Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy

Antinori, Spinello; Galimberti, Laura; Grande, Romualdo; Bianco, Roberto; Oreni, Letizia; Traversi, Letizia; Ricaboni, Davide; Bestetti, Giovanna; Lai, Alessia; Mileto, Davide; Gismondo, Maria Rita; Petullà, Marina; Garelli, Silvia; Maio, Gianfranco De; Cogliati, Chiara; Torzillo, Daniela; Villa, Anna; Egidi, Ada Maristella; Repetto, Ernestina; Ridolfo, Anna Lisa; Corbellino, Mario; Galli, Massimo

doi:10.1016/j.cmi.2018.03.017

Cited by 13 publications

(16 citation statements)

References 29 publications

(41 reference statements)

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“…Alternatively, a posterior study proposed a S/CO !3.80 [16], which according to our results would be too low to discriminate against cross-reactions with Leishmania species, a common problem in areas where both trypanosomatids co-exist [27]. The S/CO value !6 was supported by another subsequent study, in which its application confirmed about 10% of all samples [18]. Therefore, this proposed cut-off can correctly classify all sera with confirmation by a second serological test of only a small proportion of samples with S/CO between 0.8 and 6 (21/831, 2.5% in this study), resulting in significant savings in time and money.…”

Section: Discussionsupporting

confidence: 72%

“…As a result of the excellent sensitivity previously reported for CMIA [15,17], which was re-enforced by the results of our group [13] and subsequent studies [16,18], the Hospital de la Santa Creu i Sant Pau implemented the use of CMIA as the main test for CD diagnosis. Hence, for all samples included in this study a CMIA negative result was deemed conclusive, whereas sera with an S/ CO !…”

Section: Data Compilation and Analysis Of Resultsmentioning

confidence: 54%

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ARCHITECT Chagas® as a single test candidate for Chagas disease diagnosis: evaluation of two algorithms implemented in a non-endemic setting

Abràs

Ballart

Fernández-Arévalo

et al. 2021

Clinical Microbiology and Infection

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Objectives: To evaluate two algorithms for the diagnosis of chronic and congenital Chagas disease (CD), both including the chemiluminescent microparticle immunoassay ARCHITECT Chagas® (CMIA) as a single test but with an amended signal-to-cut-off ratio (S/CO) of !6, instead of an S/CO of !1 as indicated by the manufacturer. Methods: The study encompassed two panels of retrospective samples: 831 sera from 786 adolescents and adults (panel A), and 96 sera from 35 newborn infants with CD-infected mothers (panel B). A CMIAnegative result was deemed conclusive, whereas samples with an S/CO ! 0.8 were confirmed by a second test (BioELISA Chagas, ELISAr). Results: In panel A, seropositivity was 13% (102/786); 10 samples gave discordant results for CMIA and ELISAr, all of which were CMIA positive and had CD confirmed through a previous diagnosis by two positive serological tests. In panel B, all newborns were considered non-infected based on both a progressive decrease in antibody titres over time and negative real-time PCR results. CMIA still gave positive results in two infants aged 10 months but no S/CO values !6 were observed from 4 months on. Conclusions: CMIA is a firm candidate for use as a single CD diagnostic test in non-endemic countries. The algorithm with the !6 S/CO is as an efficient method for chronic CD diagnosis. CMIA could also be used as a single test to screen infants for congenital infection at the age of 10 months or even earlier if applying the corrected cut-off ratio, although further studies are required.

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Section: Discussionsupporting

confidence: 72%

Section: Data Compilation and Analysis Of Resultsmentioning

confidence: 54%

ARCHITECT Chagas® as a single test candidate for Chagas disease diagnosis: evaluation of two algorithms implemented in a non-endemic setting

Abràs

Ballart

Fernández-Arévalo

et al. 2021

Clinical Microbiology and Infection

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“…Likewise, in a recent study that evaluated prevalence and risk factors for CD in Latin American immigrants residing in Italy, the authors found a sensitivity of 96.8% (95% CI: 82.2%-100%); importantly, this study was limited to 263 samples not obtained from blood donors, of which only 31 were positive. 27 Another recent study stringently evaluated the performance parameters of seven commonly utilized platforms for CD diagnosis, including Roche's Elecsys Chagas electrochemiluminescence assay, DiaSorin's Liaison XL Murex Chagas and Abbott's Prism Chagas and Architect Chagas CLIAs, among other assays, including four commercially available ELISAs. 28 Interestingly, these authors evaluated the analytical sensitivity of all platforms utilizing two WHO reference sera (NIBSC 09/188: TcI; NIBSC 09/186: TcII), observing that DiaSorin's Liaison XL offered detection sensitivity rates similar to those of some of the ELISAs evaluated.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Liaison XL Murex Chagas diagnostic performance in blood screening for Chagas disease using a reference array of chimeric antigens

et al. 2021

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Background: Chagas disease (CD) serological screening at blood banks is usually performed by a single highly sensitive serological assay, with chemiluminescent immunoassays (CLIAs) being the method of choice. CLIAs employ recombinant, fusion peptides and/or chimeric antigens that selectively capture anti-Trypanosoma cruzi antibodies. However, despite high sensitivity, the ability of these tests to identify CD-positive cases should be evaluated against T. cruzi strains circulating in specific locales. Herein, we used a latent class analysis (LCA) approach employing an array of four chimeric antigens to assess the diagnostic performance of the Liaison XL Murex Chagas CLIA for the detection of anti-T. cruzi IgG in serum samples. Study Design and Methods:The study included a panel of 5014 serum samples collected from volunteer blood donors at the Hematology and Hemotherapy Foundation of the State of Bahia, submitted to anti-T. cruzi antibody detection using Liaison Chagas CLIA and LCA as a reference test in the absence of a gold standard.Results: LCA classified 4993 samples as negative, while positivity for T. cruzi antibodies was predicted in 21 samples. Compared with LCA, CLIA demonstrated sensitivity and specificity of 76.2% and 99.5%, respectively, providing an overall accuracy of 99.4%. Discussion: In blood banks lacking a de facto highly sensitive screening immunoassay, the low sensitivity offered by Liaison Chagas CLIA renders it unsuitable for standalone use in serological screening procedures for CD. Moreover, blood banks are encouraged to carefully assess the ability of diagnostic methods to identify local T. cruzi strains in circulation.

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“…Chagas disease is a clinical condition of growing epidemiological importance. In Latin America alone, it is estimated that 6 million people have been infected with Trypanosoma cruzi 1 and an unknown number of individuals are silent carriers; more recently, migration has further contributed to the dissemination of the disease, 2 and currently 400 000 infected individuals are thought to live in non‐endemic areas 3 . Importantly, it is estimated that up to 20–30% of the infected individuals may eventually develop cardiac disease, and Chagas cardiomyopathy is reported to be the cause of heart failure (HF) in up to 25% of the HF cases in referral centres 4…”

Section: Introductionmentioning

confidence: 99%

The course of patients with Chagas heart disease during episodes of decompensated heart failure

et al. 2021

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Aims This study aimed to analyse the clinical presentation and prognosis of patients with Chagas cardiomyopathy and decompensated heart failure (HF), as compared with other aetiologies. Methods and results A prospective cohort of patients admitted with decompensated HF. We included 767 patients (63.9% male), with median age of 58 years [interquartile range 48.2-66.7 years]. Main aetiologies were non-Chagas/non-ischaemic cardiomyopathies in 389 (50.7%) patients, ischaemic disease in 209 (27.2%), and Chagas disease in 169 (22%). Median left ventricular ejection fraction was 26% (interquartile range 22-35%). Patients with Chagas differed from both patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies for a higher proportion of cardiogenic shock at admission

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Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy

Abstract: CD is highly prevalent among Bolivians and Salvadorans living in Milan. Regions with a large Latin American immigrant population should implement programmes of active detection and treatment.

Cited by 13 publications

References 29 publications

ARCHITECT Chagas® as a single test candidate for Chagas disease diagnosis: evaluation of two algorithms implemented in a non-endemic setting

ARCHITECT Chagas® as a single test candidate for Chagas disease diagnosis: evaluation of two algorithms implemented in a non-endemic setting

Assessment of Liaison XL Murex Chagas diagnostic performance in blood screening for Chagas disease using a reference array of chimeric antigens

The course of patients with Chagas heart disease during episodes of decompensated heart failure

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