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Practical diagnostic algorithms for Chagas disease: a focus on low resource settings
Juan Carlos Gabaldón-Figueira1, Malia Skjefte2, Silvia Longhi3
1Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain.
Insights
Diagnosing Chagas disease in the Americas is complex. New point-of-care tests for Trypanosoma cruzi infections offer simpler, faster diagnosis, improving treatment access in endemic regions.
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.
Introduction:
Chagas disease, caused by parasite Trypanosoma cruzi, is the most important neglected tropical disease in the Americas. Two drugs are available for treatment, but access to them is challenging, in part due to complex diagnostic algorithms. These are stage-dependent, involve multiple tests, and are ill-adapted to the reality of vast areas where the disease is endemic. Molecular and serologic tools are used to detect acute and chronic infections, with the performance of the latter showing geographic differences. Breakthroughs in the development of new diagnostic tools include the validation of a loop-mediated isothermal amplification assay for acute infections (T. cruzi-LAMP), and the regional validation of several rapid diagnostic tests (RDTs) for chronic infection, which simplify testing in resource-limited settings. The literature search was carried out in the MEDLINE database until 1 August 2023.
Areas Covered:
This review outlines existing algorithms, and proposes new ones focused on point-of-care testing.
Expert Opinion:
Integrating point-of-care testing into existing diagnostic algorithms in certain endemic areas will increase access to timely diagnosis and treatment. However, additional research is needed to validate the use of these techniques across a wider geography, and to better understand the cost-effectiveness of their large-scale implementation.
