Sensitivity of the Point-of-Care Circulating Cathodic Antigen Urine Cassette Test for Diagnosis of Schistosoma mansoni in Low-Endemicity Settings in Cote d'Ivoire

The sensitivity of a point-of-care circulating cathodic antigen (POC-CCA) urine cassette test for diagnosis of Schistosoma mansoni in low-endemicity settings is poorly understood. We conducted a cross-sectional survey in 14 villages in western Cote d'Ivoire and diagnosed children aged 9-12 years for schistosomiasis. Two stool samples were subjected to triplicate Kato-Katz thick smears each for diagnosis of S. mansoni, whereas a single urine sample was examined by POC-CCA for S. mansoni, filtration for Schistosoma haematobium, and reagent strip for microhematuria. According to the Kato-Katz technique, we found 45 out of 681 children positive for S. mansoni (6.6%) with a mean intensity among infected children of 72.2 eggs per gram of stool. Point-of-care circulating cathodic antigen revealed a prevalence of S. mansoni of 33.0% when trace results were considered positive and 12.5% when trace results were considered negative. Eggs of S. haematobium were found in eight participants (1.2%), whereas the prevalence of microhematuria was 13.5%. A single POC-CCA urine cassette test revealed a several-fold higher prevalence of S. mansoni than multiple Kato-Katz thick smears in this low-endemicity area. Our findings have important ramifications for choosing an appropriate diagnostic tool in low-endemic areas that might be targeted for elimination.