Gutierrez R, Angulo V M, Tarazona Z, Britto C, Fernandes O
Centro de Investigaciones en Enfermedades Tropicales, Universidad Industrial de Santander, Km 2 Via El Refugio-Piedecuesta, Santander, A.A. 678 Bucaramanga, Colombia.
Parasitology. 2004 Oct;129(Pt 4):439-44. doi: 10.1017/s0031182004005785.
The performance of 4 serological tests for the diagnosis of Chagas disease was evaluated in Santander, Colombia, a region still presenting active transmission. Serum samples from 638 individuals were submitted to an enzyme immunoassay test (EIA), using total lysate of a local Trypanosoma cruzi strain and 52.5% were positive (335/638). A subset of this group (94 positive individuals and 90 seronegatives) was randomly selected for further serological confirmation. Three additional tests were used--indirect immunofluorescence (IIF) and 2 distinct enzyme-linked immunosorbent assays using total lysate of the Y strain (EIA BM) and a mixture of 2 recombinant antigens (EIA RA). Seventy-nine patients were seropositive in all tests (84.0%-79/94). The number of positive sera with the IIF, EIA RA and EIA BM was 84/94 (89.4%), 80/94 (85.1%) and 79/94 (84.0%), respectively. In 15 out of the 94 EIA seropositive patients (16.0%), 10 individuals were negative in all 3 tests (10.6%-10/94). One was negative in the EIA BM and positive in the other two tests (1.1%-1/94) and 4 patients were positive, solely, in the IIF assay (4.3%-4/94). Relative to the 90 EIA negative individuals, 89 were confirmed in all other tests (98.9%-89/90). One individual, although seronegative in the IIF, was positive in both confirmatory EIA tests (1.1%-1/90). In addition, 120 blood specimens were submitted to PCR amplification. This group consisted of 79 confirmed seropositive cases, 16 individuals with discordant serological results and 25 validated seronegative individuals. The PCR was able to detect the presence of parasite DNA in 67 out of the 79 seropositive patients (84.8%), in 8 individuals with discordant serology (50.0%) and in only one seronegative individual (4.0%). The results pointed to the necessity for performing more than one serological test, preferentially with antigens from autochthonous strains, to achieve a reliable diagnosis of Chagas disease in Colombia.
在哥伦比亚桑坦德省（一个仍存在活跃传播的地区）对4种用于诊断恰加斯病的血清学检测方法进行了评估。638名个体的血清样本接受了酶免疫测定试验（EIA），使用当地克氏锥虫菌株的总裂解物，52.5%的样本呈阳性（335/638）。从该组中随机选取了一个子集（94名阳性个体和90名血清阴性个体）进行进一步的血清学确认。另外使用了三种检测方法——间接免疫荧光法（IIF）以及两种不同的酶联免疫吸附测定法，分别使用Y菌株的总裂解物（EIA BM）和两种重组抗原的混合物（EIA RA）。79名患者在所有检测中均呈血清阳性（84.0%——79/94）。IIF、EIA RA和EIA BM检测呈阳性的血清数量分别为84/94（89.4%）、80/94（85.1%）和79/94（84.0%）。在94名EIA血清阳性患者中的15名（16.0%），有10名个体在所有三种检测中均为阴性（10.6%——10/94）。1名个体在EIA BM检测中为阴性，在其他两种检测中为阳性（1.1%——1/94），4名患者仅在IIF检测中呈阳性（4.3%——4/94）。相对于90名EIA阴性个体，89名在所有其他检测中得到确认（98.9%——89/90）。1名个体尽管在IIF检测中为血清阴性，但在两种确认性EIA检测中均为阳性（1.1%——1/90）。此外，120份血液标本进行了PCR扩增。该组包括79例确诊的血清阳性病例、16例血清学结果不一致的个体和25例经证实的血清阴性个体。PCR能够在79名血清阳性患者中的67名（84.8%）、16名血清学结果不一致的个体中的8名（50.0%）以及仅1名血清阴性个体（4.0%）中检测到寄生虫DNA。结果表明，在哥伦比亚为实现恰加斯病的可靠诊断，有必要进行不止一种血清学检测，优先使用本地菌株的抗原。
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