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Int J Infect Dis. 2018 Aug;73:93-101. doi: 10.1016/j.ijid.2018.05.019. Epub 2018 Jun 4.

Course of serological tests in treated subjects with chronic Trypanosoma cruzi infection: A systematic review and meta-analysis of individual participant data.

Author information

1
Centro Rosarino de Estudios Perinatales, Rosario, Argentina; Instituto Nacional de Parasitología, Fatala Chaben-ANLIS, Buenos Aires, Argentina. Electronic address: ysguassero@crep.org.ar.
2
Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Argentina.
3
Instituto de Efectividad Clínica y Sanitaria. CONICET, Buenos Aires, Argentina.
4
Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brazil.
5
Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
6
Centro Nacional de Investigación y Diagnóstico en Endemoepidemias (CeNDIE-ANLIS), Buenos Aires, Argentina.
7
Departamento de Saúde Coletiva, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
8
Departamento de Análise Clínica, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
9
Medical Department, Médecins sans Frontières, Barcelona, Spain.
10
Centro de Investigaciones sobre Endemias Nacionales (CIEN), Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina.
11
Instituto de Pesquisa Biológica, Laboratório Central, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brazil.
12
Unidad de Leishmaniasis, Servicio de Parasitología, Instituto de Salud Carlos III, Madrid, España.
13
Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Brazil.
14
Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Institute of Global Health, University of Geneva, Geneva, Switzerland.
15
Dirección de Primer Nivel de Atención, Área Operativa N° LV, Salta, Argentina.
16
Departamento de Ciências Básicas da Vida, Universidade Federal de Juiz de Fora, Campus Governador Valadares, Brazil.
17
Departamento de Medicina Tropical, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay.
18
Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal do Triangulo Mineiro, Brazil.
19
Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain; International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain.
20
Laboratorio de Patología Experimental, Universidad Nacional de Salta, Salta, Argentina.
21
Laboratorio de Ecología, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile; Laboratorio de Parasitología Básico-Clínico Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
22
Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España; Departamento de Genética y Microbiología, Universidad de Murcia, Espinardo, Murcia, España.
23
Escola de Saúde e Medicina, Universidade Católica de Brasília, Brazil; Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brazil.
24
Cátedra de Inmunología, Facultad de Ciencias Agrarias y Veterinarias, Universidad Católica de Salta, Argentina; Cátedra de Química Biológica, Facultad de Ciencias Exactas, Universidad Nacional de Salta, Argentina.
25
Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brazil.
26
Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
27
Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de Santa Catarina, Brazil.
28
Laboratorio de Parasitología Básico-Clínico Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
29
Instituto Nacional de Parasitología, Fatala Chaben-ANLIS, Buenos Aires, Argentina; Instituto de Efectividad Clínica y Sanitaria. CONICET, Buenos Aires, Argentina. Electronic address: ssosaestani@gmail.com.

Abstract

OBJECTIVE:

To determine the course of serological tests in subjects with chronic Trypanosoma cruzi infection treated with anti-trypanosomal drugs.

METHODS:

A systematic review and meta-analysis was conducted using individual participant data. Survival analysis and the Cox proportional hazards regression model with random effects to adjust for covariates were applied. The protocol was registered in the PROSPERO database (http://www.crd.york.ac.uk/PROSPERO; CRD42012002162).

RESULTS:

A total of 27 studies (1296 subjects) conducted in eight countries were included. The risk of bias was low for all domains in 17 studies (63.0%). Nine hundred and thirteen subjects were assessed (149 seroreversion events, 83.7% censored data) for enzyme-linked immunosorbent assay (ELISA), 670 subjects (134 events, 80.0% censored) for indirect immunofluorescence assay (IIF), and 548 subjects (99 events, 82.0% censored) for indirect hemagglutination assay (IHA). A higher probability of seroreversion was observed within a shorter time span in subjects aged 1-19 years compared to adults. The chance of seroreversion also varied according to the country where the infection might have been acquired. For instance, the pooled adjusted hazard ratio between children/adolescents and adults for the IIF test was 1.54 (95% confidence interval 0.64-3.71) for certain countries of South America (Argentina, Bolivia, Chile, and Paraguay) and 9.37 (95% confidence interval 3.44-25.50) for Brazil.

CONCLUSIONS:

The disappearance of anti-T. cruzi antibodies was demonstrated along the course of follow-up. An interaction between age at treatment and country setting was found.

KEYWORDS:

Chronic disease; Follow-up studies; Individual participant data; Meta-; Serologic tests; Trypanosoma cruzi; analysis

PMID:
29879524
PMCID:
PMC6069672
DOI:
10.1016/j.ijid.2018.05.019
[Indexed for MEDLINE]
Free PMC Article

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