Molecular monitoring of the therapeutic effect of Albendazole on Ascaris lumbricoides and Ancylostoma duodenale infected children using conventional multiplex PCR

Abstract

Background: Globally, many individuals are infected with soil-transmitted helminths (STHs) with majority occurring in tropical and subtropical regions of the world. Albendazole (ADZ) is a broad-spectrum anthelmintic used efficiently for STHs control. Upgrading the assessment of ADZ efficacy is important to confirm that drug resistance has not emerged. Objective: To assess the therapeutic efficacy of ADZ in both A. lumbricoides and A. duodenale infections by conventional multiplex PCR. Subjects and Methods: Stool specimens from 191 boys and 123 girls, aged from 2 to 13 years were screened by saline wet mount and iodine stained smears and cellophane thick smears (Kato-Katz technique). All positive cases were given a single oral dose of 400 mg ADZ then 2 weeks later new stool samples were collected and subjected to multiplex PCR. Before medication, anemia assessment (finger prick capillary blood sample) was performed. Results: Prevalence of infection with A. lumbricoides and A. duodenale was 20.7% and 5.4%, respectively. Parasitic infections were more prevalent in age group 7-13 years (59%) than in 2-6 years (41%) respectively. Boys were slightly more affected than girls (52.6% versus 47.4%). Prevalence of parasitic infections among cases living in rural areas proved to be higher than those living in urban areas (65.4% versus 34.6%). Examination for associated anemia showed that 35.9% of infected cases were anemic (Hb level <11.5 mg/dl) versus 9.7% in non-infected cases. Diarrhea and colic were more prevalent in infected cases (39.7% and 62.8%, respectively) than in those that were non-infected (5.5% and 8.9%, respectively). The therapeutic efficacy of ADZ resulted in a cure rate of 93.8% and 88.2% for A. lumbricoides and A. duodenale infections, respectively; with an egg reduction rate (ERR) of 96.1% and 91.2%, respectively. The multiplex PCR sensitivity was 100% for detection of both worms; the specificity was 96.8% and 93.8%, respectively, with diagnostic accuracy of 96.9% and 94.1%, respectively. Conclusion: Multiplex PCR was useful for measurement of the therapeutic efficacy of ADZ as an anthelminthic drug.