The Trypomastigote Small Surface Antigen from Trypanosoma cruzi Improves Treatment Evaluation and Diagnosis in Pediatric Chagas Disease
The Trypomastigote Small Surface Antigen from Trypanosoma cruzi Improves Treatment Evaluation and Diagnosis in Pediatric Chagas Disease
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DOI：
10.1128/jcm.01317-17
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发表时间：
2017-12-01
影响因子：
9.4
通讯作者：
Altcheh, Jaime
中科院分区：
文献类型：
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作者：
Balouz, Virginia;Melli, Luciano J.;Altcheh, Jaime
查加斯病是由原生动物寄生虫克氏锥虫引起的。用现有药物治疗后对寄生虫治愈的评估依赖于在常规寄生虫学和血清学试验中获得一致的阴性结果，这可能需要数年时间才能评估。在这里，我们评估了使用重组T。cruzi抗原称为锥鞭毛体小表面抗原（TSSA），是锥鞭毛体药物疗效的早期血清学标志物。受克氏病毒感染的儿童一组由78名T.这项研究包括了受克氏病毒感染的母亲。仅39名儿童感染T。cruzi，他们立即接受了锥虫药物治疗。在随访期间，使用内部酶联免疫吸附试验（ELISA），并与传统的血清学方法进行比较，在感染和未感染的人群中对TSSA的血清学反应进行了评价。抗TSSA抗体滴度的下降速度明显快于常规血清学检测的抗全寄生虫抗体。正在接受有效治疗的克鲁济感染患者和未感染者。差异动力学允许在所需的随访期，以评估治疗反应或排除母胎传播显着减少。最后，我们提出的情况下，先天性感染的病人与一个非典型的过程中，TSSA提供了一个早期标记T。克氏感染总之，我们表明，TSSA对快速评估治疗效果和对有先天性T细胞瘤风险的婴儿进行早期阴性诊断都是有效的。克氏感染基于这些发现，我们建议纳入TSSA，以完善治疗后治愈标准和儿科恰加斯病的其他诊断需求。
Chagas disease is caused by the protozoan parasite Trypanosoma cruzi. Assessment of parasitological cure upon treatment with available drugs relies on achieving consistent negative results in conventional parasitological and serological tests, which may take years to assess. Here, we evaluated the use of a recombinant T. cruzi antigen termed trypomastigote small surface antigen (TSSA) as an early serological marker of drug efficacy in T. cruzi-infected children. A cohort of 78 pediatric patients born to T. cruzi-infected mothers was included in this study. Only 39 of the children were infected with T. cruzi, and they were immediately treated with trypanocidal drugs. Serological responses against TSSA were evaluated in infected and noninfected populations during the follow-up period using an in-house enzyme-linked immunosorbent assay (ELISA) and compared to conventional serological methods. Anti-TSSA antibody titers decreased significantly faster than anti-whole parasite antibodies detected by conventional serology both in T. cruzi-infected patients undergoing effective treatment and in those not infected. The differential kinetics allowed a significant reduction in the required follow-up periods to evaluate therapeutic responses or to rule out maternal-fetal transmission. Finally, we present the case of a congenitally infected patient with an atypical course in whom TSSA provided an early marker for T. cruzi infection. In conclusion, we showed that TSSA was efficacious both for rapid assessment of treatment efficiency and for early negative diagnosis in infants at risk of congenital T. cruzi infection. Based upon these findings we propose the inclusion of TSSA for refining the posttherapeutic cure criterion and other diagnostic needs in pediatric Chagas disease.