Chagas disease control: deltamethrin-treated collars reduce Triatoma infestans feeding success on dogs

Dogs are domestic reservoir hosts of Trypanosoma cruzi, the aetiological agent of Chagas disease. Using an experimental set-up mimicking rural mud-and-thatch houses, we evaluated the effect of deltamethrin-treated dog collars on the feeding success and survival of Triatoma infestans, the main T. cruzi vector in Latin America. Seven collared and three uncollared control dogs were exposed to colonized T. infestans at day 0 (i.e. before attachment of collars), at 15 days, and then monthly for 3 months post collar attachment. Following overnight exposure to uncollared dogs, 96% (1473/1538) of bugs fed, of which 51% (746/1473) fully engorged. Feeding rates were significantly reduced on collared dogs for up to 1 month post collar attachment with the lowest rates of 91% (551/604) observed at day 30 (P<0.05). Amongst those bugs that fed, engorgement rates were significantly reduced on collared dogs throughout the trial, during which average rates were 31% (543/1768) (P<0.001). No collar effect on individual bug survival was observed. Although observed effects on feeding and engorgement were limited, the strong association between blood-feeding, blood meal size and T. cruzi transmission suggests that deltamethrin-treated dog collars could help to control canine (and possibly human) T. cruzi infection.

Some considerations about the ecology of Triatominae

Observations on the ecology of silvatic Triatominae are still fragmentary, principally because target species in control process are almost exclusively domestic. Report of silvatic species invading human dwellings must lead research to be focused on their original ecology, in order to assist in understanding their process of domestication and devising strategies for surveillance.

Molecular research and the control of Chagas disease vectors

Chagas disease control initiatives are yielding promising results. Molecular research has helped successful programs by identifying and characterizing introduced vector populations and by defining intervention targets accurately. However, researchers and health officials are facing new challenges throughout Latin America. Native vectors persistently reinfest insecticide-treated households, and sylvatic triatomines maintain disease transmission in humid forest regions (including Amazonia) without colonizing human dwellings. In these scenarios, fine-scale vector studies are essential to define epidemiological risk patterns and clarify the involvement of little-known triatomine taxa in disease transmission. These eco-epidemiological investigations, as well as the planning and monitoring of control interventions, rely by necessity on accurate taxonomic judgments. The problems of cryptic speciation and phenotypic plasticity illustrate this need - and how molecular systematics can provide the fitting answers. Molecular data analyses also illuminate basic aspects of vector evolution and adaptive trends. Here we review the applications of molecular markers (concentrating on allozymes and DNA sequencing) to the study of triatomines. We analyze the suitability, strengths and weaknesses of the various techniques for taxonomic, systematic and evolutionary investigations at different levels (populations, species, and higher taxonomic categories).

Lessons from a national survey of Chagas disease transmission risk in Colombia

In recent years, there has been a revitalization of large-scale programmes to control parasitic disease in developing countries. In 1997, the Governments of Colombia, Venezuela, Ecuador and Peru committed themselves to replicate the cost-effective elimination of Trypanosoma cruzi transmission achieved in the Southern Cone by using insecticides against the domestic triatomine vectors (in combination with blood-bank screening). Central American Governments launched a complementary initiative. All plan to interrupt vectorial transmission throughout the region by 2010 but specific targets are decided nationally. In this article, we highlight the novel approach taken by the Colombian Government for determining the geographic distribution of Chagas disease risk to select where to intervene first.

Recent developments in the identification of chemotherapeutics for Chagas disease

Chagas Disease, caused by the T. cruzi parasite, is one of the largest public health problems in the Western hemisphere. Although its spread has diminished due to vector eradication programs, effective chemotherapeutics for the disease itself remain elusive. Many efforts towards the development of antiparasitic agents active against a number of targets have been described recently in the literature. This review summarizes developments in trypanosidal agents from 2000 through 2003.

Ampliação de raio de pesquisa de triatomíneos na atividade de atendimento às notificações em área de Triatoma sordida (Stål, 1859) no Estado de São Paulo

O objetivo deste estudo foi avaliar a ampliação da vistoria realizada nas unidades domiciliares situadas em um raio de 200m, a partir da casa notificante. Foram avaliadas as notificações recebidas pelos Serviços Regionais da Superintendência de Controle de Endemias de São José do Rio Preto, Araçatuba e Presidente Prudente, nos meses de agosto, setembro e outubro de 2002. Foram recebidas no período 263 notificações de triatomíneos, sendo 79 positivas. A ampliação de raio foi responsável pela pesquisa de mais 610 UD's, com presença de triatomíneos em 14,5% destas. Observou-se que 24,7% das UD's vizinhas a casa que notificou apresentou resultado positivo na pesquisa de triatomíneos. Quando a UD notificante apresentou resultado positivo na notificação, a ampliação de raio mostrou positividade em 42,5% das UD's obtendo-se valor de "Odds ratio" de 2,252 (1,25<OR<4,06) com 95% confiança. Este estudo demonstrou que se torna necessário uma ampliação do raio de pesquisa na atividade de atendimento às notificações encaminhadas pela população.

Can wild Triatoma infestans foci in Bolivia jeopardize Chagas disease control efforts?

The expected success of Chagas disease control programs in the Southern Cone countries relied on the assumption that Triatoma infestans, the main domestic vector, did not maintain silvatic foci except in the Cochabamba valley in Bolivia. Recent fieldwork revealed that wild populations of this vector are much more widespread throughout Bolivia than previously thought. Therefore, it is important to find out whether these silvatic populations could jeopardize control efforts in Bolivia, and to investigate their possible occurrence in neighboring regions of Paraguay and Argentina.

Protective immunity against Trypanosoma cruzi provided by oral immunization with Phytomonas serpens: role of nitric oxide

We have previously demonstrated that Phytomonas serpens, a tomato parasite, shares antigens with Trypanosoma cruzi, the protozoa that causes Chagas' disease. These antigens are recognized by human sera and induce protective immunity in Balb/c mice. In the present study, inducible nitric oxide synthase (iNOS) knockout (KO) mice and C57BL/6 mice treated with the nitric oxide inhibitor, aminoguanidine (AG, 50 mg kg(-1)) infected with T. cruzi, were used to demonstrate the role of nitric oxide (NO) to host protection against T. cruzi infection achieved by oral immunization with live P. serpens. A reduction in parasitaemia and an increase in survival were observed in C57BL/6 infected mice and previously immunized with P. serpens, when compared to non-immunized mice. iNOS (KO) mice immunized and C57BL/6 immunized and treated with AG presented parasitaemia and mortality rates comparable to those of infected and non-immunized mice. By itself, immunization with P. serpens did not induce inflammation in the myocardium, but C57BL/6 mice so immunized showed fewer amastigotes nests in the heart following an acute T. cruzi infection than those in non-immunized mice. These results suggest that protective immunity against T. cruzi infection induced by immunization with P. serpens is dependent upon enhanced NO production during the acute phase of T. cruzi infection.

European strategies against the parasite transfusion risk

Protozoal infections are endemic in mainly tropical low income countries, affecting millions of people. Malaria, American trypanosomiasis (Trypanosoma cruzi/Chagas disease) and protozoal tickborne diseases (e.g. Babesia) can be efficiently transmitted by transfusion of cellular blood components. In non-endemic areas like Europe malaria, Chagas disease and Babesia are imported diseases resulting of travelling to endemic areas and migration of autochthons from these endemic areas. A recent International Forum showed that in Europe, as well as the USA, prevention of transfusion-associated protozoal infections depend mainly on selection of donors using questionnaires. Most countries divide donors at risk for malaria in two groups: individuals who have lived in the first 5 years of their life in malaria endemic areas and those who are borne and residing in non-endemic areas and visited the endemic area(s). The first category of donors is rejected for 3 years after their last visit to the endemic area, and in one country such donors are permanently rejected. In some countries such donors are accepted after 4 months-3 years, provided a test for malaria is non-reactive. Persons from non-endemic areas, who visited the malaria endemic area, are rejected for 4-12 months. Some countries reject these donors for 3 years or permanently when they resided for more than 6 months in the endemic area. The rejection rate of donors for malaria risk in the various countries was 0.003-0.43% of all donations. Over the last decade only a few cases of TT-malaria were reported in the various countries. In several countries donors are questioned for risk of T. cruzi infection. In some countries donors are excluded when they (or their mothers) were born in South or Central America, if they received a blood transfusion in these areas and if they lived in rural areas in these endemic countries for more than 4 weeks. In none of the countries donors are asked if they had Babesia or Leishmania. At present implemented measures to prevent TT-malaria in the European countries are probably highly effective. More research is needed to establish the theoretical risk of TT-T. cruzi and TT-Leishmania infection in Europe, before preventive measures may be considered.

Vigilância entomológica da doença de Chagas na região centro-oeste de Minas Gerais, Brasil, entre os anos de 2000 e 2003

Em Minas Gerais, Brasil, após a eliminação do Triatoma infestans, realizada pelo Programa de Controle da Doença de Chagas (PCDCh), algumas espécies, como Panstrongylus megistus, merecem maior atenção da vigilância entomológica. Com a reforma sanitária, as ações do PCDCh couberam aos municípios, e alguns têm encontrado dificuldades administrativas e operacionais para a realização e/ou manutenção do programa. O presente trabalho objetivou analisar a vigilância entomológica da doença de Chagas nos 54 municípios supervisionados pela Diretoria de Ações Descentralizadas da Saúde de Divinópolis, entre 2000 e 2003. Em 46 municípios, foram capturados 1.531 triatomíneos nesse período, sendo que 94,1% dos insetos eram exemplares de P. megistus. O índice de infecção para T. cruzi foi de 1,3% nos insetos examinados. Ao todo, foram realizadas 850 notificações distribuídas em 46 municípios, que resultaram em 835 atendimentos, o que mostra que o PCDCh está ativo e eficiente na maioria dos municípios analisados. Constatou-se que os triatomíneos continuam a invadir e eventualmente colonizar o ambiente domiciliar, ainda que em baixa densidade, demonstrando a importância da manutenção e do aprimoramento da vigilância entomológica na região.

Epidemiología de la enfermedad de Chagas en el estado de Veracruz

OBJECTIVE

To assess the seroprevalence, household risk factors, and entomological indicators, in order to frame control measures in 11 Sanitary Jurisdictions of the state.

MATERIAL AND METHODS

This study included 281 towns, 2 526 households, and 9782 individuals. Data were collected using a questionnaire. Blood was obtained in filter paper and a search for triatomines was conducted inside of and around dwellings. Prevalence rates were used to quantify exposure to risk factors and seropositivity. Odds ratios with 95% confidence intervals and Mantel-Haenszel chi-squared tests were obtained. Multivariate analysis was performed with unconditional logistic regression,variables included in the model were those that had a p-value up to 0.20 in the bivariate analysis. The etiologic fraction in the exposed was also obtained.

RESULTS

The prevalence of Chagas disease was between 0 and 2.8%. Jurisdictions at a higher risk wereTuxpan, Panuco and Cordoba; Orizaba showed no risk. The main household risk factors were palma/zacate (palm-tree, grass leaves) roof and walls, dirt floor, the presence of the vector, and ventilation.

CONCLUSIONS

Epidemiological surveillance should emphasize health education, housing improvement, and use of insecticides.

Chagas disease in bone marrow transplantation: an approach to preemptive therapy

The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

Isolation of Beauveria bassiana (Bals.) Vuill. (Deuteromycotina: Hyphomycetes) from the Chagas disease vector, Triatoma infestans (Hemiptera: Reduviidae) in Argentina

A survey for natural entomopathogenic fungi of the Chagas disease vector Triatoma infestans was conducted in five provinces of Argentina since 2001. Nymphs (1.5%) and adults (3.3%) infected with a strain of the fungus Beauveria bassiana were found at Dean Funes, Cordoba province, Argentina. Field collected insects that died in the laboratory were maintained in moist chambers and incubated at 22 degrees C. Beauveria bassiana from infected insects was cultured on SDAY media. Pathogenicity tests were conducted with a conidial suspension (1 x 10(7) conidia/ml) of this isolate on T. infestans adults. A mortality rate of 100% was obtained at 15 days post-infection. This is the first record of natural infection of T. infestans by B. bassiana.

Enfermedad de Chagas en Argentina: herramientas para que los escolares vigilen y determinen la presencia de factores de riesgo en sus viviendas

El objetivo de este trabajo fue validar herramientas para que escolares puedan vigilar sus viviendas. Se desarrollaron dos tipos de planillas, una sobre la presencia de factores de riesgos y otra para registrar la presencia de vinchucas en las viviendas. Estas planillas fueron puestas a prueba en campo por 100 escolares de escuelas de áreas endémicas de Argentina y validadas en campo por personal técnico. Los resultados obtenidos por los escolares sobre porcentajes de viviendas que presentan factores de riesgos y viviendas positivas fueron similares a los obtenidos por el personal técnico. La información recabada permitió a los docentes caracterizar las viviendas como "con mucho riesgo", "de riesgo" o "sin riesgo". Esta información sobre nivel de riesgo de las viviendas puede ser una importante ayuda para los agentes primarios de salud. Por lo tanto, se recomienda incluir estas estrategias educativas en los programas de control, en especial para la fase de vigilancia.

Safety of the blood supply in Latin America

Appropriate selection of donors, use of sensitive screening tests, and the application of a mandatory quality assurance system are essential to maintain the safety of the blood supply. Laws, decrees, norms, and/or regulations covering most of these aspects of blood transfusion exist in 16 of the 17 countries in Latin America that are the subject of this review. In 17 countries, there is an information system that, although still incomplete (there are no official reports on adverse events and incidents), allows us to establish progress made on the status of the blood supply since 1993. Most advances originated in increased screening coverage for infectious diseases and better quality assurance. However, in 2001 to 2002, tainted blood may have caused infections in 12 of the 17 countries; no country reached the number of donors considered adequate, i.e., 5% of the population, to avoid blood shortages, or decreased significantly the number of blood banks, although larger blood banks are more efficient and take advantage of economies of scale. In those years, paid donors still existed in four countries and replacement donors made up >75% of the blood donors in another eight countries. In addition, countries did not report the number of voluntary donors who were repeat donors, i.e., the healthiest category. In spite of progress made, more improvements are needed.

[Cost effectiveness study of a control program of congenital Chagas disease in Bolivia]

Cost effectiveness analysis of Chagas' vertical transmission control program in Bolivia: Today, Bolivia is the most concerned country in America by Chagas disease: Trypanosoma cruzi infection affects 20% of whole population, around 1800000 inhabitants, and mother-to-child transmission is around 5%, from 1.6 to 9.8%. Direct and indirect costs derived from disease complications and death, from birth to adulthood, add up around US$ 21 millions per year for 2,718 infected new-borns. This cost falls on individual, family and society, when the nation is struggling in a depressed economy. On the other side, an effective control program could detect and treat all cases with an investment of US$ 123 per infected new-born, or US$ 1.2 per new-born in Bolivia. Indirect benefits, apart of suffering relieve and improving of life quality, are related with Chagas vector control program, increasing the demand thanks to increasing risk awareness and also induced demand testing all pregnant women in endemic areas. So the conclusion is that such investment is profitable.

Dynamics between sylvatic, peridomestic and domestic populations of Triatoma brasiliensis (Hemiptera: Reduviidae) in Ceara State, Northeastern Brazil

Triatoma brasiliensis is the most important Chagas disease vector in the drier regions of the "Brazilian Caatinga", colonizing both sylvatic and domestic environments, usually forming abundant colonies. Control trials using insecticides against domestic and peridomestic populations suggest that the T. brasiliensis has a high capacity to repopulate treated habitats from the neighboring sylvatic populations, making its elimination more complex. The aim of this work was to determine genetic variability among sylvatic, peridomestic and domestic populations of T. brasiliensis using head morphometry and random amplified polymorphic DNA (RAPD). Both morphometric analysis and RAPD patterns showed a separation between sylvatic and domestic populations, being the peridomestic ones between them. Based on this data, we suggest that there exists a flow between natural and artificial environments, being the peridomestic population mainly responsible for this interchange. It is possible that the peridomestic environment is maintaining the variability on the insects found on artificial habitats, which guarantee T. brasiliensis success on adaptation in both environments and also increase the risk of introduction of new Trypanosoma cruzi strains in the domestic cycle of Chagas disease in this region.

Utility of the Trypanosoma cruzi sequence database for identification of potential vaccine candidates by in silico and in vitro screening

Glycosylphosphatidylinositol (GPI)-anchored proteins are abundantly expressed in the infective and intracellular stages of Trypanosoma cruzi and are recognized as antigenic targets by both the humoral and cellular arms of the immune system. Previously, we demonstrated the efficacy of genes encoding GPI-anchored proteins in eliciting partially protective immunity to T. cruzi infection and disease, suggesting their utility as vaccine candidates. For the identification of additional vaccine targets, in this study we screened the T. cruzi expressed sequence tag (EST) and genomic sequence survey (GSS) databases. By applying a variety of web-based genome-mining tools to the analysis of approximately 2,500 sequences, we identified 348 (37.6%) EST and 260 (17.4%) GSS sequences encoding novel parasite-specific proteins. Of these, 19 sequences exhibited the characteristics of secreted and/or membrane-associated GPI proteins. Eight of the selected sequences were amplified to obtain genes TcG1, TcG2, TcG3, TcG4, TcG5, TcG6, TcG7, and TcG8 (TcG1-TcG8) which are expressed in different developmental stages of the parasite and conserved in the genome of a variety of T. cruzi strains. Flow cytometry confirmed the expression of the antigens encoded by the cloned genes as surface proteins in trypomastigote and/or amastigote stages of T. cruzi. When delivered as a DNA vaccine, genes TcG1-TcG6 elicited a parasite-specific antibody response in mice. Except for TcG5, antisera to genes TcG1-TcG6 exhibited trypanolytic activity against the trypomastigote forms of T. cruzi, a property known to correlate with the immune control of T. cruzi. Taken together, our results validate the applicability of bioinformatics in genome mining, resulting in the identification of T. cruzi membrane-associated proteins that are potential vaccine candidates.

Spatio-temporal analysis of reinfestation by Triatoma infestans (Hemiptera: Reduviidae) following insecticide spraying in a rural community in northwestern Argentina

The spatio-temporal reinfestation patterns by Triatoma infestans following a blanket insecticide spraying in the rural community of Amama in northwestern Argentina were analyzed using a geographic information system, satellite imagery, and spatial statistics. Domestic and peridomestic reinfestation by triatomine bugs was monitored from 1993 to 1997. Triatoma infestans was detected at least once in 75% of 2,110 sites evaluated. The prevalence of sites positive at least once for T. infestans during the study period increased sharply from 1993-1995 (0.6-2.9%) to November 1997 (32%). The initial source of T. infestans was a pig corral in southern Amama one year post-spraying. Subsequent infestations were clustered around this initial focus at a distance of approximately 400 meters starting in 1995. In 1996, clustering was maximized in sites within the same or in neighboring compounds at distances of 25-175 meters. An effective control program on the community level will be based on the spraying of actual epicenters and sites within 450 meters of these epicenters to prevent the propagation of T. infestans.

Protective immunity against trypanosoma cruzi infection in a highly susceptible mouse strain after vaccination with genes encoding the amastigote surface protein-2 and trans-sialidase

Protective immunity against lethal infection is developed when BALB/c or C57BL/6 mice are immunized with plasmids containing genes from the protozoan parasite Trypanosoma cruzi. However, genetic vaccination of the highly susceptible mouse strain A/Sn promoted limited survival after challenge. This observation questioned whether this type of vaccination would be appropriate for highly susceptible individuals. Here, we compared the protective efficacy and the immune response after individual or combined genetic vaccination of A/Sn mice with genes encoding trans-sialidase (TS) or the amastigote surface protein-2 (ASP-2). After challenge, a significant proportion of A/Sn mice immunized with either the asp-2 gene or simultaneously with asp-2 and ts genes, survived infection. In contrast, the vast majority of mice immunized with the ts gene or the vector alone died. Parasitological and histological studies performed in the surviving mice revealed that these mice harbored parasites; however, minimal inflammatory responses were seen in heart and striated muscle. We used this model to search for an in vitro correlation for protection. We found that protective immunity correlated with a higher secretion of interferon- by spleen cells on in vitro restimulation with ASP-2 and the presence of ASP-2-specific CD8 cells. Depletion of either CD4 or CD8 or both T-cell subpopulations prior to the challenge rendered the mice susceptible to infection demonstrating the critical contribution of both cell types in protective immunity. Our results reinforce the prophylactic potential of genetic vaccination with asp-2 and ts genes by describing protective immunity against lethal T. cruzi infection and chronic tissue pathology in a highly susceptible mouse strain.