Multicenter evaluation of BD max enteric parasite real-time PCR assay for detection of Giardia duodenalis, Cryptosporidium hominis, Cryptosporidium parvum, and Entamoeba histolytica

S. Madison-Antenucci, Ryan Relich, L. Doyle, N. Espina, D. Fuller, T. Karchmer, A. Lainesse, J. E. Mortensen, P. Pancholi, W. Veros, S. M. Harrington

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Common causes of chronic diarrhea among travelers worldwide include protozoan parasites. The majority of parasitic infections are caused by Giardia duodenalis, Entamoeba histolytica, Cryptosporidium parvum, and Cryptosporidium hominis. Similarly, these species cause the majority of parasitic diarrhea acquired in the United States. Detection of parasites by gold standard microscopic methods is time-consuming and requires considerable expertise; enzyme immunoassays and direct fluorescentantibody (DFA) stains have lowered hands-on time for testing, but improvements in sensitivity and technical time may be possible with a PCR assay. We performed a clinical evaluation of a multiplex PCR panel, the enteric parasite panel (EPP), for the detection of these common parasites using the BD Max instrument, which performs automated extraction and amplification. A total of 2,495 compliant specimens were enrolled, including 2,104 (84%) specimens collected prospectively and 391 (16%) specimens collected retrospectively. Approximately equal numbers were received in 10% formalin (1,273 specimens) and unpreserved (1,222 specimens). The results from the EPP were compared to those from alternate PCR and bidirectional sequencing (APCR), as well as DFA (G. duodenalis and C. parvum or C. hominis) or trichrome stain (E. histolytica). The sensitivity and specificity for prospective and retrospective specimens combined were 98.2% and 99.5% for G. duodenalis, 95.5% and 99.6 for C. parvum or C. hominis, and 100% and 100% for E. histolytica, respectively. The performance of the FDA-approved BD Max EPP compared well to the reference methods and may be an appropriate substitute for microscopic examination or immunoassays.

Original languageEnglish (US)
Pages (from-to)2681-2688
Number of pages8
JournalJournal of clinical microbiology
Volume54
Issue number11
DOIs
StatePublished - Nov 1 2016

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Cryptosporidium parvum
Giardia lamblia
Cryptosporidium
Entamoeba histolytica
Real-Time Polymerase Chain Reaction
Parasites
Diarrhea
Polymerase Chain Reaction
Parasitic Diseases
Multiplex Polymerase Chain Reaction
Immunoenzyme Techniques
Immunoassay
Formaldehyde
Coloring Agents
Sensitivity and Specificity

ASJC Scopus subject areas

  • Microbiology (medical)

Cite this

Multicenter evaluation of BD max enteric parasite real-time PCR assay for detection of Giardia duodenalis, Cryptosporidium hominis, Cryptosporidium parvum, and Entamoeba histolytica. / Madison-Antenucci, S.; Relich, Ryan; Doyle, L.; Espina, N.; Fuller, D.; Karchmer, T.; Lainesse, A.; Mortensen, J. E.; Pancholi, P.; Veros, W.; Harrington, S. M.

In: Journal of clinical microbiology, Vol. 54, No. 11, 01.11.2016, p. 2681-2688.

Research output: Contribution to journalArticle

Madison-Antenucci, S, Relich, R, Doyle, L, Espina, N, Fuller, D, Karchmer, T, Lainesse, A, Mortensen, JE, Pancholi, P, Veros, W & Harrington, SM 2016, 'Multicenter evaluation of BD max enteric parasite real-time PCR assay for detection of Giardia duodenalis, Cryptosporidium hominis, Cryptosporidium parvum, and Entamoeba histolytica', Journal of clinical microbiology, vol. 54, no. 11, pp. 2681-2688. https://doi.org/10.1128/JCM.00765-16
Madison-Antenucci, S. ; Relich, Ryan ; Doyle, L. ; Espina, N. ; Fuller, D. ; Karchmer, T. ; Lainesse, A. ; Mortensen, J. E. ; Pancholi, P. ; Veros, W. ; Harrington, S. M. / Multicenter evaluation of BD max enteric parasite real-time PCR assay for detection of Giardia duodenalis, Cryptosporidium hominis, Cryptosporidium parvum, and Entamoeba histolytica. In: Journal of clinical microbiology. 2016 ; Vol. 54, No. 11. pp. 2681-2688.
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abstract = "Common causes of chronic diarrhea among travelers worldwide include protozoan parasites. The majority of parasitic infections are caused by Giardia duodenalis, Entamoeba histolytica, Cryptosporidium parvum, and Cryptosporidium hominis. Similarly, these species cause the majority of parasitic diarrhea acquired in the United States. Detection of parasites by gold standard microscopic methods is time-consuming and requires considerable expertise; enzyme immunoassays and direct fluorescentantibody (DFA) stains have lowered hands-on time for testing, but improvements in sensitivity and technical time may be possible with a PCR assay. We performed a clinical evaluation of a multiplex PCR panel, the enteric parasite panel (EPP), for the detection of these common parasites using the BD Max instrument, which performs automated extraction and amplification. A total of 2,495 compliant specimens were enrolled, including 2,104 (84{\%}) specimens collected prospectively and 391 (16{\%}) specimens collected retrospectively. Approximately equal numbers were received in 10{\%} formalin (1,273 specimens) and unpreserved (1,222 specimens). The results from the EPP were compared to those from alternate PCR and bidirectional sequencing (APCR), as well as DFA (G. duodenalis and C. parvum or C. hominis) or trichrome stain (E. histolytica). The sensitivity and specificity for prospective and retrospective specimens combined were 98.2{\%} and 99.5{\%} for G. duodenalis, 95.5{\%} and 99.6 for C. parvum or C. hominis, and 100{\%} and 100{\%} for E. histolytica, respectively. The performance of the FDA-approved BD Max EPP compared well to the reference methods and may be an appropriate substitute for microscopic examination or immunoassays.",
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AU - Relich, Ryan

AU - Doyle, L.

AU - Espina, N.

AU - Fuller, D.

AU - Karchmer, T.

AU - Lainesse, A.

AU - Mortensen, J. E.

AU - Pancholi, P.

AU - Veros, W.

AU - Harrington, S. M.

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