Abstract
Current diagnosis of chronic Chagas disease relies on serologic detection of specific immunoglobulin G against Trypanosoma cruzi. However, the presence of parasites detected by polymerase chain reaction (PCR) in patients without positive conventional serologic testing has been observed. We determined the prevalence and clinical characteristics of persons with seronegative results for T. cruzi DNA detected by PCR in a population at high risk for chronic American trypanosomiasis. We studied a total of 194 persons from two different populations: 110 patients were recruited from an urban cardiology clinic, and 84 persons were nonselected citizens from a highly disease-endemic area. Eighty (41%) of persons had negative serologic findings; 12 (15%) had a positive PCR. Three patients with negative serologic findings and positive PCR results had clinical signs and symptoms that suggested Chagas cardiomyopathy. This finding challenges the current recommendations for Chagas disease diagnosis, therapy, and blood transfusion policies.
Highlights
Current diagnosis of chronic Chagas disease relies on serologic detection of specific immunoglobulin G against Trypanosoma cruzi
T. cruzi was detected by polymerase chain reaction (PCR) amplification of a nuclear DNA fragment by using the O1/O2 primers
We observed that persons with positive T. cruzi in blood and negative serologic findings could be detected in a population with high epidemiologic risk
Summary
Current diagnosis of chronic Chagas disease relies on serologic detection of specific immunoglobulin G against Trypanosoma cruzi. We determined the prevalence and clinical characteristics of persons with seronegative results and T. cruzi DNA detected by PCR in a population at high risk for chronic American trypanosomiasis. Three patients with negative serologic findings and positive PCR results had clinical signs and symptoms that suggested Chagas cardiomyopathy. This finding challenges the current recommendations for Chagas disease diagnosis, therapy, and blood transfusion policies. During the indeterminate and chronic clinical periods, detection of immunoglobulin (Ig) G against Trypanosoma cruzi by more than two different serologic tests is the standard for diagnosis [1]. We conducted a cross-sectional study in two populations at high risk for Chagas disease to evaluate the prevalence of positive T. cruzi PCR results in seronegative persons. We describe the results of that study as well as the clinical characteristics of a subgroup of patients
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