Use of a Latent Class Analysis in the Diagnosis of Chronic Chagas Disease in the Washington Metropolitan Area

Yagahira E. Castro-Sesquen, Antonella Saldaña, Dhayanna Patino Nava, Tabitha Bayangos, Diana Paulette Evans, Kelly Detoy, Alexia Trevino, Rachel Marcus, Caryn Bern, Robert H. Gilman, Kawsar R. Talaat

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The diversity of individuals at risk for Trypanosoma cruzi infection in the United States poses challenges for diagnosis. We evaluated the diagnostic accuracy of Food and Drug Administration (FDA)-cleared tests in the Washington Metropolitan area (WMA). Methods: In total, 1514 individuals were evaluated (1078 from Mexico, Central and northern South America [TcI-predominant areas], and 436 from southern South America [TcII/V/VI-predominant areas]). Optical density (OD) values from the Hemagen EIA and Chagatest v.3 Wiener, and categorical results of the IgG-TESA-blot (Western blot with trypomastigote excretory-secretory antigen), and the Chagas detect plus (CDP), as well as information of area of origin were used to determine T. cruzi serostatus using latent class analysis. Results: We detected 2 latent class (LC) of seropositives with low (LC1) and high (LC2) antibody levels. A significantly lower number of seropositives were detected by the Wiener, IgG-TESA-blot, and CDP in LC1 (60.6%, P <. 001, 93.1%, P =. 014, and 84.9%, P =. 002, respectively) as compared to LC2 (100%, 100%, and 98.2%, respectively). LC1 was the main type of seropositives in TcI-predominant areas, representing 65.0% of all seropositives as opposed to 22.8% in TcII/V/VI-predominant areas. The highest sensitivity was observed for the Hemagen (100%, 95% confidence interval [CI]: 96.2-100.0), but this test has a low specificity (90.4%, 95% CI: 88.7-91.9). The best balance between positive (90.9%, 95% CI: 83.5-95.1), and negative (99.9%, 95% CI: 99.4-99.9) predictive values was obtained with the Wiener. Conclusions: Deficiencies in current FDA-cleared assays were observed. Low antibody levels are the main type of seropositives in individuals from TcI-predominant areas, the most frequent immigrant group in the United States.

Original languageEnglish (US)
Pages (from-to)E303-E310
JournalClinical Infectious Diseases
Issue number9
StatePublished - May 1 2021


  • Chronic Chagas disease
  • Latent class analysis
  • Latin American immigrants
  • Serodiagnosis
  • Test accuracy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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