Publication: Diagnóstico inmunológico de las tripanosomosis
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2017-02
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Abstract
La tripanosomosis americana o enfermedad de Chagas es causada por el protozoo flagelado Trypanosoma cruzi. En la fase aguda, debido a la alta carga parasitaria en sangre, el diagnóstico es parasitológico directo. En la fase crónica, debido a la disminución de la carga parasitaria, se necesitan técnicas de diagnóstico inmunológico indirectas. La tripanosomosis africana o enfermedad del sueño está causada por dos subespecies de Trypanosoma: Trypanosoma brucei gambiense y Trypanosoma brucei rhodesiense. Se caracteriza por presentar glicoproteínas de alta variabilidad (VSG) que protegen al parásito de nuestro sistema inmunitario. En el presente trabajo se describirán las diferentes técnicas de diagnóstico inmunológico de las tripanosomosis americana y africana disponibles en la actualidad. Se procederá, para ello, a la revisión de la literatura científica en el los últimos 10 años. En la tripanosomiasis americana o enfermedad de Chagas: Hasta el momento no disponemos de una técnica de referencia para el diagnóstico inmunológico. Según la OMS, se precisan dos test con resultados positivos. Disponemos de técnicas de diagnóstico inmunológico con alta sensibilidad y especificidad, tradicionales (ELISA, IFI, HAI) y de nueva generación (CMIA). Determinados test rápidos se ofrecen como alternativa a los anteriores, especialmente útiles en áreas con pocos recursos. En caso de discrepancia de los anteriores, se recomienda un tercer test confirmatorio como el western-blot. En la tripanosomiasis africana o enfermedad del sueño: La evidencia es más limitada que en la enfermedad anterior. El diagnóstico serológico de la enfermedad del sueño requiere técnicas que empleen múltiples antígenos, que excluyan la obtención de falsos negativos. Además, también existen pruebas rápidas útiles en el cribado de la enfermedad pero por sus variables valores de sensibilidad y especificidad, no deben de emplearse como técnicas para realizar un diagnóstico definitivo.
American trypanosomosis or Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi. In the acute phase, due to the high parasitic blood load, the diagnosis is direct parasitological. In the chronic phase, due to the decrease in the parasite load, in direct immunological diagnostic techniques are needed. African trypanosomosis or sleep disease is caused by two subspecies of Trypanosoma: Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. It is characterized by high glycoproteins (VSG) that protect the parasite from our immune system. In the present work the different techniques of immunological diagnosis of the American and African trypanosomosis available today will be described. To this end, a review of the scientific literature will be carried out in the last 10 years. In American tripanosomiasis or Chagas disease: To date, we do not have a reference technique for immunological diagnosis. According to the WHO, two tests with positive results are needed. We have techniques of immunological diagnosis with high sensitivity and specificity, traditional (ELISA, IFI, HAI) and new generation (CMIA). Certain rapid tests are offered as an alternative to the above, especially useful in areas with few resources. In case of discrepancy of the previousones, a third confirmatory test like western-blot is recommended. In African tripanosomiasis or sleeping sickness: The evidenceis more limited than in the previous disease. The serological diagnosis of sleep disease requires techniques that employ multiple antigens, which exclude the obtaining of false negatives. In addition, there are also rapid tests useful in the screening of the disease, but because of their variable values of sensitivity and specificity, they should not be used as techniques for a definitive diagnosis.
American trypanosomosis or Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi. In the acute phase, due to the high parasitic blood load, the diagnosis is direct parasitological. In the chronic phase, due to the decrease in the parasite load, in direct immunological diagnostic techniques are needed. African trypanosomosis or sleep disease is caused by two subspecies of Trypanosoma: Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. It is characterized by high glycoproteins (VSG) that protect the parasite from our immune system. In the present work the different techniques of immunological diagnosis of the American and African trypanosomosis available today will be described. To this end, a review of the scientific literature will be carried out in the last 10 years. In American tripanosomiasis or Chagas disease: To date, we do not have a reference technique for immunological diagnosis. According to the WHO, two tests with positive results are needed. We have techniques of immunological diagnosis with high sensitivity and specificity, traditional (ELISA, IFI, HAI) and new generation (CMIA). Certain rapid tests are offered as an alternative to the above, especially useful in areas with few resources. In case of discrepancy of the previousones, a third confirmatory test like western-blot is recommended. In African tripanosomiasis or sleeping sickness: The evidenceis more limited than in the previous disease. The serological diagnosis of sleep disease requires techniques that employ multiple antigens, which exclude the obtaining of false negatives. In addition, there are also rapid tests useful in the screening of the disease, but because of their variable values of sensitivity and specificity, they should not be used as techniques for a definitive diagnosis.