Low diagnostic performance of thick blood smears of 50 µl in comparison with direct examination of 10 µl blood and the leukoconcentration technique of 5ml blood among loiasis-suspected patients with low microfilaremia in Gabon, Central Africa, using the STARD-BLCM guidelines.

BACKGROUND: The aim of this study was to determine performance indicators of thick blood smears of 50 µl (TBS-50), following the Standards for the Reporting of Diagnostic Accuracy Studies-Bayesian Latent Class Model (STARD-BLCM) guidelines. TBS-50 was compared with two common parasitological techniques-direct examination of 10 µl blood and a leukoconcentration of 5 ml-for the diagnosis of microfilaremic loiasis. METHODS: The study population was recruited among patients of the Department of Parasitology-Mycology-Tropical Medicine over a period of 1 year. Age, sex, symptoms, and eosinophilia variables were recorded from laboratory registers and medical files. Direct examination of 10 µl of blood, TBS-50, and the leukoconcentration technique with 5 ml of blood were performed for each patient. The classical formula and BLCM were used to determine the diagnostic accuracy of the three techniques as well as the prevalence of microfilaremic loiasis. Three models were built within the framework of BLCM-the BLCM model I and alternative models II and III-for sensitivity analysis. RESULTS: In total, 191 patients consented to be included. The direct blood examination and TBS-50 yielded comparable qualitative and quantitative results. Hence, they are reported together. The prevalence of Loa loa microfilaremia was 9.4% (95% CI 5.7-14.5; n = 18/191) with direct blood examination/TBS-50 and 12.6% [8.2-18.1] (n = 24/191) for leukoconcentration. Comparing TBS-50 with the leukoconcentration method using the classical formula, the sensitivity was 75.0% [53.3-90.2], specificity was 100.0% [97.8-100.0], the positive predictive value was 100.0% [81.5-100.0], and the negative predictive value was 96.5% [92.6-98.7]. The prevalence of microfilaremic loiasis was estimated at 9.7% [6.2-13.7] using BLCM model I. The outputs of BLCM model I showed sensitivity of 78.9% [65.3-90.3], specificity of 100.0% [99.3-100.0], a positive predictive value of 99.1% [87.2-100.0], and a negative predictive value of 93.0% [87.3-97.7] for direct blood examination/TBS-50. CONCLUSIONS: TBS-50 demonstrates low sensitivity relative to two other techniques. In one in five cases, the result will be falsely declared negative using these methods. However, this method can be deployed with limited funds.

Sewage sludge or cattle slurry as pasture fertilisers: comparative cysticercosis and trichostrongylosis risk for grazing cattle.

Sewage sludge and slurry are used as fertilisers on pastures grazed by ruminants. The former may be a source of Taenia saginata, which causes cysticercosis in cattle and taeniosis in man. The latter is a source of digestive tract-strongyles, a major helminth infection in cattle. The interest of application on pastures of these two biowastes is environmental (optimal recycling of biowastes) and agronomic (fertilisation). The parasitic risk and the fertilisation value of such applications on pastures were evaluated during one grazing season. Liquid sewage sludge did induce higher herbage biomass, which corresponded to higher liveweight gains during the first 2 months of grazing, compared to slurry spread pastures and calves grazing them. The sludge group of calves did not acquire live cysticerci and thus the risk was nil under the conditions of the study (delay of 6 weeks between application and grazing). The slurry group of calves did become lightly infected with digestive-tract strongyles, mostly Ostertagia ostertagi. Under the conditions of this experiment, a 6-week delay between application and grazing strongly reduced the risk of infection: it renders compatible the agronomic use and requirements of public or animal health.