COMPARISON OF THE THICK SMEAR AND KATO-KATZ TECHNIQUES FOR DIAGNOSIS OF

C
INTESTINAL HELMINTH INFECTIONS

A STUDY MADE BY FRED LUCIANO NEVES SANTOS, ELZIO JOS LIMA CERQUEIRA AND NECI MATOS SOARES

REVISTA DA SOCIEDADE BRASILEIRA DE MEDICINA TROPICAL 38(2):196-198, MAR-ABR, 2005

 PRESENTED BY:
AGUILAR, CESS ALEN
DE LUZON,
C ANA
GALLARDO, NIGELL
SILVESTRE, RICHARD
SORVETO, DAYLEDANIEL
TORIANO, SHERWIN
 OBJECTIVE:
THIS STUDY COMPARED THE C EFFICIENCY OF KATO-KATZ
THICK SMEAR AND THICK SMEAR TECHNIQUES FOR
THE DIAGNOSIS OF INTESTINAL HELMINTHS.
 SAMPLE SIZE: 258
TARGET GROUP : SCHOOL-CHILDREN, AGED 6-14,
FROM A PUBLIC SCHOOL
LOCATION : SALINAS DAC MARGARIDA COUNTY,
BAHIA STATE, BRAZIL
DURATION OF STUDY: JANUARY TO JUNE 2001
(INSERT GEOGRAPHICAL BACKGROUND)
 METHODS:
ALL SAMPLES WERE EXAMINED BY THE QUANTITATIVE
KATO-KATZ AND THE QUALITATIVE THICK
C
SMEAR METHODS.
Three slides were prepared per person, and egg-
counts
from Kato-Katz slides were conducted 24 hours after
its preparation.

(insert methodology discussion)

 DATA INTERPRETATION:
THE SENSITIVITY AND SPECIFICITY OF EACH METHOD
C
IN ISOLATION AND OF THE TWO METHODS
TOGETHER WERE CALCULATED USING
EPI-INFO SOFTWARE.
 THE KAPPA STATISTIC WAS USED TO ASSESS THE
CONCORDANCE OF TEST RESULTS OBTAINED
WITH THE TWO INDIVIDUAL TECHNIQUES.
C
MCNEMARS TEST FOR PAIRED PROPORTIONS
WAS USED TO COMPARE THE PREVALENCE OBTAINED
WITH EACH OF THE INDIVIDUAL METHODS.
(INSERT STATISTICAL TOOL DESCRIPTION)
 DATA AND FINDINGS:
THE GATHERED DATA ARE PRESENTED COMPARATIVELY
BETWEEN THE TWO METHODS C (THICK SMEAR AND KATO-
KATZ)
WITH REGARDS TO THE PREVALENCE (TABLE 1) AND THE
SPECIFICITY, SENSITIVITY AND AGREEMENT (TABLE 2).
Table 1 - Prevalence of common intestinal parasites detected by different techniques
of faecal examination in 258 children from a public school in Salinas da Margarida,
County, Bahia, Brazil

(%)
Prevalence
Parasite (eggs Thick smear Kato-Katz Thick smear +
and larvae) Method Technique Kato-Katz

Trichuris 170 (66.0%) 151 (58.5%) 205 (79.5%)

Ascaris 120 (46.5%) 107 (41.5%) 142 (55.0%)

Hookworms 73 (28.3%) 1 (0.4%) 73 (28.3%)

Strongyloides 4 (1.5%) - 4 (1.5%)

Enterobius 3 (1.2%) - 3 (1.2%)

S. mansoni 1 (0.4%) 2 (0.8%) 2 (0.8%)

 OVERALL, 79.5% OF SAMPLES WERE POSITIVE FOR
HELMINTH EGGS (TABLE 1). THICK SMEAR IDENTIFIED
A LARGER FRACTION OF PATIENTS INFECTED
WITH HELMINTHS. THE DIFFERENCE
C
WAS MOST
EVIDENT FOR HOOKWORM, WHERE THE RATIO
OF POSITIVE SAMPLES IDENTIFIED BY THICK SMEAR
AND KATO-KATZ WAS 73:1. HOWEVER, COMBINED
EXAMINATION WITH THE THICK SMEAR AND
KATO-KATZ TECHNIQUES GAVE BETTER RESULTS
THAN WHEN THE THICK-SMEAR WAS USED ALONE.
Table 2 -Results of thick smear and Kato-Katz analysis of 258 stool samples from public
school children in Salinas da Margarida County, Bahia, Brazil.

Kato-katz Smear Specificit Kappa

Thick Sensitivit y Index
positive negative y (%)
(%)
Trichuris positive 116 35 68.2 60.2 0.27
negative 54 53

Ascaris positive 85 22 70.8 84.1 0.55

negative 35 116

positive 1 0 1.4 100 0.02

Hookworm
negative 72 185

S. mansoni positive 1 1 100 99.6 0.66

negative 0 256
 COMPARED TO THICK SMEAR (TABLE 2),
THE SENSITIVITY OF THE KATO-KATZ METHOD WAS:
68.2% - T. TRICHIURA
70.8% - ASCARIS
1.4% - HOOKWORM
C

THE SPECIFICITY WAS:

60.2 % - TRICHURIS
84.1% - ASCARIS
100% - HOOKWORM
 THE KAPPA STATISTIC INDICATED THAT AGREEMENT
BETWEEN THE KATO AND THICK SMEAR METHODS WAS:
GOOD - ASCARIS ( = 0.55)
MARGINAL - TRICHURA ( = 0.27)
MARGINAL - HOOKWORM
C ( = 0.02)
IN ADDITION, MCNEMARS TEST INDICATED THAT DIRECT
EXAMINATION WAS MORE LIKELY TO CORRECTLY
IDENTIFY TRICHURIS THAN THE KATO-KATZ METHOD
(2 = 3.64, P = 0.056),
ALTHOUGH THE PREVALENCES OF ASCARIS WERE NOT
SIGNIFICANTLY DIFFERENT (2 = 2.526, P = 0.11).
Conclusions and Recommendations:
The sensitivity of the thick smear technique
was higher than that ofCthe Kato-Katz
method for the diagnosis of all helminths,
except Schistosoma mansoni.
The study found that the Kato-Katz method
were less sensitive than thick smear for
detecting hookworm infections.
 Previous studies have suggested that Kato-Katz
could be adequate for detecting hookworm.
However, these studies only examined a single
slide per patient, and the Kato-Katz slides
were read immediatelyC
after preparation.
It is likely that hookworm eggs deteriorate during
the standardized 24-hour period before slide
reading, which would explain the low prevalence
identified by Kato-Katz in this study.
Nevertheless, the researchers concluded that the
Kato-Katz method, when used with the thick
C
smear, would be particularly appropriate for large-
scale surveys because of its simplicity, lower cost,
and rapidity.
 STRENGTHS AND LIMITATIONS OF THE STUDY
STRENGTHS :
> ADEQUATEC SAMPLE SIZE
> DURATION OF THE STUDY IS UNPRESSURED
> APPROPRIATE STATISTICAL TOOL
> SENSITIVITY AND SPECIFICITY OF THE METHODS
ARE PRESENTED IN TABLES
> REVEALS THE ADVANTAGES AS WELL AS THE LOW
POINTS OF THE METHODS
 LIMITATIONS :
> TARGET GROUP IS ONLY SCHOOL-CHILDREN, 6-14 YRS,
FROM A PUBLIC SCHOOL
> THE STUDY WAS ONLY FORCTHE DETECTION OF ASCARIS,
TRICHURIS, HOOKWORMS AND S. MANSONI
>THE KATO-KATZ SLIDES ARE READ 24 HRS AFTER
PREPARATION
> PROTOZOA AND OTHER FINDINGS ARE NOT PRESENTED
> NEGATIVE TESTS DO NOT CONCLUDE NON-INFECTION
 SCALE UP THE INTERVENTION:
> EXTEND THE RANGE OF THE AGE GROUP OF CHILDREN
TO INCLUDE TODDLERS FROM 2-4 YRS OLD;
AT THESE AGE CHILDREN
C ARE ACTIVELY PLAYING
ON THE GROUND AND EAT ALMOST ANYTHING
> INCLUDE SCHOOL-CHILDREN FROM PRIVATE SCHOOLS
AND A COMPARISON CAN BE MADE BY
SCHOOL CATEGORY
> INCREASE THE SAMPLE SIZE TO 300-500
 RECOMMENDED MODIFICATIONS:
> CHANGE THE MICROSCOPY PROTOCOL BY READING
THE KATO-KATZ SLIDES WITHIN AN HOUR AND
AFTER 1 HOUR OF
C
PREPARATION
> INCLUDE OTHER FINDINGS LIKE PROTOZOA
> PERFORM A CONCENTRATION TECHNIQUE COMPARATIVE
TO THE KATO-KATZ AND THICK SMEAR
METHODS OF DETECTION
> DESCRIBE IN DETAIL THE METHODS USED IN
EXPERIMENTATION
INCLUDING THE MODIFICATIONS IN THE METHODS
THANK
C YOU