Posttherapeutic cure criteria in Chagas disease : conventional serology followed by supplementary serological, parasitological, and molecular tests.
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2012
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We performed a critical study of conventional serology, followed by supplementary serological, parasitological, and molecular
tests, to assess the response to etiologic treatment of Chagas’ disease. A group of 94 Chagas’ disease patients treated with benznidazole
at least 10 years earlier were evaluated from the laboratory and clinical points of view. When conventional serology (enzyme-
linked immunosorbent assay [ELISA], indirect immunofluorescence [IIF], and indirect hemagglutination [IHA]) and classic
criteria (consistent results with any two of the three tests) or more rigorous criteria (consistent results from the three tests)
were used, 10.6% and 8.5% of patients were considered treated and cured (TC) by classic and rigorous criteria, respectively. Patients
were then evaluated using supplementary (recombinant ELISA and Trypanosoma cruzi excreted-secreted antigen blotting
[TESA-blot]), parasitological (hemoculture), and molecular (PCR) tests. The results of recombinant ELISA were similar to those
with the rigorous criterion (three consistent test results). The TESA-blot group showed a higher percentage (21.3%) of negative
results than the groups defined by either cure criterion. Hemoculture and PCR gave negative results for all treated and cured
(TC) patients, regardless of the criterion used. Recombinant ELISA and TESA-blot tests showed negative results for 70% and
87.5% of the patients categorized as TC by the classic and three-test criteria, respectively. For patients with discordant conventional
serology, the supplementary serological and molecular tests were the decisive factor in determining therapeutic failure.
Clinical evaluation showed that 62.5% of TC patients presented with the indeterminate form of the disease. Additionally, treated
patients with negative TESA-blot results should be reevaluated later with all methodologies used here to verify whether TESAblot
is a reliable way to determine early parasitological cure of Chagas’ disease.
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ASSIS, G. F. M. de et al. Posttherapeutic cure criteria in Chagas disease: conventional serology followed by supplementary serological, parasitological, and molecular tests. Clinical and Vaccine Immunology, v. 19, p. 1283-1291, 2012. Disponível em: <http://cvi.asm.org/content/19/8/1283>. Acesso em: 20 jan. 2017.