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Costa-Oliveira CND, Paiva-Cavalcanti MD, Barros MDS, Nakazawa M, Melo MGND, Pessoa-E-Silva R, Torres DJL, Oliveira KKDS, Moreira LR, Morais RCSD, Goes TCD, Oliveira GMDA, Júnior WDO, Silva MMDME, Batista FP, Montenegro D, Lorena VMBD. Outbreak of Chagas disease in Brazil: Validation of a molecular diagnostic method. Exp Parasitol 2023; 247:108478. [PMID: 36731642 DOI: 10.1016/j.exppara.2023.108478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
Chagas disease (CD), caused by the protozoan Trypanosoma cruzi (T. cruzi), affects millions of people worldwide. Polymerase Chain Reaction (PCR) and real-time quantitative PCR (qPCR) have been used as tools to monitor parasitic levels in the bloodstream of individuals exposed to infection, thus enabling the monitoring of relapses and the effectiveness of therapy, for example. The aim of this study was to evaluate the TcSAT-IAM system, developed by our research group, on samples from patients with suspected Chagas disease infection. Initially, primer systems were developed for the detection of the nuclear DNA (SAT-DNA) from T. cruzi (TcSAT-IAM). The Cruzi system, predicted in the literature, and TcSAT-IAM were then evaluated in relation to their analytical sensitivity, specificity and efficiency. Afterwards, the applicability of the qPCR technique using both systems (separately) for the diagnosis of acute CD was evaluated in samples from 77 individuals exposed to the outbreak that occurred in Pernambuco-Brazil, relating the results obtained to those of the classical diagnostic methods recommended for this stage of the infection. TcSAT-IAM and Cruzi had a detection limit of 1 fg of target DNA (0,003 parasites). Thirty-eight cases were recorded, 28 by laboratory criteria and 10 by clinical and epidemiological criteria. Blood samples from 77 subjects were submitted to qPCR by both systems, reaching an agreement of 89.61% between them. After analyzes between systems and diagnostic criteria, the TcSAT-IAM showed sensitivity and specificity of 52.36% (CI 37.26-67.52) and 92.31% (CI 79.68-97.35), respectively, accuracy of 72.73% and moderate agreement. The TcSAT-IAM showed an accuracy of 72.58% and 75% in relation to parasitological and serological tests (IgM anti-T. cruzi), respectively. Therefore, quantitative PCR should be incorporated into the diagnosis of suspected acute cases of Chagas disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Filipe Prohaska Batista
- University Hospital Oswaldo Cruz (HUOC) - Pernambuco University (UPE), Recife, Pernambuco, Brazil
| | - Demetrius Montenegro
- University Hospital Oswaldo Cruz (HUOC) - Pernambuco University (UPE), Recife, Pernambuco, Brazil
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Ciapponi A, Barreira F, Perelli L, Bardach A, Gascón J, Molina I, Morillo C, Prado N, Riarte A, Torrico F, Villar JC, Reidel S, Gibbons L, Sosa-Estani S. Direct evidence gap on fixed versus adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: Systematic review and individual patient data meta-analysis. Trop Med Int Health 2023; 28:2-16. [PMID: 36420767 DOI: 10.1111/tmi.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the comparative efficacy and safety of a fixed dose of benznidazole (BZN) with an adjusted-dose for Trypanosoma cruzi-seropositive adults without cardiomyopathy. METHODS We conducted a systematic review and individual participant data (IPD) meta-analysis following Cochrane methods, and the PRISMA-IPD statement for reporting. Randomised controlled trials (RCTs) allocating participants to fixed or adjusted doses of BZN for T. cruzi-seropositive adults without cardiomyopathy were included. We searched (December 2021) Cochrane, MEDLINE, EMBASE, LILACS and trial registries and contacted Chagas experts. Selection, data extraction, risk of bias assessment using the Cochrane tool, and a GRADE summary of finding tables were performed independently by pairs of reviewers. We conducted a random-effects IPD meta-analysis using the one-stage strategy, or, if that was impossible, the two-stage strategy. RESULTS Five RCTs (1198 patients) were included, none directly comparing fixed with adjusted doses of BZN. Compared to placebo, BZN therapy was strongly associated with negative qPCR and sustainable parasitological clearance regardless of the type of dose and subgroup analysed. For negative qPCR, the fixed/adjusted rate of odds ratios (RORF/A ) was 8.83 (95% CI 1.02-76.48); for sustained parasitological clearance, it was 4.60 (95% CI 0.40-52.51), probably indicating at least non-inferior effect of fixed doses, with no statistically significant interactions by scheme for global and most subgroup estimations. The RORF/A for treatment interruption due to adverse events was 0.44 (95% CI 0.14-1.38), probably indicating no worse tolerance of fixed doses. CONCLUSIONS We found no direct comparison between fixed and adjusted doses of BZN. However, fixed doses versus placebo are probably not inferior to weight-adjusted doses of BZN versus placebo in terms of parasitological efficacy and safety. Network IPD meta-analysis, through indirect comparisons, may well provide the best possible answers in the near future. REGISTRATION The study protocol was registered in PROSPERO (CRD42019120905).
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Affiliation(s)
- Agustín Ciapponi
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Fabiana Barreira
- Chagas Clinical Project, Drugs for Neglected Diseases Initiative, Río de Janeiro, Brazil
| | - Lucas Perelli
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,International Health Program, Catalan Institute of Health, Barcelona, Spain
| | - Carlos Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Nilda Prado
- Instituto Nacional de Parasitología Dr. M Fatala Chaben, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Adelina Riarte
- Instituto Nacional de Parasitología Dr. M Fatala Chaben, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Faustino Torrico
- Parasitología y Enfermedades Infecciosas, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Juan Carlos Villar
- Departamento de Investigaciones, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Sara Reidel
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Luz Gibbons
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Chagas Clinical Project, Drugs for Neglected Diseases Initiative, Río de Janeiro, Brazil
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Trypanosoma cruzi infection in the wild Chagas disease vector, Mepraia spinolai: Parasitic load, discrete typing units, and blood meal sources. Acta Trop 2022; 229:106365. [PMID: 35150641 DOI: 10.1016/j.actatropica.2022.106365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mepraia spinolai, a wild vector of Trypanosoma cruzi in Chile, is an abundant triatomine species that is frequently infected by the parasite that causes Chagas disease. The aim of this study was to determine if the parasitic load of T. cruzi in M. spinolai is related to its blood meal source and the infecting DTUs of T. cruzi. METHODS The vector was captured in rural areas. In the laboratory, DNA was extracted from its abdomen and T. cruzi was quantified using qPCR. Real time PCR assays for four T. cruzi DTUs were performed. Blood meal sources were identified by real-time PCR amplification of vertebrate cytochrome b gene sequences coupled with high resolution melting (HRM). RESULTS Trypanosoma cruzi was detected in 735 M. spinolai; in 484 we identified one blood meal source, corresponding to human, sylvatic, and domestic species. From these, in 224 we were able to discriminate the infecting DTU. When comparing the parasitic loads between the unique blood meal sources, no significant differences were found, but infections with more than one DTU showed higher parasitic loads than single infections. DTU TcI was detected in a high proportion of the samples. CONCLUSIONS Higher parasitic loads are related to a greater number of T. cruzi DTUs infecting M. spinolai, and this triatomine seems to have a wide span of vertebrate species in its diet.
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Chen Y, Wu S, Wu H, Cheng P, Wang X, Qian S, Zhang M, Xu J, Ji F, Wu J. CRISPR/Cas12a-Based Versatile Method for Checking Quantitative Polymerase Chain Reaction Samples with Cycles of Threshold Values in the Gray Zone. ACS Sens 2021; 6:1963-1970. [PMID: 33973766 DOI: 10.1021/acssensors.1c00515] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Quantitative polymerase chain reaction (qPCR) is widely applied in foodborne pathogen detection and diagnosis. According to the cycles of threshold (Ct) values of qPCR testing, samples are judged as positive or negative. However, samples with Ct values in the gray zone are classified as "possibly positive" and required to be tested again. Repetitive qPCR may not eliminate the uncertain results but increase the workload of detection. CRISPR/Cas12a can specifically recognize the nucleic acid of the nM level and then indiscriminately slash the single-strand DNA with multiple turnovers. In this way, the detection signals can be greatly amplified. Here, we propose a CRISPR-based checking method to solve gray zone problems. After qPCR testing, the screening gray zone samples can be successfully checked by the CRISPR/Cas12a method. Furthermore, to conduct CRISPR reaction assay more conveniently and prevent possible aerosol contamination in the operational process, a gray zone checking cassette is designed. African swine fever virus (ASFV) is selected as an example to demonstrate the feasibility of the CRISPR-based checking method. Of 28 real swine blood samples, 6 ASFV qPCR gray zone samples are successfully checked. The CRISPR-based checking method provides a novel solution to eliminate gray zone sample problems with no additional effects on the PCR, which is operable and applicable in practical detection. The entire process can be completed within 10-15 min. This method will be a good supplementary and assistance for qPCR-based detection, especially in the diagnosis of diseases such as COVID-19.
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Affiliation(s)
- Yanju Chen
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Shuyue Wu
- The Architectural Design & Research Institute of Zhejiang University Company Ltd., Hangzhou 310028, China
| | - Hui Wu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Peng Cheng
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China
| | - Xiaofu Wang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China
| | - Siwenjie Qian
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Mengyao Zhang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Junfeng Xu
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China
| | - Feng Ji
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jian Wu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
- Key Laboratory of On Site Processing Equipment for Agricultural Products, Ministry of Agriculture, Hangzhou 310058, China
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Figueredo F, Stolowicz F, Vojnov A, Coltro WKT, Larocca L, Carrillo C, Cortón E. Towards a versatile and economic Chagas Disease point-of-care testing system, by integrating loop-mediated isothermal amplification and contactless/label-free conductivity detection. PLoS Negl Trop Dis 2021; 15:e0009406. [PMID: 33989282 PMCID: PMC8153438 DOI: 10.1371/journal.pntd.0009406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/26/2021] [Accepted: 04/25/2021] [Indexed: 01/17/2023] Open
Abstract
Rapid diagnosis by using small, simple, and portable devices could represent one of the best strategies to limit the damage and contain the spread of viral, bacterial or protozoa diseases, principally when they can be transmitted by air and are highly contagious, as some respiratory viruses are. The presence of antibodies in blood or serum samples is not the best option for deciding when a person must be quarantined to stop transmission of disease, given that cured patients have antibodies, so the best diagnosis methods rely on the use of nucleic acid amplification procedures. Here we present a very simple device and detection principle, based on paper discs coupled to contactless conductivity (C4D) sensors, can provide fast and easy diagnostics that are needed when an epidemic outbreak develops. The paper device presented here solves one of the main drawbacks that nucleic acid amplification tests have when they are performed outside of central laboratories. As the device is sealed before amplification and integrally disposed in this way, amplimers release cannot occur, allowing repetitive testing in the physician’s practice, ambulances, or other places that are not prepared to avoid cross-contamination of new samples. The use of very low volume samples allows efficient reagent use and the development of low cost, simple, and disposable point-of-care diagnostic systems. In 2005, the World Health Organization (WHO) recognized Chagas Disease as a neglected tropical disease. Meanwhile the serological tests, recommended by WHO, can be performed for chronic disease diagnosis, the nucleic acid amplification tests must be performed for the detection of the acute phase of the disease. Although the existing laboratory diagnosis tests for Chagas Disease are sensitive and highly reproducible, they cannot be performed in rural, low infrastructure environments, where this disease prevails. In this sense, the use of simple and portable analytical devices may be able to offer an affordable solution to this problem, allowing fast sampling, diagnosis and treatment prescription in one simple and fast intervention, as the performed by short term medical missions. In this study we show for the first time a diagnosis test comprising low cost materials and employing a contactless and label-free conductivity detection system that is used to read the result of a nucleic acid amplification reaction. The test showed high sensitivity for Chagas Disease diagnosis showing the potential to be used in rural and low income places.
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Affiliation(s)
- Federico Figueredo
- Biological Chemistry Department, Science School and IQUIBICEN (FCEN–UBA-CONICET), Argentine
- Science and Technology Institute Cesar Milstein (ICT–Milstein–CONICET), Argentine
| | - Fabiana Stolowicz
- Science and Technology Institute Cesar Milstein (ICT–Milstein–CONICET), Argentine
| | - Adrián Vojnov
- Science and Technology Institute Cesar Milstein (ICT–Milstein–CONICET), Argentine
| | - Wendell K. T. Coltro
- Chemistry Institute, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
- National Institute of Science and Technology in Bioanalytics, Campinas, Brazil
| | - Luciana Larocca
- Science and Technology Institute Cesar Milstein (ICT–Milstein–CONICET), Argentine
| | - Carolina Carrillo
- Science and Technology Institute Cesar Milstein (ICT–Milstein–CONICET), Argentine
| | - Eduardo Cortón
- Biological Chemistry Department, Science School and IQUIBICEN (FCEN–UBA-CONICET), Argentine
- * E-mail:
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