Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2025
Evaluation of rectal swab compared with bulk stool sampling for detection of Cryptosporidium infection by light-emitting diode auramine-phenol microscopy in young children with diarrhoea.
СтатьяСравнительное исследованиеОценочное исследованиеНазвание и аннотация: Перевод в очереди
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Abate Degu, Robertson Lucy J, Seyoum Berhanu, Dessie Yadeta, Carmena David, Johansen Øystein Haarklau, Tschopp Rea, Abdissa Alemseged, Hanevik Kurt
Аннотация
OBJECTIVES: Traditionally, the detection of intestinal parasites, including Cryptosporidium, has relied on microscopic examination of bulk stool samples. However, obtaining bulk stool samples requires waiting time, collection can be messy, and children may not readily produce a sample, particularly if severely dehydrated. This study aimed to evaluate the diagnostic performance of rectal swab samples in comparison with bulk stool samples for the point-of-care diagnosis of cryptosporidiosis using light-emitting diode auramine-phenol (LED-AP) fluorescence microscopy.
METHODS: A cross-sectional study was conducted among diarrhoeic children aged 1-59 months attending six health centres in Dire Dawa and Shinile, Eastern Ethiopia. Both rectal swabs and bulk stool samples were collected, stained with auramine-phenol and examined for Cryptosporidium spp. oocysts using LED-AP fluorescence microscopy, blinded to the results obtained from the corresponding sample. The diagnostic performance of rectal swabs was evaluated against bulk stool results by estimating sensitivity, specificity, positive and negative predictive values, and the kappa coefficient. McNemar's test was used to assess whether discordant results between rectal swabs and bulk stools were statistically significant.
RESULTS: Stool and rectal swab samples were obtained from 485 children with median age of 16 months (interquartile range: 12-28). Most children (71.5%, 347/485) were below 2 years of age. Cryptosporidium was detected in 19.4% (94/485) of stool and 17.1% (83/485) of rectal swab samples by LED-AP fluorescence microscopy, with 96.9% (95% CI 95.0-98.3%) overall concordance. Compared with bulk stools, rectal swabs showed 86.2% (95% CI 83.1-89.2%) sensitivity, 99.5% (95% CI 98.5-100.0%) specificity, and excellent agreement (κ = 0.90, 95% CI 0.81-0.99). Oocyst numbers were consistently higher in bulk stool samples than in rectal swabs.
CONCLUSIONS: Rectal swabs demonstrated high diagnostic accuracy and excellent agreement with bulk stools, supporting their use as a reliable and practical alternative when rapid results are needed or stool collection is challenging.
METHODS: A cross-sectional study was conducted among diarrhoeic children aged 1-59 months attending six health centres in Dire Dawa and Shinile, Eastern Ethiopia. Both rectal swabs and bulk stool samples were collected, stained with auramine-phenol and examined for Cryptosporidium spp. oocysts using LED-AP fluorescence microscopy, blinded to the results obtained from the corresponding sample. The diagnostic performance of rectal swabs was evaluated against bulk stool results by estimating sensitivity, specificity, positive and negative predictive values, and the kappa coefficient. McNemar's test was used to assess whether discordant results between rectal swabs and bulk stools were statistically significant.
RESULTS: Stool and rectal swab samples were obtained from 485 children with median age of 16 months (interquartile range: 12-28). Most children (71.5%, 347/485) were below 2 years of age. Cryptosporidium was detected in 19.4% (94/485) of stool and 17.1% (83/485) of rectal swab samples by LED-AP fluorescence microscopy, with 96.9% (95% CI 95.0-98.3%) overall concordance. Compared with bulk stools, rectal swabs showed 86.2% (95% CI 83.1-89.2%) sensitivity, 99.5% (95% CI 98.5-100.0%) specificity, and excellent agreement (κ = 0.90, 95% CI 0.81-0.99). Oocyst numbers were consistently higher in bulk stool samples than in rectal swabs.
CONCLUSIONS: Rectal swabs demonstrated high diagnostic accuracy and excellent agreement with bulk stools, supporting their use as a reliable and practical alternative when rapid results are needed or stool collection is challenging.