Title
Use of a Latent Class Analysis in the Diagnosis of Chronic Chagas Disease in the Washington Metropolitan Area
Date Issued
01 May 2021
Access level
open access
Resource Type
journal article
Author(s)
Saldaña A.
Patino Nava D.
Bayangos T.
Paulette Evans D.
Detoy K.
Trevino A.
Marcus R.
Bern C.
Talaat K.R.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
Publisher(s)
Oxford University Press
Abstract
Background: The diversity of individuals at risk for Trypanosoma cruzi infection in the United States poses challenges for diagnosis. We evaluated the diagnostic accuracy of Food and Drug Administration (FDA)-cleared tests in the Washington Metropolitan area (WMA). Methods: In total, 1514 individuals were evaluated (1078 from Mexico, Central and northern South America [TcI-predominant areas], and 436 from southern South America [TcII/V/VI-predominant areas]). Optical density (OD) values from the Hemagen EIA and Chagatest v.3 Wiener, and categorical results of the IgG-TESA-blot (Western blot with trypomastigote excretory-secretory antigen), and the Chagas detect plus (CDP), as well as information of area of origin were used to determine T. cruzi serostatus using latent class analysis. Results: We detected 2 latent class (LC) of seropositives with low (LC1) and high (LC2) antibody levels. A significantly lower number of seropositives were detected by the Wiener, IgG-TESA-blot, and CDP in LC1 (60.6%, P <. 001, 93.1%, P =. 014, and 84.9%, P =. 002, respectively) as compared to LC2 (100%, 100%, and 98.2%, respectively). LC1 was the main type of seropositives in TcI-predominant areas, representing 65.0% of all seropositives as opposed to 22.8% in TcII/V/VI-predominant areas. The highest sensitivity was observed for the Hemagen (100%, 95% confidence interval [CI]: 96.2-100.0), but this test has a low specificity (90.4%, 95% CI: 88.7-91.9). The best balance between positive (90.9%, 95% CI: 83.5-95.1), and negative (99.9%, 95% CI: 99.4-99.9) predictive values was obtained with the Wiener. Conclusions: Deficiencies in current FDA-cleared assays were observed. Low antibody levels are the main type of seropositives in individuals from TcI-predominant areas, the most frequent immigrant group in the United States.
Start page
E303
End page
E310
Volume
72
Issue
9
Language
English
OCDE Knowledge area
Parasitología Ciencias médicas, Ciencias de la salud
Scopus EID
2-s2.0-85106068935
PubMed ID
Source
Clinical Infectious Diseases
ISSN of the container
10584838
Sponsor(s)
Potential conflicts of interest. Y. E. C.-S. reports nonfinancial support from InBios International Inc. during the conduct of the study and outside the submitted work. C. B. reports grants from Mundo Sano Foundation, personal fees from UpToDate, both outside the submitted work. R. H. G. reports grants, nonfinancial support and other from InBios International during the conduct of the study and outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Sources of information: Directorio de Producción Científica Scopus