Accuracy of diagnostic strategies for detecting Schistosoma mansoni infection in Brazil: A systematic review and meta-analysis.

BACKGROUND: Schistosoma mansoni infection remains a major public health concern in Brazil. Accurate diagnostic methods are essential for monitoring transmission and guiding control and elimination strategies. This systematic review and meta-analysis aimed to assess the performance of diagnostic tests used for S. mansoni infection in Brazil. METHODS: Studies conducted in endemic areas of Brazil that used parasitological methods as the reference standard, reported sensitivity and specificity, and were published through October 2024, were included in the analysis. Diagnostic performance was synthesized using univariate and multivariate meta-analyses, and risk of bias was assessed with QUADAS-2. RESULTS: Thirty-three studies were included; most were conducted in Minas Gerais (63%). The main reference standard was Kato-Katz alone (48%) or combined with other parasitological methods (42.4%). Enzyme-linked immunosorbent (ELISA)-SEA results showed higher accuracy than ELISA-SWAP (81% vs 68%), although both exhibited heterogeneity above 80%. Point-of-care circulating cathodic antigen with trace results interpreted as positive (POC-CCA+) or negative (POC-CCA-) showed similar accuracy (70% vs 73%, respectively), with heterogeneity exceeding 80%. For conventional PCR, PCR-ELISA, real-time PCR, and loop-mediated isothermal amplification (LAMP), accuracy ranged from 67% to 82% (heterogeneity: > 90%. In multivariate analysis, conventional PCR had the highest diagnostic odds ratio (DOR: 99.4), followed by PCR-ELISA (DOR: 12.4), whereas the two POC-CCA reading criteria resulted in lower values (trace-positive: 8.5, trace-negative: 6.1). CONCLUSIONS: Overall, these observations support the use of combined diagnostic strategies and underscore the need for multicenter, methodologically rigorous studies to strengthen surveillance, control, and elimination efforts for Schistosoma mansoni infection in Brazil.