Early Molecular Diagnosis of Acute Chagas Disease After Transplantation With Organs From Trypanosoma cruzi–Infected Donors

Abstract

Organ transplantation (TX) is a novel transmission modality of Chagas disease. The results of molecular diagnosis and characterization of Trypanosoma cruzi acute infection in na€ ıve TX recipients transplanted with organs from infected deceased donors are reported. Peripheral blood and cerebrospinal fluid samples from the TX recipients of organs from infected donors were prospectively and sequentially studied for detection of T. cruzi by means of kinetoplastid DNA polymerase chain reaction (kDNA-PCR). In positive blood samples, a PCR algorithm for identification of T. cruzi Discrete Typing Units (DTUs) and quantitative real-time PCR (qPCR) to quantify parasitic loads were performed. Minicircle signatures of T. cruzi infecting populations were also analyzed using restriction fragment length polymorphism (RFLP)-PCR. Eight seronegative TX recipients from four infected donors were studied. In five, the infection was detected at 68.4 days post-TX (36-98 days). In one case, it was transmitted to two of three TX recipients. The comparison of the minicircle signatures revealed nearly identical RFLP-PCR profiles, confirming a common source of infection. The five cases were infected by DTU TcV. This report reveals the relevance of systematic monitoring of TX recipients using PCR strategies in order to provide an early diagnosis allowing timely anti-trypanosomal treatment.

Reactivation of Chagas disease among heart transplant recipients in the United States, 2012‐2016

“…The approach of monitoring for laboratory evidence of CDR and treating before the onset of clinical manifestations is intended to prevent severe symptoms and damage to the transplanted heart . Among the patients we reviewed who were monitored and treated promptly following laboratory evidence of CDR, outcomes were good.…”

Diagnosing Neglected Tropical Diseases in HIV Coinfection

“…69 The onset of treatment during the acute phase has good resolution rates; therefore, PCR may help in the early diagnosis of Chagas disease. 13,70 A decrease in parasite load is observed in the chronic phase, and the diagnostic method indicated at this stage is serology. But depending on the serological assay used, cross-reactivity with other parasites, such as Leishmania spp., or false-negative results may occur.…”

“…In this scenario, the polymerase chain reaction (PCR) has contributed to improving the sensitivity and specificity of the diagnosis of these diseases throughout the world and, therefore, it has been increasingly used. [11][12][13][14] In this article, we discuss the clinical manifestations and laboratory diagnosis of NTDs (malaria, leishmaniasis, and Chagas disease) in relation to HIV infection.…”

Chagas Disease in Transplantation: Time to Enter an Era of Better Diagnosis and Better Outcomes

“…The study of Cura et al (4) in this issue highlights important features of CD management in solid organ transplant recipients: (1) the use of extended criteria donors including those infected with T. cruzi, especially in endemic regions; (2) the need for sensitive assays for pretransplant screening of donors and recipients; (3) the need for new diagnostic platforms allowing rapid diagnosis of Chagas transmission from infected donors, as well as for monitoring the response to therapy if transmission occurs; and (4) the use of molecular epidemiologic tools to characterize T. cruzi into the Discrete Typing Units (DTUs), allowing the evaluation of parasite relatedness, geographic origin and possible associations with disease severity.…”

“…The implementation of quantitative PCR to determine the parasite load and evolution through treatment could then be used to assess the microbiological response, as shown in the study of Cura et al (4).…”