard STAT and ELISA assays were compared on the basis of the attributes which are number of detected cases, sensitivity, specificity, time required for the procedure and screening, ease of performance and interpretation, and cost. Microscopic examination revealed that 13.3 % of the samples were positive for Giardia and 2.2 % for Cryptosporidium. By ELISA, 16.7 % of the samples were infected with Giardia and 3.3 % with Cryptosporidium, while by ImmunoCard STAT, 17.8 and 4.45 % of the samples were positive for Giardia and Cryptosporidium, respectively. There is no statistically significant difference between the results of ELISA and ImmunoCard STAT assays. The lowest concentration detected in the stool samples was 10.50 ± 1.05 Giardia cysts and 2.83 ± 1.72 Cryptosporidium oocysts. The ImmunoCard STAT was extremely easy to read, thus requiring much less time, but its cost was much higher than ELISA. We concluded that although the overall ranking of both assays was high, the ImmunoCard STAT rapid assay was a more desirable test despite its higher cost.

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References

  • Abou El-Naga FI, Gaafar MR (2014) Auramine-phenol VS modified Kinyoun’s acid fast stains for detection of coccidian parasites. Lab Med 45(1):65–73

    Article  PubMed  Google Scholar 

  • Agnamey P, Sarfati C, Pinel C, Rabodoniriina M, Kapel N, Dutoit E, Garnaud C, Diouf M, Garin J, Tolet A, Derouin F (2011) Evaluation of four commercial rapid immunochromatographic assays for detection of Cryptosporidium antigens in stool samples: a blind multicenter trial. J Clin Microbiol 49(4):1605–7

    Article  PubMed Central  PubMed  Google Scholar 

  • Aldeen WE, Carroll K, Robison A, Morrison M, Hale D (1998) Comparison of nine commercially available enzyme-linked immunosorbent assays for detection of Giardia in fecal specimens. J Clin Microbiol 36:1338–40

    CAS  PubMed Central  PubMed  Google Scholar 

  • Ali SA, Hill DR (2003) Giardia intestinalis. Curr Opin Infect Dis 16:453–60

    Article  PubMed  Google Scholar 

  • Beltran S, Orejuela RSN, Jamaica AA, Lozano RG, Montenegro S, James MA (2002) Detection of Giardia duodenalis antigen in human fecal elutes by enzyme-linked immunosorbent assay using polyclonal antibodies. Mem Inst Oswaldo Cruz 97:1165–8

    Article  Google Scholar 

  • Carter WB, Beach LR, Inui TS (1986) The flu shot study: using multiattribute utility theory to design a vaccination intervention. Organ Behav Hum Decis Process 38:378–91

    Article  CAS  PubMed  Google Scholar 

  • Chan R, Chen J, York MK, Setijono N, Kaplan RL, Fitzroy Graham F, Tanowitz HB (2000) Evaluation of a combination rapid immunoassay for detection of Giardia and Cryptosporidium antigens. J Clin Microbiol 38:393–4

    CAS  PubMed Central  PubMed  Google Scholar 

  • Chen XM, Keithly JS, Paya CV, LaRusso NF (2002) Cryptosporidiosis. N Engl J Med 346:1723–31

    Article  PubMed  Google Scholar 

  • Dolan JG (1989) Medical decision making using the analytic hierarchy process: choice of initial antimicrobial therapy for acute pyelonephritis. Med Dec Making 9:51–6

    Article  CAS  Google Scholar 

  • Dolan JG, Isselhardt BJ, Cappuccio JD (1989) The analytic hierarchy process in medical decision making: a tutorial. Med Dec Making 9:40–50

    Article  CAS  Google Scholar 

  • Drury RAB, Wallington EA (1980) Carleton’s histological technique, 5th edn. Oxford University Press, Oxford, New York, Toronto

    Google Scholar 

  • Eckmann L (2002) Small bowel infections. Curr Opin Gastroenterol 18(2):197–202

    Article  PubMed  Google Scholar 

  • El-Hamshary EM, El-Sayed HF, Hussein EM, Rayan HZ, Soliman RH (2008) Comparison of polymerase chain reaction, immunochromatographic assay and staining techniques in diagnosis of cryptosporidiosis. PUJ 1(2):77–86

    Google Scholar 

  • Gaafar MR (2012) Efficacy of Allium sativum (garlic) against experimental cryptosporidiosis. Alex J Med 48:59–66

    Article  Google Scholar 

  • Garcia LS (2001) Procedures for detecting stool parasites. In: Diagnostic Medical Parasitology, 4th edn, Washington DC USA, 741–82

  • Garcia LS, Shimizu RY (1997) Evaluation of nine immunoassay kits (enzyme immunoassay and direct fluorescence) for detection of Giardia lamblia and Cryptosporidium parvum in human fecal specimens. J Clin Microbiol 35:1526–9

    CAS  PubMed Central  PubMed  Google Scholar 

  • Garcia LS, Shimizu RY (2000) Detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal specimens using the Col-or PAC combination rapid solid-phase qualitative immunochromatographic assay. J Clin Microbiol 38:1267–8

    CAS  PubMed Central  PubMed  Google Scholar 

  • Garcia LS, Bruckner D, Brewer T, Shimizu R (1983) Techniques for the recovery and identification of Cryptosporidium oocysts from stool specimens. J Clin Microbiol 18:185–90

    CAS  PubMed Central  PubMed  Google Scholar 

  • Garcia LS, Shimizu RY, Novak S, Carroll M, Chan F (2003) Commercial assay for detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal specimens by rapid solid-phase qualitative immunochromatography. J Clin Microbiol 41(1):209–12

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Green E, Miles M, Warhurst D (1985) Immunodiagnostic detection of giardia antigen in faeces by a rapid visual enzyme linked immunosorbent assay. Lancet 28:691–3

    Article  Google Scholar 

  • Hawash Y (2014) Evaluation of an immunoassay-based algorithm for screening and identification of giardia and cryptosporidium antigens in human faecal specimens from Saudi Arabia. Parasitol Res. doi:10.1155/2014/213745

    Google Scholar 

  • Helmy YA, Krucken J, Nockler K, Samson-Himmelstjerna GV, Zessin KH (2014) Comparison between two commercially available serological tests and polymerase chain reaction in the diagnosis of Cryptosporidium in animal and diarrhoeic children. Parasitol Res 113(1):211–6

    Article  PubMed  Google Scholar 

  • Janoff EN, Craft JC, Pickering LK, Novotny T, Blaser MJ, Knisley CV, Reller LB (1989) Diagnosis of infections by detection of parasite-specific antigens. J Clin Microbiol 27:431–5

    CAS  PubMed Central  PubMed  Google Scholar 

  • Johnston SP, Ballard MM, Beach MJ, Causer L, Wilkins PP (2003) Evaluation of three commercial assays for detection of Giardia and Cryptosporidium organisms in fecal specimens. J Clin Microbiol 41:623–6

    Article  PubMed Central  PubMed  Google Scholar 

  • Karanis P, Kourenti C, Smith H (2007) Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health 5(1):1–38

    Article  PubMed  Google Scholar 

  • Kehl KC, Cicirello H, Havens PL (1995) Comparison of four different methods for the detection of Cryptosporidium species. J Clin Microbiol 33:416–18

    CAS  PubMed Central  PubMed  Google Scholar 

  • Kirkpatrick LA, Feeney BC (2013) In: Student (ed) A simple guide to IBM SPSS statistics for version 20.0. Wadsworth, Cengage Learning, Belmont

    Google Scholar 

  • Kotz S, Balakrishnan N, Read CB, Vidakovic B (2006) Encyclopedia of statistical sciences, 2nd edn. Wiley-Interscience, Hoboken

    Google Scholar 

  • Liorente MT, Clavel A, Varea M, Olivera S, Castillo FJ, Sahagun J, Rubio MC, Gomez-Lus R (2002) Evaluation of an immunochromatographic dip strip test for the detection of Cryptosporidium oocysts in stool specimens. Eur J Clin Microbiol Infect Dis 21:624–5

    Article  Google Scholar 

  • MacPherson DW, McQueen R (1993) Cryptosporidiosis: multiattribute evaluation of six diagnostic methods. J Clin Microbiol 31:198–202

    CAS  PubMed Central  PubMed  Google Scholar 

  • Marshall MM, Naumovitz D, OrtegaY SCR (1997) Waterborne protozoan pathogens. Clin Microbiol Rev 10:67–85

    CAS  PubMed Central  PubMed  Google Scholar 

  • Minak J, Kabir M, Mahmud I, Liu Y, Liu L, Haque R, Petri WA (2011) Evaluation of rapid antigen point-of-care tests for detection of Giardia and Cryptosporidium species in human fecal specimens. J Clin Microbiol 50(1):154–6

    Article  PubMed  Google Scholar 

  • Nash T, Herrington D, Levine M (1987) Usefulness of an enzyme linked immunosorbent assay for detection of Giardia antigen in feces. J Clin Microbiol 25(7):1169–71

    CAS  PubMed Central  PubMed  Google Scholar 

  • Ndao M (2009) Diagnosis of parasitic diseases: old and new approaches. Interdiscip Perspect Infect Dis 2009, 278246

    PubMed Central  PubMed  Google Scholar 

  • Newman RD, Jaeger KL, Wuhib T, Lima AA, Guerrant RL, Sears CL (1993) Evaluation of an antigen capture enzyme-linked immunosorbent assay for detection of Cryptosporidium oocysts. J Clin Microbiol 31:2080–4

    CAS  PubMed Central  PubMed  Google Scholar 

  • Okhuysen PC (2001) Traveler’s diarrhea due to intestinal protozoa. Clin Infect Dis 33:110–4

    Article  CAS  PubMed  Google Scholar 

  • Rosenblatt JE, Sloan LM (1993) Evaluation of enzyme-linked immunosorbent assay for detection of Cryptosporidium spp. in stool specimens. J Clin Microbiol 31:1468–71

    CAS  PubMed Central  PubMed  Google Scholar 

  • Rosoff JD, Sanders CA, Sonnad SS, De Lay PR, Hadley WK, Vincenzi FF, Yajko DM, O’Hanley PD (1989) Stool diagnosis of giardiasis using a commercially available enzyme immunoassay to detect Giardia-specific antigen 65 (GSA 65). J Clin Microbiol 9:1997–2002

    Google Scholar 

  • Saroj DPM, Vinayak VK (1991) Enzyme-linked immunosorbent assay for copro-diagnosis of giardiasis and characterisation of a specific Giardia lamblia antigen in stools. J Med Microbiol 34:271–5

    Article  Google Scholar 

  • Schuurman T, Lankamp P, Belkum AV, Kooistra-Smid M, Zwet AV (2007) Comparison of microscopy, real-time PCR and a rapid immunoassay for the detection of Giardia lamblia in human stool specimens. Clin Microbiol Infect 13:1186–91

    Article  CAS  PubMed  Google Scholar 

  • Stibbs HH (1989) Monoclonal antibody-based enzyme immunoassay for Giardia lamblia antigen in human stool. J Clin Microbiol 27:2582–8

    CAS  PubMed Central  PubMed  Google Scholar 

  • Ungar BLP (1990) Enzyme-linked immunoassay for detection of Cryptosporidium antigen in fecal specimens. J Clin Microbiol 28:2491–5

    CAS  PubMed Central  PubMed  Google Scholar 

  • Verweij JJ, Blangé RA, Templton ED, Schinkel J, Brienen EA, van Rooyen MA, Lieshout LV, Poldeman AM (2004) Simultaneous detection of Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum in fecal samples by using multiplex real-time PCR. J Clin Microbiol 42(3):1220–3

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Weber R, Bryan RT, Bishop HS, Wahlquist SP, Sullivan JJ, Juranek DD (1991) Threshold of detection of Cryptosporidium oocysts in human stool specimens; evidence for low sensitivity of current diagnostic methods. J Clin Microbiol 29(7):1323–7

    CAS  PubMed Central  PubMed  Google Scholar 

  • Weitzel S, Dittrich I, Möhl E, Adusu E, Jelinek T (2006) Evaluation of seven commercial antigen detection tests for Giardia and Cryptosporidium in stool samples. Clin Microbiol Infect 12:656–9

    Article  CAS  PubMed  Google Scholar 

  • Wolfe MS (1992) Giardiasis. Clin Microbiol Rev 5:93–100

    CAS  PubMed Central  PubMed  Google Scholar 

  • Zimmerman SK, Needham CA (1995) Comparison of conventional stool concentration and preserved-smear methods with merifluor Cryptosporidium / Giardia direct immunofluorescence assay and ProSpecT Giardia EZ microplate assay for detection of Giardia lamblia. J Clin Microbiol 33:1942–3

    CAS  PubMed Central  PubMed  Google Scholar 

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Parasitology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

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Authors and Affiliations

  1. Department of Parasitology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    H. A. Sadaka, M. R. Gaafar, R. F. Mady & N. N. Hezema

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  1. H. A. Sadaka
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  2. M. R. Gaafar
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  3. R. F. Mady
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  4. N. N. Hezema
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Correspondence to M. R. Gaafar.

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Sadaka, H.A., Gaafar, M.R., Mady, R.F. et al. Evaluation of ImmunoCard STAT test and ELISA versus light microscopy in diagnosis of giardiasis and cryptosporidiosis. Parasitol Res 114, 2853–2863 (2015). https://doi.org/10.1007/s00436-015-4486-z

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  • DOI: https://doi.org/10.1007/s00436-015-4486-z

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