Comparison of four serological tests for the diagnosis of Chagas disease in a Colombian endemic area
Comparison of four serological tests for the diagnosis of Chagas disease in a Colombian endemic area
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DOI：
10.1017/s0031182004005785
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发表时间：
2004-10-01
期刊：
影响因子：
2.4
通讯作者：
Fernandes, O
中科院分区：
文献类型：
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作者：
Gutierrez, R;Angulo, VM;Fernandes, O
在仍呈现活跃传播的哥伦比亚桑坦德地区，评估了诊断恰加斯病的4种血清学试验的表现。用当地克氏锥虫株的总裂解物对638例血清标本进行了酶免疫测定，结果阳性率为52.5%(335/638)。随机选择这一组中的一组(94名阳性个体和90名血清阴性者)进行进一步的血清学确认。使用Y株总裂解物(EIA BM)和两种重组抗原的混合物(EIA RA)进行了三种不同的间接免疫荧光法(I IF)和两种不同的酶联免疫吸附试验(EIA RA)。79例患者所有试验均为阳性(84%，-79/94)。1117、EIA RA和EIA BM阳性血清分别为84/94(89/4)、80/94(85/1)和79/94(84/0)。在94例EIA阳性患者中，15例(16%)3项试验均为阴性(10例为6%-10/94)。1例EIA BM阴性，另2例阳性(1%~1/94)，4例IIF试验阳性(4%~3%)。相对于90名环评阴性的人，89人在所有其他测试中得到确认(98%~89/90)。一名个体，尽管在IIF中呈血清阴性，但在两次确认性EIA试验中均呈阳性(1(.)1%-1/90)。此外，还对120份血液样本进行了PCR扩增。这一组包括79例确诊的血清阳性病例，16例血清学结果不一致的人和25名经确认的血清阴性的人。在79例血清阳性患者中，67例(84%)检测到寄生虫DNA，8例血清学不一致患者(50%)检出寄生虫DNA，仅1例血清阴性患者(4%)检出寄生虫DNA。结果表明，有必要进行一次以上的血清学检测，优先使用来自本土菌株的抗原，以实现哥伦比亚恰加斯病的可靠诊断。
The performance of 4 serological tests for the diagnosis of Chagas disease was evaluated in Santander, Colombia, a region still presenting active transmission. Serum samples from 638 individuals were submitted to an enzyme immunoassay test (EIA), using total lysate of a local Trypanosoma cruzi strain and 52(.)5% were positive (335/638). A subset of this group (94 positive individuals and 90 seronegatives) was randomly selected for further serological confirmation. Three additional tests were used - indirect immunofluorescence (I IF) and 2 distinct enzyme-linked immunosorbent assays using total lysate of the Y strain (EIA BM) and a mixture of 2 recombinant antigens (EIA RA). Seventy-nine patients were seropositive in all tests (84(.)0%, - 79/94). The number of positive sera with the 1117, EIA RA and EIA BM was 84/94 (89(.)4%), 80/94 (85(.)1%) and 79/94 (84(.)0%), respectively. In 15 out of the 94 EIA seropositive patients (16(.)0%), 10 individuals were negative in all 3 tests (10(.)6% - 10/94). One was negative in the EIA BM and positive in the other two tests (1(.)1% - 1/94) and 4 patients were positive, solely, in the IIF assay (4(.)3%) - 4/94). Relative to the 90 EIA negative individuals, 89 were confirmed in all other tests (98(.)9% - 89/90). One individual, although seronegative in the IIF, was positive in both confirmatory EIA tests (1(.)1% - 1/90). In addition, 120 blood specimens were submitted to PCR amplification. This group consisted of 79 confirmed seropositive cases, 16 individuals with discordant serological results and 25 validated seronegative individuals. The PCR was able to detect the presence of parasite DNA in 67 out of the 79 seropositive patients (84(.)8%), in 8 individuals with discordant serology (50(.)0%) and in only one seronegative individual (4(.)0%). The results pointed to the necessity for performing more than one serological test, preferentially with antigens from autochthonous strains, to achieve a reliable diagnosis of Chagas disease in Colombia.