Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients

Detalhes bibliográficos
Autor(a) principal: Costa, Priscilla Almeida da
Data de Publicação: 2017
Outros Autores: Segatto, Marcela [UNESP], Durso, Danielle Fernandes, Carvalho Moreira, Wagson Jose de, Junqueira, Lucas Lodi, Castilho, Fabio Morato de, Andrade, Silvio Amadeu de, Gelape, Claudio Leo, Chiari, Egler, Teixeira-Carvalho, Andrea, Junho Pena, Sergio Danilo, Machado, Carlos Renato, Franco, Gloria Regina, Brasileiro Filho, Geraldo, Vieira Moreira, Maria da Consolacao, Macedo, Andrea Mara
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.1016/j.healun.2017.02.018
http://hdl.handle.net/11449/159592
Resumo: BACKGROUND: Heart transplantation is a valuable therapeutic option for Chagas disease patients with severe cardiomyopathy. During patient follow-up, the differential diagnosis between cardiac transplant rejection and Chagas disease infection reactivation remains a challenging task, which hinders rapid implementation of the appropriate treatment. Herein we investigate whether polymerase chain reaction (PCR) strategies could facilitate early detection of Trypanosoma cruzi (T cruzi) in transplanted endomyocardial biopsies (EMBs). METHODS: In this study we analyzed 500 EMB specimens obtained from 58 chagasic cardiac transplant patients, using PCR approaches targeted to nuclear (rDNA 24S alpha) and kinetoplastid (kDNA) markers, and compared the efficiency of these approaches with that of other tests routinely used. RESULTS: T cruzi DNA was detected in 112 EMB specimens derived from 39 patients (67.2%). The first positive result occurred at a median 1.0 month post-transplant. Conventional histopathologic, blood smear and hemoculture analyses showed lower sensitivity and higher median time to the first positive result. Patient follow-up revealed that 31 of 39 PCR-positive cases presented clinical reactivation of Chagas disease at different time-points after transplantation. PCR techniques showed considerable sensitivity (0.82) and specificity (0.60), with area under the receiver operating characteristic (ROC) curves of 0.708 (p = 0.001). Moreover, PCR techniques anticipated the clinical signs of Chagas disease reactivation by up to 36 months, with a median time of 6 months and an average of 9.1 months. CONCLUSIONS: We found a good association between the PCR diagnosis and the clinical signs of the disease, indicating that the PCR approaches used herein are suitable for early diagnosis of Chagas disease reactivation, with high potential to assist physicians in treatment decisions. For this purpose, an algorithm is proposed for surveillance based on the molecular tests. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.
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spelling Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patientsChagas disease reactivationendomyocardial biopsyheart transplantationmolecular diagnosticspolymerase chain reactionBACKGROUND: Heart transplantation is a valuable therapeutic option for Chagas disease patients with severe cardiomyopathy. During patient follow-up, the differential diagnosis between cardiac transplant rejection and Chagas disease infection reactivation remains a challenging task, which hinders rapid implementation of the appropriate treatment. Herein we investigate whether polymerase chain reaction (PCR) strategies could facilitate early detection of Trypanosoma cruzi (T cruzi) in transplanted endomyocardial biopsies (EMBs). METHODS: In this study we analyzed 500 EMB specimens obtained from 58 chagasic cardiac transplant patients, using PCR approaches targeted to nuclear (rDNA 24S alpha) and kinetoplastid (kDNA) markers, and compared the efficiency of these approaches with that of other tests routinely used. RESULTS: T cruzi DNA was detected in 112 EMB specimens derived from 39 patients (67.2%). The first positive result occurred at a median 1.0 month post-transplant. Conventional histopathologic, blood smear and hemoculture analyses showed lower sensitivity and higher median time to the first positive result. Patient follow-up revealed that 31 of 39 PCR-positive cases presented clinical reactivation of Chagas disease at different time-points after transplantation. PCR techniques showed considerable sensitivity (0.82) and specificity (0.60), with area under the receiver operating characteristic (ROC) curves of 0.708 (p = 0.001). Moreover, PCR techniques anticipated the clinical signs of Chagas disease reactivation by up to 36 months, with a median time of 6 months and an average of 9.1 months. CONCLUSIONS: We found a good association between the PCR diagnosis and the clinical signs of the disease, indicating that the PCR approaches used herein are suitable for early diagnosis of Chagas disease reactivation, with high potential to assist physicians in treatment decisions. For this purpose, an algorithm is proposed for surveillance based on the molecular tests. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Departamento de Ciencia e Tecnologia do Ministerio da Saude (Decit/SCTIE/MS)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Fed Minas Gerais, Inst Ciencias Biol, Dept Bioquim & Imunol, Ave Antonio Carlos 6627, BR-31270901 Belo Horizonte, MG, BrazilUniv Estadual Paulista, Inst Biociencias, Dept Genet, Sao Paulo, BrazilUniv Fed Minas Gerais, Hosp Clin, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Fac Med, Dept Cirurgia, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Inst Ciencias Biol, Dept Parasitol, Belo Horizonte, MG, BrazilFiocruz Minas, Ctr Pesquisas Rene Rachou, Grp Integrado Pesquisas Biomarcadores, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Fac Med, Dept Patol, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Fac Med, Dept Clin Med, Belo Horizonte, MG, BrazilUniv Estadual Paulista, Inst Biociencias, Dept Genet, Sao Paulo, BrazilElsevier B.V.Universidade Federal de Minas Gerais (UFMG)Universidade Estadual Paulista (Unesp)Fiocruz MinasCosta, Priscilla Almeida daSegatto, Marcela [UNESP]Durso, Danielle FernandesCarvalho Moreira, Wagson Jose deJunqueira, Lucas LodiCastilho, Fabio Morato deAndrade, Silvio Amadeu deGelape, Claudio LeoChiari, EglerTeixeira-Carvalho, AndreaJunho Pena, Sergio DaniloMachado, Carlos RenatoFranco, Gloria ReginaBrasileiro Filho, GeraldoVieira Moreira, Maria da ConsolacaoMacedo, Andrea Mara2018-11-26T15:44:34Z2018-11-26T15:44:34Z2017-07-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article797-805application/pdfhttp://dx.doi.org/10.1016/j.healun.2017.02.018Journal Of Heart And Lung Transplantation. New York: Elsevier Science Inc, v. 36, n. 7, p. 797-805, 2017.1053-2498http://hdl.handle.net/11449/15959210.1016/j.healun.2017.02.018WOS:000404494100014WOS000404494100014.pdfWeb of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal Of Heart And Lung Transplantation4,592info:eu-repo/semantics/openAccess2023-12-13T06:22:37Zoai:repositorio.unesp.br:11449/159592Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T20:14:53.200517Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
title Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
spellingShingle Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
Costa, Priscilla Almeida da
Chagas disease reactivation
endomyocardial biopsy
heart transplantation
molecular diagnostics
polymerase chain reaction
title_short Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
title_full Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
title_fullStr Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
title_full_unstemmed Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
title_sort Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
author Costa, Priscilla Almeida da
author_facet Costa, Priscilla Almeida da
Segatto, Marcela [UNESP]
Durso, Danielle Fernandes
Carvalho Moreira, Wagson Jose de
Junqueira, Lucas Lodi
Castilho, Fabio Morato de
Andrade, Silvio Amadeu de
Gelape, Claudio Leo
Chiari, Egler
Teixeira-Carvalho, Andrea
Junho Pena, Sergio Danilo
Machado, Carlos Renato
Franco, Gloria Regina
Brasileiro Filho, Geraldo
Vieira Moreira, Maria da Consolacao
Macedo, Andrea Mara
author_role author
author2 Segatto, Marcela [UNESP]
Durso, Danielle Fernandes
Carvalho Moreira, Wagson Jose de
Junqueira, Lucas Lodi
Castilho, Fabio Morato de
Andrade, Silvio Amadeu de
Gelape, Claudio Leo
Chiari, Egler
Teixeira-Carvalho, Andrea
Junho Pena, Sergio Danilo
Machado, Carlos Renato
Franco, Gloria Regina
Brasileiro Filho, Geraldo
Vieira Moreira, Maria da Consolacao
Macedo, Andrea Mara
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade Federal de Minas Gerais (UFMG)
Universidade Estadual Paulista (Unesp)
Fiocruz Minas
dc.contributor.author.fl_str_mv Costa, Priscilla Almeida da
Segatto, Marcela [UNESP]
Durso, Danielle Fernandes
Carvalho Moreira, Wagson Jose de
Junqueira, Lucas Lodi
Castilho, Fabio Morato de
Andrade, Silvio Amadeu de
Gelape, Claudio Leo
Chiari, Egler
Teixeira-Carvalho, Andrea
Junho Pena, Sergio Danilo
Machado, Carlos Renato
Franco, Gloria Regina
Brasileiro Filho, Geraldo
Vieira Moreira, Maria da Consolacao
Macedo, Andrea Mara
dc.subject.por.fl_str_mv Chagas disease reactivation
endomyocardial biopsy
heart transplantation
molecular diagnostics
polymerase chain reaction
topic Chagas disease reactivation
endomyocardial biopsy
heart transplantation
molecular diagnostics
polymerase chain reaction
description BACKGROUND: Heart transplantation is a valuable therapeutic option for Chagas disease patients with severe cardiomyopathy. During patient follow-up, the differential diagnosis between cardiac transplant rejection and Chagas disease infection reactivation remains a challenging task, which hinders rapid implementation of the appropriate treatment. Herein we investigate whether polymerase chain reaction (PCR) strategies could facilitate early detection of Trypanosoma cruzi (T cruzi) in transplanted endomyocardial biopsies (EMBs). METHODS: In this study we analyzed 500 EMB specimens obtained from 58 chagasic cardiac transplant patients, using PCR approaches targeted to nuclear (rDNA 24S alpha) and kinetoplastid (kDNA) markers, and compared the efficiency of these approaches with that of other tests routinely used. RESULTS: T cruzi DNA was detected in 112 EMB specimens derived from 39 patients (67.2%). The first positive result occurred at a median 1.0 month post-transplant. Conventional histopathologic, blood smear and hemoculture analyses showed lower sensitivity and higher median time to the first positive result. Patient follow-up revealed that 31 of 39 PCR-positive cases presented clinical reactivation of Chagas disease at different time-points after transplantation. PCR techniques showed considerable sensitivity (0.82) and specificity (0.60), with area under the receiver operating characteristic (ROC) curves of 0.708 (p = 0.001). Moreover, PCR techniques anticipated the clinical signs of Chagas disease reactivation by up to 36 months, with a median time of 6 months and an average of 9.1 months. CONCLUSIONS: We found a good association between the PCR diagnosis and the clinical signs of the disease, indicating that the PCR approaches used herein are suitable for early diagnosis of Chagas disease reactivation, with high potential to assist physicians in treatment decisions. For this purpose, an algorithm is proposed for surveillance based on the molecular tests. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.
publishDate 2017
dc.date.none.fl_str_mv 2017-07-01
2018-11-26T15:44:34Z
2018-11-26T15:44:34Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1016/j.healun.2017.02.018
Journal Of Heart And Lung Transplantation. New York: Elsevier Science Inc, v. 36, n. 7, p. 797-805, 2017.
1053-2498
http://hdl.handle.net/11449/159592
10.1016/j.healun.2017.02.018
WOS:000404494100014
WOS000404494100014.pdf
url http://dx.doi.org/10.1016/j.healun.2017.02.018
http://hdl.handle.net/11449/159592
identifier_str_mv Journal Of Heart And Lung Transplantation. New York: Elsevier Science Inc, v. 36, n. 7, p. 797-805, 2017.
1053-2498
10.1016/j.healun.2017.02.018
WOS:000404494100014
WOS000404494100014.pdf
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Journal Of Heart And Lung Transplantation
4,592
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 797-805
application/pdf
dc.publisher.none.fl_str_mv Elsevier B.V.
publisher.none.fl_str_mv Elsevier B.V.
dc.source.none.fl_str_mv Web of Science
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv
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