Fasciola hepatica: can the coproantigen ELISA replace the faecal egg sedimentation test?

Question In adult cattle, is the sensitivity of the coproantigen ELISA test equal or superior to the sensitivity of the faecal egg sedimentation test for the diagnosis of Fasciola hepatica?   Clinical bottom line The category of research question was: Diagnosis. The number and type of study designs that were critically appraised were: Three studies were appraised. This included two cross-sectional diagnostic accuracy studies and one case control diagnostic accuracy study. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Moderate. The outcomes reported are summarised as follows… The first study reported the findings from 619 tested cattle over 3 sample periods comparing the sensitivity and specificity of the different tests. The sensitivity of the faecal egg sedimentation test varied greatly between the sample periods from 0.81 (95% beta coefficient (BCI) 0.72–0.90) to 0.58 (95% BCI 0.43–0.72) with the coproantigen ELISAs sensitivity remaining consistent at 0.77 (95% BCI 0.64–0.88) throughout. The second study reported the findings of 200 tested cattle over 2 sampling periods comparing the sensitivity and specificity of the different tests. The mean sensitivity of the coproantigen ELISA was significantly higher than the 4 g/10 g preparations of the faecal egg sedimentation tests at 94% (95% CI 87%–98%) (P < 0.001).  The third study reported the findings of Coproantigen ELISA testing on 250 bovine faecal samples with 94 confirmed positive for liver fluke via faecal sedimentation testing. The sensitivity of the coproantigen ELISA was 80% and the specificity was 100% compared with 70% and 80% respectively for the faecal egg sedimentation test. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… All three studies demonstrated either an increased or equivalent sensitivity of the coproantigen ELISA to the faecal sedimentation test, but only one study reported a statistically significant increase in test sensitivity. Whilst all three studies were diagnostic accuracy validity studies, the systematic sampling strategy of one study was superior to the convenience sampling method of one of the other studies and to the case control method of the other. Several sources of bias also exist within the included studies. Sampling and selection bias is present in the two of studies due to the animals selected only being sampled over one year. The results of these studies are susceptible to changes in the fluke lifecycle of that year, and the sampled animals are more likely to be fit and well-conditioned as they are presenting for slaughter, and as such are less likely to carry significant/chronic fluke burdens. All three studies are susceptible to validity issues due to an absence of clinical information regarding flukicide treatment and concurrent parasitic diseases which, whilst not impacting the efficacy of diagnostic testing, may cause issues if the studies are to be repeated. The coproantigen ELISA can be utilised as a suitable adjunctive test to aid in the diagnosis of Fasciola hepatica in adult cattle and has the scope to be used as an early diagnostic test, but whilst the results of the reported studies indicate that the coproantigen ELISA is an accurate and reliable test, it does not provide definitive evidence to warrant the discontinuation of the simple and affordable faecal egg sedimentation test. In order to come to a conclusion regarding the more sensitive test more literature is required that directly compares the coproantigen ELISA to the faecal egg sedimentation test in different clinical scenarios and exploring different diagnostic techniques.