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Open Access Highly Accessed Research article

Serological and parasitological response in chronic Chagas patients 3 years after nifurtimox treatment

Yves Jackson1*, Eric Chatelain2, Anne Mauris3, Marylise Holst1, Qianqian Miao4, Francois Chappuis5 and Momar Ndao4

Author Affiliations

1 Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

2 Drug for Neglected Diseases Initiative, Geneva, Switzerland

3 Department of genetics and laboratory analysis, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

4 National Reference Center for Parasitology, Department of Medicine, Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, Canada

5 Division of international and humanitarian medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

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BMC Infectious Diseases 2013, 13:85  doi:10.1186/1471-2334-13-85

Published: 13 February 2013

Abstract

Background

With declining vectorial transmission, Chagas disease predominantly affects adults nowadays. The efficacy of nifurtimox in the chronic phase in adult patients is poorly known, particularly in regions where there is no risk of reinfection. Recommendations for treatment outcome assessment rely on serological follow-up. We evaluated the serological and parasitological response to nifurtimox in a cohort of adult patients three years post-treatment in Switzerland.

Methods

Patients treated with nifurtimox in 2008 during a cross-sectional study in Geneva, Switzerland, were contacted for follow-up in 2011. Two ELISAs and a rapid immunochromatographic test were used to test 2008 and 2011 serum samples simultaneously. In addition, conventional and real-time PCR were performed on 2011 samples.

Results

Thirty-seven (84.1%) of 44 eligible patients, predominantly female, middle-aged, Bolivians at the indeterminate stage, were enrolled. All 2011 ELISA and immunochromatographic tests were positive. Twenty-eight (75.7%) patients presented a lower optical density (OD) in 2011 compared to 2008. This OD difference was significant in both commercial (P < 0.001) and in-house (P = 0.002) ELISAs. Agreement between the two ELISAs was low (Kappa = 0.469). All patients had negative conventional PCR results but one (2.7%) was positive with real-time PCR.

Conclusion

Our results highlight the inadequacy of serology for assessing response in adults, three years after treatment. In our cohort, 97.3% had results that could either indicate treatment failure or persistant humoral response despite treatment. The lack of accurate early post-treatment tests of cure prevents appropriate patients information and councelling. New follow-up tests are needed to assess treatments efficacy given the large adult population in need of antiparasitic therapy.

Keywords:
Chagas disease; Trypanosoma cruzi; Diagnostic tests; Follow-up; Serology; PCR; Rapid diagnostic tests