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

Area of Science:

• Tropical Medicine
• Parasitology
• Infectious Diseases

Background:

• Chagas disease, caused by Trypanosoma cruzi, is a major neglected tropical disease in the Americas.
• Current diagnostic algorithms are complex, stage-dependent, and ill-suited for endemic areas, hindering treatment access.
• Existing molecular and serologic tools show geographic variability in performance.

Purpose of the Study:

• To review current Chagas disease diagnostic algorithms.
• To propose new algorithms incorporating point-of-care testing (POCT).
• To enhance accessibility of timely diagnosis and treatment for Chagas disease.

Main Methods:

• Literature search of the MEDLINE database until August 1, 2023.
• Analysis of existing diagnostic algorithms for Chagas disease.
• Evaluation of novel diagnostic tools, including Trypanosoma cruzi-LAMP and rapid diagnostic tests (RDTs).

Main Results:

• A loop-mediated isothermal amplification assay (T. cruzi-LAMP) has been validated for acute infections.
• Regional validation of several rapid diagnostic tests (RDTs) simplifies chronic infection diagnosis in resource-limited settings.
• New algorithms focused on POCT are proposed to improve diagnostic accessibility.

Conclusions:

• Integrating POCT into diagnostic algorithms can improve access to timely Chagas disease diagnosis and treatment in endemic areas.
• Further research is required to validate POCT across diverse geographies.
• Cost-effectiveness studies are needed for large-scale implementation of new diagnostic strategies.