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Candia-Puma MA, Machaca-Luque LY, Roque-Pumahuanca BM, Galdino AS, Giunchetti RC, Coelho EAF, Chávez-Fumagalli MA. Accuracy of Diagnostic Tests for the Detection of Chagas Disease: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:2752. [PMID: 36359595 PMCID: PMC9689806 DOI: 10.3390/diagnostics12112752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/02/2023] Open
Abstract
The present systematic review and meta-analysis about the accuracy of diagnostic tests aim to describe the findings of literature over the last thirty years for the diagnosis of Chagas disease (CD). This work aimed to determine the accuracy of diagnostic techniques for CD in the disease's acute and chronic phases. The PubMed database was searched for studies published between 1990 and 2021 on CD diagnostics. Fifty-six published studies that met the criteria were analyzed and included in the meta-analysis, evaluating diagnostic accuracy through sensitivity and specificity. For Enzyme-Linked Immunosorbent Assay (ELISA), Fluorescent Antibody Technique (IFAT), Hemagglutination Test (HmT), Polymerase Chain Reaction (PCR), and Real-Time Polymerase Chain Reaction (qPCR) diagnosis methods, the sensitivity had a median of 99.0%, 78.0%, 75.0%, 76.0%, and 94.0%, respectively; while specificity presented a median of 99.0%, 99.0%, 99.0%, 98.0%, and 98.0%, respectively. This meta-analysis showed that ELISA and qPCR techniques had a higher performance compared to other methods of diagnosing CD in the chronic and acute phases, respectively. It was concluded utilizing the Area Under the Curve restricted to the false positive rates (AUCFPR), that the ELISA diagnostic test presents the highest performance in diagnosing acute and chronic CD, compared to serological and molecular tests. Future studies focusing on new CD diagnostics approaches should be targeted.
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Affiliation(s)
- Mayron Antonio Candia-Puma
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04000, Peru
- Facultad de Ciencias Farmacéuticas, Bioquímicas y Biotecnológicas, Universidad Católica de Santa María, Arequipa 04000, Peru
| | - Laura Yesenia Machaca-Luque
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04000, Peru
- Facultad de Ciencias Farmacéuticas, Bioquímicas y Biotecnológicas, Universidad Católica de Santa María, Arequipa 04000, Peru
| | - Brychs Milagros Roque-Pumahuanca
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04000, Peru
- Facultad de Ciencias Farmacéuticas, Bioquímicas y Biotecnológicas, Universidad Católica de Santa María, Arequipa 04000, Peru
| | - Alexsandro Sobreira Galdino
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal São João Del-Rei, Divinópolis 35501-296, MG, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratório de Biologia das Interações Celulares, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador 40015-970, BA, Brazil
| | - Eduardo Antonio Ferraz Coelho
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
- Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Miguel Angel Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04000, Peru
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Suescún-Carrero SH, Tadger P, Sandoval Cuellar C, Armadans-Gil L, Ramírez López LX. Rapid diagnostic tests and ELISA for diagnosing chronic Chagas disease: Systematic revision and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010860. [PMID: 36256676 PMCID: PMC9616215 DOI: 10.1371/journal.pntd.0010860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/28/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the diagnostic validity of the enzyme-linked immunosorbent assay (ELISA) and Rapid Diagnostic Tests (RDT) among individuals with suspected chronic Chagas Disease (CD). METHODOLOGY A search was made for studies with ELISA and RDT assays validity estimates as eligibility criteria, published between 2010 and 2020 on PubMed, Web of Science, Scopus, and LILACS. This way, we extracted the data and assessed the risk of bias and applicability of the studies using the QUADAS-2 tool. The bivariate random effects model was also used to estimate the overall sensitivity and specificity through forest-plots, ROC space, and we visually assessed the heterogeneity between studies. Meta-regressions were made using subgroup analysis. We used Deeks' test to assess the risk of publication bias. RESULTS 43 studies were included; 27 assessed ELISA tests; 14 assessed RDTs; and 2 assessed ELISA and RDTs, against different reference standards. 51.2 % of them used a non-comparative observational design, and 46.5 % a comparative clinical design ("case-control" type). High risk of bias was detected for patient screening and reference standard. The ELISA tests had a sensitivity of 99% (95% CI: 98-99) and a specificity of 98% (95% CI: 97-99); whereas the Rapid Diagnostic Tests (RDT) had values of 95% (95% CI: 94-97) and 97% (95% CI: 96-98), respectively. Deeks' test showed asymmetry on the ELISA assays. CONCLUSIONS ELISA and RDT tests have high validity for diagnosing chronic Chagas disease. The analysis of these two types of evidence in this systematic review and meta-analysis constitutes an input for their use. The limitations included the difficulty in extracting data due to the lack of information in the articles, and the comparative clinical-type design of some studies.
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Affiliation(s)
| | - Philippe Tadger
- Universidad de Boyacá, Tunja, Colombia
- Real World Solutions, IQVIA, Zaventem, Belgium
| | | | - Lluis Armadans-Gil
- Epidemiology and Preventive Medicine Service, Hospital Universitari Vall d’Hebron—Universitat Autónoma de Barcelona, Barcelona, Spain
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Forsyth CJ, Manne-Goehler J, Bern C, Whitman J, Hochberg NS, Edwards M, Marcus R, Beatty NL, Castro-Sesquen YE, Coyle C, Stigler Granados P, Hamer D, Maguire JH, Gilman RH, Meymandi S. Recommendations for Screening and Diagnosis of Chagas Disease in the United States. J Infect Dis 2022; 225:1601-1610. [PMID: 34623435 PMCID: PMC9071346 DOI: 10.1093/infdis/jiab513] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chagas disease affects an estimated 326 000-347 000 people in the United States and is severely underdiagnosed. Lack of awareness and clarity regarding screening and diagnosis is a key barrier. This article provides straightforward recommendations, with the goal of simplifying identification and testing of people at risk for US healthcare providers. METHODS A multidisciplinary working group of clinicians and researchers with expertise in Chagas disease agreed on 6 main questions, and developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, after reviewing the relevant literature on Chagas disease in the United States. RESULTS Individuals who were born or resided for prolonged time periods in endemic countries of Mexico and Central and South America should be tested for Trypanosoma cruzi infection, and family members of people who test positive should be screened. Women of childbearing age with risk factors and infants born to seropositive mothers deserve special consideration due to the risk of vertical transmission. Diagnostic testing for chronic T. cruzi infection should be conducted using 2 distinct assays. CONCLUSIONS Increasing provider-directed screening for T. cruzi infection is key to addressing this neglected public health challenge in the United States.
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Affiliation(s)
- Colin J Forsyth
- Drugs for Neglected Diseases initiative, New York, New York, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachussetts, USA
| | - Morven Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rachel Marcus
- Medstar Union Memorial Hospital, Washington, District of Columbia, USA
- Latin American Society of Chagas, Washington, District of Columbia, USA
| | - Norman L Beatty
- Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christina Coyle
- Division of Infectious Diseases, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | | | - Davidson Hamer
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - James H Maguire
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease, Olive View-University of California, Los Angeles Medical Center, Sylmar, California, USA
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Ortiz JV, Couceiro KDN, Doria SS, Sousa DRTD, Silveira HMCD, Kesper Junior N, Guerra MDGVB, Guerra JADO, Barbosa-Ferreira JMB. Chagas Cardiomyopathy in the Brazilian Amazon Region: Low Prevalence or Underdiagnosis? Arq Bras Cardiol 2021; 117:770-774. [PMID: 34709304 PMCID: PMC8528347 DOI: 10.36660/abc.20201236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jessica Vanina Ortiz
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Katia do Nascimento Couceiro
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Susan Smith Doria
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Débora Raysa Teixeira de Sousa
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | | | | | - Maria das Graças Vale Barbosa Guerra
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brasil
| | - Jorge Augusto de Oliveira Guerra
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brasil
| | - João Marcos Bemfica Barbosa-Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil.,Fundação Hospital do Coração Francisca Mendes, Manaus, AM - Brasil
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