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. 2025 Jan 21;219(1):uxae092.
doi: 10.1093/cei/uxae092.

Diagnostic accuracy of saliva-based testing as a Vibrio cholerae surveillance tool among naturally infected patients

Caroline C Chisenga  1 , Bernard Phiri  1 , Harriet Ng'ombe  1 , Mutinta Muchimba  1 , Fraser Liswaniso  1 , Biana Bernshtein  2 , Adam F Cunningham  3 , David Sack  4 , Samuel Bosomprah  1   5
Affiliations

Diagnostic accuracy of saliva-based testing as a Vibrio cholerae surveillance tool among naturally infected patients

Caroline C Chisenga et al. Clin Exp Immunol. .

Abstract

Saliva, as a diagnostic medium, offers a promising alternative to blood by virtue of its non-invasive collection, which enhances patient compliance, especially in paediatric and geriatric populations. In this study, we assessed the utility of saliva as a non-invasive medium for measuring Vibrio cholerae-specific serum antibodies in naturally infected individuals. We tested paired serum and saliva samples obtained from a total of 63 patients with cholera enrolled in a cohort study. Vibriocidal antibodies assay (IgM/IgG) as markers for accurate determination was used to determine cholera-specific antibody levels. Using receiver operating characteristics (ROC) curve, we found that the best cut-off that maximizes (sensitivity + specificity) is 10 titres. At this saliva titre, the sensitivity is 76.9% (95%CI: 60.9%, 87.7%) and specificity is 80.0% (95%CI: 56.6%, 92.5%). Using Spearman's correlation coefficient, we also found evidence of a positive correlation between V. cholerae saliva and serum antibodies (rho = 0.66, P < 0.001). In conclusion, saliva-based diagnostic cholera tests have high diagnostic accuracy and would be advantageous, cheaper, and quicker for early diagnosis of severe cholera outcomes.

Keywords: cholera; natural infection; saliva; vibriocidal antibodies.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
correlation between log-transformed saliva and serum V. cholerae antibody responses among naturally infected patients (correlation curve); receiver characteristics curve.
Figure 2:
Figure 2:
V. cholerae serum and saliva antibody geometric mean titres in naturally infected patients at different infection days. GMTs: geometric mean titres.
See this image and copyright information in PMC

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