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Marchiol AR, Herazo R, Flórez Sánchez C, Ayala Sotelo MS, Segura ML, Cortés Cortés LJ, Caicedo Díaz RA. [Evaluation of a change in the serological diagnostic algorithm for Chagas disease in ColombiaAvaliação da mudança do algoritmo de diagnóstico sorológico da doença de Chagas na Colômbia]. Rev Panam Salud Publica 2023; 47:e141. [PMID: 37881802 PMCID: PMC10597392 DOI: 10.26633/rpsp.2023.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/11/2023] [Indexed: 10/27/2023] Open
Abstract
Objective To evaluate the effects of changing the algorithm for serological diagnosis of T. cruzi infection in departmental-level public health laboratories and in the National Reference Laboratory of Colombia, from the perspective of access to diagnosis. Methods A descriptive, cross-sectional study was carried out, based on secondary sources between 2015 and 2021, consolidating the number of serological tests carried out by the laboratories. A survey was developed to identify benefits and limitations in the implementation of the new algorithm for serological diagnosis. Totals, proportions, and averages of the number of tests were estimated by comparing two different periods. Results Information from 33 public health laboratories was analyzed, 87.9% of which processed serological assays during the period under study. The use of serological tests increased after the publication of the new guideline in 2017, and the capacity to perform the second test increased from four to 33 public health laboratories. In absolute terms, ELISAs for antigens and recombinant antigens became the most performed tests in Colombia after 2017. Conclusions The change in the algorithm for serological diagnosis of Chagas disease in Colombia in 2017 had positive effects on access to diagnosis since it facilitated the use of the second test. This change resulted in increased diagnostic coverage. The country's laboratories have access to a simple, timely, quality algorithm that could be implemented in almost any clinical laboratory in the country.
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Affiliation(s)
- Andrea Rosana Marchiol
- Drugs for Neglected Diseases initiativeRio de JaneiroBrasilDrugs for Neglected Diseases initiative, Rio de Janeiro, Brasil.
| | - Rafael Herazo
- Drugs for Neglected Diseases initiativeRio de JaneiroBrasilDrugs for Neglected Diseases initiative, Rio de Janeiro, Brasil.
| | | | | | - Maryi Lorena Segura
- Instituto Nacional de SaludBogotáColombiaInstituto Nacional de Salud, Bogotá, Colombia.
| | | | - Ricardo Andrés Caicedo Díaz
- Drugs for Neglected Diseases initiativeRio de JaneiroBrasilDrugs for Neglected Diseases initiative, Rio de Janeiro, Brasil.
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Marchiol A, Florez Sanchez AC, Caicedo A, Segura M, Bautista J, Ayala Sotelo MS, Herazo R, Forsyth C, Bohorquez LC. Laboratory evaluation of eleven rapid diagnostic tests for serological diagnosis of Chagas disease in Colombia. PLoS Negl Trop Dis 2023; 17:e0011547. [PMID: 37607214 PMCID: PMC10473487 DOI: 10.1371/journal.pntd.0011547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 09/01/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Chagas disease is a public health challenge in Colombia, where only an estimated 1.2% of people at risk have accessed diagnosis, while less than 0.5% of affected people have obtained treatment. The development of simplified diagnostic algorithms would enable progress in access to diagnosis; however, the current diagnostic algorithm relies on at least two laboratory-based tests that require qualified personnel, processing equipment, and infrastructure, which are still generally lacking at the primary care level. Rapid diagnostic tests (RDTs) for Chagas disease could simplify diagnosis, but their performance in the epidemiological context of Colombia is not well known. METHODOLOGY A retrospective analytical observational study of RDTs was performed to estimate the operational characteristics of 11 commercially available RDTs designed for in vitro detection of anti-T. cruzi IgG antibodies. The study was performed under controlled laboratory conditions using human serum samples. PRINCIPAL FINDINGS Eleven RDTs were assessed, ten using 585 serum samples and one using 551 serum samples. Employing the current national diagnostic algorithm as a reference standard for serological diagnosis of chronic infection, the sensitivity of the assessed RDTs ranged from 75.5% to 99.0% (95% CI 70.5-100), while specificity ranged from 70.9% to 100% (95% CI 65.3-100). Most tests (7/11, 63.6%) had sensitivity above 90%, and almost all (10/11, 90.9%) had specificity above 90%. Five RDTs had both sensitivity and specificity above 90%. CONCLUSIONS/SIGNIFICANCE The evaluation of these 11 commercially available RDTs under controlled laboratory conditions is a first step in the assessment of the diagnostic performance of RDTs in Colombia. As a next step, field studies will be conducted on available RDTs with sensitivity and specificity greater than 90% in this study, to evaluate performance in real world conditions, with the final goal to allow simplified diagnostic algorithms.
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Affiliation(s)
- Andrea Marchiol
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, Brazil
| | | | - Andrés Caicedo
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, Brazil
| | - Maryi Segura
- Departamento de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jessica Bautista
- Departamento de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia
| | | | - Rafael Herazo
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, Brazil
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, Brazil
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Gabaldón-Figueira JC, Skjefte M, Longhi S, Escabia E, García LJ, Ros-Lucas A, Martínez-Peinado N, Muñoz-Calderón A, Gascón J, Schijman AG, Alonso-Padilla J. Practical diagnostic algorithms for Chagas disease: a focus on low resource settings. Expert Rev Anti Infect Ther 2023; 21:1287-1299. [PMID: 37933443 DOI: 10.1080/14787210.2023.2279110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
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.
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Affiliation(s)
| | - Malia Skjefte
- Population Services International (PSI), Washington, MA, USA
| | - Silvia Longhi
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Elisa Escabia
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Lady Juliette García
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Albert Ros-Lucas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Nieves Martínez-Peinado
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Arturo Muñoz-Calderón
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Joaquim Gascón
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
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Suescún-Carrero SH, Tadger P, Sandoval Cuellar C, Armadans-Gil L, Ramírez López LX. Rapid diagnostic tests and ELISA for diagnosing chronic Chagas disease: Systematic revision and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010860. [PMID: 36256676 PMCID: PMC9616215 DOI: 10.1371/journal.pntd.0010860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/28/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the diagnostic validity of the enzyme-linked immunosorbent assay (ELISA) and Rapid Diagnostic Tests (RDT) among individuals with suspected chronic Chagas Disease (CD). METHODOLOGY A search was made for studies with ELISA and RDT assays validity estimates as eligibility criteria, published between 2010 and 2020 on PubMed, Web of Science, Scopus, and LILACS. This way, we extracted the data and assessed the risk of bias and applicability of the studies using the QUADAS-2 tool. The bivariate random effects model was also used to estimate the overall sensitivity and specificity through forest-plots, ROC space, and we visually assessed the heterogeneity between studies. Meta-regressions were made using subgroup analysis. We used Deeks' test to assess the risk of publication bias. RESULTS 43 studies were included; 27 assessed ELISA tests; 14 assessed RDTs; and 2 assessed ELISA and RDTs, against different reference standards. 51.2 % of them used a non-comparative observational design, and 46.5 % a comparative clinical design ("case-control" type). High risk of bias was detected for patient screening and reference standard. The ELISA tests had a sensitivity of 99% (95% CI: 98-99) and a specificity of 98% (95% CI: 97-99); whereas the Rapid Diagnostic Tests (RDT) had values of 95% (95% CI: 94-97) and 97% (95% CI: 96-98), respectively. Deeks' test showed asymmetry on the ELISA assays. CONCLUSIONS ELISA and RDT tests have high validity for diagnosing chronic Chagas disease. The analysis of these two types of evidence in this systematic review and meta-analysis constitutes an input for their use. The limitations included the difficulty in extracting data due to the lack of information in the articles, and the comparative clinical-type design of some studies.
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Affiliation(s)
| | - Philippe Tadger
- Universidad de Boyacá, Tunja, Colombia
- Real World Solutions, IQVIA, Zaventem, Belgium
| | | | - Lluis Armadans-Gil
- Epidemiology and Preventive Medicine Service, Hospital Universitari Vall d’Hebron—Universitat Autónoma de Barcelona, Barcelona, Spain
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On-site experience of a project to increase access to diagnosis and treatment of Chagas disease in high-risk endemic areas of Colombia. Acta Trop 2022; 226:106219. [PMID: 34757043 DOI: 10.1016/j.actatropica.2021.106219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
Colombia has one of the largest burdens of Chagas disease globally, with about 438,000 people affected according to 2015 estimates. Despite this, < 1% of the population has had access to diagnosis and treatment. A patient-centered roadmap for Chagas disease was developed from 2015 onwards to address access barriers and increase diagnostic and therapeutic coverage and was implemented in five municipalities where Chagas disease is endemic. The mean number of people tested per year increased from 37 before the project to 262 following implementation, and the average days between medical order and diagnostic confirmation results decreased from 258 to 19. The mean days from diagnostic confirmation to treatment initiation decreased from 354 before the project to 135 after implementation. The 5,654 people tested included 3,467 women of childbearing age. The prevalence of T. cruzi infection was 11.5%, and thus far 266 people have received antitrypanosomal treatment. Collaborative creation and implementation of a patient-centered roadmap can address access barriers in specific contexts, helping to reduce the invisibility and burden of this neglected disease.
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Suescún-Carrero SH, Salamanca-Cardozo LP, Pinazo MJ, Armadans-Gil L. Sensitivity and Specificity of two rapid tests for the diagnosis of infection by Trypanosoma cruzi in a Colombian population. PLoS Negl Trop Dis 2021; 15:e0009483. [PMID: 34077424 PMCID: PMC8202949 DOI: 10.1371/journal.pntd.0009483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/14/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate diagnostic precision of two rapid diagnostic tests (RDT’s) on patients with chronic Chagas disease. Methodology Prospective study with the following inclusion criteria: subjects older than 3 years, signed informed consent. Exclusion criterion: subjects could not have previously received treatment for infection with T. cruzi. The study population were participants in a screening process undertaken in rural and urban zones of the department Boyacá, Colombia. Two RDT’s were performed to all participants: the Chagas Detect Plus InBios (CDP) and the Chagas Stat-Pak (CSP) and as a reference standard the ELISA Chagas III GrupoBios and the Chagas ELISA IgG+IgM I Vircell tests were used. In the case of discordant results between the two ELISA tests, an indirect immunofluorescence was done. Results Three hundred-five (305) subjects were included in the study (38 patients with leishmaniasis), of which 215 tested negative for T cruzi and 90 tested positive according to the reference standard. The sensitivity of the RDT’s were 100% (CI 95% 95.9–100), and the specificity of the CDP was 99.1% (CI 95% 96.6–99.8) and for CSP was 100% (CI 95% 98.3–100). The agreement of CDP was 99.5% and for CSP was 100% with Kappa values of (k = 99.1; CI 95% 92.6–99.8%) and (k = 100; CI 95% 94.3–100), respectively. RDT’s did not present cross-reactions with samples from patients who were positive for leishmaniasis. Conclusions The findings demonstrate excellent results from the RDT’s in terms of validity, safety, and reproducibility. The results obtained provide evidence for the recommendation for using these tests in a Colombian epidemiological context principally in endemic areas in which laboratory installations necessary to perform conventional tests are not available, or they are scarce and to help in diagnosing chronic Chagas disease in order to provide access to treatment as soon as possible. Chagas is a disease caused by the parasite Trypanosoma cruzi, and is one of the most important public health concerns affecting the population of Latin America. This disease presents an acute phase that generally goes undiagnosed and a chronic phase with cardiac manifests principally, is diagnosed through serological tests that are not available in the majority of regions endemic for Chagas disease (CD), the results may take weeks to be returned due to logistical and operational reasons that comprise the main obstacles in initiating treatment of the disease. In the present article, quality indices of two RDT’s were evaluated during a field study in the department of Boyacá Colombia, these tests are easy to administer, require only minimal quantities of sample, provide rapid results and do not require electrical equipment or refrigeration. The sensitivity of the two RDT’s was 100% and the specificity of CDP was 99.1% and for CSP was 100% according to reference tests. The results obtained support the recommendation of using RDT’s in order to help diagnose chronic Chagas disease and thus to improve access to treatment for the populations studied as soon as possible.
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Affiliation(s)
- Sandra Helena Suescún-Carrero
- Grupo de Investigación del Laboratorio de Salud Pública de Boyacá, Secretaria de Salud de Boyacá, Tunja, Colombia, Doctorado en Metodología de la Investigación Biomédica y Salud Pública, Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Lyda Pilar Salamanca-Cardozo
- Grupo de Investigación del Laboratorio de Salud Pública de Boyacá, Secretaria de Salud de Boyacá, Tunja, Colombia
| | - María-Jesus Pinazo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic—University of Barcelona, Barcelona, Spain
| | - Lluis Armadans-Gil
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitari Vall d’Hebron—Universitat Autònoma de Barcelona, Barcelona, Spain
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Reifert J, Kamath K, Bozekowski J, Lis E, Horn EJ, Granger D, Theel ES, Shon J, Sawyer JR, Daugherty PS. Serum Epitope Repertoire Analysis Enables Early Detection of Lyme Disease with Improved Sensitivity in an Expandable Multiplex Format. J Clin Microbiol 2021; 59:e01836-20. [PMID: 33148704 PMCID: PMC8111119 DOI: 10.1128/jcm.01836-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Widely employed diagnostic antibody serology for Lyme disease, known as standard two-tier testing (STTT), exhibits insufficient sensitivity in early Lyme disease, yielding many thousands of false-negative test results each year. Given this problem, we applied serum antibody repertoire analysis (SERA), or next-generation sequencing (NGS)-based serology, to discover IgG and IgM antibody epitope motifs capable of detecting Lyme disease-specific antibodies with high sensitivity and specificity. Iterative motif discovery and bioinformatic analysis of epitope repertoires from subjects with Lyme disease (n = 264) and controls (n = 391) yielded a set of 28 epitope motifs representing 20 distinct IgG antibody epitopes and a set of 38 epitope motifs representing 21 distinct IgM epitopes, which performed equivalently in a large validation cohort of STTT-positive samples. In a second validation set from subjects with clinically defined early Lyme disease (n = 119) and controls (n = 257), the SERA Lyme IgG and IgM assay exhibited significantly improved sensitivity relative to STTT (77% versus 62%; Z-test; P = 0.013) and improved specificity (99% versus 97%). Early Lyme disease subjects exhibited significantly fewer reactive epitopes (Mann-Whitney U test; P < 0.0001) relative to subjects with Lyme arthritis. Thus, SERA Lyme IgG and M panels provided increased accuracy in early Lyme disease in a readily expandable multiplex assay format.
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Affiliation(s)
| | | | | | - Ewa Lis
- Serimmune Inc., Goleta, California, USA
| | | | - Dane Granger
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota, USA
| | - John Shon
- Serimmune Inc., Goleta, California, USA
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Imai K, Murakami T, Misawa K, Fujikura Y, Kawana A, Tarumoto N, Maesaki S, Maeda T. Optimization and evaluation of the ARCHITECT Chagas assay and in-house ELISA for Chagas disease in clinical settings in Japan. Parasitol Int 2020; 80:102221. [PMID: 33137505 DOI: 10.1016/j.parint.2020.102221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022]
Abstract
Approximately 250,000 immigrants from Latin America live in Japan and it is estimated that 1500-3000 of them are potentially infected with Trypanosoma cruzi, the cause of Chagas disease. Therefore, the establishment of a standardized diagnostic method for Chagas disease in Japan is urgently needed. In this study, we optimized and evaluated the ARCHITECT Chagas assay and in-house ELISA for Chagas disease in clinical settings. In particular, we evaluated the performance of ARCHITECT Chagas as well as ELISA with whole-cell lysates and three recombinant proteins (TcF, TcBCDE, and CP1 + CP3) using 93 Chagas disease-positive serum samples and 108 Chagas disease-positive samples. The sensitivities of ARCHITECT Chagas, whole-cell lysate, TcF, TcBCDE, and CP1 + CP3 ELISA were respectively 100%, 100%, 98.9%, 98.9%, and 89.2% and the corresponding specificities were 100%, 99.1%, 99.1%, 100%, and 99.1%. False-positive results were obtained for whole-cell lysate, TcF, and CP1 ± CP3 ELISA. This is the first evidence that OD cut-off values optimized for in-house ELISA are similar in terms of sensitivity and specificity to those of the ARCHITECT Chagas test, supporting the use of these in-house assays as diagnostic tests for Chagas disease in the clinical setting in Japan.
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Affiliation(s)
- Kazuo Imai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Takashi Murakami
- Department of Microbiology, Saitama Medical University, Saitama, Japan
| | - Kazuhisa Misawa
- Department of Infectious Diseases and Respiratory Medicine, National Defense Medical College, Saitama, Japan
| | - Yuji Fujikura
- Department of Infectious Diseases and Respiratory Medicine, National Defense Medical College, Saitama, Japan
| | - Akihiko Kawana
- Department of Infectious Diseases and Respiratory Medicine, National Defense Medical College, Saitama, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Takuya Maeda
- Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan; Department of Laboratory Medicine, Saitama Medical University, Saitama, Japan.
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Pinazo MJ, Pereiro A, Herazo R, Chopita M, Forsyth C, Lenardón M, Losada I, Torrico F, Marchiol A, Vera M. Interventions to bring comprehensive care to people with Chagas disease: Experiences in Bolivia, Argentina and Colombia. Acta Trop 2020; 203:105290. [PMID: 31811865 DOI: 10.1016/j.actatropica.2019.105290] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 11/14/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
Chagas disease (CD) affects over six million people and is a leading cause of heart failure in the Americas. Few are able to access diagnosis and treatment for CD, resulting in a missed opportunity to prevent morbimortality. Integration of testing and treatment with the primary healthcare level is a key step in ensuring affected people receive timely antitrypansomal therapy, which increasing evidence shows can prevent chronic complications from the disease and halt congenital transmission. This article describes three collaborative projects focused on increasing access to testing and treatment for CD through primary healthcare facilities in Bolivia, Argentina, and Colombia.
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Affiliation(s)
| | - Ana Pereiro
- Fundacion Mundo Sano, Buenos Aires, Argentina, Madrid, Spain.
| | - Rafael Herazo
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil.
| | - Marina Chopita
- Secretariat of Health and Social Medicine of the Municipality of La Plata, Argentina
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Mabel Lenardón
- Secretariat of Health and Social Medicine of the Municipality of La Plata, Argentina
| | - Irene Losada
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Faustino Torrico
- Universidad Mayor de San Simón, Faculty of Medicine, Cochabamba, Bolivia; Fundación CEADES, Cochabamba, Bolivia
| | - Andrea Marchiol
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Mauricio Vera
- Ministry of Health and Social Protection, Bogotá, Colombia
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Méndez C, Duque MC, Romero Y, Pérez J, Rodríguez O, Correa-Cárdenas CA, Alvarado MT, Cantillo-Barraza O. Prevalence of Trypanosoma cruzi infection in active military population of The Colombian National Army gathered in five departments. PLoS One 2019; 14:e0223611. [PMID: 31596874 PMCID: PMC6785108 DOI: 10.1371/journal.pone.0223611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background The National Army of Colombia is present in all of the national territory, focused in sylvatic zones where they are exposed continually to potential risk of transmission of Trypanosoma cruzi, the etiological agent of the Chagas disease. People of this study were active personal that were born and lived during their first years in endemic areas of transmission through domiciled vectors as Rhodnius prolixus. Aim The main aim of this study was to estimate the prevalence of Chagas disease in the active military population of the National Army, gathered in five departments. Methods An observational and descriptive study with cross-sectional analysis was carried out. Blood sample each patient in order to apply serological diagnosis by two different Enzyme Linked ImmunoSorbent Assay tests, following the algorithm of National Institute of Health, Colombia. In cases of serum results with inconsistencies, a Hemagglutination Inhibition test and Indirect Immunofluorescence assay test were performed to solve inconclusiveness. Positive samples by two different tests were considered seropositive. Additionally, to each positive sample by at least one serological test, we did extraction of DNA for molecular diagnosis. Results 295 serums were analyzed and two of them were positive in order to get a prevalence of 0.68%. Two samples analyzed by molecular diagnosis were negative. Conclusion The prevalence was < 1% It is probable the infection in the seropositive individuals occurred before enlisting in the military service due to origin locations with transmission such as Casanare and Boyacá. These findings allow defining the prevention and control programs of chronic cases and reduction in the disease burden.
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Affiliation(s)
- Claudia Méndez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
- * E-mail:
| | - Maria Clara Duque
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
| | - Yanira Romero
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
| | - Julie Pérez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
| | - Omaira Rodríguez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
| | - Camilo A. Correa-Cárdenas
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
| | - Maria Teresa Alvarado
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
| | - Omar Cantillo-Barraza
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad, Bogotá, Colombia
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