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Review
. 2022 Nov 10;12(11):2752.
doi: 10.3390/diagnostics12112752.

Accuracy of Diagnostic Tests for the Detection of Chagas Disease: A Systematic Review and Meta-Analysis

Mayron Antonio Candia-Puma  1   2 , Laura Yesenia Machaca-Luque  1   2 , Brychs Milagros Roque-Pumahuanca  1   2 , Alexsandro Sobreira Galdino  3 , Rodolfo Cordeiro Giunchetti  4   5 , Eduardo Antonio Ferraz Coelho  6   7 , Miguel Angel Chávez-Fumagalli  1
Affiliations
Review

Accuracy of Diagnostic Tests for the Detection of Chagas Disease: A Systematic Review and Meta-Analysis

Mayron Antonio Candia-Puma et al. Diagnostics (Basel). .

Abstract

The present systematic review and meta-analysis about the accuracy of diagnostic tests aim to describe the findings of literature over the last thirty years for the diagnosis of Chagas disease (CD). This work aimed to determine the accuracy of diagnostic techniques for CD in the disease's acute and chronic phases. The PubMed database was searched for studies published between 1990 and 2021 on CD diagnostics. Fifty-six published studies that met the criteria were analyzed and included in the meta-analysis, evaluating diagnostic accuracy through sensitivity and specificity. For Enzyme-Linked Immunosorbent Assay (ELISA), Fluorescent Antibody Technique (IFAT), Hemagglutination Test (HmT), Polymerase Chain Reaction (PCR), and Real-Time Polymerase Chain Reaction (qPCR) diagnosis methods, the sensitivity had a median of 99.0%, 78.0%, 75.0%, 76.0%, and 94.0%, respectively; while specificity presented a median of 99.0%, 99.0%, 99.0%, 98.0%, and 98.0%, respectively. This meta-analysis showed that ELISA and qPCR techniques had a higher performance compared to other methods of diagnosing CD in the chronic and acute phases, respectively. It was concluded utilizing the Area Under the Curve restricted to the false positive rates (AUCFPR), that the ELISA diagnostic test presents the highest performance in diagnosing acute and chronic CD, compared to serological and molecular tests. Future studies focusing on new CD diagnostics approaches should be targeted.

Keywords: Chagas disease; diagnostic tests; meta-analysis; sensitivity and specificity; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Systematic review and meta-analysis workflow diagram.
Figure 2
Figure 2
Papers were selected for the different diagnostic techniques using MeSH terms in the PubMed database. (A) Bibliometric map created by VOSviewer based on MeSH terms co-occurrence. (B) Number of papers found in the search for each diagnostic technique found in cluster analysis.
Figure 3
Figure 3
The geographical location of Chagas’s disease studies. (A) The pie chart shows the biomarkers; (B) the clinical description of patients, and (C) the Number of CD patients included in the selected studies worldwide. (D) Estimative of the global prevalence of Chagas disease, 2017 [8].
Figure 4
Figure 4
Study data and paired forest plot of the sensitivity and specificity of Enzyme-linked immunosorbent assay (ELISA) in Chagas’s disease diagnosis. Data from each study are summarized. Sensitivity and specificity are reported with a mean (95% confidence limits). The Forest plot depicts the estimated sensitivity and specificity (black squares) and its 95% confidence limits (horizontal black line) [46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79].
Figure 5
Figure 5
Study data and paired forest plot of the sensitivity and specificity of Fluorescence antibody assay (IFAT) in Chagas’s disease diagnosis. Data from each study are summarized. Sensitivity and specificity are reported with a mean (95% confidence limits). The Forest plot depicts the estimated sensitivity and specificity (black squares) and its 95% confidence limits (horizontal black line) [66,67,80,81,82,83,84].
Figure 6
Figure 6
Study data and paired forest plot of the sensitivity and specificity Hemagglutination test (HmT) in Chagas’s disease diagnosis. Data from each study are summarized. Sensitivity and specificity are reported with a mean (95% confidence limits). The Forest plot depicts the estimated sensitivity and specificity (black squares) and its 95% confidence limits (horizontal black line) [63,66,76,84,85,86,87].
Figure 7
Figure 7
Study data and paired forest plot of the sensitivity and specificity Polymerase chain reaction (PCR) in Chagas’s disease diagnosis. Data from each study are summarized. Sensitivity and specificity are reported with a mean (95% confidence limits). The Forest plot depicts the estimated sensitivity and specificity (black circles) and its 95% confidence limits (horizontal black line) [66,67,76,88,89,90,91,92,93,94,95,96,97].
Figure 8
Figure 8
Study data and paired forest plot of the sensitivity and specificity quantitative Polymerase chain reaction (qPCR) in Chagas’s disease diagnosis. Data from each study are summarized. Sensitivity and specificity are reported with a mean (95% confidence limits). The Forest plot depicts the estimated sensitivity and specificity (black squares) and its 95% confidence limits (horizontal black line) [27,94,95,97,98,99,100].
Figure 9
Figure 9
Meta-analysis of diagnostic test accuracy analysis. Summary receiver operating curve (sROC) plot of false positive rate and sensitivity. Comparison between ELISA, IFAT, HmT, PCR, and qPCR methods in the diagnosis of chronic Chagas disease.
Figure 10
Figure 10
Meta-analysis of diagnostic test accuracy analysis. Summary receiver operating curve (sROC) plot of false positive rate and sensitivity. Comparison between ELISA and qPCR methods in the diagnosis of acute Chagas disease.
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