Addressing the Challenges of Chagas Disease

Abstract

Chagas disease is an emerging health concern in the United States. US health care providers have an unparalleled opportunity to respond to the challenges this infection poses and to provide state-of-the-art care for patients with Chagas disease. Most of the approximately 300,000 persons with Trypanosoma cruzi infection living in the United States have chronic, asymptomatic infection acquired in endemic regions in Latin America. Congenital infection is often asymptomatic and, even when symptomatic, has no features that distinguish it from other congenitally transmitted infections. Health care providers and the public have limited awareness of this infection. Recognizing risk groups and performing targeted diagnostic testing for at-risk infants, children, and adults are a health priority because early treatment can effect cure and avert the life-threatening cardiac manifestations of Chagas disease. Two medications for treatment, benznidazole and nifurtimox, are available through the Centers for Disease Control and Prevention. Although challenges exist, informed health care providers can greatly reduce the effects of Chagas disease in the United States.

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

“…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.…”

“…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. [35][36][37] One known contributor to test performance variability is the implementation of different T. cruzi antigens and their respective antigenic preparations.…”

“…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.…”

“…21 As Chagas tests often lead to inconclusive results, current guidelines recommend evaluating suspected cases through at least two diagnostic tests. 20,22,23 In the case that both confirmatory tests are serological, the two tests should detect different antigens. Given that Chagas disease most often affects marginalized populations living in limited-resource settings, there is a need not only to improve standard diagnostic tools, but also to promote better diagnostic coverage through the development of reliable, affordable, and accurate point-of-care tests.…”

Kinetic and Structural Characterization of Trypanosoma cruzi Hypoxanthine–Guanine–Xanthine Phosphoribosyltransferases and Repurposing of Transition-State Analogue Inhibitors

“…California, Texas, and Florida show the highest incidence rates, with approximately 20% of cases reported in Texas from 2013 to 2019 confirmed to be locally acquired infections . CD is a parasitic infection caused by the protozoan Trypanosoma cruzi , and its current treatment includes the trypanocidal drugs benznidazole and nifurtimox, both of which are ineffective in treating the advanced, chronic stage of the disease. , The high frequency of adverse side effects, apparent lack of efficacy in chronic infections, and length of required drug regimens often result in abandonment of treatment. − Thus, new drugs with fewer side effects and improved efficacy against both the early and late stages of the disease are urgently needed.…”