Screening

High-risk population screening

Screening asymptomatic people for Trypanosoma cruzi infection is a key strategy for Chagas disease control in many endemic countries and high-risk populations.[12]​​[29][33][54]​ Conventional serologic tests (parasite lysate enzyme-linked immunosorbent assays [ELISAs] or recombinant antigens, and immunofluorescent antibody [IFA] tests) are used for screening individuals with recognized risk (i.e., those living in endemic areas, travelers, immigrants).

In the US, screening is recommended in patients who were born in Latin America, who have spent >6 months in a rural area of Latin America, and/or who report exposure to triatomines.[33]​ In total, there are four commercial immunoassays available for clinical use: 3 ELISAs (Wiener Chagatest ELISA recombinante, Hemagen ELISA, and Ortho T. cruzi ELISA) and one rapid assay (InBios Chagas Detect Plus).[134]

Screening of blood and organ donors

Blood donors are screened by parasite lysate ELISA tests (sensitivity of 100% in patients with Chagas disease and a specificity of 99.997% among blood donors), according to Food and Drug Administration-approved labeling.[164] Considering the large number of Latin American immigrant populations in nonendemic countries, screening of transplant donors has become increasingly important, and a multidisciplinary working group has published recommendations for screening and treatment of Chagas disease in organ transplant recipients.[165]

Familial screening

Family members of patients with similar histories of possible parasite exposure in endemic settings should be tested. Children of infected women should also be tested.

Prenatal screening

Mothers with recognized risk are screened using conventional serologic tests (parasite lysate ELISA, or recombinant antigens and immunofluorescent antibody). Serologic tests remain positive in the offspring for 6-9 months after birth.

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