There is currently no "gold standard" test for the diagnosis of late-stage Chagas' disease. As a result, protection of the blood supply in areas where Chagas' disease is endemic remains problematic. A panel of 709 serum samples from subjects with confirmed Chagas' disease (n ‫؍‬ 195), healthy controls (n ‫؍‬ 400), and patients with other parasitic diseases (n ‫؍‬ 114) was used to assess enzyme-linked immunosorbent assays (ELISAs) based on a concentrated extract of excretory-secretory antigens from either Brazil or Tulahuen strain Trypanosoma cruzi trypomastigotes (total trypomastigote excretory-secretory antigens [TESAs]). The total TESA-based assays had excellent overall sensitivity (100%) and specificity (>94%), except for cross-reactivity with Leishmania-infected sera. In an attempt to increase the specificity of the assay, immunoaffinity chromatography was used to purify the TESA proteins (TESA IA proteins). By Western blotting, a series of polypeptide bands with molecular masses ranging from 60 to 220 kDa were recognized by pooled sera positive for Chagas' disease. An ELISA based on TESA IA proteins had a slightly lower sensitivity (98.6%) but an improved specificity (100%) compared to the sensitivity and specificity of the total TESA protein-based ELISAs. A 60-kDa polypeptide was identified as a major contributor to the cross-reactivity with Leishmania. These data suggest the need for field validation studies of TESA-and TESA IA -based assays in regions where Chagas' disease is endemic.

SUMMARY. Many serological tests have been developed for the diagnosis of ChagasÕ disease, but few have been subjected to a rigorous field evaluation. We have recently described several novel enzyme immunoassays (EIAs) based on fixed-whole organisms or trypomastigote excretory-secretory antigens (TESA) from different Trypanosoma cruzi strains (Tulahuen or Brazil). This study evaluated the most promising of these novel assays (e.g. fixed-epimastigotes, fixedtrypomastigotes, TESA Brazil and TESA Tulahuen antigens) in a field study of Venezuelan blood bank specimens. The assays were tested in an operatorblinded fashion using 2038 blood bank samples obtained from low and high T. cruzi prevalence regions of Venezuela (n ¼ 1050 and n ¼ 988 from Bolivar and Portuguesa states, respectively). Based on National Laboratory for Chagas Immunodiagnosis (NLCI)Ôgold standardÕ results, all novel EIAs were superior to the commercial kit currently used in Venezuela, achieving 100% sensitivity and >99% specificity at optimal cut-off values. The novel assays identified seven false-negative samples compared with the routine screening performed by the Venezuelan blood bank although two samples were also misclassified as positive. Minor differences in the performance of the four novel assays were observed at lower arbitrary cutoff values. This study confirms the potential utility of both the fixed-organism and the TESA-based assays in the diagnosis of T. cruzi infection.

An indirect enzyme-linked immunoabsorbent assay (ELISA) for Trypanosoma cruzi was developed using epimastigote secretion/excretion proteins (ESEA antigens) obtained from axenic culture supernatants. A panel of 120 serum samples from subjects with confirmed Chagas disease (n = 50), healthy controls (n = 50), and patients with other parasitic diseases (n = 20) was used to evaluate the new ESEA-based ELISA (ELISAESEA). This new test had excellent sensitivity (98%) and acceptable specificity (88%). Cross-reactivity was observed largely in sera from subjects with Leishmania and Ascaris infections. Using Western blotting and epimastigotes from two distinct T. cruzi isolates, several polypeptide bands with molecular masses ranging from 50 to 220 kDa were detected in pooled chagasic sera. However, the band pattern for each isolate was different. These data suggest that an inexpensive and technically simple ELISA based on ESEA antigens is a promising new tool for the diagnosis of Chagas disease.

Contribución de los autores:Mariolga Berrizbeitia: coordinadora del proyecto a nivel regional, realización del análisis estadístico y escritura del manuscrito. Juan Luis Concepción: coordinador nacional del proyecto, revisión y aprobación del manuscrito. Valentina Cazorla: realización de los ensayos, contribución en la escritura del manuscrito. Jessicca Rodríguez: realización de los ensayos. Ana Cáceres y Wilfredo Quiñones: asesoría en la elaboración del proyecto, revisión del análisis estadístico. . No significant statistic association was found between the T. cruzi infection in dogs and the evaluated epidemiological variables: hunting dogs that slept oudoors roaming freely in the populated center, sex of the animal and eating habits. The T. cruzi infection was associated to the age of canines, being significantly higher in the group of 0 to 3 years, when compared with older dogs. ARTÍCULO ORIGINAL

No ideal test exists for Chagas' disease, and better diagnostic strategies are needed. We determined the diagnostic utility of an 85-kDa Trypanosoma cruzi protein in a multiple antigen binding assay (MABA). A standardized MABA test based on concentrated trypomastigote excretory-secretory antigen (TESA) and an 85-kDa purified protein showed 100% sensitivity and specificity. In field conditions, 6/66 individuals tested in a region not thought to be endemic (Rio Brito) were identified as seropositive for T. cruzi infection with our MABA test. In parallel, an enzyme-linked immunosorbent assay based on fixed epimastigotes detected 7/66 positives, which were independently confirmed. These data suggest that the 85-kDa and TESA proteins could be used in the MABA format as a complementary tool for the diagnosis of latent Chagas' disease. High anti-T. cruzi antibody detection rates, poor knowledge of Chagas' disease and its vector, and the demonstration of infected vectors in the study community all suggest a significant risk of reemergence of T. cruzi infection in this region of Venezuela.

Contribución de los autores:Noris García-Jordán: realización de los ensayos, análisis de datos y escritura del manuscrito Mariolga Berrizbeitia: coordinación del proyecto a nivel regional, colaboración en la escritura del manuscrito y análisis de datos Juan Luis Concepción: coordinación nacional del proyecto, colaboración y revisión del manuscrito Elis Aldana: asesoramiento en la clasificación taxonómica de los vectores y realización de las pruebas para identificación de especies de triatominos Ana Cáceres y Wilfredo Quiñones: asesoría en la elaboración del proyecto, y revisión del análisis de datos y del manuscrito

We investigated the seroprevalence of Trypanosoma cruzi infection in an indigenous Kariña population in eastern Venezuela. A total of 175 serum samples were collected in the community of Piñantal during February 2009. Interviews targeting socioeconomic and environmental factors associated with the T. cruzi transmission were also conducted. Samples were evaluated using trypomastigote excreted/secreted antigens (TESAs) in an ELISA format. TESA-ELISA positive samples were confirmed by indirect haemagglutination (HAI) (Wiener). A nonsystematic collection of vectors was also undertaken. T. cruzi seroprevalence was 7.43% according to both assays, and the mean age of infected patients was 48.61 ± 10.40 years (range 34 to 73 years). The vector infection rate was 20.00% (2/10). T. cruzi seropositivity was associated with a history of triatomine bites, the ability to recognize the vector and poor knowledge about Chagas disease, but no associations were found with gender, house type, knowledge of how the disease is transmitted, or the presence of vectors or animals inside dwellings. To our knowledge, this is the first study of the seroprevalence of T. cruzi in an indigenous population in eastern Venezuela. All of the epidemiological variables required for the establishment of active vectorial transmission of T. cruzi were present in this community.

Seroprevalencia de la infección por