Criterios para diagnosticar precozmente la enfermedad de Chagas en atención primaria en Ecuador: Revisión sistemática

Chagas disease represents a silent threat to public health in Latin America, and timely diagnosis remains insufficient in Ecuador. Despite growing knowledge about Trypanosoma cruzi, gaps persist in early detection at the primary care level due to the lack of unified clinical-epidemiological protocols and systematic screening strategies. This study aimed to identify and analyze clinical-epidemiological criteria used in endemic countries for early diagnosis of Chagas disease, assessing their applicability to the Ecuadorian context. A systematic review was conducted following PRISMA guidelines and the PICO strategy, including 12 studies published between 2014 and 2024, retrieved from PubMed, LILACS, and Web of Science. Findings indicate that the most effective strategies combine simple clinical-epidemiological algorithms, the use of rapid diagnostic tests (RDTs), healthcare personnel training, and community participation. These interventions enhanced active case detection in rural areas and enabled identification even in asymptomatic individuals. RDTs demonstrated good reliability when confirmed with conventional serology. The quality of evidence was moderate to high, though limited by lack of external validation and long-term follow-up. It is concluded that applying these strategies in Ecuador requires local contextualization, strengthening of primary healthcare services, and promotion of implementation-focused research.