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Background  Clonorchiasis is a chronic neglected disease caused by a liver fluke,  Clonorchis sinensis . Chemotherapy is the mainstay of control and treatment efficacy is usually determined by microscopic examination of fecal samples. We assessed the diagnostic accuracy of the Kato-Katz method and the formalin-ether concentration technique (FECT) for  C. sinensis  diagnosis, and studied the effect of diagnostic approach on drug efficacy evaluation.    Methods  Overall, 74 individuals aged ≥18 years with a parasitological confirmed  C. sinensis  infection at baseline were re-examined 3 weeks after treatment. Before and after treatment, two stool samples were obtained from each participant and each sample was subjected to triplicate Kato-Katz thick smears and a single FECT examination.    Results  Thirty-eight individuals were still positive for  C. sinensis  according to our diagnostic ‘gold’ standard (six Kato-Katz thick smears plus two FECT). Two FECT had a significantly lower sensitivity than six Kato-Katz thick smears (44.7%  versus  92.1%;  p  <0.001). Examination of single Kato-Katz and single FECT considerably overestimated cure rates.    Conclusions  In settings where molecular diagnostic assays are absent, multiple Kato-Katz thick smears should be examined for an accurate diagnosis of  C. sinensis  infection and for assessing drug efficacy against this liver fluke infection.

parasites and vectors

Accuracy of the Kato-Katz method and formalin-ether concentration technique for the diagnosis of Clonorchis sinensis, and implication for assessing drug efficacy