Use of a Latent Class Analysis in the Diagnosis of Chronic Chagas Disease in the Washington Metropolitan Area
| Autor: | Yagahira E, Castro-Sesquen, Antonella, Saldaña, Dhayanna, Patino Nava, Tabitha, Bayangos, Diana, Paulette Evans, Kelly, DeToy, Alexia, Trevino, Rachel, Marcus, Caryn, Bern, Robert H, Gilman, Kawsar R, Talaat, Fatima, Zapata |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Chagas disease Washington medicine.medical_specialty Trypanosoma cruzi Chronic Chagas' disease Antibody level Internal medicine medicine Humans Chagas Disease Online Only Articles Mexico biology business.industry South America biology.organism_classification medicine.disease Predictive value Latent class model Confidence interval Infectious Diseases Latent Class Analysis North America business Serostatus |
| Zdroj: | Clin Infect Dis |
| ISSN: | 1537-6591 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|