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Chagas Disease in Southern Coastal Ecuador: Coinfections with Arboviruses and a Comparison of Serological Assays for Chagas Disease Diagnosis
Occurrence of Chagas disease and arbovirus coinfections is unknown, despite the vast co-endemic areas throughout the Americas. This study examined the proportion of individuals positive for Trypanosoma cruzi and coinfections with dengue, chikungunya, and Zika viruses in Machala, Ecuador (January 2014–December 2015). Chagas seropositivity was evaluated with five commercially available assays. Dengue infections were identified by nonstructural protein 1 rapid test and enzyme linked immunosorbent assay (ELISA), immunoglobulin M ELISA, and reverse transcription PCR (RT-PCR); chikungunya and Zika infections were identified by RT-PCR. Of 658 individuals, six were positive for T. cruzi (0.91%), including one T. cruzi/dengue coinfection and one T. cruzi/chikungunya/dengue coinfection. The clinical manifestations of coinfected individuals corresponded to severe dengue and dengue with warning signs, respectively. We observed discrepant results by using the Hemagen Chagas kit and the rapid test Chagas Detect Plus (false positives: 3.9% and 15.4%), highlighting the need to assess diagnostic assays in geographic regions with distinct taxonomic units of T. cruzi.
Author Notes
Financial support: Y. C. S. reports grants and nonfinancial support from Inbios International, other from Hemagen, during the conduct of the study; and grants and nonfinancial support from Inbios International outside the submitted work. E. M. reports grants from Syracuse University, during the conduct of the study.
Authors’ addresses: Neida K. Mita-Mendoza, Elizabeth McMahon, Aileen Kenneson, Cinthya Cueva, and Christina D. Lupone, Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, E-mails: mitamenn@upstate.edu, eamcmahon12@gmail.com, aileen.kenneson@yahoo.com, cin_ka10@hotmail.com, and luponeC@upstate.edu. Arturo Barbachano-Guerrero and Christine A. King, Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, E-mails: barbacha@upstate.edu and kingch@upstate.edu. Efrain Beltran-Ayala, Department of Medicine, Universidad Tecnica de Machala, Machala, El Oro Province, Ecuador, E-mail: felixbeltran57@hotmail.com. Yagahira E. Castro-Sesquen and Robert H. Gilman, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: ycastro1@jhu.edu and gilmanbob@gmail.com. Timothy P. Endy, Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, and Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, E-mail: endyt@upstate.edu. Anna M. Stewart-Ibarra, Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, and Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, E-mail: stewarta@upstate.edu.
These authors contributed equally to this work.