Accuracy of urine circulating cathodic antigen (CCA) test for Schistosoma mansoni diagnosis in different settings of Côte d'Ivoire

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. methodology: 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. principal findings: 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. conclusion/significance: 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. © 2011 coulibaly et al.