31–33 Most assays target parasite DNA sequences common to all human schistosome species. Assays using species-specific probes are less sensitive.34 A real-time PCR assay to detect schistosome DNA in plasma was found to be 100% sensitive in parasite proven established infection, and showed superior diagnostic sensitivity compared with serology in AS.16 In Wichmann’s series of eight patients with AS, schistosome DNA could be demonstrated in 10 mL

plasma from all, at an average of 40 days after exposure, and at an average of 14 days after symptom onset, while schistosome EIA antibody detection was still negative in three of eight patients. This was also the case in the present cluster, C59 wnt in vitro but then the time lapse between first exposure and diagnosis was considerably longer (mean 78 d). This suggests that schistosome DNA detection in serum appears to be superior to egg detection and serum antibody assays as a qualitative marker of early symptomatic infection, and that

a Etoposide order 2 mL serum sample may contain enough schistosome DNA to be amplified, at least when infected with S mansoni. Actually the number of copies per genome of the 121-bp tandem repeat sequence target gene may vary considerably between human schistosome species.17 To be clinically useful in a post-travel setting, where only limited amounts of blood are routinely taken, its sensitivity should also be assessed in acute urinary schistosomiasis (Schistosoma hematobium) using an equally small serum sample. Furthermore, the minimum time lapse after infection needed to detect parasite DNA by this method has not yet been determined. The amount of schistosome DNA copies in serum did not diminish significantly, despite a very clear drop in the mean eosinophil count and the halting of egg excretion 5 weeks after initial praziquantel treatment. This is in line with results of animal studies, and probably results from the continued release of cell-free DNA from degrading schistosomes, from persisting schistosomes still immature at the time when the initial praziquantel

treatment was given.16,25 Clearance of this circulating cell-free DNA is Epothilone B (EPO906, Patupilone) apparently a very slow process. In Wichmann’s series of patients with AS, schistosome DNA was still detectable in most patients even up to 15 months after treatment. Only by then the plasma DNA concentration had substantially declined. Schistosome DNA detection in serum obviously fails as an early quantitative marker of therapeutic success, in contrast with PCR assays on fecal samples.31 It is tempting to assume that the number of cycles required to attain parasite DNA detection in a blood sample by a real-time PCR assay is a reliable marker of parasite burden. However, there is insufficient evidence supporting that thesis, and there is considerable interpersonal variation even when exposure is similar. This study was not designed to address this issue.