title: Validation of a rapid immunochromatographic assay for diagnosis of Trypanosoma cruzi infection among Latin-American Migrants in Geneva, Switzerland.
abstract: Chagas' disease is a global public health problem due to the recent exchange of population between Latin America and other regions, including Europe. The recent development of rapid diagnostic tests (RDTs) for Trypanosoma cruzi infection may improve patient access to diagnosis and care worldwide. We evaluated the diagnostic accuracy of the Chagas Stat-Pak RDT in a cohort of undocumented Latin-American migrants living in Geneva, Switzerland. Study participants were enrolled in a primary health care center. The Chagas Stat-Pak test was performed independently on blood and serum samples. A combination of two commercialized enzyme-linked immunosorbent assay (ELISA)-based serological tests was used for comparison (reference standard). A total of 999 adults (median age, 36 years) were included in the study; the majority were women (83%) and originally from Bolivia (47%) or Brazil (25%). A total of 125 participants (12.5%) were diagnosed with T. cruzi infection; with the exception of three individuals, all individuals diagnosed with T. cruzi were originally from Bolivia. The sensitivity and specificity of the Chagas Stat-Pak test on blood samples were 95.2% (95% confidence interval [95% CI], 89.2% to 97.9%) and 99.9% (95% CI, 99.3% to 100%), respectively. When the test was performed on serum samples, the sensitivity was 96% (95% CI, 91% to 98.3%), and the specificity was 99.8% (95% CI, 99.2% to 99.9%). The concordance of test results for blood and serum samples was 99.7%. Both negative and positive predictive values were above 98%. The Chagas Stat-Pak is an accurate diagnostic test for T. cruzi infection among Latin-American migrants living in Europe. The mild deficit in sensitivity should be interpreted in light of its ease of use and capacity to provide immediate results, which allow more people at risk to have access to diagnosis and care both in countries where Chagas' disease is endemic and in countries where this disease is not endemic.
authors.affiliation: Division of International and Humanitarian Medicine, Department of Community Medicine and Primary Care, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland. francois.chappuis@hcuge.ch
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.forename: Anne
authors.initials: A
authors.lastname: Mauris
authors.forename: Marylise
authors.initials: M
authors.lastname: Holst
authors.forename: Pedro
authors.initials: P
authors.lastname: Albajar-Vinas
authors.forename: Jean
authors.initials: J
authors.lastname: Jannin
authors.forename: Alejandro O
authors.initials: AO
authors.lastname: Luquetti
authors.forename: Yves
authors.initials: Y
authors.lastname: Jackson
mesh_terms: D000328:Adult; D001769:Blood / Q000469:parasitology; D014355:Chagas Disease / Q000175:diagnosis*; D054242:Emigrants and Immigrants; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007843:Latin America; D008297:Male; D008875:Middle Aged; D010274:Parasitology / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D044967:Serum / Q000469:parasitology; D013557:Switzerland; D014349:Trypanosoma cruzi / Q000276:immunology / Q000302:isolation & purification*