Laboratory diagnosis of Trypanosoma cruzi infection: a narrative review

Diagnosing Chagas in Pregnancy and Childhood: What's Old and New

Trypanosoma cruzi, the parasite that causes Chagas disease, affects as many as 300,000 individuals in the United States. Screening individuals of childbearing age can prevent congenital transmission, and diagnosing infants and children can prevent long-term sequelae of Chagas disease. Current methods to diagnose Chagas have limations, including relying on identification of at-risk individuals and requiring at least 2 separate tests to confirm infection.

Novel IgM-based lateral flow assay for diagnosis of congenital Chagas disease

BACKGROUND

The diagnosis of congenital Chagas disease in newborns relies on the microhematocrit method which exhibits reduced sensitivity during the early stages of infection and quantitative PCR for Trypanosoma cruzi, which is applied only in specialised centre due to its technical complexity. Consequently, the majority of congenital transmission cases are confirmed after an extended period of serological monitoring, resulting in delayed treatments and reduced cure rates. The need for new, accurate tests for the timely diagnosis of the disease in newborns is evident.

OBJECTIVES

We developed a lateral flow assay based on IgM detection (IgM-LFA) using the novel chimeric antigen CP4, which have demonstrated high performance in IgM-ELISA, as previously reported by our group.

METHODS

The accuracy of IgM-LFA was evaluated comparatively with IgM-ELISA using 28 serum samples from infants up to three months old, congenitally infected (n = 11) or non-infected (n = 17) with T. cruzi. Additionally, it was assessed for its agreement with microhematocrit and quantitative PCR, through estimating the Cohen's Kappa coefficient (k).

RESULTS

The IgM-LFA showed 100% specificity and 81.82% sensitivity and IgM-ELISA gave 100% specificity and sensitivity when evaluated against the standard algorithm diagnosis for congenital Chagas disease. Notably, the IgM-LFA identified two additional cases in relation to microhematocrit and showed a correlation of k = 0.84 with quantitative PCR, corresponding to almost perfect agreement with this molecular test.

CONCLUSION

These results suggest that IgM-LFA has the potential to facilitate decentralised detection of congenital Chagas disease, contributing to the early and enhance detection of infected newborns.

A specific, stable, and accessible LAMP assay targeting the HSP70 gene of Trypanosoma cruzi

Diagnostic delays prevent most Chagas disease patients from receiving timely therapy during the acute phase when treatment is effective. qPCR-based diagnostic methods provide high sensitivity during this phase but require specialized equipment and complex protocols. More simple and cost-effective tools are urgently needed to optimize early Chagas disease diagnosis in low-income endemic regions. Here, we present a loop-mediated isothermal amplification (LAMP) that targets a highly conserved region in the HSP70 gene of Trypanosoma cruzi, the causative agent of Chagas disease. This assay demonstrates species-specific amplification across multiple parasite genetic lineages while maintaining stability after 2 hours of incubation and at least 8 months of storage at -20°C. Moreover, the assay is at least 12 times less expensive than the TaqMan qPCR that is currently routinely used for acute Chagas diagnostics. Population-based validation in 100 infants born to Chagas-positive mothers in Santa Cruz, Bolivia, yielded a specificity of 100% and sensitivity exceeding 77% when compared to a TaqMan qPCR that targets satellite DNA. This cost-effective assay holds promise for large-scale diagnosis of Chagas disease in endemic regions with limited resources.

Congenital Chagas disease: A cohort study to assess molecular diagnostic methods at the Chagas disease national reference center of Argentina

BACKGROUND

Trypanosoma cruzi is a protozoan parasite which causes Chagas disease. Mother-to-child transmission is the main route of transmission in vector-free areas. Congenital Chagas disease refers specifically to cases arising from this route of transmission. This work evaluates the clinical sensitivity of two qPCR techniques for diagnosis of congenital Chagas disease.

METHODS

The study was developed in the National Institute of parasitology (NIP), Argentina, and Pan-American Health Organization/ Word Health Organization Collaborating Center for Chagas Disease. Between July 2014 and May 2018, a prospective cohort study was carried out with 499 children born to seropositive for T. cruzi infection included. The performance of qPCR techniques was compared with the gold standard diagnostic algorithm for Congenital Chagas disease (CCD-GS), which comprises performing more than one parasitological test on children from birth until nine months of age, and serology from ten months of age.

FINDINGS

Of the 961 babies born to women seropositive for Chagas disease who were attended at the NIP laboratory, 462 did not meet the study inclusion criteria; 22 cases were diagnosed with congenital Chagas disease. qPCR showed 100% clinical sensitivity and 98 to 100% clinical specificity for the diagnosis of congenital Chagas disease compared with CCD-GS algorithm.

INTERPRETATION

The results obtained in this study demonstrate the clinical accuracy and effectiveness of qPCR SatDNA and qPCR kDNA for diagnosis of congenital Chagas disease. It could be a powerful tool for chagas test and treat strategies to reduce late complications of the disease.

FUNDING

This work was financed by the INP Dr. Mario Fatala Chaben, ANLIS Dr. Carlos G. Malbran.

Interlaboratory Harmonization Study and Prospective Evaluation of the PURE-Trypanosoma cruzi-Loop-Mediated Isothermal Amplification Assay for Detecting Parasite DNA in Newborn's Dried Blood Spots

Timely diagnosis of vertical Trypanosoma cruzi infections involves microscopy-based detection of circulating parasites from peripheral blood, which lacks sensitivity and is operator dependent. Consequently, most children born to T. cruzi-infected mothers are required to undergo serological testing after 9 months, which risks loss to follow-up. Alternatively, the loop-mediated isothermal amplification (LAMP) test for T. cruzi DNA offers high analytical and clinical performance and is easy to use in low-complexity laboratories. Recently, we optimized this technique using an ultrarapid DNA extraction method combined with the LAMP in dried blood spots (DBSs) on Flinders Technology Associates cards. The procedure has been implemented in 10 public maternities across Paraguay, Bolivia, and Argentina, involving the training of 14 technicians. Operators' performance was evaluated using a standardized DBS testing panel for harmonization, including negative controls and DBS samples artificially contaminated with T. cruzi at 50 and 20 cells/mL. There was strong agreement (ĸ = 0.924) for controls and 50 cells/mL samples, and good agreement (ĸ = 0.718) across all testing panels, even at the detection limit of the test. A prospective study collected 306 DBSs from 222 newborns at birth and/or 2 months, detecting T. cruzi microscopically in four cases. LAMP identified eight positive cases and perfectly aligned with real-time PCR (ĸ = 1), demonstrating higher sensitivity than microscopic observation for early detection of infection in infants.

Euphane and Tirucallane Triterpenes with Trypanocidal Activity from Euphorbia desmondii

The phytochemical investigation of Euphorbia desmondii resulted in the isolation of 15 previously undescribed triterpenoids (desmondiins A, C-P) and 8 already described compounds. The structures of the isolated compounds were determined by extensive spectroscopic analyses. The compounds were identified as tirucallane and euphane triterpenes based on 7-keto-8-ene, 11-keto-8-ene, or 7,11-diketo-8-ene skeletons. Additionally, the selective trypanocidal activities of these compounds against Trypanosoma cruzi were evaluated. Desmondiins A, C, D, F, H, and M exhibited IC50 values in the range of 3-5 μM, and selectivity indices between 5-9, against T. cruzi epimastigotes over the host cell (RAW264.7 macrophages). Furthermore, desmondiin A efficiently inhibited amastigote replication in host cells (IC50 = 2.5 ± 0.3 μM), which was comparable to that of the positive control, benznidazole (3.6 ± 0.4 μM). Overall, the isolated euphane and tirucallane triterpenoids could act as antichagasic lead scaffolds.

The use of rapid diagnostic tests for chronic Chagas disease: An expert meeting report

Chagas disease, caused by Trypanosoma cruzi, affects millions of people globally and is associated with significant underdiagnosis and undertreatment. Current diagnostic algorithms face challenges in remote regions. We aimed to review the potential of rapid diagnostic tests (RDTs) for screening or diagnosing chronic Chagas disease in endemic areas. An expert panel representing scientific and academic institutions from the Americas convened with the aim of discussing the use of RDTs. The study employed the nominal group technique, gathering insights from diverse experts during a 3-day meeting. Panel discussions covered RDT application, research protocols, and regulatory mechanisms. The results indicate that RDTs play a crucial role in surveillance and screening, although limitations in sensitivity and specificity exist. The expert group recommends standardized protocols, emphasizes the importance of cost-effectiveness assessments, and highlights the need to consider geographic validation. Despite these challenges, RDTs present a promising avenue for improving Chagas disease diagnosis in resource-limited settings. Future research and a collaborative approach are deemed essential for effective implementation.

Trajectory-driven computational analysis for element characterization in Trypanosoma cruzi video microscopy

Optical microscopy videos enable experts to analyze the motion of several biological elements. Particularly in blood samples infected with Trypanosoma cruzi (T. cruzi), microscopy videos reveal a dynamic scenario where the parasites' motions are conspicuous. While parasites have self-motion, cells are inert and may assume some displacement under dynamic events, such as fluids and microscope focus adjustments. This paper analyzes the trajectory of T. cruzi and blood cells to discriminate between these elements by identifying the following motion patterns: collateral, fluctuating, and pan-tilt-zoom (PTZ). We consider two approaches: i) classification experiments for discrimination between parasites and cells; and ii) clustering experiments to identify the cell motion. We propose the trajectory step dispersion (TSD) descriptor based on standard deviation to characterize these elements, outperforming state-of-the-art descriptors. Our results confirm motion is valuable in discriminating T. cruzi of the cells. Since the parasites perform the collateral motion, their trajectory steps tend to randomness. The cells may assume fluctuating motion following a homogeneous and directional path or PTZ motion with trajectory steps in a restricted area. Thus, our findings may contribute to developing new computational tools focused on trajectory analysis, which can advance the study and medical diagnosis of Chagas disease.