Evaluation of polymerase chain reaction as an additional tool for the diagnosis of low-intensity Schistosoma mansoni infection.

The aim of the present study was to evaluate polymerase chain reaction (PCR) as an alternative tool for diagnosing schistosomiasis in individuals with low-level parasite burden from areas of low endemicity or under occasional risk of infection by Schistosoma mansoni. A total of 102 samples were tested in this study using 2 PCR assays utilizing distinct primer pairs. One of the primer pairs was targeted to a highly repeated 121-base pair sequence of S. mansoni, and the other was targeted to Schistosoma 28S rDNA. The samples were divided into 4 groups according to parasite burden of the individual as follows: 16 individuals with schistosomiasis excreting less than 10 eggs per gram of feces (EPG), 18 individuals excreting higher than 10 EPG, 22 individuals with reactive IgG-ELISA against S. mansoni soluble membrane antigen and negative coproscopy, and 46 controls samples including 25 individuals with other intestinal parasites and 21 individuals with negative parasitologic examination. The results obtained with stool samples from individuals with schistosomiasis showed a high sensitivity for PCR as S. mansoni DNA was detected in 91% (31/34) of the samples analyzed. No amplification was observed in 3 stool samples from individuals excreting below 10 EPG. The specificity of the test for both pairs of primers was 100%. In the group of seropositive individuals, S. mansoni DNA was detected in 59% (13/22) of fecal samples, corroborating the serologic results. Overall, PCR can be an important tool for detecting S. mansoni infection in individuals excreting few eggs in feces. Moreover, the determination of the infection through the detection of S. mansoni DNA in stool samples from seropositive individuals represents a new means of confirming the results of IgG-ELISA for schistosomiasis. Therefore, studies in this direction should be encouraged and extended.