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Bloch EM, Busch MP, Corash LM, Dodd R, Hailu B, Kleinman S, O'Brien S, Petersen L, Stramer SL, Katz L. Leveraging Donor Populations to Study the Epidemiology and Pathogenesis of Transfusion-Transmitted and Emerging Infectious Diseases. Transfus Med Rev 2023; 37:150769. [PMID: 37919210 PMCID: PMC10841704 DOI: 10.1016/j.tmrv.2023.150769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 11/04/2023]
Abstract
The tragedy of transfusion-associated hepatitis and HIV spurred a decades-long overhaul of the regulatory oversight and practice of blood transfusion. Consequent to improved donor selection, testing, process control, clinical transfusion practice and post-transfusion surveillance, transfusion in the United States and other high-income countries is now a very safe medical procedure. Nonetheless, pathogens continue to emerge and threaten the blood supply, highlighting the need for a proactive approach to blood transfusion safety. Blood donor populations and the global transfusion infrastructure are under-utilized resources for the study of infectious diseases. Blood donors are large, demographically diverse subsets of general populations for whom cross-sectional and longitudinal samples are readily accessible for serological and molecular testing. Blood donor collection networks span diverse geographies, including in low- and middle-income countries, where agents, especially zoonotic pathogens, are able to emerge and spread, given limited tools for recognition, surveillance and control. Routine laboratory storage and transportation, coupled with data capture, afford access to rich epidemiological data to assess the epidemiology and pathogenesis of established and emerging infections. Subsequent to the State of the Science in Transfusion Medicine symposium in 2022, our working group (WG), "Emerging Infections: Impact on Blood Science, the Blood Supply, Blood Safety, and Public Health" elected to focus on "leveraging donor populations to study the epidemiology and pathogenesis of transfusion-transmitted and emerging infectious diseases." The 5 landmark studies span (1) the implication of hepatitis C virus in post-transfusion hepatitis, (2) longitudinal evaluation of plasma donors with incident infections, thus informing the development of a widely used staging system for acute HIV infection, (3) explication of the dynamics of early West Nile Virus infection, (4) the deployment of combined molecular and serological donor screening for Babesia microti, to characterize its epidemiology and infectivity and facilitate routine donor screening, and (5) national serosurveillance for SARS-CoV-2 during the COVID-19 pandemic. The studies highlight the interplay between infectious diseases and transfusion medicine, including the imperative to ensure blood transfusion safety and the broader application of blood donor populations to the study of infectious diseases.
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Affiliation(s)
- Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence M Corash
- Cerus Corporation, Concord, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Roger Dodd
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Benyam Hailu
- Division of Blood Diseases Research, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | | | - Sheila O'Brien
- Canadian Blood Services, Epidemiology and Surveillance, Microbiology, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lyle Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Louis Katz
- ImpactLife Blood Services, Davenport, IA, USA
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2
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Our Current Understanding of Chagas Disease and Trypanosoma cruzi Infection in the State of Florida — an Update on Research in this Region of the USA. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose of Review
Chagas disease (CD) is a neglected tropical disease caused by the protozoan parasite, Trypanosoma cruzi. Parasite transmission primarily occurs through direct interaction with an infected triatomine insect vector (kissing bug), but other routes are known. We aim to review the literature and discuss the unique circumstances of CD in the US state of Florida.
Recent Findings
Florida is home to naturally occurring kissing bugs that are invading homes and harbor T. cruzi. The state is also home to a diverse population of immigrants from Chagas-endemic regions in Latin America. In the USA, Florida is the state with the third highest estimated burden of CD, although the true prevalence is unknown.
Summary
Chagas disease is a chronic infection that often remains silent for decades. Those who manifest chronic disease may eventually die from debilitating cardiac and/or gastrointestinal manifestations. Florida is an opportune region of the USA for the study of CD, due to the existence of endemic transmission cycles in addition to the burden among people born in Chagas-endemic regions.
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Patel EU, Bloch EM, Tobian AAR. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serosurveillance in Blood Donor Populations. J Infect Dis 2021; 225:1-4. [PMID: 34626464 DOI: 10.1093/infdis/jiab517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A R Tobian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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4
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Caballero E Z, Correa R, Nascimento MS, Villarreal A, Llanes A, Kesper N. High sensitivity and reproducibility of in-house ELISAs using different genotypes of Trypanosoma cruzi. Parasite Immunol 2019; 41:e12627. [PMID: 30908676 DOI: 10.1111/pim.12627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 02/08/2019] [Accepted: 03/20/2019] [Indexed: 02/01/2023]
Abstract
The adequate choice of Trypanosoma cruzi strains as antigen source for the diagnosis of Chagas disease is still controversial due to differences in terms of accuracy reported between different diagnostic tests. In this study was determined if the genetic variability between different genotypes of T. cruzi (TcI, TcII and TcIV) affect the final diagnosis of Chagas disease. The sensitivity and specificity index of in-house ELISA tests prepared with different T. cruzi strains were evaluated with chagasic and non-chagasic control sera and using the TESA-blot as a reference test. The results of this study revealed that the sensitivity index did not vary, with percentages of 100% for all strains in both tests. However, the specificity index for ELISA tests showed differences between 92% and 98%, but were reduced to 78%-89% when Leishmania-positive sera were included. All ELISAs and TESA-blot prepared with different antigens and the recombinant Wiener test were challenged in an endemic community for Chagas disease in Panama. Both ELISAs and TESA-blot recognized the same positive sera, corroborating the sensitivity indexes (100%) found with the control sera. The TESA-blot maintained the specificity index of 100% and did not display false positives. However, the recombinant Wiener test decreased its sensitivity to 81.25%.
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Affiliation(s)
- Zuleima Caballero E
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Asociación de Interés Público (INDICASAT-AIP), Panamá, República of Panamá.,Sistema Nacional de Investigación - Secretaría Nacional de Ciencia, Tecnología e Innovación (SNI-SENACYT), Panamá, República de Panamá
| | - Ricardo Correa
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Asociación de Interés Público (INDICASAT-AIP), Panamá, República of Panamá.,Sistema Nacional de Investigación - Secretaría Nacional de Ciencia, Tecnología e Innovación (SNI-SENACYT), Panamá, República de Panamá
| | - Marilda S Nascimento
- Instituto de Medicina Tropical da Universidade de São Paulo (IMT-USP), São Paulo, Brasil
| | - Alcibiades Villarreal
- Sistema Nacional de Investigación - Secretaría Nacional de Ciencia, Tecnología e Innovación (SNI-SENACYT), Panamá, República de Panamá
| | - Alejandro Llanes
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Asociación de Interés Público (INDICASAT-AIP), Panamá, República of Panamá
| | - Norival Kesper
- Instituto de Medicina Tropical da Universidade de São Paulo (IMT-USP), São Paulo, Brasil
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Dodd RY, Groves JA, Townsend RL, Notari EP, Foster GA, Custer B, Busch MP, Stramer SL. Impact of one-time testing for Trypanosoma cruzi
antibodies among blood donors in the United States. Transfusion 2018; 59:1016-1023. [DOI: 10.1111/trf.15118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Roger Y. Dodd
- Scientific Affairs; American Red Cross; Gaithersburg Maryland
| | - Jamel A. Groves
- Scientific Affairs; American Red Cross; Gaithersburg Maryland
| | | | | | | | - Brian Custer
- Vitalant Research Institute; San Francisco California
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6
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Carmona-Castro O, Moo-Llanes DA, Ramsey JM. Impact of climate change on vector transmission of Trypanosoma cruzi (Chagas, 1909) in North America. MEDICAL AND VETERINARY ENTOMOLOGY 2018; 32:84-101. [PMID: 28887895 DOI: 10.1111/mve.12269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/05/2017] [Accepted: 07/29/2017] [Indexed: 06/07/2023]
Abstract
Climate change can influence the geographical range of the ecological niche of pathogens by altering biotic interactions with vectors and reservoirs. The distributions of 20 epidemiologically important triatomine species in North America were modelled, comparing the genetic algorithm for rule-set prediction (GARP) and maximum entropy (MaxEnt), with or without topographical variables. Potential shifts in transmission niche for Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) (Chagas, 1909) were analysed for 2050 and 2070 in Representative Concentration Pathway (RCP) 4.5 and RCP 8.5. There were no significant quantitative range differences between the GARP and MaxEnt models, but GARP models best represented known distributions for most species [partial-receiver operating characteristic (ROC) > 1]; elevation was an important variable contributing to the ecological niche model (ENM). There was little difference between niche breadth projections for RCP 4.5 and RCP 8.5; the majority of species shifted significantly in both periods. Those species with the greatest current distribution range are expected to have the greatest shifts. Positional changes in the centroid, although reduced for most species, were associated with latitude. A significant increase or decrease in mean niche elevation is expected principally for Neotropical 1 species. The impact of climate change will be specific to each species, its biogeographical region and its latitude. North American triatomines with the greatest current distribution ranges (Nearctic 2 and Nearctic/Neotropical) will have the greatest future distribution shifts. Significant shifts (increases or decreases) in mean elevation over time are projected principally for the Neotropical species with the broadest current distributions. Changes in the vector exposure threat to the human population were significant for both future periods, with a 1.48% increase for urban populations and a 1.76% increase for rural populations in 2050.
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Affiliation(s)
- O Carmona-Castro
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Mexico
| | - D A Moo-Llanes
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México City, Mexico
| | - J M Ramsey
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Mexico
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Gunter SM, Murray KO, Gorchakov R, Beddard R, Rossmann SN, Montgomery SP, Rivera H, Brown EL, Aguilar D, Widman LE, Garcia MN. Likely Autochthonous Transmission of Trypanosoma cruzi to Humans, South Central Texas, USA. Emerg Infect Dis 2018; 23:500-503. [PMID: 28221110 PMCID: PMC5382766 DOI: 10.3201/eid2303.161157] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is a major neglected tropical disease affecting the Americas. The epidemiology of this disease in the United States is incomplete. We report evidence of likely autochthonous vectorborne transmission of T. cruzi and health outcomes in T. cruzi–seropositive blood donors in south central Texas, USA.
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Traina M, Meymandi S, Bradfield JS. Heart Failure Secondary to Chagas Disease: an Emerging Problem in Non-endemic Areas. Curr Heart Fail Rep 2017; 13:295-301. [PMID: 27807757 DOI: 10.1007/s11897-016-0305-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chagas disease affects millions of people worldwide. Though the majority of infected individuals remain asymptomatic, approximately 30 % of patients progress to develop cardiac manifestations and eventual heart failure. While vectorial transmission occurs predominantly in South America, Central America, and Mexico, millions of people originally from these endemic regions immigrate to non-endemic countries in North America, Europe, and Asia. Outside of rare specialized centers, health-care providers lack experience diagnosing and treating this disease. This lack of experience likely leads to far fewer Chagas disease patients being diagnosed than what actually exist in non-endemic countries, with subsequent adverse effect on patient outcomes and health-care expenses. Underdiagnosis increases the risk of developing cardiomyopathy, associated heart failure, and life-threatening ventricular arrhythmias as the disease progresses.
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Affiliation(s)
- Mahmoud Traina
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA, 91342, USA
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, PO Box 112412, Al Maryah Island, Abu Dhabi, UAE
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA, 91342, USA
| | - Jason S Bradfield
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA, 91342, USA.
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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9
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Leiby DA, Nguyen ML, Proctor MC, Townsend RL, Stramer SL. Frequency of Trypanosoma cruzi parasitemia among infected blood donors with a potential association between parasite lineage and transfusion transmission. Transfusion 2017; 57:1426-1432. [PMID: 28295355 DOI: 10.1111/trf.14082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trypanosoma cruzi is endemic to the Americas where it demonstrates multiple lineages over a vast geographic range (i.e., United States to Argentina). These lineages possess divergent geographic and biologic characteristics, including variations in disease manifestations. Herein, we report the frequency of parasitemia among seropositive US blood donors and the potential association between parasite lineage and transfusion transmission. STUDY DESIGN AND METHODS Blood donors identified as T. cruzi seropositive during screening were enrolled in follow-up studies, including hemoculture testing and a risk factor questionnaire. Positive hemocultures were expanded to obtain sufficient parasites for molecular lineage determination and analysis. Country of birth, obtained from the questionnaire, was used to predict parasite lineage in the absence of demonstrable parasitemia for infected donors. RESULTS Eighteen (6.8%) of 263 seropositive donors were hemoculture positive. Among the 17 hemocultures expanded for lineage determination, TcV was identified more frequently (n = 12), compared to TcI (n = 2), TcII (n = 1), and TcVI (n = 2). When presumptive parasite lineages were compared to hemoculture results, only two of 157 (1.3%) TcI versus 13 of 38 (34.2%) TcII/TcV/TcVI non-US donors were parasitemic; three of 44 (6.8%) US donors were TcV or TcVI. CONCLUSIONS Based on lineage determination for donors with parasitemia; hemoculture positivity associated with presumptive parasite lineage; and implicated donors from US, Canadian, and Spanish transfusion cases, donors from Southern South America are significantly more likely to have parasitemia and transmit infection to blood recipients (TcII, TcV, or TcVI vs. TcI). Thus, parasite lineage may be associated with risk of transfusion-transmitted T. cruzi.
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Affiliation(s)
- David A Leiby
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
| | - Megan L Nguyen
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
| | - Melanie C Proctor
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
| | | | - Susan L Stramer
- Scientific Support Office, American Red Cross, Gaithersburg, Maryland
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10
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Brasil PEAAD, Xavier SS, Holanda MT, Hasslocher-Moreno AM, Braga JU. Does my patient have chronic Chagas disease? Development and temporal validation of a diagnostic risk score. Rev Soc Bras Med Trop 2017; 49:329-40. [PMID: 27384830 DOI: 10.1590/0037-8682-0196-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With the globalization of Chagas disease, unexperienced health care providers may have difficulties in identifying which patients should be examined for this condition. This study aimed to develop and validate a diagnostic clinical prediction model for chronic Chagas disease. METHODS This diagnostic cohort study included consecutive volunteers suspected to have chronic Chagas disease. The clinical information was blindly compared to serological tests results, and a logistic regression model was fit and validated. RESULTS The development cohort included 602 patients, and the validation cohort included 138 patients. The Chagas disease prevalence was 19.9%. Sex, age, referral from blood bank, history of living in a rural area, recognizing the kissing bug, systemic hypertension, number of siblings with Chagas disease, number of relatives with a history of stroke, ECG with low voltage, anterosuperior divisional block, pathologic Q wave, right bundle branch block, and any kind of extrasystole were included in the final model. Calibration and discrimination in the development and validation cohorts (ROC AUC 0.904 and 0.912, respectively) were good. Sensitivity and specificity analyses showed that specificity reaches at least 95% above the predicted 43% risk, while sensitivity is at least 95% below the predicted 7% risk. Net benefit decision curves favor the model across all thresholds. CONCLUSIONS A nomogram and an online calculator (available at http://shiny.ipec.fiocruz.br:3838/pedrobrasil/chronic_chagas_disease_prediction/) were developed to aid in individual risk estimation.
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Affiliation(s)
| | - Sergio Salles Xavier
- Laboratório de Pesquisa Clínica em doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Marcelo Teixeira Holanda
- Laboratório de Pesquisa Clínica em doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Alejandro Marcel Hasslocher-Moreno
- Laboratório de Pesquisa Clínica em doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - José Ueleres Braga
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
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11
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Garcia MN, Aguilar D, Gorchakov R, Rossmann SN, Montgomery SP, Rivera H, Woc-Colburn L, Hotez PJ, Murray KO. Evidence of autochthonous Chagas disease in southeastern Texas. Am J Trop Med Hyg 2015; 92:325-30. [PMID: 25371187 PMCID: PMC4347336 DOI: 10.4269/ajtmh.14-0238] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/10/2014] [Indexed: 01/05/2023] Open
Abstract
Autochthonous transmission of Trypanosoma cruzi in the United States is rarely reported. Here, we describe five newly identified patients with autochthonously acquired infections from a small pilot study of positive blood donors in southeast Texas. Case-patients 1-4 were possibly infected near their residences, which were all in the same region ∼100 miles west of Houston. Case-patient 5 was a young male with considerable exposure from routine outdoor and camping activities associated with a youth civic organization. Only one of the five autochthonous case-patients received anti-parasitic treatment. Our findings suggest an unrecognized risk of human vector-borne transmission in southeast Texas. Education of physicians and public health officials is crucial for identifying the true disease burden and source of infection in Texas.
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Affiliation(s)
- Melissa N Garcia
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - David Aguilar
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Rodion Gorchakov
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Susan N Rossmann
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Susan P Montgomery
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Hilda Rivera
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Laila Woc-Colburn
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Peter J Hotez
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Kristy O Murray
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
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Mundt JM, Rouse L, Van den Bossche J, Goodrich RP. Chemical and biological mechanisms of pathogen reduction technologies. Photochem Photobiol 2014; 90:957-64. [PMID: 25041351 PMCID: PMC4277684 DOI: 10.1111/php.12311] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/01/2014] [Indexed: 01/25/2023]
Abstract
Within the last decade new technologies have been developed and implemented which employ light, often in the presence of a photosensitizer, to inactivate pathogens that reside in human blood products for the purpose of transfusion. These pathogen reduction technologies attempt to find the proper balance between pathogen kill and cell quality. Each system utilizes various chemistries that not only impact which pathogens they can inactivate and how, but also how the treatments affect the plasma and cellular proteins and to what degree. This paper aims to present the various chemical mechanisms for pathogen reduction in transfusion medicine that are currently practiced or in development.
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13
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Dodd RY. Transfusion-transmitted infections: testing strategies and residual risk. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R. Y. Dodd
- American Red Cross; Holland Laboratory; Rockville MD USA
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14
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A case of vertical transmission of Chagas disease contracted via blood transfusion in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:32-4. [PMID: 24421790 DOI: 10.1155/2013/406402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chagas disease is caused by the protozoan parasite Trypanosoma cruzi and is endemic in many countries in Latin America, where infected bugs of the Triatominea subfamily carry the parasite in the gut and transmit it to humans through fecal contamination of a bite. However, vertical transmission and transmission through blood transfusion and organ transplantation is well documented. Increasing immigration from endemic countries to North America has prompted blood operators, including Canadian Blood Services and Hema Quebec, to initiate blood donor testing for Chagas antibody. In the present report, an unusual case of vertical transmission from a mother, most likely infected through blood transfusion, and detected as part of a concurrent seroprevalence study in blood donors is described.
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15
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Glynn SA, Busch MP, Dodd RY, Katz LM, Stramer SL, Klein HG, Simmons G, Kleinman SH, Shurin SB. Emerging infectious agents and the nation's blood supply: responding to potential threats in the 21st century. Transfusion 2013; 53:438-54. [PMID: 22690676 PMCID: PMC3644861 DOI: 10.1111/j.1537-2995.2012.03742.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Simone A Glynn
- Transfusion Medicine and Cellular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Gallagher LM, Ganz PR, Yang H, Kessler DA, O'Brien SF, Custer BS, Busch MP, Dodd RY, Stramer SL, Walderhaug MO, Forshee RA, Williams AE, Epstein JS, Anderson SA. Advancing risk assessment for emerging infectious diseases for blood and blood products: proceedings of a public workshop. Transfusion 2012; 53:455-63. [PMID: 22845334 DOI: 10.1111/j.1537-2995.2012.03808.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Lou M Gallagher
- Center for Biologics Evaluation and Research, US FDA, Rockville, Maryland, USA.
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Kitchen AD, Hewitt PE, Chiodini PL. The early implementation of Trypanosoma cruzi antibody screening of donors and donations within England: preempting a problem. Transfusion 2012; 52:1931-9. [PMID: 22414025 DOI: 10.1111/j.1537-2995.2012.03599.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trypanosoma cruzi is a parasitic infection endemic in Central and Southern America, but is spreading into nonendemic countries with migration of infected individuals from endemic countries. The parasite is transmitted by transfusion or transplantation and donation screening is performed routinely in endemic countries to prevent transmission. In situations where migrants from endemic countries have settled in nonendemic countries and present as donors (blood or other cellular products), intervention is required to prevent transfusion or transplantation transmission. STUDY DESIGN AND METHODS A screening program for T. cruzi was developed and has been used successfully for over 10 years that includes donor selection and donation screening. Donor selection criteria to identify specific risk of T. cruzi infection were developed together with laboratory screening of donations for T. cruzi antibodies and the subsequent confirmation of screen reactivity. RESULTS Since the introduction of T. cruzi screening in England in 1998, a total of 38,585 donors and donations have been screened for T. cruzi antibodies, of which 223 were repeat reactive on screening and referred for confirmation: 206 confirmed negative, 14 inconclusive, and three positive. Since the move in 2005 from donor qualification to donation release testing, 15,536 donations were collected and screened, of which 15,499 (99.8%) were T. cruzi antibody negative and released to inventory. CONCLUSION An effective program to minimize risk of the transmission of T. cruzi infection via donations has been developed and implemented. Not only does the program minimize risk of transmission, it also minimizes the cumulative, and needless, loss of donors and donations that would ensue if permanent donor deferral alone was adopted.
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Affiliation(s)
- Alan D Kitchen
- National Transfusion Microbiology Reference Laboratory and Clinical Transfusion Microbiology, NHS Blood and Transplant, Hospital for Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Biologic and genetics aspects of chagas disease at endemic areas. J Trop Med 2012; 2012:357948. [PMID: 22529863 PMCID: PMC3317048 DOI: 10.1155/2012/357948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/28/2011] [Indexed: 11/17/2022] Open
Abstract
The etiologic agent of Chagas Disease is the Trypanosoma cruzi, transmitted through blood-sucking insect vectors of the Triatominae subfamily, representing one of the most serious public health concerns in Latin America. There are geographic variations in the prevalence of clinical forms and morbidity of Chagas disease, likely due to genetic variation of the T. cruzi and the host genetic and environmental features. Increasing evidence has supported that inflammatory cytokines and chemokines are responsible for the generation of the inflammatory infiltrate and tissue damage. Moreover, genetic polymorphisms, protein expression levels, and genomic imbalances are associated with disease progression. This paper discusses these key aspects. Large surveys were carried out in Brazil and served as baseline for definition of the control measures adopted. However, Chagas disease is still active, and aspects such as host-parasite interactions, genetic mechanisms of cellular interaction, genetic variability, and tropism need further investigations in the attempt to eradicate the disease.
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Custer B, Agapova M, Bruhn R, Cusick R, Kamel H, Tomasulo P, Biswas H, Tobler L, Lee TH, Caglioti S, Busch M. Epidemiologic and laboratory findings from 3 years of testing United States blood donors for Trypanosoma cruzi. Transfusion 2012; 52:1901-11. [DOI: 10.1111/j.1537-2995.2012.03569.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Benjamin RJ, Stramer SL, Leiby DA, Dodd RY, Fearon M, Castro E. Trypanosoma cruzi infection in North America and Spain: evidence in support of transfusion transmission. Transfusion 2012; 52:1913-21; quiz 1912. [PMID: 22321142 DOI: 10.1111/j.1537-2995.2011.03554.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The United States, Canada, and Spain perform selective testing of blood donors for Trypanosoma cruzi infection (Chagas disease) to prevent transfusion transmission. The donor, product, and patient characteristics associated with transfusion-transmitted infections are reviewed and the infectivity of components from donors with serologic evidence of infection is estimated. STUDY DESIGN AND METHODS A systematic review of transfusion-transmitted T. cruzi cases and recipient tracing undertaken in North America and Spain is described. Cases were assessed for the imputability of the evidence for transfusion transmission. RESULTS T. cruzi infection in 20 transfusion recipients was linked to 18 serologically confirmed donors between 1987 and 2011, including 11 identified only by recipient tracing. Cases were geographically widely distributed and were not associated with incident or autochthonous infections. Index clinical cases were described only in immunocompromised patients. All definite transmissions (n = 11) implicated apheresis or whole blood-derived platelets (PLTs), including leukoreduced and irradiated products. There is no evidence of transmission by red blood cells (RBCs) or frozen products, while transmission by whole blood transfusion remains a possibility. Recipient tracing reveals low component infectivity from serologically confirmed, infected donors of 1.7% (95% confidence interval [CI], 0.7%-3.5%) overall: 13.3% (95% CI, 5.6%-25.7%) for PLTs, 0.0% (95% CI, 0.0%-1.5%) for RBCs, and 0.0% (95% CI, 0%-3.7%) for plasma and cryoprecipitate. CONCLUSIONS T. cruzi is transmitted by PLT components from some donors with serologic evidence of infection. Evidence of transmission before the implementation of widespread testing in the countries studied is sparse, and selective testing of only PLT and fresh whole blood donations should be considered.
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Affiliation(s)
- Richard J Benjamin
- American Red Cross Holland Laboratories, Rockville, Maryland 20855, USA.
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Bern C, Kjos S, Yabsley MJ, Montgomery SP. Trypanosoma cruzi and Chagas' Disease in the United States. Clin Microbiol Rev 2011; 24:655-81. [PMID: 21976603 PMCID: PMC3194829 DOI: 10.1128/cmr.00005-11] [Citation(s) in RCA: 456] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi and causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles of T. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected with T. cruzi. In the eastern United States, the prevalence of T. cruzi is highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, most T. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derived T. cruzi infections have been documented in the United States and Canada. As improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century.
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Affiliation(s)
- Caryn Bern
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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O'Brien SF, Zou S, Laperche S, Brant LJ, Seed CR, Kleinman SH. Surveillance of transfusion-transmissible infections comparison of systems in five developed countries. Transfus Med Rev 2011; 26:38-57. [PMID: 21944935 PMCID: PMC7134890 DOI: 10.1016/j.tmrv.2011.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Most industrialized countries maintain surveillance programs for monitoring transmissible infection in blood donations, revising approaches to methodology and risk assessment as new threats emerge. A comparison of programs in the United States, Canada, France, the UK, and Australia indicates that they have similar function, although the structure of blood programs vary as does the extent and nature of formal ties with public health. The emergence of HIV in the late 1970s and early 1980s was key in recognizing that surveillance systems specific to blood transfusion were essential. Hence, most industrialized countries monitor transfusion-transmissible infections in donors and evaluate the impact of new testing and of predonation screening strategies. Emerging infections since HIV have had different transmission pathways and challenged blood programs to draw upon resources for a rapid and effective response, with recognition that the original focus on sexual/drug-related risk of HIV and hepatitis was inadequate. The focus of surveillance programs on new and emerging pathogens fulfills a key role in risk assessment and policy formulation. The precise nature of such activities varies by country because of the structure of the blood programs and surveillance systems, the strategic focus of the blood programs, and the epidemiology of disease in each country.
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Affiliation(s)
- Sheila F O'Brien
- National Epidemiology and Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, Canada K1G 4J5. sheila.o'
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Dealing with initial inconclusive serological results for chronic Chagas disease in clinical practice. Eur J Clin Microbiol Infect Dis 2011; 31:965-74. [DOI: 10.1007/s10096-011-1393-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 08/18/2011] [Indexed: 11/27/2022]
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Prevalence of antibody to Trypanosoma cruzi in Hispanic-surnamed patients seen at Parkland Health & Hospital System, Dallas, Texas. BMC Res Notes 2011; 4:132. [PMID: 21529355 PMCID: PMC3108937 DOI: 10.1186/1756-0500-4-132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 04/29/2011] [Indexed: 11/25/2022] Open
Abstract
Background Chagas disease constitutes an important public health threat in terms of morbidity and mortality in the areas in the United States where immigrant populations from Latin America are conspicuous. We conducted a survey to assess the prevalence of anti-T. cruzi antibody in Hispanic-surnamed patients seen at Parkland Memorial Hospital in Dallas, Texas. Findings Five hundred serum specimens from Hispanic-surnamed patients were tested by a preliminary ELISA method. On a subset of 50 sera confirmatory testing was also performed using an alternative ELISA, indirect immunofluorescence, and TESA immunoblot. For 274 of 500 Hispanic-surnamed patients, we were able to ascertain immigration status upon medical chart review. Of the 274 sera analyzed, one sample tested as positive for anti-T. cruzi antibody by the preliminary ELISA, and by the three confirmatory methods. Conclusions The goal of this study is to increase the awareness of T. cruzi infection and Chagas disease in areas where the Latin American immigrant communities are growing. Our study highlights the importance of testing for Chagas disease in the populations most at risk, and the need for current data on the actual seroprevalence in areas where such immigrant populations are conspicuous. Larger-scale epidemiologic surveys on Chagas disease in the immigrant communities from Latin America are warranted.
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Chin-Hong PV, Schwartz BS, Bern C, Montgomery SP, Kontak S, Kubak B, Morris MI, Nowicki M, Wright C, Ison MG. Screening and treatment of chagas disease in organ transplant recipients in the United States: recommendations from the chagas in transplant working group. Am J Transplant 2011; 11:672-80. [PMID: 21401868 DOI: 10.1111/j.1600-6143.2011.03444.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-derived transmission of Trypanosoma cruzi, the etiologic agent of Chagas disease, has emerged as an issue in the United States over the past 10 years. Acute T. cruzi infection causes substantial morbidity and mortality in the posttransplant setting if not recognized and treated early. We assembled a working group of transplant infectious disease specialists, laboratory medicine specialists, organ procurement organization representatives and epidemiologists with expertise in Chagas disease. Based on review of published and unpublished data, the working group prepared evidence-based recommendations for donor screening, and follow-up testing and treatment of recipients of organs from infected donors. We advise targeted T. cruzi screening of potential donors born in Mexico, Central America and South America. Programs can consider transplantation of kidneys and livers from T. cruzi-infected donors with informed consent from recipients. However, we recommend against heart transplantation from infected donors. For other organs, we recommend caution based on the anticipated degree of immunosuppression. Our recommendations stress the need for systematic monitoring of recipients by polymerase chain reaction, and microscopy of buffy coat and advance planning for immediate antitrypanosomal treatment if recipient infection is detected. Data on management and outcomes of all cases should be collected to inform future guidelines and to assist in coordination with public health authorities.
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Affiliation(s)
- P V Chin-Hong
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
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Verani JR, Montgomery SP, Schulkin J, Anderson B, Jones JL. Survey of obstetrician-gynecologists in the United States about Chagas disease. Am J Trop Med Hyg 2010; 83:891-5. [PMID: 20889886 DOI: 10.4269/ajtmh.2010.09-0543] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease affects an estimated 300,000 people in the United States, and as many as 300 congenital infections are estimated to occur annually. The level of knowledge about Chagas disease among obstetricians-gynecologists in the United States has not been assessed. The American College of Obstetricians and Gynecologists surveyed a representative sample of 1,000 members about Chagas disease. Among 421 respondents, 68.2% (95% confidence interval [CI] = 63.5-72.6) described their knowledge level about Chagas disease as "very limited." Only 8.8% (95% CI = 6.2-12.0) knew the risk of congenital infection, and 7.4% (95% CI = 5.1-10.4) were aware that both acute and chronic maternal infections can lead to congenital transmission. The majority of respondents (77.9%; 95% CI = 73.5-81.9) reported "never" considering a diagnosis of Chagas disease among their patients from endemic countries. Most of those who did consider the diagnosis did so "rarely." Knowledge of Chagas disease among obstetricians-gynecologists in the United States is limited. Greater awareness may help to detect treatable congenital Chagas cases.
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Affiliation(s)
- Jennifer R Verani
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Morris MI, Fischer SA, Ison MG. Infections Transmitted by Transplantation. Infect Dis Clin North Am 2010; 24:497-514. [DOI: 10.1016/j.idc.2010.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, Wingard JR, Young JAH, Boeckh MJ, Boeckh MA. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143-238. [PMID: 19747629 PMCID: PMC3103296 DOI: 10.1016/j.bbmt.2009.06.019] [Citation(s) in RCA: 1145] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/23/2009] [Indexed: 02/07/2023]
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Cunha-Neto E, Bilate AM, Hyland KV, Fonseca SG, Kalil J, Engman DM. Induction of cardiac autoimmunity in Chagas heart disease: A case for molecular mimicry. Autoimmunity 2009; 39:41-54. [PMID: 16455581 DOI: 10.1080/08916930500485002] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Up to 18 million of individuals are infected by the protozoan parasite Trypanosoma cruzi in Latin America, one third of whom will develop chronic Chagas disease cardiomyopathy (CCC) up to 30 years after infection. Cardiomyocyte destruction is associated with a T cell-rich inflammatory infiltrate and fibrosis. The presence of such lesions in the relative scarcity of parasites in the heart, suggested that CCC might be due, in part, to a postinfectious autoimmune process. Over the last two decades, a significant amount of reports of autoimmune and molecular mimicry phenomena have been described in CCC. The authors will review the evidence in support of an autoimmune basis for CCC pathogenesis in humans and experimental animals, with a special emphasis on molecular mimicry as a fundamental mechanism of autoimmunity.
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Affiliation(s)
- Edecio Cunha-Neto
- Heart Institute (InCor), Laboratory of Immunology, São Paulo, Brazil.
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Houghton RL, Stevens YY, Hjerrild K, Guderian J, Okamoto M, Kabir M, Reed SG, Leiby DA, Morrow WJW, Lorca M, Raychaudhuri S. Lateral flow immunoassay for diagnosis of Trypanosoma cruzi infection with high correlation to the radioimmunoprecipitation assay. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2009; 16:515-20. [PMID: 19211772 PMCID: PMC2668284 DOI: 10.1128/cvi.00383-08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/12/2008] [Accepted: 02/02/2009] [Indexed: 11/20/2022]
Abstract
The incidence of blood donors seropositive for Trypanosoma cruzi in North America has increased with population migration and more rigorous surveillance. The United States, considered nonendemic for T. cruzi, could therefore be at risk to exposure to parasite transmission through blood or organ donations. Current tests show variable reactivity, especially with Central American sera. Here we describe the development of a lateral flow immunoassay for the rapid detection of T. cruzi infection that has a strong correlation to the radioimmunoprecipitation assay (RIPA) "gold standard" in the United States. Such a test could have utility in small blood banks for prescreening donors, as well as in cardiac transplantation evaluation. T. cruzi consensus and/or RIPA-positive sera from Central and South America were evaluated in enzyme immunoassays (EIAs). These included commercial panels from Boston Biomedica, Inc. (BBI) (n = 14), and HemaBio (n = 21). Other sources included RIPA-positive sera from the American Red Cross (ARC) (n = 42), as well as from Chile. Sera were tested with the multiepitope recombinant TcF. All but one of the BBI samples were positive and 7 of 21 HemaBio samples and 6 of 42 ARC samples were low positive or negative. This observation indicated the need for additional antigens. To complement TcF reactivity, we tested the sera with peptides 30, 36, SAPA, and 1.1, 1.2, and 1.3 His fragments of 85-kDa trans-sialidase. We identified a promising combination of the tested antigens and constructed a single recombinant protein, ITC6, that enhanced the relative sensitivity in U.S. blood donor sera compared to that of TcF. The data on its evaluation using RIPA-confirmed positive sera in EIA and lateral flow immunoassay studies are presented, along with an additional recombinant protein, ITC8.2, with two additional sequences for peptide 1 and Kmp-11. The latter, when evaluated in a dipstick assay with consensus positive sera, had a sensitivity of 99.2% and a specificity of 99.1%.
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Leiby D, Herron, Jr. R, Garratty G, Herwaldt B. Trypanosoma cruziParasitemia in US Blood Donors with Serologic Evidence of Infection. J Infect Dis 2008; 198:609-13. [DOI: 10.1086/590159] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Schmunis GA. Epidemiology of Chagas disease in non-endemic countries: the role of international migration. Mem Inst Oswaldo Cruz 2008; 102 Suppl 1:75-85. [PMID: 17891282 DOI: 10.1590/s0074-02762007005000093] [Citation(s) in RCA: 390] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 07/02/2007] [Indexed: 11/22/2022] Open
Abstract
Human infection with the protozoa Trypanosoma cruzi extends through North, Central, and South America, affecting 21 countries. Most human infections in the Western Hemisphere occur through contact with infected bloodsucking insects of the triatomine species. As T. cruzi can be detected in the blood of untreated infected individuals, decades after infection took place; the infection can be also transmitted through blood transfusion and organ transplant, which is considered the second most common mode of transmission for T. cruzi. The third mode of transmission is congenital infection. Economic hardship, political problems, or both, have spurred migration from Chagas endemic countries to developed countries. The main destination of this immigration is Australia, Canada, Spain, and the United States. In fact, human infection through blood or organ transplantation, as well as confirmed or potential cases of congenital infections has been described in Spain and in the United States. Estimates reported here indicates that in Australia in 2005-2006, 1067 of the 65,255 Latin American immigrants (16 per 1000) may be infected with T. cruzi, and in Canada, in 2001, 1218 of the 131,135 immigrants (9 per 1000) whose country of origin was identified may have been also infected. In Spain, a magnet for Latin American immigrants since the 2000, 6141 of 38,777 to 339,954 [corrected] legal immigrants in 2003 (25 per 1000), could be infected. In the United States, 56,028 to 357,205 of the 7,20 million, legal immigrants (8 to 50 per 1000), depending on the scenario, from the period 1981-2005 may be infected with T. cruzi. On the other hand, 33,193 to 336,097 of the estimated 5,6 million undocumented immigrants in 2000 (6 to 59 per 1000) could be infected. Non endemic countries receiving immigrants from the endemic ones should develop policies to protect organ recipients from T. cruzi infection, prevent tainting the blood supply with T. cruzi, and implement secondary prevention of congenital Chagas disease.
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Affiliation(s)
- Gabriel A Schmunis
- Pan American Health Organization/World Health Organization, 525 23rd Street, NW Washington, DC 20037, USA.
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O'Brien SF, Chiavetta JA, Fan W, Xi G, Yi QL, Goldman M, Scalia V, Fearon MA. Assessment of a travel question to identify donors with risk of Trypanosoma cruzi: operational validity and field testing. Transfusion 2008; 48:755-61. [DOI: 10.1111/j.1537-2995.2007.01602.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Souza F, Castro-e-Silva O, Marin Neto J, Sankarankutty A, Teixeira A, Martinelli A, Gaspar G, Melo L, Figueiredo J, Romano M, Maciel B, Passos Ä, Rossi M. Acute Chagasic Myocardiopathy After Orthotopic Liver Transplantation With Donor and Recipient Serologically Negative for Trypanosoma cruzi: A Case Report. Transplant Proc 2008; 40:875-8. [DOI: 10.1016/j.transproceed.2008.02.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hanford EJ, Zhan FB, Lu Y, Giordano A. Chagas disease in Texas: Recognizing the significance and implications of evidence in the literature. Soc Sci Med 2007; 65:60-79. [PMID: 17434248 DOI: 10.1016/j.socscimed.2007.02.041] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Indexed: 11/26/2022]
Abstract
Chagas disease is endemic and is recognized as a major health problem in many Latin American countries. Despite the parallels between socio-economic and environmental conditions in Texas and much of Latin America, Chagas disease is not a notifiable human disease in Texas. Based on extensive review of related literature, this paper seeks to recognize the evidence that Chagas Disease is endemic to Texas but the epidemiological, parasitological and entomological patterns of Chagas disease in Texas are both different from and parallel to other endemic regions. We find that with a growing immigrant human reservoir, the epidemiological differences may be reduced and result in increasing incidence of the disease. Chagas disease should be recognized as an emerging disease among both immigrant and indigenous populations. Without proper actions, Chagas disease will place increasing burden on the health care system. Current medical treatments consist of chemotherapies that carry the risk of serious side effects; curing the potentially fatal disease remains equivocal. Therefore, as shown in South America, prevention is paramount and can be successfully achieved through intervention and education. We conclude that biogeographical research is needed to (1) distinguish the dynamic evolution of the agent-vector-host system, (2) document locations with greater risk and identify mechanisms responsible for observed changes in risk, and (3) assist in developing a model for Triatomid vector-borne disease in states like Texas where the disease is both endemic and may be carried by a sizeable immigrant population. Tracking of Chagas disease and planning for appropriate health care services would also be aided by including Chagas disease on the list of reportable diseases for humans.
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Affiliation(s)
- Elaine Jennifer Hanford
- Department of Geography, Texas Center for Geographic Information Science, Texas State University, Texas, San Marcos, TX 78666, USA.
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Buekens P, Almendares O, Carlier Y, Dumonteil E, Eberhard M, Gamboa-Leon R, James M, Padilla N, Wesson D, Xiong X. Mother-to-Child Transmission of Chagas’ Disease in North America: Why Don’t We Do More? Matern Child Health J 2007; 12:283-6. [PMID: 17602289 DOI: 10.1007/s10995-007-0246-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 06/11/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mothers with Chagas' disease can transmit Trypanosoma cruzi to their fetuses, who often become carriers of the infection and are then at risk of developing severe cardiac disease later in the course of their lives. If identified early enough after birth, the infected newborns can be treated and cured. Our objective was to review the data available in Canada, Mexico, and the United States and to discuss the need for prevention programs. METHODS We reviewed the literature and estimated the number of seropositive mothers and newborns infected by T. cruzi. RESULTS We estimate that about 40,000 pregnant women and 2,000 newborns are likely to be infected by T. cruzi in North America. We have not identified any ongoing prevention programs. CONCLUSIONS Mother-to-child transmission of T. cruzi has all the characteristics required to be a public health priority, as it is relatively frequent, severe, identifiable, and treatable. In reality, it is a neglected disease and a missed opportunity. It is urgent to better understand the epidemiology of mother-to-child transmission of T. cruzi in North America and to develop effective prevention programs.
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Affiliation(s)
- Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2430, New Orleans, LA 70112, USA.
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44
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Abstract
BACKGROUND A 3(1/2)-year-old girl with Stage 4 neuroblastoma received multiple blood components and was subsequently diagnosed with Chagas disease, which is caused by Trypanosoma cruzi. STUDY DESIGN AND METHODS All blood donors of the units that were transfused were requested to return to the collection facility for a blood sample to be tested for antibodies to T. cruzi. RESULTS One first-time donor was found to be positive for the presence of T. cruzi antibodies. This donor was originally from Bolivia and immigrated to the United States 17 years previously. She had not returned to her native country since her emigration. CONCLUSIONS This is the seventh reported case of Chagas disease transmission by blood transfusion in the United States and Canada. Although this would not be expected to occur in New England, it did, and this case demonstrates the significance of the immune status of patients as it relates to transfusion-acquired infections, the impact of geographic mobility in disease transmission, and the need for a licensed screening test for Chagas disease for the US blood supply.
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Affiliation(s)
- Carolyn Young
- Rhode Island Blood Center, Brown University, Hasbro Children's Hospital of Rhode Island, Providence, Rhode Island 02908, USA.
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45
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Tobler LH, Contestable P, Pitina L, Pitina L, Groth H, Shaffer S, Blackburn GR, Warren H, Lee SR, Busch MP. Evaluation of a new enzyme-linked immunosorbent assay for detection of Chagas antibody in US blood donors. Transfusion 2007; 47:90-6. [PMID: 17207235 DOI: 10.1111/j.1537-2995.2007.01068.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chagas disease, caused by the parasite Trypanosoma cruzi, represents a serious blood safety problem due to increasing immigration from Latin America. The Food and Drug Administration recently recommended implementation of Chagas antibody screening for US donors as soon as a suitable assay is licensed. An anonymized preclinical study of a prototype T. cruzi lysate-based enzyme-linked immunosorbent assay (ELISA) developed by Ortho-Clinical Diagnostics was conducted. STUDY DESIGN AND METHODS Two populations of specimens were evaluated: 1) 10,192 sequential donations from blood donors residing in the El Paso, Texas, area and 2) 178 specimens from South America which were presumptively positive for antibodies to T. cruzi and purchased from commercial vendors. RESULTS A total of 10,189 (99.97%) of the 10,192 screened donor specimens did not react, whereas 3 (0.03%) tested initially reactive. The 3 initially reactive specimens tested repeat reactive and were confirmed by radioimmunoprecipitation analysis (RIPA). Based on antibody profile analysis, 2 of the 3 Chagas-positive specimens were from the same donor. Observed specificity of the test was therefore 100 percent. Of the specimens from South America, 173 of 178 were reactive by the prototype ELISA. Of the 5 nonreactive specimens, all did not react by indirect fluorescence assay, but 4 were positive by RIPA. Therefore, calculated sensitivity of the ELISA was 97.7 percent (173/177). CONCLUSIONS These studies indicate that the prototype ELISA has excellent sensitivity and specificity for detection of antibodies to T. cruzi in donors. Moreover, among donations from a geographically selected collection region of the United States, observed seroprevalence was 0.03 percent.
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Affiliation(s)
- Leslie H Tobler
- Blood Systems Research Institute, San Francisco, California 94118, USA.
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46
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Berrizbeitia M, Ndao M, Bubis J, Gottschalk M, Aché A, Lacouture S, Medina M, Ward BJ. Field evaluation of four novel enzyme immunoassays for Chagas' disease in Venezuela blood banks: comparison of assays using fixed-epimastigotes, fixed-trypomastigotes or trypomastigote excreted?secreted antigens from two Trypanosoma cruzi strains. Transfus Med 2006; 16:419-31. [PMID: 17163873 DOI: 10.1111/j.1365-3148.2006.00703.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many serological tests have been developed for the diagnosis of Chagas' disease, but few have been subjected to a rigorous field evaluation. We have recently described several novel enzyme immunoassays (EIAs) based on fixed-whole organisms or trypomastigote excretory-secretory antigens (TESA) from different Trypanosoma cruzi strains (Tulahuen or Brazil). This study evaluated the most promising of these novel assays (e.g. fixed-epimastigotes, fixed-trypomastigotes, TESA Brazil and TESA Tulahuen antigens) in a field study of Venezuelan blood bank specimens. The assays were tested in an operator-blinded fashion using 2038 blood bank samples obtained from low and high T.cruzi prevalence regions of Venezuela (n= 1050 and n= 988 from Bolivar and Portuguesa states, respectively). Based on National Laboratory for Chagas Immunodiagnosis (NLCI) 'gold standard' results, all novel EIAs were superior to the commercial kit currently used in Venezuela, achieving 100% sensitivity and >99% specificity at optimal cut-off values. The novel assays identified seven false-negative samples compared with the routine screening performed by the Venezuelan blood bank although two samples were also misclassified as positive. Minor differences in the performance of the four novel assays were observed at lower arbitrary cut-off values. This study confirms the potential utility of both the fixed-organism and the TESA-based assays in the diagnosis of T.cruzi infection.
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Affiliation(s)
- M Berrizbeitia
- National Reference Centre for Parasitology, Montreal General Hospital, McGill University, Quebec, Canada
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47
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Chang CD, Cheng KY, Jiang LX, Salbilla VA, Haller AS, Yem AW, Bryant JD, Kirchhoff LV, Leiby DA, Schochetman G, Shah DO. Evaluation of a prototype Trypanosoma cruzi antibody assay with recombinant antigens on a fully automated chemiluminescence analyzer for blood donor screening. Transfusion 2006; 46:1737-44. [PMID: 17002630 DOI: 10.1111/j.1537-2995.2006.00965.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chagas disease is caused by Trypanosoma cruzi, a protozoan parasite that can be transmitted by transfusion. The diagnosis of chronic T. cruzi infection is generally made by detecting specific antibodies that bind to parasite antigens. The aim of this study was to assess the sensitivity and specificity of a new serologic assay for antibodies to T. cruzi on a fully automated analyzer (PRISM, Abbott Laboratories). STUDY DESIGN AND METHODS A prototype chemiluminescent immunoassay based on chimeric recombinant antigens and run on the automated PRISM system was developed for detecting antibodies to T. cruzi in human serum and plasma. Assay specificity was evaluated by testing samples from random blood donors and from a diverse group of specimens from persons with diseases or conditions often associated with false-positive reactions in T. cruzi assays. Sensitivity was determined by testing 377 geographically diverse T. cruzi antibody-positive specimens. RESULTS Six of 7911 samples (0.08%) from random donors were repeatedly reactive in the prototype PRISM Chagas assay. One of these was reactive in three other tests, including the radioimmune precipitation assay and was presumed to be a true positive. Hence, the specificity was 99.94 percent (7905/7910) in the negative donor group studied. All 377 T. cruzi antibody-positive specimens were positive in the prototype assay and thus the sensitivity was 100 percent. CONCLUSION The results obtained to date, in terms of sensitivity as well as specificity, strongly suggest that the PRISM Chagas assay should function well as a tool for screening blood for serologic evidence of T. cruzi infection.
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Affiliation(s)
- Chi-Deu Chang
- Emerging Pathogens R&D, Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, Illinois 60064, USA
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48
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Steele LS, MacPherson DW, Kim J, Keystone JS, Gushulak BD. The Sero-Prevalence of Antibodies to Trypanosoma cruzi in Latin American Refugees and Immigrants to Canada. J Immigr Minor Health 2006; 9:43-7. [PMID: 17006766 DOI: 10.1007/s10903-006-9014-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chagas' disease is caused by infection with the protozoan agent Trypanosoma cruzi. An estimated sixteen to eighteen million people are infected in Latin America. Outside of endemic regions, Chagas' disease may be transmitted through the transfusion of infected blood components, congenital infection and organ transplantation. We sought to determine the sero-prevalence of antibodies to T. cruzi in a community sample of Latin American refugees and immigrants to Canada. METHODS This was a sero-prevalence study in Latin American refugees and immigrants living in Canada. Eligible subjects were born in South America, Central America or in Mexico. Participants were recruited from a variety of community settings, as well as from medical clinics. Serum was tested by enzyme-linked immunoassay for antibodies to T. cruzi. RESULTS A total of 102 participants were enrolled. One sample tested positive for antibodies for T. cruzi. The seroprevalence in our sample was 1.0% (95% CI: 0.2%- 5.3%). INTERPRETATION We found a low sero-prevalence of Chagas' disease in a community sample of Latin American immigrants and refugees. Physicians who treat Latin American immigrants should consider the risk profile and clinical status of the individual in their decision to screen for Chagas' disease.
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Affiliation(s)
- L S Steele
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
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49
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Kirchhoff LV, Paredes P, Lomelí-Guerrero A, Paredes-Espinoza M, Ron-Guerrero CS, Delgado-Mejía M, Peña-Muñoz JG. Transfusion-associated Chagas disease (American trypanosomiasis) in Mexico: implications for transfusion medicine in the United States. Transfusion 2006; 46:298-304. [PMID: 16441610 DOI: 10.1111/j.1537-2995.2006.00715.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Trypanosoma cruzi, the protozoan cause of Chagas disease, causes life-long infection and is easily transmitted by blood transfusion. Our goals were to determine the prevalence of Chagas disease among donors in five Mexican blood banks, to look for evidence of transmission of T. cruzi by transfusion, and to evaluate two serologic assays for Chagas disease. STUDY DESIGN AND METHODS Blood samples from donors were tested initially with the Abbott Chagas EIA or the Meridian Chagas' IgG ELISA. Samples giving readings that were at least 50% of the cutoffs were run in a confirmatory radioimmune precipitation assay (RIPA), as were samples from recipients of blood products from RIPA-positive donors. RESULTS The overall prevalence of Chagas disease was 1/133 (55/7,296; 0.75%). In addition, 4 of 9 surviving recipients of blood products from T. cruzi-infected donors were in turn infected. Using the manufacturers' recommended cutoffs, the sensitivity and specificity of the Abbott test were 92.0% (23/25) and 99.8% (2,865/2,872) respectively, and the corresponding values for the Meridian assay were 70.0% (21/30) and 100.0% (4,369/4,369). CONCLUSIONS These findings indicate clearly that transfusion-associated transmission of T. cruzi is occurring in the study areas. Serologic testing of blood donors for Chagas disease should be performed there and in the rest of Mexico. The two screening assays evaluated may lack the accuracy necessary for blood donor testing when used as suggested by the manufacturers.
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Affiliation(s)
- Louis V Kirchhoff
- Department of Internal Medicine, University of Iowa, Department of Veterans Affairs Medical Center, Iowa City, Iowa 52242, USA.
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50
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Malan AK, Avelar E, Litwin SE, Hill HR, Litwin CM. Serological diagnosis of Trypanosoma cruzi: evaluation of three enzyme immunoassays and an indirect immunofluorescent assay. J Med Microbiol 2006; 55:171-178. [PMID: 16434709 DOI: 10.1099/jmm.0.46149-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Chagas' disease is an important cause of heart failure in Latin America, but is rare in the United States. The immigration of persons from endemic countries increases the potential of encountering patients with the disease. Concerns have also been raised about the introduction of Trypanosoma cruzi, the parasite that causes the disease, into the blood supply and during organ transplantation. To compare Chagas' antibody tests that are available in the United States, we evaluated three IgG ELISAs, CeLLabs T. cruzi ELISA, Hemagen Chagas' kit and IVD Research Chagas' Serum Microwell ELISA, and MarDx indirect immunofluorescent assays. The CeLLabs and Hemagen IgG ELISAs had 100 % agreement, sensitivity and specificity. The IVD Research IgG ELISA had 94·6 % agreement, 100 % sensitivity and 93 % specificity.
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Affiliation(s)
- Annette K Malan
- University of Utah, Associated Regional and University Pathologists (ARUP) Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
| | | | | | - Harry R Hill
- University of Utah, Associated Regional and University Pathologists (ARUP) Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
| | - Christine M Litwin
- University of Utah, Associated Regional and University Pathologists (ARUP) Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
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