Serological diagnosis of chronic Chagas disease: Is it time for a change?

Abstract

Chagas disease has spread to non-endemic areas with human migration. Since no single reference standard test is available, serological diagnosis of chronic Chagas disease requires at least two tests. New generation techniques have significantly improved the accuracy of Chagas disease diagnosis by the use of a large mixture of recombinant antigens with different detection systems, such as chemiluminescence. The aim of the present study was to assess the overall accuracy of a new generation kit, Architect Chagas (cut-off ≥ 1 S/CO, sample relative light units/cut-off value), as a single technique in the diagnosis of chronic Chagas disease. Architect Chagas showed a sensitivity of 100% (95% confidence interval, CI = 99.5-100) and a specificity of 97.6% (95% CI = 95.2-99.9). Five out of six false-positive sera were a consequence of cross-reactivity with Leishmania spp. and all of them achieved results < 5 S/CO. We propose Architect Chagas as a single technique for screening in blood banks and for routine diagnosis in clinical laboratories. Only grey zone and positive sera with a result ≤ 6 S/CO would need to be confirmed by a second serological assay, thus avoiding false-positive sera and the problem of cross-reactivity with Leishmania spp. The application of this proposal would result in important savings in the cost of Chagas disease diagnosis and therefore in the management and control of the disease.