Test accuracy of loop-mediated isothermal amplification for schistosomiasis in low endemicity areas: a systematic review and meta-analysis.

Abstract

Background: Schistosomiasis, caused by parasitic flatworms of the genus Schistosoma, remains a significant public health challenge in tropical and subtropical regions, affecting over hundreds of millions of people in these areas. Accurate diagnosis is crucial for effective disease control, particularly in low-endemic areas where traditional methods like microscopy are no longer effective. We aimed to evaluate the diagnostic performance of loop-mediated isothermal amplification (LAMP) for Schistosoma infection.

Methods: Adhering to Preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a comprehensive search on 10 May 2025 across multiple databases including PubMed, Cochrane Library, Latin American and Caribbean Literature on Health Sciences, Embase, China National Knowledge Infrastructure, and Wanfang Data, using keywords such as "schistosom*", "LAMP", and "loop-mediated isothermal amplification". Based on available literature, pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and 95% confidential interval (CI) were calculated using STATA18.0 software. Subgroup analyses and univariable meta-regression were performed to explore the source of heterogeneity. Specifically, subgroup analyses were performed by categorizing into species (S. japonicum, S. mansoni, S. haematobium), sample type (stool, urine, serum, snails), and DNA extraction methods to explore factors influencing test performance.

Results: The study finally included 24 individual studies derived from 14 published articles. The pooled analyses of LAMP data from all included studies resulted in a sensitivity of 0.90 (95% CI: 0.80-0.90), specificity of 0.82 (95% CI: 0.60-0.93), PLR of 4.98 (95% CI: 2.01-12.29), NLR of 0.13 (95% CI: 0.06-0.26) and diagnostic odds ratio of 39 (95% CI: 10-158). The area under the summary receiver operating characteristic curve reached 0.93, indicating excellent diagnostic performance. Subgroup analyses revealed optimal performance for S. japonicum and snail samples with lower heterogeneity (I² < 50%).

Conclusions: LAMP shows promise as a rapid, sensitive and specific diagnostic tool for schistosomiasis, particularly in resource-limited settings. This technique enables field application, supporting global efforts toward elimination of schistosomiasis by 2030.