Practical diagnostic algorithms for Chagas disease: a focus on low resource settings

Gabaldón-Figueira, Juan Carlos; Skjefte, Malia; Longhi, Silvia; Escabia, Elisa; García, Lady Juliette; Ros-Lucas, Albert; Martínez-Peinado, Nieves; Muñoz-Calderón, Arturo; Gascón, Joaquim; Schijman, Alejandro Gabriel; Alonso-Padilla, Julio

doi:10.1080/14787210.2023.2279110

Cited by 13 publications

(4 citation statements)

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“…The overall positivity of the serological tests was 91.4% (32/35). This result was in line with those of several other publications [35,42,42]. It was not possible to perform IgM, given that this is a complex technique and that it could present false positive results, especially with leishmaniasis (an endemic disease in this region), and the reference laboratory did not have the resources to do this test.…”

Section: Discussionsupporting

confidence: 89%

An outbreak of Chagas disease through oral transmission: 115 years after discovery by Carlos Chagas, the disease is still hard to manage

Alves Simões-Neto,

Santos,

Bomfim

et al. 2024

Preprint

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BackgroundOrally transmitted acute Chagas disease (ACD) mostly affects low-visibility and low-income individuals, mainly in tropical and subtropical zones. However, even more than 100 years after Carlos Chagas’ discovery, several difficulties in managing ACD are still faced. Ita expansion to other, non-endemic areas through globalization processes has transformed it into a global health problem.Methodology and findingsThis report addresses an outbreak of 39 cases of ACD due to oral transmission. A clinical-epidemiological investigation with an entomological search was performed. Laboratory criteria (positive peripheral blood smear (PBS), seroconversion of IgG and 2x increase in IgG titer) and clinical-epidemiological criteria (clinical findings, epidemiological exposure and at least one positive IgG) were used for diagnoses. In-house conventional polymerase chain reaction (PCR) was performed on 33 samples. All patients were treated with benznidazole. After 4.5 years, IgG was investigated in 26 individuals. Their mean age was 33.6 years, with no difference in gender distribution; the mean incubation period was 13.8 days and mean time between symptom onset and treatment was 16.6 days. The most frequent symptoms were fever and lymphadenopathy (90%). For 66.6%, laboratory criteria yielded the diagnosis and for 23%, clinical-epidemiological criteria, while 10.2% showed negative tests but were treated due to high clinical suspicion. Test positivity rates: PBS 69.7%; serology 91.4%; PCR 100%. There were no deaths. Serological cure was achieved for 34.6% and decreased IgG titers for 15.3%.Conclusions and significanceWe present all the barriers encountered in managing real-life situations: vulnerability of the population; dependence on old diagnostic techniques; lack of standardization of molecular biology techniques; and few therapeutic options. We demonstrated the importance of rapid surveillance action with early treatment, such that this outbreak did not give rise to deaths. We also propose that conventional PCR should become standardized within the diagnostic routine.AUTHOR SUMMARYIn this study we present an outbreak of orally transmitted acute Chagas disease (ACD), a neglected tropical disease. The source of transmission was bacaba juice served at a celebration held in a quilombola community and 39 individuals were affected. The focus of this study was clinical-epidemiological investigation and diagnostic tools. There were no deaths due to this event, probably because of the quick action of the surveillance team and the early start of treatment. We show all the difficulties facing a real-life situation (vulnerability of population affected, weaknesses regarding good food safety practices and obstacles to following what guidelines recommend), discuss the performance and executability of the diagnostic method used and address the global threat that Chagas disease may pose. Furthermore, we propose that the polymerase chain reaction should become standardized in diagnosing acute disease, given that this was the only method with 100% positivity, even among patients whose other tests were all negative.

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Section: Discussionsupporting

confidence: 89%

An outbreak of Chagas disease through oral transmission: 115 years after discovery by Carlos Chagas, the disease is still hard to manage

Alves Simões-Neto,

Santos,

Bomfim

et al. 2024

Preprint

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“…This is particularly important in the case of diseases such as CSF, which are so impactful as to require mandatory notification to the WOAH ( Mansour et al., 2015 ; World organisation for animal health (WOAH), 2019b ). It is therefore highly important to improve the detection protocols, which can be achieved by enhancing either the diagnostic algorithms or techniques used ( Wang et al., 2020a ; Gabaldón-Figueira et al., 2023 ). LAMP poses an interesting addition to the array of diagnostic tools for diseases that require rapid detection, given its potential to be used as a point of care test ( Chaouch, 2021 ; Moehling et al., 2021 ; Papadakis et al., 2022 ; Atceken et al., 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Development of a new loop-mediated isothermal amplification test for the sensitive, rapid, and economic detection of different genotypes of Classical swine fever virus

Bohórquez,

Muñoz-Aguilera,

Lanka

et al. 2024

Front. Cell. Infect. Microbiol.

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BackgroundClassical swine fever virus (CSFV) remains one of the most important pathogens in animal health. Pathogen detection relies on viral RNA extraction followed by RT-qPCR. Novel technologies are required to improve diagnosis at the point of care.MethodsA loop-mediated isothermal amplification (LAMP) PCR technique was developed, with primers designed considering all reported CSFV genotypes. The reaction was tested using both fluorometric and colorimetric detection, in comparison to the gold standard technique. Viral strains from three circulating CSFV genotypes were tested, as well as samples from infected animals. Other pathogens were also tested, to determine the LAMP specificity. Besides laboratory RNA extraction methods, a heating method for RNA release, readily available for adaptation to field conditions was evaluated.ResultsThree primer sets were generated, with one of them showing better performance. This primer set proved capable of maintaining optimal performance at a wide range of amplification temperatures (60°C - 68°C). It was also able to detect CSFV RNA from the three genotypes tested. The assay was highly efficient in detection of samples from animals infected with field strains from two different genotypes, with multiple matrices being detected using both colorimetric and fluorometric methods. The LAMP assay was negative for all the unrelated pathogens tested, including Pestiviruses. The only doubtful result in both fluorometric and colorimetric LAMP was against the novel Pestivirus italiaense, ovine Italy Pestivirus (OVPV), which has proven to have cross-reaction with multiple CSFV diagnostic techniques. However, it is only possible to detect the OVPV in a doubtful result if the viral load is higher than 10000 viral particles.ConclusionThe results from the present study show that LAMP could be an important addition to the currently used molecular diagnostic techniques for CSFV. This technique could be used in remote locations, given that it can be adapted for successful use with minimal equipment and minimally invasive samples. The joined use of novel and traditional diagnostic techniques could prove to be a useful alternative to support the CSF control.

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“…Moreover, Polymerase Chain Reaction’s sensitivity is low in the chronic phase of the disease when the circulating parasites are rare, and few confirmatory tests based on the Western blot method are globally available. Advancements in diagnostic technology have led to the validation of a loop-mediated isothermal amplification assay ( T. cruzi -LAMP) for early-stage infections and the local endorsement of various quick diagnostic tests (Rapid diagnostic tests, RDTs) for long-term infections, making testing easier in areas with limited resources [ 12 , 13 ]; the interest of low invasiveness biological sampling should also be further explored [ 14 ]. In addition, efforts have been made to improve the screening of blood donations in endemic regions to prevent transfusion-transmitted CD.…”

Section: Advances In Diagnostics and Treatmentmentioning

confidence: 99%

“…However, these treatments are not without challenges [ 17 ], as they are less effective in the chronic phase and can have severe side effects. Shorter treatment protocols [ 18 ], simplified diagnostic algorithms [ 12 ], and pediatric formulations of existing drugs [ 19 ] will facilitate treatment. In addition, the development of drug resistance, in conjunction with the fact that Nifurtimox and Benznidazole are considered as “obsolete” urge the development of new alternative [ 20 ].…”

Section: Advances In Diagnostics and Treatmentmentioning

confidence: 99%

Chagas Disease across the Ages: A Historical View and Commentary on Navigating Future Challenges

Sereno,

Oury,

Grijalva

2024

Microorganisms

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Chagas disease, discovered over a century ago, continues to pose a global health challenge, affecting millions mainly in Latin America. This historical review with commentary outlines the disease’s discovery, its evolution into a global concern due to migration, and highlights significant advances in diagnostics and treatment strategies. Despite these advancements, the paper discusses ongoing challenges in eradication, including vector control, congenital transmission, the disease’s asymptomatic nature, and socioeconomic barriers to effective management. It calls for a multidisciplinary approach, enhanced diagnostics, improved treatment accessibility, and sustained vector control efforts. The review emphasizes the importance of global collaboration and increased funding to reduce Chagas disease’s impact.

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Practical diagnostic algorithms for Chagas disease: a focus on low resource settings

Cited by 13 publications

References 90 publications

An outbreak of Chagas disease through oral transmission: 115 years after discovery by Carlos Chagas, the disease is still hard to manage

An outbreak of Chagas disease through oral transmission: 115 years after discovery by Carlos Chagas, the disease is still hard to manage

Development of a new loop-mediated isothermal amplification test for the sensitive, rapid, and economic detection of different genotypes of Classical swine fever virus

Chagas Disease across the Ages: A Historical View and Commentary on Navigating Future Challenges

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