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PLoS Negl Trop Dis. 2016 Feb 26;10(2):e0004407. doi: 10.1371/journal.pntd.0004407. eCollection 2016 Feb.

Use of a Chagas Urine Nanoparticle Test (Chunap) to Correlate with Parasitemia Levels in T. cruzi/HIV Co-infected Patients.

Author information

1
Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
2
Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, United States of America.
3
Department of International Health, Bloomberg School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
4
Colectivo de Estudios Aplicados, Desarrollo Social, Salud y Medio Ambiente, Cochabamba, Bolivia.
5
Department of Internal Medicine and Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America.
6
Division of Cardiovascular Medicine, University of California Davis, Davis, California, United States of America.
7
Tulane University Medical Center, New Orleans, Louisiana, United States of America.
8
Servicio de Infectología, Hospital Clínico Viedma, Cochabamba, Bolivia.
9
Hospital San Juan De Dios, Santa Cruz de la Sierra, Bolivia.
10
School of Medicine, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, United States of America.
11
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
12
Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.
13
Global Health Sciences, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America.

Abstract

BACKGROUND:

Early diagnosis of reactivated Chagas disease in HIV patients could be lifesaving. In Latin America, the diagnosis is made by microscopical detection of the T. cruzi parasite in the blood; a diagnostic test that lacks sensitivity. This study evaluates if levels of T. cruzi antigens in urine, determined by Chunap (Chagas urine nanoparticle test), are correlated with parasitemia levels in T. cruzi/HIV co-infected patients.

METHODOLOGY/PRINCIPAL FINDINGS:

T. cruzi antigens in urine of HIV patients (N = 55: 31 T. cruzi infected and 24 T. cruzi serology negative) were concentrated using hydrogel particles and quantified by Western Blot and a calibration curve. Reactivation of Chagas disease was defined by the observation of parasites in blood by microscopy. Parasitemia levels in patients with serology positive for Chagas disease were classified as follows: High parasitemia or reactivation of Chagas disease (detectable parasitemia by microscopy), moderate parasitemia (undetectable by microscopy but detectable by qPCR), and negative parasitemia (undetectable by microscopy and qPCR). The percentage of positive results detected by Chunap was: 100% (7/7) in cases of reactivation, 91.7% (11/12) in cases of moderate parasitemia, and 41.7% (5/12) in cases of negative parasitemia. Chunap specificity was found to be 91.7%. Linear regression analysis demonstrated a direct relationship between parasitemia levels and urine T. cruzi antigen concentrations (p<0.001). A cut-off of > 105 pg was chosen to determine patients with reactivation of Chagas disease (7/7). Antigenuria levels were 36.08 times (95% CI: 7.28 to 64.88) higher in patients with CD4+ lymphocyte counts below 200/mL (p = 0.016). No significant differences were found in HIV loads and CD8+ lymphocyte counts.

CONCLUSION:

Chunap shows potential for early detection of Chagas reactivation. With appropriate adaptation, this diagnostic test can be used to monitor Chagas disease status in T. cruzi/HIV co-infected patients.

PMID:
26919324
PMCID:
PMC4768913
DOI:
10.1371/journal.pntd.0004407
[Indexed for MEDLINE]
Free PMC Article

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