Efficacy of triage parasite panel in diagnosis of Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum antigens in symptomatic children stool specimens

Background: Parasitosis are one of the most widespread and destructive infections all over the world, which lead to millions of annual morbidities and mortalities. Delay in diagnosis and treatment may lead to fatality. So, rapid and accurate diagnosis plays a critical role in patient’s management.
Aim: Evaluation of immunochromatographic test (ICT) combi, for copro-antigen detection of amebiasis, giardiasis and cryptosporidiosis compared with microscopy and ELISA.
Methodology: A total of 95 stool samples. Group 1: Included 70 stool samples from symptomatic children complaining of gastrointestinal symptoms suggestive of intestinal amebiasis, giardiasis, and cryptosporidiosis. Group 2: Included 25 stool samples from healthy asymptomatic children. Samples examined by direct wet saline smear or stained with iodine, formol-ether sed. concentration technique, staining with modified Ziehl-Neelsen and antigen detection using ICT and ELISA. Microscopic examination was taken as standard reference and the sensitivity and specificity of the ICT (combi) was measured in comparison with copro- ELLISA.
Results: Our study revealed non-significant difference in age, sex, and residence between symptomatic children and controls p>0.5. Of 70 stool specimens, 25 were confirmed as true positives for Entameba histolytica/dispar, 30 for Giardia, and 11 for Cryptosporidium by wet mount microscopy directly or after using formol-ether concentration method and modified Ziehl-Neelsen staining for the detection of C. parvum. The sensitivities and specificities of ICT (combi)  for, Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum were 80.0%, 76.7%, 81.8%,  and 88 % , 84%, 96%   respectively. The sensitivities and specificities of Techlab copro-ELISA for Entamoeba, Giardia, and Cryptosporidium were 64.3%, 70%, 90.9%, and 100 % , 88%, 92% respectively.
Conclusion: ICTs (combi) are simple, fast, highly sensitive and specific can be used for rapid screening and diagnosis of amebiasis, giardiasis and cryptosporidiosis and able to recognize species in different parasite genera as Cryptosporidium, and Entamoeba. Also, differentiate pathogenic E. histolytica from nonpathogenic E. dispar. It can be used in combination with microscopy in symptomatic children having repeated negative results.