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Schistosomiasis is a significant public health concern, especially in Sub-Saharan Africa. Conventional microscopy is the standard diagnostic method in resource-limited settings, but with limitations, such as the need for expert microscopists. An automated digital microscope with artificial intelligence (Schistoscope), offers a potential solution. This field study aimed to validate the diagnostic performance of the Schistoscope for detecting and quantifying Schistosoma haematobium eggs in urine compared to conventional microscopy and to a composite reference standard (CRS) consisting of real-time PCR and the up-converting particle (UCP) lateral flow (LF) test for the detection of schistosome circulating anodic antigen (CAA). Based on a non-inferiority concept, the Schistoscope was evaluated in two parts: study A, consisting of 339 freshly collected urine samples and study B, consisting of 798 fresh urine samples that were also banked as slides for analysis with the Schistoscope. In both studies, the Schistoscope, conventional microscopy, real-time PCR and UCP-LF CAA were performed and samples with all the diagnostic test results were included in the analysis. All diagnostic procedures were performed in a laboratory located in a rural area of Gabon, endemic for S. haematobium. In study A and B, the Schistoscope demonstrated a sensitivity of 83.1% and 96.3% compared to conventional microscopy, and 62.9% and 78.0% compared to the CRS. The sensitivity of conventional microscopy in study A and B compared to the CRS was 61.9% and 75.2%, respectively, comparable to the Schistoscope. The specificity of the Schistoscope in study A (78.8%) was significantly lower than that of conventional microscopy (96.4%) based on the CRS but comparable in study B (90.9% and 98.0%, respectively). Overall, the performance of the Schistoscope was non-inferior to conventional microscopy with a comparable sensitivity, although the specificity varied. The Schistoscope shows promising diagnostic accuracy, particularly for samples with moderate to higher infection intensities as well as for banked sample slides, highlighting the potential for retrospective analysis in resource-limited settings. NCT04505046 ClinicalTrials.gov.

Background Cryptosporidium is a protozoan parasite that causes mild to severe diarrhoeal disease in humans. To date, several commercial companies have developed rapid immunoassays for the detection of Cryptosporidium infection. However, the challenge is to identify an accurate, simple and rapid diagnostic tool for the estimation of cryptosporidiosis burden. This study aims at evaluating the accuracy of CerTest Crypto, a commercialized rapid diagnostic test (RDT) for the detection of Cryptosporidium antigens in the stool of children presenting with diarrhoea. Methods A cross-sectional study was conducted in four study sites in Sub-Saharan Africa (Gabon, Ghana, Madagascar, and Tanzania), from May 2017 to April 2018. Stool samples were collected from children under 5 years with diarrhoea or a history of diarrhoea within the last 24 hours. All specimens were processed and analyzed using CerTest Crypto RDT against a composite diagnostic panel involving two polymerase chain reaction (PCR) tests (qPCR and RFLP-PCR,) as the gold standard. Results A total of 596 stool samples were collected. Evaluation of the RDT yielded a very low overall sensitivity of 49.6% (confidence interval (CI) 40.1-59.0), a specificity of 92.5% (CI 89.8-94.7), positive predictive value of 61.3% (CI 50.6-71.2), and negative predictive value of 88.5% (85.3-91.1) when compared to the composite reference standard of qPCR and RFLP-PCR for the detection of Cryptosporidium species. Moreover, the performance of this test varied across different sites. Conclusion The weak performance of the studied RDT suggests the need to carefully evaluate available commercial RDTs before their use as standard tools in clinical trials and community survey of Cryptosporidium infections in pediatric cohorts.

Background: Polyparasitic infections remain widespread in endemic regions, yet its contributing factors and health impact are not well understood. This study aims to estimate the prevalence and associated factors and examines the effect of polyparasitic infection on haemoglobin levels among children. Methods: A cross-sectional study was conducted in Lambaréné, Gabon, among children aged 2–17 years from November 2019 to December 2020. Haemoglobin levels, environmental conditions, and sociodemographic data were collected. Stool, urine, and blood samples were analysed using light microscopy for parasite detection. Factors associated with polyparasitism were explored. Results: Out of 656 participants, 65.4% had at least one infection, with intestinal protozoa species (21.3%), Trichuris trichiura (33%), Ascaris lumbricoides (22%), Schistosoma haematobium (20%), and Plasmodium falciparum (10%) being the most common. Polyparasitic infection was identified in 26% of children, mostly as bi-infections (69.2%), and was negatively associated with haemoglobin levels (β = −0.06). Conclusions: These findings emphasise the burden of polyparasitic infections and adverse health effects in Lambaréné, Gabon.

Protozoa and helminths cause significant morbidity and mortality, particularly in tropical and subtropical regions where an accurate understanding of their epidemiological profile is needed to improve their control. In Gabon, a country endemic for a diverse range of both helminths and protozoa, epidemiological data for protozoa are lacking, whereas updated data for helminths are needed. This study aimed to describe the distribution of helminth and protozoan infections in the Moyen-Ogooué province of Gabon. This cross-sectional study included individuals aged one year and older living in the study areas for at least one year. The participants were selected via a stratified sampling procedure. Blood, urine, and stool samples, along with sociodemographic data, were collected. Soil-transmitted helminths (STHs) were diagnosed using the Kato-Katz, coproculture and Harada-Mori techniques. Urogenital schistosomiasis was diagnosed using the urine filtration technique. Intestinal protozoa were diagnosed using the mercurothiolate-iodine-formol technique. Plasmodium spp. and filarial infections were diagnosed by thick blood smear microscopy, and, in addition for filaria, by leucoconcentration technique. A total of 1,084 participants were included, with a mean age of 31.6 years (SD: 23.6) and a female-to-male sex ratio of 1.15. The overall prevalence of helminth infections was 36% (95%IC: 33-39), with STHs being most common (21%; 95%CI: 18-23), followed by schistosomiasis (11%; 95%CI: 8 - 13) and filariasis (9%; 95%CI: 7-10). The most prevalent STH species were Trichuris trichiura (11%; 95%CI: 10-14), followed by hookworm (9%; 95%CI: 8-11). The prevalence of Plasmodium spp. was 13% (95%CI: 11-15), and the overall prevalence of intestinal protozoa was 28% (95%CI: 25-31), with Blastocystis hominis (11%; 95%CI: 9-13) and Entamoeba coli (8%; 95%CI: 7-10) being the most common intestinal protozoan species. Coinfections with multiple parasite species were observed in 42% of the infected participants, predominantly involving T. trichiura, Schistosoma haematobium, and Plasmodium spp. infection prevalence varied with age, gender, location, and occupation. This study reveals a moderate prevalence of helminths and protozoa in our community, with age, gender, and location playing a significant role in their distribution, as do common coinfections between helminths and protozoa. These findings call for further research to provide valuable insights for controlling helminth transmission in the region.

Background Rotavirus A (RVA) infections remain a major cause of severe acute diarrhea affecting children worldwide. To date, rapid diagnostic tests (RDT) are widely used to detect RVA. However, paediatricians question whether the RDT can still detect the virus accurately. Therefore, this study aimed to evaluate the performance of the rapid rotavirus test in comparison to the one-step RT-qPCR method. Methods A cross-sectional study was conducted in Lambaréné, Gabon, from April 2018 to November 2019. Stool samples were collected from children under 5 years of age with diarrhoea or a history of diarrhoea within the last 24 h, and from asymptomatic children from the same communities. All stool samples were processed and analysed using the SD BIOLINE Rota/Adeno Ag RDT against a quantitative reverse transcription PCR (RT-qPCR), which is considered the gold standard. Results For a total of 218 collected stool samples, the overall sensitivity of the RDT was 46.46% (confidence interval (CI) 36.38–56.77), with a specificity of 96.64% (CI 91.62–99.08) compared to one-step RT-qPCR. After confirming the presence or absence of RVA gastroenteritis, the RDT showed suitable results in detecting rotavirus A-associated disease, with a 91% concordance with the RT-qPCR. Furthermore, the performance of this test varied when correlated with seasonality, symptoms, and rotavirus genotype. Conclusion This RDT showed high sensitivity and was suitable for the detection of RVA in patients with RVA gastroenteritis, although some asymptomatic RVA shedding was missed by RT-qPCR. It could be a useful diagnostic tool, especially in low-income countries.

Enteric viruses are the leading cause of diarrhea in children globally. Identifying viral agents and understanding their genetic diversity could help to develop effective preventive measures. This study aimed to determine the detection rate and genetic diversity of four enteric viruses in Gabonese children aged below five years. Stool samples from children <5 years with (n = 177) and without (n = 67) diarrhea were collected from April 2018 to November 2019. Norovirus, astrovirus, sapovirus, and aichivirus A were identified using PCR techniques followed by sequencing and phylogenetic analyses. At least one viral agent was identified in 23.2% and 14.9% of the symptomatic and asymptomatic participants, respectively. Norovirus (14.7%) and astrovirus (7.3%) were the most prevalent in children with diarrhea, whereas in the healthy group norovirus (9%) followed by the first reported aichivirus A in Gabon (6%) were predominant. The predominant norovirus genogroup was GII, consisting mostly of genotype GII.P31-GII.4 Sydney. Phylogenetic analysis of the 3CD region of the aichivirus A genome revealed the presence of two genotypes (A and C) in the study cohort. Astrovirus and sapovirus showed a high diversity, with five different astrovirus genotypes and four sapovirus genotypes, respectively. Our findings give new insights into the circulation and genetic diversity of enteric viruses in Gabonese children.

Purpose: To assess the efficacy of three proposed anthelminthic combination regimens for the treatment of strongyloidiasis using real-time polymerase chain reaction (real-time PCR) diagnostic method. Methods: We conducted an interventional randomized assessor-blinded clinical trial in which participants positive for strongyloidiasis were treated with three different therapeutic regimens: albendazole (ABZ) once a day for three days, and ABZ on days 1 and 3 associated with mebendazole (MBZ) or pyrantel (PYR) on day 2, respectively. All participants were seen after treatment for drug efficacy assessment. Microscopy methods and real-time PCR analysis were used for the diagnosis of strongyloidiasis, and the proportions of positive cases were compared between the two tests. Cure rate (CR) was reported to describe the efficacy of each treatment regimen. Risk factors for strongyloidiasis were assessed. Results: Fifty-nine of the 272 participants included in the study were positive for S. stercoralis infection at baseline as determined by either microscopy and/or PCR. The PCR-positive cases were 3.92 times higher than microscopy positive cases. The microscopy- and PCR-based corrected CRs were 100% and 68% (95%CI: 53–81), respectively. The CR was greater for the ABZ-ABZ-ABZ (77%; 95%CI: 55–92) than for the ABZ-MBZ-ABZ (69%; 95%CI: 39–91) or ABZ-PYR-ABZ (50%; 95%CI: 21–79) regimens, but the difference was not statistically significant. None of the factors investigated (age, sex, or location) were associated with either being infected with S. stercoralis in our cohort or being cured. Conclusion: Our findings indicate that on the one hand, the need for a more sensitive method than current microscopy for the diagnosis of strongyloidiasis and on the other hand ABZ alone repeated over three days has better efficacy for the treatment of strongyloidiasis than alternating ABZ with MBZ or PYR for the same period of treatment. However, its efficacy remains limited, raising the necessity for the development of alternative treatments. Clinical trial: Registered at ClinicalTrials.gov (NCT04326868) on March 04, 2020.