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Background  In an effort to enhance accuracy of diagnosis of  Schistosoma haematobium , this study explores day-to-day variability and diagnostic performance of real-time PCR for detection and quantification of  Schistosoma  DNA compared to other diagnostic tools in an endemic area before and after treatment.    Methodology  Previously collected urine samples (N = 390) from 114 preselected proven parasitological and/or clinical  S. haematobium  positive Kenyan schoolchildren were analyzed by a  Schistosoma  internal transcribed spacer-based real-time PCR after 14 years of storage. Pre-treatment day-to-day fluctuations of PCR and microscopy over three consecutive days were measured for 24 children using intra-class correlation coefficient. A combined ‘gold standard’ (PCR and/or microscopy positive) was used to measure sensitivity and negative predictive value (NPV) of several diagnostic tools at baseline, two and 18 months post-treatment with praziquantel.    Principal Findings  All 24 repeatedly tested children were PCR-positive over three days with little daily variation in median Ct-values, while 83.3% were found to be egg-positive for  S. haematobium  at day 1 and 75.0% at day 2 and 3 pre-treatment, signifying daily fluctuations in microscopy diagnosis. Of all 114 preselected schoolchildren, repeated microscopic measurements were required to detect 96.5% versus 100% of positive pre-treatment cases by single PCR. At two months post-treatment, microscopy and PCR detected 22.8% versus 69.3% positive children, respectively. Based on the ‘gold standard’, PCR showed high sensitivity (>92%) as compared to >31% sensitivity for microscopy, both pre- and post-treatment.    Conclusions/Significance  Detection and quantification of  Schistosoma  DNA in urine by real-time PCR was shown to be a powerful and specific diagnostic tool for detection of  S. haematobium  infections, with less day-to-day variation and higher sensitivity compared to microscopy. The superior performance of PCR before, and two and 18 months post-treatment provides a compelling argument for PCR as an accurate and reproducible tool for monitoring treatment efficacy.

plos neglected tropical diseases

Diagnostic Performance of Schistosoma Real-Time PCR in Urine Samples from Kenyan Children Infected with Schistosoma haematobium: Day-to-day Variation and Follow-up after Praziquantel Treatment