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A Research Agenda for Helminth Diseases of Humans: Diagnostics for Control and Elimination Programmes

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      Abstract

      Diagnostic tools appropriate for undertaking interventions to control helminth infections are key to their success. Many diagnostic tests for helminth infection have unsatisfactory performance characteristics and are not well suited for use in the parasite control programmes that are being increasingly implemented. Although the application of modern laboratory research techniques to improve diagnostics for helminth infection has resulted in some technical advances, uptake has not been uniform. Frequently, pilot or proof of concept studies of promising diagnostic technologies have not been followed by much needed product development, and in many settings diagnosis continues to rely on insensitive and unsatisfactory parasitological or serodiagnostic techniques. In contrast, PCR-based xenomonitoring of arthropod vectors, and use of parasite recombinant proteins as reagents for serodiagnostic tests, have resulted in critical advances in the control of specific helminth parasites. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR) was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, the diagnostic technologies relevant to control of helminth infections, either available or in development, are reviewed. Critical gaps are identified and opportunities to improve needed technologies are discussed.

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          Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis.

          More than a quarter of the human population is likely infected with soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) in highly endemic areas. Preventive chemotherapy is the mainstay of control, but only 4 drugs are available: albendazole, mebendazole, levamisole, and pyrantel pamoate. To assess the efficacy of single-dose oral albendazole, mebendazole, levamisole, and pyrantel pamoate against A lumbricoides, hookworm, and T trichiura infections. A systematic search of PubMed, ISI Web of Science, ScienceDirect, the World Health Organization library database, and the Cochrane Central Register of Controlled Trials (1960 to August 2007). From 168 studies, 20 randomized controlled trials were included. Information on study year and country, sample size, age of study population, mean infection intensity before treatment, diagnostic method used, time between evaluations before and after treatment, cure rate (the percentage of individuals who became helminth egg negative following treatment with an anthelminthic drug), egg reduction rate, adverse events, and trial quality was extracted. Relative risk, including a 95% confidence interval (CI), was used to measure the effect of the drugs on the risk of infection prevalence with a random-effects model. Single-dose oral albendazole, mebendazole, and pyrantel pamoate for infection with A lumbricoides resulted in cure rates of 88% (95% CI, 79%-93%; 557 patients), 95% (95% CI, 91%-97%; 309 patients), and 88% (95% CI, 79%-93%; 131 patients), respectively. Cure rates for infection with T trichiura following treatment with single-dose oral albendazole and mebendazole were 28% (95% CI, 13%-39%; 735 patients) and 36% (95% CI, 16%-51%; 685 patients), respectively. The efficacy of single-dose oral albendazole, mebendazole, and pyrantel pamoate against hookworm infections was 72% (95% CI, 59%-81%; 742 patients), 15% (95% CI, 1%-27%; 853 patients), and 31% (95% CI, 19%-42%; 152 patients), respectively. No pooled relative risks could be calculated for pyrantel pamoate against T trichiura and levamisole for any of the parasites investigated. Single-dose oral albendazole, mebendazole, and pyrantel pamoate show high cure rates against A lumbricoides. For hookworm infection, albendazole was more efficacious than mebendazole and pyrantel pamoate. Treatment of T trichiura with single oral doses of current anthelminthics is unsatisfactory. New anthelminthics are urgently needed.
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            Author and article information

            Affiliations
            [1 ]Queensland Institute of Medical Research, University of Queensland, Herston, Australia
            [2 ]Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, United States of America
            [3 ]Department of Schistosomiasis Control, Jiangsu Institute of Parasitic Diseases, Jiangsu, People's Republic of China
            [4 ]High Institute of Public Health, Alexandria University, Alexandria, Egypt
            [5 ]Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
            [6 ]Tropical Disease Research Laboratory, Division of Experimental Pathology, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
            [7 ]Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
            [8 ]Institute of Parasitology, McGill University, Montreal, Canada
            [9 ]Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
            London School of Hygiene & Tropical Medicine, United Kingdom
            Author notes
            Contributors
            Role: Editor
            Journal
            PLoS Negl Trop Dis
            PLoS Negl Trop Dis
            plos
            plosntds
            PLoS Neglected Tropical Diseases
            Public Library of Science (San Francisco, USA )
            1935-2727
            1935-2735
            April 2012
            24 April 2012
            : 6
            : 4
            3335877
            22545166
            PNTD-D-11-01002
            10.1371/journal.pntd.0001601
            (Editor)
            McCarthy et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
            Counts
            Pages: 13
            Categories
            Review
            Medicine
            Infectious Diseases
            Neglected Tropical Diseases
            Clonorchiasis
            Echinococcosis
            Food-Borne Trematodes
            Hookworm
            Loiasis
            Lymphatic Filariasis
            Neurocysticercosis
            Onchocerciasis
            Opisthorchiasis
            Schistosomiasis
            Soil-Transmitted Helminths
            Parasitic Diseases
            Filariasis
            Helminth Infection
            Taeniasis
            Trichuriasis

            Infectious disease & Microbiology

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