Table 6.

Diagnostic test characteristics and resource requirements of protocols identified in this systematic review for surveillance of Echinococcus multilocularis in canids, humans, and/or the environment (2008–2018).

Diagnostic test	Through-puta	Equipment requirements	Sn% (95%CI)b	Sp% (95%CI)c	Notes	Citation
Canids - post-mortem intestinal examination
Sedimentation & Counting Technique (SCT)	Low	Biosafety space and/or −80 °C freezer, microscope	88.5 (82.7–93.4)	100	-Requires skilled microscopist -Sample quality impacts cestode identification -Quantifying worm burden can be time intensive	Otero-Abad et al., 2017
Segmental Sedimentation & Counting Technique	Low	Biosafety space and/or −80 °C freezer, microscope	56.4–98.3 (depending on segment)	<100	-See SCT notes -Selective examination of E. multilocularis predilection sites to increase throughput -Lower intensity estimate accuracy than SCT	Umhang et al., 2011
Canids – fecal examination
Arecoline hydrobromide purgation	Low	Microscope	21 (11–34)	100	-Not all canids purge after arecoline dose -Canids must be restrained -Adverse effects possible; contraindicated for pregnant bitches, puppies, and older canids	Ziadinov et al., 2008
Taeniid egg recovery/multiplex PCRd	Low	−80 °C freezer, centrifuge, PCR thermocycler, gel electrophoresis system, UV visualization	(1) 50 (29–72) (2) 54.8 (48.5–61)	(1) 100 (97–100) (2) 93.4 (87.3–99.1)	-Requires skilled technician -Detection depends on egg recovery assay, DNA extraction technique, and PCR protocol	(1) Ziadinov et al., 2008; (2) Otero-Abad et al., 2017
Copro-DNA/PCR (various DNA extraction kits/PCR system combinations)	Low	−80 °C freezer, microcentrifuge, PCR/qPCR system	QIAamp/QT-qPCR: 81 QIAamp/PCR: 52	QIAamp/QT-qPCR: 100 QIAamp/PCR: 100	-Requires skilled technician -DNA extraction kits limited to 0.15–0.5 g/reaction -Copro-inhibitors impact extraction	Maksimov et al., 2017
Copro-antigen ELISAe	High	Incubator, ELISA plate washer, ELISA reader	Monoclonal: 63.2 (55.3–70.8) Polyclonal: 56 (48.0–63.9)	Monoclonal: 70.0 (60.1–79.4) Polyclonal: 65.9 (55.8–75.6)	-Requires skilled technician -Detects patent and pre-patent infections -Sensitivity depends on worm burden	Otero-Abad et al., 2017
Magnetic Capture RT-PCR	Moderate	−80 °C freezer, Tissue homogenizer, magnet, rotator, heat block, RT-PCR system	88.2 (79.8–93.9)	99.9 (99.7–100)	-Requires skilled technician -Throughput can be optimized using an automated nucleic acid extraction robot	Isaksson et al., 2014
Canids – serology
EUROLINE®-WB (IgG, rEm18, rEm95, rEgAgB)	Moderate	SDS-PAGE electrophoresis machine, incubator, UV visualization	100 (74–100)	98 (91–100)	-Requires skilled technician -Commercially available; recombinant antigens widely available	Frey et al., 2017
Western Blot (EmVF)	Moderate	SDS-PAGE electrophoresis machine, incubator, UV visualization	100 (77–100)	100 (94–100)	-Requires skilled technician	Frey et al., 2017
ELISA (EmVF, Em2, rEm95, rEm18)	High	Incubator, ELISA plate washer, ELISA reader	EmVF: 100 (78–100) Em2: 79 (52–92) rEm18: 79 (52–92) rEm95: 100 (72–100)	EmVF: 85 (74–92) Em2: 97 (89–99) rEm18: 85 (74–92) rEm95: 100 (93–100)	-Requires skilled technician -Throughput can be optimized using an automated robot	Frey et al., 2017
Humans – serology
Em2-DIGFAf	High	DIGFA test kit	77.8	97.1	-Commercially available -Rapid diagnostic test suitable for field conditions	Feng et al., 2010
Antibody Gold Immuno-chromatographic assay	High	Immunochromatographic test kit	97.5g	95.8	-Commercially available -Rapid diagnostic test suitable for field conditions	Gao et al., 2018
Environment – soil
Taeniid egg recovery/RT-PCR	Low	−80 °C freezer, centrifuge, RT-PCR system	33–100	NR	-Requires skilled technician -Detection depends on egg recovery assay, DNA extraction technique and PCR primers	Umhang et al., 2017

^aLow - <20 samples/technician/day; Moderate - 21–50 samples/technician/day; High - >50 samples/technician/day.

^bSensitivity.

^cSpecificity.

^dMultiplex Polymerase Chain Reaction using Trachsel et al., 2007 primers

^eEnzyme-linked Immunosorbent Assay.

^fDot Immunogold Filtration Assay.

^gOther test characteristics: PLR: 23.0 (17.3–30.7); NLR: 0.03 (0.01–0.07); PPV: 78.2 (72.8–82.7); NPV: 99.6 (99.0–99.9); Accuracy: 96 (94.8–97.0).