Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , , , , , , , , |
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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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 |
|
_version_ |
1808129179417313280 |