Korean J Parasitol.  2016 Feb;54(1):1-8. 10.3347/kjp.2016.54.1.1.

An Improved PCR-RFLP Assay for Detection and Genotyping of Asymptomatic Giardia lamblia Infection in a Resource-Poor Setting

Affiliations
  • 1Department of Medical Laboratory Science, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia. yousryhawash@gmail.com
  • 2Department of Medical Parasitology, National Liver Institute, Menoufia University, Shebin El-Koom, Menoufia 23513, Egypt.
  • 3Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Shebin El-Koom, Menoufia 23513, Egypt.

Abstract

Laboratory workers, in resource-poor countries, still consider PCR detection of Giardia lamblia more costly and more time-consuming than the classical parasitological techniques. Based on 2 published primers, an in-house one-round touchdown PCR-RFLP assay was developed. The assay was validated with an internal amplification control included in reactions. Performance of the assay was assessed with DNA samples of various purities, 91 control fecal samples with various parasite load, and 472 samples of unknown results. Two cysts per reaction were enough for PCR detection by the assay with exhibited specificity (Sp) and sensitivity (Se) of 100% and 93%, respectively. Taking a published small subunit rRNA reference PCR test results (6%; 29/472) as a nominated gold standard, G. lamblia was identified in 5.9% (28/472), 5.2%, (25/472), and 3.6% (17/472) by PCR assay, RIDA® Quick Giardia antigen detection test (R-Biopharm, Darmstadt, Germany), and iodine-stained smear microscopy, respectively. The percent agreements (kappa values) of 99.7% (0.745), 98.9% (0.900), and 97.7% (0.981) were exhibited between the assay results and that of the reference PCR, immunoassay, and microscopy, respectively. Restriction digestion of the 28 Giardia-positive samples revealed genotype A pattern in 12 and genotype B profile in 16 samples. The PCR assay with the described format and exhibited performance has a great potential to be adopted in basic clinical laboratories as a detection tool for G. lamblia especially in asymptomatic infections. This potential is increased more in particular situations where identification of the parasite genotype represents a major requirement as in epidemiological studies and infection outbreaks.

Keyword

Giardia lamblia; PCR-RFLP; genotype; asymptomatic human infection

MeSH Terms

DNA, Protozoan/genetics
Developing Countries
Feces/parasitology
Genotype
Giardia lamblia/genetics
Giardiasis/*diagnosis
Humans
Microscopy
Parasitology/economics/instrumentation/*methods
*Polymerase Chain Reaction
*Polymorphism, Restriction Fragment Length
Reproducibility of Results
Sensitivity and Specificity
DNA, Protozoan
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