Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/32201
Title: ELISA versus PCR for diagnosis of chronic Chagas disease: systematic review and meta-analysis
Authors: Brasil, Pedro E. A . A.
Castro, Liane de
Hasslocher-Moreno, Alejandro M.
Sangenis, Luiz H. C.
Braga, José U.
Affilliation: Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Centro de Referência Professor Hélio Fraga. Rio de Janeiro, RJ, Brasil.
Abstract: Background: Most current guidelines recommend two serological tests to diagnose chronic Chagas disease. When serological tests are persistently inconclusive, some guidelines recommend molecular tests. The aim of this investigation was to review chronic Chagas disease diagnosis literature and to summarize results of ELISA and PCR performance. Methods: A systematic review was conducted searching remote databases (MEDLINE, LILACS, EMBASE, SCOPUS and ISIWeb) and full texts bibliography for relevant abstracts. In addition, manufacturers of commercial tests were contacted. Original investigations were eligible if they estimated sensitivity and specificity, or reliability -or if their calculation was possible - of ELISA or PCR tests, for chronic Chagas disease. Results: Heterogeneity was high within each test (ELISA and PCR) and threshold effect was detected only in a particular subgroup. Reference standard blinding partially explained heterogeneity in ELISA studies, and pooled sensitivity and specificity were 97.7% [96.7%-98.5%] and 96.3% [94.6%-97.6%] respectively. Commercial ELISA with recombinant antigens studied in phase three investigations partially explained heterogeneity, and pooled sensitivity and specificity were 99.3% [97.9%-99.9%] and 97.5% [88.5%-99.5%] respectively. ELISA’s reliability was seldom studied but was considered acceptable. PCR heterogeneity was not explained, but a threshold effect was detected in three groups created by using guanidine and boiling the sample before DNA extraction. PCR sensitivity is likely to be between 50% and 90%, while its specificity is close to 100%. PCR reliability was never studied. Conclusions: Both conventional and recombinant based ELISA give useful information, however there are commercial tests without technical reports and therefore were not included in this review. Physicians need to have access to technical reports to understand if these serological tests are similar to those included in this review and therefore correctly order and interpret test results. Currently, PCR should not be used in clinical practice for chronic Chagas disease diagnosis and there is no PCR test commercially available for this purpose. Tests limitations and directions for future research are discussed.
Keywords: Chagas disease
Diagnosis
ELISA
PCR
Issue Date: 2010
Publisher: BMC
Citation: BRASIL, Pedro E. A. A. et al. ELISA versus PCR for diagnosis of chronic Chagas disease: systematic review and meta-analysis. BMC Infectious Diseases, v. 10, n. 337, p. 1-17, 2010.
DOI: 10.1186/1471-2334-10-337
ISSN: 1471-2334
Copyright: open access
Appears in Collections:ENSP - Artigos de Periódicos
INI - Artigos de Periódicos

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