■查加斯病(CD),克氏锥虫引起的,是一个全球健康问题,地理范围不断扩大。尽管改进和易于使用的测试方法,诊断CD的各个阶段仍然很复杂。临床情景的存在,包括免疫抑制患者,移植相关的CD再激活,输血相关病例,经口传播的急性感染,增加了诊断挑战。所有阶段都没有单一的黄金标准测试,以及泛美卫生组织和CDC倡导使用两种血清学方法进行慢性CD诊断的建议,而急性期建议采用分子方法或直接寄生虫检测。鉴于CD诊断领域的复杂性,本范围审查的目的是在临床实验室中描述可用的CD诊断测试.
■在PubMed中对与人类体外诊断(IVD)相关的研究进行了文献检索,以英文发表,西班牙语,或截至2023年8月28日的葡萄牙语,并向后延伸,没有预定的时间框架。研究经过标题和摘要筛选,其次是全文回顾。包括的研究根据所使用的诊断方法进行分类。测试方法分为血清学,分子,和其他方法。性能,可用性,和监管地位也有特点。
■在最终审查中包含的85项研究中,确定了115种不同的测试。这些测试包括89种血清学测试类型,21种分子测试类型,和其他5种测试方法。主要的血清学测试包括ELISA(38项研究,44.70%),快速测试(19项研究,22.35%),和化学发光(10项研究,11.76%)。在分子测试中,聚合酶链反应(PCR)测定是显著的。全球批准了28项测试用于IVD或供体测试,都是血清学方法。在美国,分子检测缺乏对IVD的批准,只有欧洲和哥伦比亚的监管机构接受。
■血清学试验,特别是ELISA,仍然是最常用和市售的诊断方法。考虑到大多数查加斯病的诊断发生在慢性期,并且WHO的黄金标准依赖于2种血清学测试来确定慢性查加斯病的诊断,这是有道理的。ELISA是可行的,成本相对较低,具有良好的性能,灵敏度在77.4%到100%之间,特异性在84.2%到100%之间。分子方法允许检测特定的变体,但依赖于寄生虫的存在,这限制了它们对寄生虫血症水平的效用。根据PCR方法和疾病的阶段,敏感性为58.88~100%,平均特异性为68.8%~100%.尽管他们的表现,分子检测仍然大多无法用于IVD。只有3个分子测试被批准用于IVD,只有在欧洲才有。FDA批准的六种商业血清学测定可用于血液和器官供体筛选。目前,没有测试CD口腔爆发的指南。尽管需要更多的证据来说明如何在特殊的临床场景中使用测试方法,临床评估和诊断测试的综合方法,不包括IVD方法,需要准确的CD诊断。
UNASSIGNED: Chagas disease (CD), caused by Trypanosoma cruzi, is a global health concern with expanding geographical reach. Despite improved and accessible test methods, diagnosing CD in its various phases remains complex. The existence of clinical scenarios, including immunosuppressed patients, transplant-related CD reactivation, transfusion-associated cases, and orally transmitted acute infections, adds to the diagnostic challenge. No singular gold standard test exists for all phases, and recommendations from PAHO and the CDC advocate for the use of two serological methods for chronic CD diagnosis, while molecular methods or direct parasite detection are suggested for the acute phase. Given the complexity in the diagnostic landscape of CD, the goal of this scoping
review is to characterize available diagnostic tests for CD in the clinical laboratory.
UNASSIGNED: A literature search in PubMed was conducted on studies related to In vitro diagnosis (IVD) in humans published in English, Spanish, or Portuguese language as of 28 August 2023, and extended backward with no predefined time frame. Studies underwent title and abstract screening, followed by full-text
review. Studies included were classified based on the diagnostic method used. Test methods were grouped as serological, molecular, and other methods. Performance, availability, and regulatory status were also characterized.
UNASSIGNED: Out of 85 studies included in the final
review, 115 different tests were identified. These tests comprised 89 serological test types, 21 molecular test types, and 5 other test methods. Predominant serological tests included ELISA (38 studies, 44.70%), Rapid tests (19 studies, 22.35%), and chemiluminescence (10 studies, 11.76%). Among molecular tests, Polymerase Chain Reaction (PCR) assays were notable. Twenty-eight tests were approved globally for IVD or donor testing, all being serological methods. Molecular assays lacked approval for IVD in the United States, with only European and Colombian regulatory acceptance.
UNASSIGNED: Serological tests, specifically ELISAs, remain the most used and commercially available diagnostic methods. This makes sense considering that most Chagas disease diagnoses occur in the chronic phase and that the WHO gold standard relies on 2 serological tests to establish the diagnosis of chronic Chagas. ELISAs are feasible and relatively low-cost, with good performance with sensitivities ranging between 77.4% and 100%, and with specificities ranging between 84.2% and 100%. Molecular methods allow the detection of specific variants but rely on the parasite\'s presence, which limits their utility to parasitemia levels. Depending on the PCR method and the phase of the disease, the sensitivity ranged from 58.88 to 100% while the mean specificity ranged from 68.8% to 100%. Despite their performance, molecular testing remains mostly unavailable for IVD use. Only 3 molecular tests are approved for IVD, which are available only in Europe. Six commercial serological assays approved by the FDA are available for blood and organ donor screening. Currently, there are no guidelines for testing CD oral outbreaks. Although more evidence is needed on how testing methods should be used in special clinical scenarios, a comprehensive approach of clinical assessment and diagnostics tests, including not IVD methods, is required for an accurate CD diagnosis.