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Evaluation of adult chronic Chagas' heart disease diagnosis by molecular and serological methods

Juan David Ramírez1, Felipe Guhl, Eufrosina Setsu Umezawa

  • 1Facultad de Ciencias, Departamento de Ciencias Biológicas, Centro de Investigaciones en Microbiología y Parasitología Tropical, CIMPAT, Universidad de los Andes, Carrera 1 No 18A 10, Bogotá, Colombia.

Journal of Clinical Microbiology
|October 23, 2009
PubMed

Insights

Conventional serological tests, like IIF and ELISA, are highly sensitive for diagnosing chronic Chagas' disease. Polymerase chain reaction (PCR) assays show lower sensitivity and are not recommended as a primary diagnostic tool.

Area of Science:

  • Infectious Diseases
  • Parasitology
  • Molecular Diagnostics

Background:

  • Chagas' disease, caused by Trypanosoma cruzi, is a significant public health issue in Latin America.
  • Trypanosoma cruzi exhibits genetic diversity, with T. cruzi I and T. cruzi II being the main lineages.
  • Current chronic phase diagnosis relies on serological tests (IIF, ELISA), while acute phase diagnosis uses parasitological methods.

Purpose of the Study:

  • To evaluate diagnostic procedures for chronic Chagas' disease in adult patients.
  • To compare the sensitivity of PCR assays against conventional serological tests.
  • To establish TESA-blot as the gold standard for comparison.

Main Methods:

  • Analysis of samples from 240 adult patients with chronic Chagas' disease.
  • Evaluation of PCR using kinetoplast and nuclear repetitive regions.
  • Comparison with serological tests: Indirect Immunofluorescence (IIF), Enzyme-Linked Immunosorbent Assay (ELISA), and TESA-blot.

Main Results:

  • TESA-blot served as the gold standard for sensitivity comparisons.
  • Sensitivities: IIF (99%), ELISA (95%), PCR (kinetoplast region, 70%), PCR (nuclear repetitive region, 75%).
  • Low concordance between PCR and serology results was observed.

Conclusions:

  • PCR assays are not validated as conventional diagnostic techniques for chronic Chagas' disease due to insufficient sensitivity.
  • Serological tests, particularly IIF and ELISA, demonstrate high reliability.
  • PCR may serve as an alternative diagnostic support and for monitoring treatment efficacy using the nuclear repetitive region.

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