Parasitological, serological and molecular diagnosis of acute and chronic Chagas disease: from field to laboratory

There is no consensus on the diagnostic algorithms for many scenarios of Trypanosoma cruzi infection, which hinders the establishment of governmental guidelines in endemic and non-endemic countries. In the acute phase, parasitological methods are currently employed, and standardised surrogate molecular tests are being introduced to provide higher sensitivity and less operator-dependence. In the chronic phase, IgG-based serological assays are currently used, but if a single assay does not reach the required accuracy, PAHO/WHO recommends at least two immunological tests with different technical principles. Specific algorithms are applied to diagnose congenital infection, screen blood and organ donors or conduct epidemiological surveys. Detecting Chagas disease reactivation in immunosuppressed individuals is an area of increasing interest. Due to its neglect, enhancing access to diagnosis of patients at risk of suffering T. cruzi infection should be a priority at national and regional levels.

目前针对克氏锥虫（Trypanosoma cruzi）感染的多种临床场景，尚未形成统一的诊断算法，这一现状阻碍了流行区与非流行区国家制定官方诊疗指南。在疾病急性期，临床当前采用病原学检测方法，同时正引入标准化替代分子检测技术，以提升检测灵敏度并降低对操作人员的依赖。疾病慢性期则以基于IgG的血清学检测为主流方案；若单项检测无法达到要求的准确度，泛美卫生组织/世界卫生组织（PAHO/WHO）推荐采用至少两种技术原理不同的免疫学检测。针对先天性感染筛查、血液与器官供者筛查以及流行病学调查，需应用针对性的诊断算法。针对免疫抑制人群的恰加斯病（Chagas disease）再激活检测，是一个日益受到关注的研究领域。鉴于恰加斯病属于被忽视的疾病范畴，提升克氏锥虫感染高风险患者的诊断可及性，应成为国家及区域层面的优先工作事项。