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Volume 22, Number 1—January 2016
Letter

Schistosomiasis Screening of Travelers to Corsica, France

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In Response: Regarding the comments by Berry et al. (1) on our previously published letter, we acknowledge that, in strict parasitological terms, confirmation of the diagnosis of urogenital schistosomiasis requires the identification of eggs by microscopic examination of urine. Nevertheless, we aimed at an operational case definition, providing criteria for identifying cases most likely to be true infections. We should not forget that microscopy has an unacceptably low sensitivity (2). We should also consider that currently available serologic tools are hampered by both a poor sensitivity and a poor specificity for Schistosoma haematobium (3). Regarding immunoblot, Berry et al. are correct in saying that there is not yet any formally published evidence of its accuracy for S. haematobium and that the high specificity declared, close to 100%, is based on data provided by the manufacturer. A formal study on the accuracy of this test is underway at the Centre for Tropical Diseases of Sacro Cuore Hospital. This assay has been less extensively assessed than that in which purified S. mansoni antigen is used, as described previously, which has shown very high accuracy (4). However, Western blot is already accepted as a diagnostic standard for the identification of other infectious diseases, including parasitic infections such as cysticercosis (for which, indeed, the direct parasitological confirmation is often impossible), and has become the test of choice for the latter (5).

Moreover, the population in our study was composed of persons not exposed to other parasites. Therefore, cross-reactions with other helminths would be extremely unlikely.

In conclusion, although we recognize that, by a strictly semantic definition, the term “confirmed” should be reserved for cases for which there is a parasitological proof, in operational terms, we could not rely on a direct test that has such a poor sensitivity in this particular patient population. Had we done so, we would have found a subestimated, and therefore totally incorrect, picture of the true prevalence, leading to inappropriate conclusions and actions (or lack thereof).

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Anna BeltrameComments to Author , Lorenzo Zammarchi, Gianluca Zuglian, Federico Gobbi, Andrea Angheben, Valentina Marchese, Monica Degani, Antonia Mantella, Leila Bianchi, Carlotta Montagnani, Luisa Galli, Matteo Bassetti, Alessandro Bartoloni, and Zeno Bisoffi
Author affiliations: Sacro Cuore Hospital, Negrar, Italy (A. Beltrame, F. Gobbi, A. Angheben, V. Marchese, M. Degani, Z. Bisoffi); Santa Maria Misericordia University Hospital of Udine, Udine, Italy (G. Zuglian, M. Bassetti); University of Florence School of Medicine, Florence, Italy (L. Zammarchi, A. Mantella, A. Bartoloni); Anna Meyer Children’s University Hospital, Florence, Italy (L. Bianchi, C. Montagnani, L. Galli)

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References

  1. Berry  A, Paris  L, Boissier  J, Caume  E. Schistosomiasis screening of travelers to Corsica, France. [zzz.]. Emerg Infect Dis. 2015;•••:21.
  2. Bierman  WF, Wetsteyn  JC, van Gool  T. Presentation and diagnosis of imported schistosomiasis: relevance of eosinophilia, microscopy for ova, and serology. J Travel Med. 2005;12:913. DOIPubMed
  3. Kinkel  HF, Dittrich  S, Bäumer  B, Weitzel  T. Evaluation of eight serological tests for diagnosis of imported schistosomiasis. Clin Vaccine Immunol. 2012;19:94853. DOIPubMed
  4. Sulahian  A, Garin  YJ, Izri  A, Verret  C, Delaunay  P, van Gool  T, Development and evaluation of a Western Blot Kit for diagnosis of schistosomiasis. Clin Diagn Lab Immunol. 2005;12:54851.PubMed
  5. Del Brutto  OH, Rajshekhar  V, White  AC, Tsang  VCW, Nash  TE, Takayanagui  OM, Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001;57:17783. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2201.151590

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Table of Contents – Volume 22, Number 1—January 2016

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Anna Beltrame, Centre for Tropical Diseases, Sacro Cuore Hospital, Via Sempreboni 5, 37024 Negrar, Italy

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Page created: December 18, 2015
Page updated: December 18, 2015
Page reviewed: December 18, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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