The challenge of discordant serology in Chagas disease: The role of two confirmatory techniques in inconclusive cases

Moure, Zaira; Sulleiro, Elena; Iniesta, Laura; Guillen, Carmen; Molina, Israel; Alcover, M. Magdalena; Riera, Cristina; Pumarola, Tomás; Fisa, Roser

doi:10.1016/j.actatropica.2018.05.010

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Due to the wide genetic and antigenic diversity of T. cruzi, no single test has proven optimal for the assessment of Chagas disease. 9,[18][19][20] To avoid inconclusive test results, the concomitant assessment of samples through at least two different immunological assays is recommended. 20,22,23 But even when these recommendations are met, high heterogeneity in the performance of standard tests can result in a misclassified or inconclusive Chagas diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…17 Unfortunately, current screening methods not only lack prioritization and inadequate coverage in both endemic and nonendemic settings, but they remain a major challenge. 9,[18][19][20] During the acute phase of the disease, blood parasitemia can be detected by direct microscopy methods or by culturing techniques. As the disease progresses, however, diagnosis is more difficult and relies on the detection of anti-T. cruzi antibodies, mostly IgG, through the standard serological methods such as indirect immunofluorescence assay (IFA), indirect hemagglutination assay (IHA), and ELISA.…”

Section: Introductionmentioning

confidence: 99%

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Gold Nanoshells-Based Lateral Flow Assay for the Detection of Chagas Disease at the Point-of-Care

Medina‐Rivera

Cárdenas

Erickson

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Chagas disease is a neglected parasitic infection and a major public health problem in the Americas. It remains underdiagnosed in the United States and internationally due to the lack of affordable testing and disparities in healthcare, particularly for those most at risk. We describe a proof-of-concept lateral flow immunoassay employing a recombinant Chagas multiantigen conjugated to gold nanoshells (AuNS) to detect circulating human anti-Chagas IgG antibodies. This is one of the first lateral flow immunoassays to capitalize on the larger surface area of AuNS compared with nanoparticles that can help amplify low-magnitude signals. Results were compared with 42 positive and negative Chagas serum samples, of which a subset of 27 samples was validated against an ELISA (Hemagen®). The sensitivity and specificity of our assay were 83% and 95%, respectively. These results suggest that an AuNS-based rapid testing for Chagas disease could facilitate in-field screening/diagnosis with a performance comparable to commercial methods.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gold Nanoshells-Based Lateral Flow Assay for the Detection of Chagas Disease at the Point-of-Care

Medina‐Rivera

Cárdenas

Erickson

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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“…The probability of cure might also be predicted by a decrease in antibody titers for T. cruzi over time, but this will depend on the specific antibody and the status of the disease before treatment [57]. However, serodiscordance remains a challenge in Chagas disease diagnosis and raises the question of the reliability of serology tests relying on one specific antigen depending on the region and patient stage [61][62][63].…”

Section: Parasite Dna Amplification and Antigens For Serological Testsmentioning

confidence: 99%

Chagas Disease Treatment Efficacy Biomarkers: Myths and Realities

2019

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Chagas disease (CD), caused by Trypanosoma cruzi, affects millions of people worldwide. Although CD R&D has made progress during the last decade, clinicians and general practitioners are still facing the same challenge, i.e., the lack of adequate markers of clinical cure, hindering assessment of new drug efficacy in clinical trials and counseling of patients about treatment outcome. To date, no new markers have been validated as surrogates of seroreversion-the only marker of parasitological cure which is itself considered to be a surrogate of clinical benefit. T. cruzi DNA detected using PCR cannot currently be considered as a surrogate of seroconversion. Much emphasis has been placed on different T. cruzi antigens but no definite proof of correlation between titers, as determined by serology at a given timepoint, and seroreversion has been shown. Thanks to the improvement of analytical methods and the application of new methodologies, the identification of potential new markers is being facilitated, and some of these are progressing. However, there is a long journey from the identification of a potential biomarker to its clinical validation and acceptance by the regulatory authorities that requires a common effort from the entire Chagas community.

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“…Additionally, the absence of a "gold standard" test that reliably and consistently detects the presence of a T. cruzi infection makes the evaluation of current methods difficult [28,66]. Serodiscordance in Chagas disease remains a challenge since individuals with inconclusive results are clinically complicated to manage [67]; this problem usually arises in the diagnosis during the chronic phase. Performing two or more serological testing does not guarantee that the result shall be univocal.…”

Section: The World Of Diagnosis For Chagas Disease: a Discordant Paramentioning

confidence: 99%

More than a Hundred Years in the Search for an Accurate Diagnosis for Chagas Disease: Current Panorama and Expectations

López‐Monteon¹,

Dumonteil²,

Ramos-Ligonio³

2019

Current Topics in Neglected Tropical Diseases

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Chagas disease, or American trypanosomiasis, is a parasitic disease of the Americas. In nature, Trypanosoma cruzi is transmitted through various species of triatomine bugs. However, non-vectorial transmission can also occur, such as transmission through blood products or by transplanting infected organs, by vertical transmission, and lately by oral route. Currently, Chagas disease affects approximately 6-7 million people worldwide, and the process of urbanization in Latin America and migratory movements from endemic countries have led to Chagas disease being diagnosed in areas where the infection is not endemic. There are several methods for diagnosing Chagas disease. Some of these are mostly used for research purposes, while others are used in routine diagnostic laboratories. According to the World Health Organization (WHO), chronic Chagas disease diagnosis is based on two serological techniques. To establish a definitive diagnosis, the results must be concordant. In the case of discordances, the WHO proposes repeating serology in a new sample, and if results remain inconclusive, a confirmatory test should be performed. This chapter shows aspects of the diagnosis of Chagas disease, which varies in its sensitivity and specificity, and its use depends on the geographical location, the available resources, and the purpose of the diagnosis.

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The challenge of discordant serology in Chagas disease: The role of two confirmatory techniques in inconclusive cases

Cited by 6 publications

References 16 publications

Gold Nanoshells-Based Lateral Flow Assay for the Detection of Chagas Disease at the Point-of-Care

Gold Nanoshells-Based Lateral Flow Assay for the Detection of Chagas Disease at the Point-of-Care

Chagas Disease Treatment Efficacy Biomarkers: Myths and Realities

More than a Hundred Years in the Search for an Accurate Diagnosis for Chagas Disease: Current Panorama and Expectations

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