High levels of Trypanosoma cruzi DNA determined by qPCR and infectiousness to Triatoma infestans support dogs and cats are major sources of parasites for domestic transmission

The competence of reservoir hosts of vector-borne pathogens is directly linked to its capacity to infect the vector. Domestic dogs and cats are major domestic reservoir hosts of Trypanosoma cruzi, and exhibit a much higher infectiousness to triatomines than seropositive humans. We quantified the concentration of T. cruzi DNA in the peripheral blood of naturally-infected dogs and cats (a surrogate of intensity of parasitemia), and evaluated its association with infectiousness to the vector in a high-risk area of the Argentinean Chaco. To measure infectiousness, 44 infected dogs and 15 infected cats were each exposed to xenodiagnosis with 10-20 uninfected, laboratory-reared Triatoma infestans that blood-fed to repletion and were later individually examined for infection by optical microscopy. Parasite DNA concentration (expressed as equivalent amounts of parasite DNA per mL, Pe/mL) was estimated by real-time PCR amplification of the nuclear satellite DNA. Infectiousness increased steeply with parasite DNA concentration both in dogs and cats. Neither the median parasite load nor the mean infectiousness differed significantly between dogs (8.1Pe/mL and 48%) and cats (9.7Pe/mL and 44%), respectively. The infectiousness of dogs was positively and significantly associated with parasite load and an index of the host's body condition, but not with dog's age, parasite discrete typing unit and exposure to infected bugs in a random-effects multiple logistic regression model. Real-time PCR was more sensitive and less time-consuming than xenodiagnosis, and in conjunction with the body condition index, may be used to identify highly infectious hosts and implement novel control strategies.

Discrete typing units of Trypanosoma cruzi identified in rural dogs and cats in the humid Argentinean Chaco

The discrete typing units (DTUs) of Trypanosoma cruzi that infect domestic dogs and cats have rarely been studied. With this purpose we conducted a cross-sectional xenodiagnostic survey of dog and cat populations residing in 2 infested rural villages in Pampa del Indio, in the humid Argentine Chaco. Parasites were isolated by culture from 44 dogs and 12 cats with a positive xenodiagnosis. DTUs were identified from parasite culture samples using a strategy based on multiple polymerase-chain reactions. TcVI was identified in 37 of 44 dogs and in 10 of 12 cats, whereas TcV was identified in 5 dogs and in 2 cats -a new finding for cats. No mixed infections were detected. The occurrence of 2 dogs infected with TcIII -classically found in armadillos- suggests a probable link with the local sylvatic transmission cycle involving Dasypus novemcinctus armadillos and a potential risk of human infection with TcIII. Our study reinforces the importance of dogs and cats as domestic reservoir hosts and sources of various DTUs infecting humans, and suggests a link between dogs and the sylvatic transmission cycle of TcIII.

Processes affecting Aedes aegypti (Diptera: Culicidae) infestation and abundance: inference through statistical modeling and risk maps in northern Argentina

Understanding the processes that affect Aedes aegypti (L.) (Diptera: Culicidae) may serve as a starting point to create and/or improve vector control strategies. For this purpose, we performed statistical modeling of three entomological surveys conducted in Clorinda City, northern Argentina. Previous 'basic' models of presence or absence of larvae and/or pupae (infestation) and the number of pupae in infested containers (productivity), mainly based on physical characteristics of containers, were expanded to include variables selected a priori reflecting water use practices, vector-related context factors, the history of chemical control, and climate. Model selection was performed using Akaike's Information Criterion. In total, 5,431 water-holding containers were inspected and 12,369 Ae. aegypti pupae collected from 963 positive containers. Large tanks were the most productive container type. Variables reflecting every putative process considered, except for history of chemical control, were selected in the best models obtained for infestation and productivity. The associations found were very strong, particularly in the case of infestation. Water use practices and vector-related context factors were the most important ones, as evidenced by their impact on Akaike's Information Criterion scores of the infestation model. Risk maps based on empirical data and model predictions showed a heterogeneous distribution of entomological risk. An integrated vector control strategy is recommended, aiming at community participation for healthier water use practices and targeting large tanks for key elements such as lid status, water addition frequency and water use.

Genetic variability, phylogenetic relationships and gene flow in Triatoma infestans dark morphs from the Argentinean Chaco

The recent discovery of sylvatic populations of Triatoma infestans outside the Andean Valleys of Bolivia prompted an evolutionary question about the putative ancestral area of origin and dispersal of the species, and an epidemiological question regarding the possible role of these sylvatic populations in the recolonization process of insecticide-treated houses. The finding of a population of sylvatic melanic T. infestans (dark morphs) in the Argentinean dry Chaco at 7 km from a peridomestic bug population of typical coloration gave us the opportunity to test both questions simultaneously by employing phylogenetic and population genetic approaches. For this purpose we analyzed sylvatic and peridomestic bugs using sequence-based mitochondrial and nuclear markers (mtCOI and ITS-1) and microsatellites. Sylvatic bugs were confirmed to be T. infestans and not hybrids, and showed high levels of genetic variability and departures from neutral expectations for mtCOI variation. New ITS-1 and mtCOI haplotypes were recorded, as well as haplotypes shared with peridomestic and/or domestic bugs from previous records. The peridomestic population was invariant for ITS-1 and mtCOI, but showed variability for microsatellites and signatures of a population bottleneck, probably due to a limited number of founders. Phylogenetic analyses were consistent with the presence of ancestral haplotypes in sylvatic bugs. According to F-statistics and assignment methods there was a significant differentiation between sylvatic and peridomestic bugs and gene flow was low and asymmetric, with more bugs moving from the peridomicile to the sylvatic environment. These results support the hypothesis of the Chaco region as the area of origin of T. infestans, and a limited role of sylvatic melanic T. infestans in peridomestic infestation in the Argentinean Chaco.

Detection of "Candidatus Rickettsia sp. strain Argentina"and Rickettsia bellii in Amblyomma ticks (Acari: Ixodidae) from Northern Argentina

Ixodid ticks were collected from vegetation and from humans, wild and domestic mammals in a rural area in the semi-arid Argentine Chaco in late spring 2006 to evaluate their potential role as vectors of Spotted Fever Group (SFG) rickettsiae. A total of 233 adult ticks, identified as Amblyomma parvum, Amblyomma tigrinum and Amblyomma pseudoconcolor, was examined for Rickettsia spp. We identified an SFG rickettsia of unknown pathogenicity, "Candidatus Rickettsia sp. strain Argentina", in A. parvum and A. pseudoconcolor by PCR assays targeting gltA, ompA, ompB and 17-kDa outer membrane antigen rickettsial genes. Rickettsia bellii was detected in a host-seeking male of A. tigrinum. Amblyomma parvum is widespread in the study area and is a potential threat to human health.

Molecular population genetics and phylogeography of the Chagas disease vector Triatoma infestans in South America

Knowledge of the genetic variability, population structure, and evolutionary history of Triatoma infestans may be useful for developing rational vector control strategies. A 661-bp fragment of the mitochondrial gene cytochrome oxidase I (COI) was sequenced and analyzed in bugs from Argentina, Uruguay, Peru, and Bolivia, including peridomestic, domestic, Andean, and Chaco sylvatic bugs. A total of 48 polymorphic sites among 37 haplotypes were described. Nucleotide variation fluctuated among samples, with the highest nucleotide diversity observed in seven Argentinean provinces. Within this group, some populations showed patterns of variability compatible with population expansions and/or fine-scale population structure, whereas others suggested population bottlenecks and/or population admixture processes. A maximum parsimony analysis of the haplotypes showed the presence of a Bolivian/Peruvian and an Argentinean/Uruguayan clade. Bolivian sequences were further divided in Chaco sylvatic and Andean domestic and sylvatic. Two different nested clades were found within the Argentinean/Uruguayan cluster. Analysis of molecular variance (AMOVA) and K(ST)* analysis supported a strong population structure in Argentina, where genetic differentiation was correlated with geographic distance. Departures from neutrality expectations and a nested cladistic analysis suggest a recent population expansion of T. infestans in Argentina, followed by restricted gene flow and patterns of isolation by distance. This expansion could have taken place as a two-wave process, as was shown by the phylogenetic analysis and signatures of population admixture in the southern most Argentinean populations.

Environmental and demographic factors determining the spatial distribution of Triatoma guasayana in peridomestic and semi-sylvatic habitats of rural northwestern Argentina

Triatoma guasayana (Wygodzinsky & Abalos), a sylvatic vector of Chagas' disease, occurs in natural and peridomestic habitats of the dry Chaco region of Argentina, Bolivia and Paraguay. Ten-year retrospective spatial analyses of peridomestic T. guasayana abundance in the rural community of Amamá were expanded to the neighbouring community of Trinidad in northwestern Argentina. The distribution of T. guasayana in domiciles, peridomiciles (storerooms, chicken coops and corrals) and natural habitats (bromeliads, dry cacti and logs) around houses (i.e. 'semi-sylvatic' habitats) was analysed. The distribution of the 316 T. guasayana specimens collected in domestic and peridomestic sites during 1993-2002 was significantly clustered in both communities. Searches confirmed that the spatial distribution of semi-sylvatic and peridomestic T. guasayana was determined by the joint effects of the local abundance of goats and the density of semi-sylvatic habitats. The integration of detailed entomological and demographic longitudinal data with geographic information system data, high-resolution satellite imagery, appropriate spatial and temporal analyses and field observations allowed us to infer the underlying processes determining the distribution of T. guasayana in rural communities. This approach may be applied to other sylvatic and peridomestic vectors of Chagas' disease in order to identify high-risk areas for targeted control or environmental management.

Domestic dogs and cats as sources of Trypanosoma cruzi infection in rural northwestern Argentina

The reservoir capacity of domestic cats and dogs for Trypanosoma cruzi infection and the host-feeding patterns of domestic Triatoma infestans were assessed longitudinally in 2 infested rural villages in north-western Argentina. A total of 86 dogs and 38 cats was repeatedly examined for T. cruzi infection by serology and/or xenodiagnosis. The composite prevalence of infection in dogs (60%), but not in cats, increased significantly with age and with the domiciliary density of infected T. infestans. Dogs and cats had similarly high forces of infection, prevalence of infectious hosts (41-42%), and infectiousness to bugs at a wide range of infected bug densities. The infectiousness to bugs of seropositive dogs declined significantly with increasing dog age and was highly aggregated. Individual dog infectiousness to bugs was significantly autocorrelated over time. Domestic T. infestans fed on dogs showed higher infection prevalence (49%) than those fed on cats (39%), humans (38%) or chickens (29%) among 1085 bugs examined. The basic reproduction number of T. cruzi in dogs was at least 8.2. Both cats and dogs are epidemiologically important sources of infection for bugs and householders, dogs nearly 3 times more than cats.

Seasonal variations in active dispersal of natural populations of Triatoma infestans in rural north-western Argentina

The flight dispersal of Triatoma infestans Klug (Hemiptera: Reduviidae) is one of the main mechanisms determining community re-infestation after control interventions. An empirical model of flight initiation coupled with data from a longitudinal study predicted that the flight dispersal of T. infestans would peak in summer. To test this prediction, longitudinal light trap collections were conducted during 3-8 nights in March (late summer), July (winter) and November (spring) 2003, and in March 2004 in a rural community in north-west Argentina. Following each light-trapping collection date, all peridomestic sites around light traps were inspected to assess the relative abundance and nutritional status of T. infestans at each site. A total of 21 adult and five nymph T. infestans, six Triatoma guasayana Wygodzinsky & Abalos, and nine Triatoma garciabesi Carcavallo et al. were collected in 96 light-trapping nights, whereas 696 T. infestans were collected from the peridomestic sites that surrounded the light traps. The arrival of T. infestans in the light traps occurred in 64% of catch stations and peaked in the summer surveys (10-14 bugs) compared with spring and winter surveys. When winds were < 5 km/h, the arrival of adult T. infestans at the light traps was significantly associated with maximum temperature and relative humidity. This is the first field report of seasonal variations in the flight dispersal activity of T. infestans.

Differential detection of Blastocrithidia triatomae and Trypanosoma cruzi by amplification of 24salpha ribosomal RNA genes in faeces of sylvatic triatomine species from rural northwestern Argentina

Flagellates indistinguishable from Trypanosoma cruzi were detected by microscopy in faecal samples of 2/110 Triatoma guasayana and 2/283 Triatoma garciabesi captured in a rural area of northwestern Argentina. Inoculation of faecal homogenates to mice followed by xenodiagnosis, haemoculture, histopathology and culture from cardiac homogenates, and PCR based on T. cruzi minicircle and nuclear sequences failed to detect T. cruzi infection, pointing to another trypanosomatidean. A PCR strategy targeted to the D7 domain of 24salpha ribosomal DNA genes amplified a 250 bp sequence from one T. guasayana and one T. garciabesi faecal lysate. Sequence analysis revealed 100% identity with 24salpha rDNA amplicons from Blastocrithidia triatomae obtained from faeces of reared Triatoma infestans bugs. Phylogenetic analysis clustered this sequence with C. fasciculata and L. major, separated from the Trypanosoma branch (bootstrap: 968/1000), in concordance with a Neighbour-joining dendrogram based on 18s rDNA sequences. This PCR procedure provides a rapid sensitive tool for differential diagnosis of morphologically similar trypanosomatids in field surveys of Chagas disease vectors and laboratory-reared triatomines used for xenodiagnosis.

Long-term reduction of Trypanosoma cruzi infection in sylvatic mammals following deforestation and sustained vector surveillance in northwestern Argentina

Long-term variations in the dynamics and intensity of sylvatic transmission of Trypanosoma cruzi were investigated around eight rural villages in the semiarid Argentine Chaco in 2002-2004 and compared to data collected locally in 1984-1991. Of 501 wild mammals from 13 identified species examined by xenodiagnosis, only 3 (7.9%) of 38 Didelphis albiventris opossums and 1 (1.1%) of 91 Conepatus chinga skunks were infected by T. cruzi. The period prevalence in opossums was four-fold lower in 2002-2004 than in 1984-1991 (32-36%). The infection prevalence of skunks also decreased five-fold from 4.1-5.6% in 1984-1991 to 1.1% in 2002-2004. Infection in opossums increased with age and from summer to spring in both study periods. The force of infection per 100 opossum-months after weaning declined more than six-fold from 8.2 in 1988-1991 to 1.2 in 2002-2004. Opossums were mainly infected by T. cruzi lineage I and secondarily by lineage IId in 1984-1991, and only by T. cruzi I in 2002-2004; skunks were infected by T. cruzi IId in 1984-1991 and by IIc in 2002-2004. The striking decline of T. cruzi infection in opossums and skunks occurred in parallel to community-wide insecticide spraying followed by selective sprays leading to very low densities of infected Triatoma infestans in domestic and peridomestic habitats since 1992; to massive deforestation around one of the villages or selective extraction of older trees, and apparent reductions in opossum abundance jointly with increases in foxes and skunks. These factors may underlie the dramatic decrease of T. cruzi infection in wild reservoir hosts.

PCR-based screening and lineage identification of Trypanosoma cruzi directly from faecal samples of triatomine bugs from northwestern Argentina

This study applied improved DNA extraction and polymerase chain reaction strategies for screening and identification of Trypanosoma cruzi lineages directly from faeces of triatomines collected in a well-defined rural area in northwestern Argentina. Amplification of the variable regions of the kinetoplastid minicircle genome (kDNA-PCR) was performed in faecal lysates from 33 microscope (MO)-positive and 93 MO-negative Triatoma infestans, 2 MO-positive and 38 MO-negative Triatoma guasayana and 2 MO-positive and 73 MO-negative Triatoma garciabesi. kDNA-PCR detected T. cruzi in 91% MO-positive and 7.5% MO-negative T. infestans, which were confirmed by amplification of the minicircle conserved region. In contrast, kDNA-PCR was negative in all faecal samples from the other triatomine species. A panel of PCR-based genomic markers (intergenic region of spliced-leader DNA, 24Salpha and 18S rRNA genes and A10 sequence) was implemented to identify the parasite lineages directly in DNA lysates from faeces and culture isolates from 28 infected specimens. Two were found to be infected with TCI, 24 with TCIIe, 1 with TCIId and 1 revealed a mixed TCI+TCII infection in the faecal sample whose corresponding culture only showed TCII, providing evidence of the advantages of direct typing of biological samples. This study provides an upgrade in the current diagnosis and lineage identification of T. cruzi in field-collected triatomines and shows T. cruziII strains as predominant in the region.

Identification and characterization of microsatellite markers in the Chagas disease vector Triatoma infestans (Heteroptera: Reduviidae)

Triatoma infestans, the main vector of Chagas disease in the southern cone countries, is the principal target of a regional elimination program. A better understanding of its dispersal, sources of reinfestation, and insecticide resistance is key to an effective control program. To address such problems, we identified and characterized 13 microsatellite loci of T. infestans. For each locus, primer sequences and PCR conditions are presented. Allele variability and frequency were analyzed in 59 T. infestans specimens from different rural communities in northwestern Argentina; nine loci were considered suitable for population genetic studies. Departure from Hardy-Weinberg equilibrium was detected in 10/13 loci with F(IS) values ranging from 0.04 to 0.91, indicating heterozygote deficit and a possible grade of sub-structure in the sample analyzed. Presence of null alleles in some loci cannot be discarded. The present work provides a promising tool to develop a population genetic study of natural populations of T. infestans in tandem with field studies and analyses of bug dispersal and the reinfestation process.

Feeding rates, nutritional status and flight dispersal potential of peridomestic populations of Triatomainfestans in rural northwestern Argentina

Triatoma infestans, the main vector of Chagas disease in Southern Cone countries, frequently infests peridomestic structures housing domestic animals. A total of 814 T. infestans collected from 35 different peridomestic sites in rural northwestern Argentina over 1-4 consecutive seasons was examined for recent blood meals and nutritional status. Bugs from goat or pig corrals had lower qualitative nutritional status and mean weight to length ratios (W/L) than those captured in chicken coops. Males systematically had lower qualitative nutritional status and W/L than females. Using logistic multiple regression, the daily feeding rates of T. infestans were significantly associated with season and stage but not ecotope, whereas the proportion of well-fed bugs varied significantly with all three factors. The seasonal trends in feeding rates and nutritional status were consistent with the local availability and breeding timing of domestic animals. The observed data fed into an empirical model predicted that the probability of flight initiation would peak in summer from pig or goat corrals, not chicken coops, and be insignificant in all ecotopes in spring and fall. Male T. infestans outnumbered females as potential fliers. This is the first study conducted in well-defined habitat units that shows significant heterogeneities in the feeding rates and nutritional status of triatomine populations linked to host demographics and management, and how these affect flight dispersal potential over seasons. Peridomestic bug populations are of great relevance as a source of domestic reinfestation and for the elimination of T. infestans.

Seasonal variations of microclimatic conditions in domestic and peridomestic habitats of Triatoma infestans in rural northwest Argentina

Our objectives were to describe and compare the seasonal variations in microclimatic conditions in domestic and peridomestic ecotopes infested by Triatoma infestans, the main vector of Chagas disease, in rural northwestern Argentina. Using data loggers for 4-7 consecutive days in October 2000, February, May and August 2001, microsite (interior of thatched roofs) and ambient temperatures or relative humidity (RH) were recorded simultaneously and compared with an external reference. The damping effects on microsite temperature and ambient RH increased successively from the goat corral to the chicken coop or pig corral, to the storeroom or human habitation. In the interior of the thatched roofs of the habitation and storeroom, average external minima were increased by +5.0 to +5.6 degrees C in all seasons, and average external maxima were decreased by -4.3 to -5.6 degrees C in October-May and -10.6 degrees C in August. On average, the human habitation damped extreme temperatures by 8 degrees C over a wider range than previously reported. The interior of the thatched roofs of the pig corral and chicken coop exerted intermediate damping effects that varied over seasons, whereas the goat corral's thatch showed little or no damping effects at all. The adobe-and-thatch habitation and storeroom presented nearly optimal and more suitable conditions for T. infestans populations than other open structures housing animals. Global climate changes are expected to affect peridomestic populations of T. infestans much more than domestic bug populations, provided other local conditions are held constant. Heterogeneous habitat conditions are expected to affect T. infestans population parameters, dispersal, control and infection with Trypanosoma cruzi.

Effects of partial housing improvement and insecticide spraying on the reinfestation dynamics of Triatoma infestans in rural northwestern Argentina

The long-term effects on domiciliary reinfestation by Triatoma infestans of smoothing the plaster of indoor walls prior to insecticide application (in Amamá village) relative to only insecticide application (in Trinidad-Mercedes villages) were evaluated in rural northwestern Argentina from 1992 to 1997. All domestic and peridomestic areas of each house were sprayed with 2.5% suspension concentrate deltamethrin at 25 mg/m(2) in October 1992, and infestations were assessed by various methods every 6 months. Domiciliary infestation decreased from 72-88% in 1992 to 6-17% in late 1995, to increase moderately thereafter without returning to baseline rates. Peridomestic sites were the first in becoming reinfested, and reached more abundant T. infestans populations than domiciliary areas. Domiciliary infestation rates and bug abundances were not significantly different between communities during surveillance. Domiciliary infestation rates in well-plastered houses were very low (5-9%) and approximately stable until 1996, but in houses with regular or bad plaster they consistently increased from 5 to 19-21% in both communities. Logistic multiple regression analysis showed that the likelihood of domestic infestation assessed through householders' collections was significantly and positively associated with the occurrence of an infested peridomestic site in the respective house, the occurrence of high-density domestic infestations before interventions, and well-plastered walls in 1996. Combining insecticide spraying and partial improvement of walls controlled domestic infestations and transmission of Trypanosoma cruzi effectively, but was not sufficient to eliminate T. infestans from the study area or increase the effectiveness of careful chemical control.

Modeling household transmission of American trypanosomiasis

American trypanosomiasis, or Chagas disease, caused by the protozoan parasite Trypanosoma cruzi and transmitted by blood-feeding triatomine bugs, is a chronic, frequently fatal infection that is common in Latin America. Neither adequate drugs nor a vaccine is available. A mathematical model calibrated to detailed household data from three villages in northwest Argentina shows that householders could greatly reduce the risk of human infection by excluding domestic animals, especially infected dogs, from bedrooms; removing potential refuges for bugs from walls and ceilings; and using domestically applied insecticides. Low-cost, locally practicable environmental management combined with intermittent use of insecticides can sustainably control transmission of T. cruzi to humans in rural Argentina and probably elsewhere.

Comparison between two artificial shelter units and timed manual collections for detecting peridomestic Triatoma infestans (Hemiptera: Reduviidae) in rural northwestern Argentina

A new artificial shelter unit was compared with segments of bamboo cane lined with pleated filter paper for detecting peridomestic Triatoma infestans Klug at Amamá and nearby rural villages in northwestern Argentina. The new shelter unit consisted of a black plastic, wide-mouthed jar with a screw cap on the top, and a removable central structure made of pleated corrugated paper. In devices exposed from February to December 1999 at 24 sites positive for T. infestans by timed manual collections with an irritant in April 1999, the cumulative percentage of sites with any sign of infestation detected by the shelter unit increased from 71% after 2 mo to 96% after 10 mo, whereas bamboo cane units concurrently detected only 12-42% of the sites. Sensitivity increased with time of exposure and the abundance of T. infestans per site. In 19 sites negative for T. infestans by inspection, shelters increasingly detected infestation at 16-63% of sites after 10 mo, whereas the bamboo canes only detected one infestation. Shelter units inspected three times over an 11-mo period were significantly more sensitive than a single manual search with an irritant performed in March 2000. Our study provided conclusive field evidence that the shelter unit was more sensitive for detecting peridomestic T. infestans than were timed manual searches, the standard reference method, or bamboo cane units. Rapid timed searches by skilled bug collectors during the early surveillance phase overlooked many peridomestic populations that, in the absence of control, inevitably would increase in abundance and repopulate treated areas.

Association between nutritional indicators and infectivity of dogs seroreactive for Trypanosoma cruzi in a rural area of northwestern Argentina

The association between the nutritional state of mongrel dogs naturally infected with Trypanosoma cruzi and their infectivity to Triatoma infestans bugs and immune response to Trypanosoma cruzi were studied in the rural village of Amamá, northwestern Argentina. All of the 97 evaluated dogs were classified into one of three categories of external clinical aspect (ECA) based on the degree of muscle development, external evidence of bone structures, state of the hair of the coat, existence of fatty deposits, and facial expression. ECA was significantly associated with two nutritional indicators, hematocrit and skin-fold thickness, but not with total serum proteins. For all dogs, hematocrit was significantly correlated with skin-fold thickness. The 2-year survival probability decreased significantly from 60.7% for dogs with good ECA to 45.9% and 31.2% for those with regular and bad ECA, respectively. The age-adjusted relative odds of infection for Triatoma infestans xeno-diagnosis nymphs that fed once on a dog seroreactive for Trypanosoma cruzi decreased significantly as ECA improved, when tested by multiple logistic regression analysis. A delayed hypersensitivity reaction was observed in all of the seroreactive dogs with good ECA but only in 45-50% of those with regular or bad ECA. Dogs with bad ECA had a 2.6 and 6.3 times greater probability of infecting triatomines after a single full blood meal than dogs with regular or good ECA, respectively. Our study shows that the reservoir competence of dogs for Trypanosoma cruzi was associated with ECA, which is a surrogate and valid index of nutritional state.

A simple method to identify triatomine (Hemiptera: Reduviidae) feces in sensing devices used in vector surveillance programs

We successfully applied the phenolphthalin (Kastle-Meyer) test used in forensic chemistry to distinguish between feces from triatomines and other domestic arthropods in sensing devices used for vector surveillance. All black or dark brown, but not white or yellow, fecal smears from laboratory-reared or field-collected Triatoma infestans Klug, Triatoma guasayana Wydgozinsky & Abalos, Triatoma sordida Ståhl (recently revalidated as Triatoma garciabesi Carcavallo, Cichero, Martínez, Prosen & Ronderos) tested positive, whereas dejecta from cockroaches and spiders, crickets, beetles, predatory bugs, and domestic flies tested negative. Black or dark brown dejecta from female Aedes aegypti L. and Cimex lectularius L. bedbugs also tested positive. In sellsing devices installed in bedrooms of 11 houses in Amamá, rural northwestern Argentina, where neither cimicid bedbugs nor argasid ticks had been found over the years, only 62% of the black or dark brown fecal smears attributed to triatomines by a skilled observer tested phenolphthalin-positive. After insecticidal spraying, when bedroom areas were not colonized by triatomines, only 33-40% of the black or dark brown fecal smears in sensor boxes attributed to triatomines by another skilled observer tested phenolphthalin-positive. Eleven (79%) ofthe 14 houses with dubious or nontypical triatomine feces tested phenolphthalin-positive at least once during 1993-1995. Our study introduces a low-cost, simple and effective procedure for the identification of triatomine feces. The test, as a helpful adjunct to sensing devices used in triatomine surveillance, will aid in the accurate detection of infestations and the determination of the need for insecticide application.

Peridomestic distribution of Triatoma garciabesi and Triatoma guasayana in north-west Argentina

The Reduviid bugs Triatoma garciabesi Carcavallo et al. (Hemiptera: Reduviidae: Triatominae), previously known as T. sordida Ståhl in the semi-arid chaco region, and T. guasayana Wygodzinsky & Abalos, vectors of Trypanosoma cruzi Chagas (Kinetoplastida: Trypanosomatidae), were found to occupy wide but different ranges of ecotopes in the peridomestic environment. At Amamá and nearby rural villages in north-western Argentina, a combined total of 1233 specimens were collected from 325/2314 (14%) sites surveyed at 6-monthly intervals from November 1994 to November 1996. Triatoma garciabesi and T. guasayana displayed a significantly different distribution among peridomestic ecotopes. Triatoma garciabesi predominated over T. guasayana in the prevalence of infested sites, the number of colonies and the number of bugs collected. For T. garciabesi, the predominant ecotopes most likely to yield T. garciabesi repeatedly were the rugged bark of Prosopis alba or P. nigra (Fabaceae) trees, where chickens roosted, and chicken coops. For T. guasayana the main ecotopes were goat or sheep corrals, piled materials and orchard fences. Triatoma garciabesi and T. guasayana were collected concurrently from the same site on 9/2314 (0.4%) occasions, and on different dates at the same site on 12 (0.5%) occasions. The observed low frequency of mixed populations (< 1%) was not significantly different from that expected from a hypothesis of independence. Triatoma garciabesi clearly outnumbered T. guasayana in four of the nine mixed populations, none of which persisted as such. Neither T. garciabesi nor T. guasayana colonized human habitations, even in the absence of T. infestans (formerly the predominant domestic vector of T. cruzi in this area), a situation that apparently has not changed in the last 50 years in northern Argentina.

Congenital transmission of Trypanosoma cruzi: an operational outline for detecting and treating infected infants in north-western Argentina

We designed a set of procedures for first-line local health services to detect and treat the congenital transmission of Trypanosoma cruzi at a province-wide scale, and field-tested the programme in the province of Tucumán, northwestern Argentina, from 1992 to 1994. The programme consists of routine screening of pregnant women for seroreactivity to T. cruzi, serological and parasitological follow-up of the newborn at least twice during the first year of age, treatment of the infected infants, and evaluation of the outcome. 927 (5.5%) of 16 842 pregnant women were seroreactive to T. cruzi by indirect haemagglutination assay and ELISA. Twenty-one (6.7%) of 315 newborns to seroreactive mothers were diagnosed as infected with T. cruzi parasites microhaematocrit concentration before 30 days of age. Five newborns who initially tested negative had a T. cruzi infection detected by microhaematocrit and/or serological techniques at 3 or 6 months of age. Thus, congenital infection was diagnosed in 26 (7.1%) infants born to seroreactive women and residing in houses free of triatomine bugs. Four of 6 infants born to seroreactive mothers died during the first year of age and had some evidence of T. cruzi infection; one of the deaths was attributed to T. cruzi based on clinical evidence. After specific treatment with nifurtimox or benznidazole, 30 of 32 infants remained parasitologically and serologically negative. This study shows the feasibility of controlling the incidence of congenitally acquired T. cruzi infections at a province-wide scale by means of a specific screening programme at first-line health services level.

[Control campaigns against Triatoma infestans in a rural community of northwestern Argentina]

Control campaigns against Triatoma infestans, the principal vector of Trypanosoma cruzi, have relied on the application of residual insecticides and have regarded the system as homogeneous. Reinfestation generally starts in peri-domestic residual foci or in preexisting foci that escaped spraying for diverse reasons. From these foci T. infestans adults actively invade other sites, or they are transported passively within objects or goods from infested communities. In the absence of additional spraying of insecticides after the attack phase, domiciliary reinfestation expanded exponentially to return to pre-spraying levels in 3-4 years in Amamá, Santiago del Estero. However, the rate of recovery of T. infestans abundance was much lower than that predicted by a simple mathematical model or in experimental field studies. Reinfestation did not progress homogeneously within the village. Two longitudinal studies in Santiago del Estero revealed that the presence of T. infestans-infested peri-domestic sites increased the risk of domiciliary reinfestation. "Key" sites where reinfestation started early were goat or sheep corrals, pig corrals, chicken houses, and store-rooms. Peri-domestic reinfestation is likely the result of multiple factors, such as insecticide breakdown by climatic agents, and the greater surface and availability of refuge and hosts in peri-domestic rather than domiciliary sites. Such environmental heterogeneity generates insecticidal effects heterogeneity and increases the probability of persistence of T. infestans even under control pressures. Several studies showed that sustained surveillance after the attack phase decreased sharply the domiciliary colonization by T. infestans and the percentage of bugs infected with T. cruzi, and the local incidence of infected children. The sustained elimination of T. infestans demands a scientific approach that is not only centered in insecticide use but that also includes the environment and house-holders in their specific social and political scenario.

[Control of congenital transmission of Trypanosoma cruzi in Argentina]

The vertical transmission of Trypanosoma cruzi has been augmenting its relative importance as vector and transfusion-mediated transmission routes have been, and continue to be, increasingly controlled. The vertical transmission of T. cruzi cannot be prevented; but early detection and treatment of congenital infection achieve cure rates close to 100%. In Argentina, the Subprogram of Control of Pregnant Women examined 58,196 women from 13 provinces in 1997 and found a 9% seropositivity to T. cruzi. In spite of such high maternal prevalence rates of T. cruzi, only a small proportion of live newborns to infected mothers acquires the infection. The probability of vertical transmission was 1.9% (range: 0.1% to 3.5%) in surveys carried out in the '70s, and 2.5% (range: 0.7% to 10.4%) in others conducted in the '70-'80s. Other more recent studies in Argentina estimated the probability of transmission in 2.6%-6.7%, but studies from Paraguay estimated 10.5% by PCR or serodiagnosis. The microhematocrit technique is the recommended parasitologic method to detect congenital infection. Routine serodiagnosis that detects IgG against T. cruzi is only helpful after the newborn reaches 6 months of age. Detection of specific IgM using recombinant antigens and PCR constitute excellent alternatives, but their feasibility from operational and cost-effective viewpoints in affected endemic areas remains to be considered. In a longitudinal project carried out in Maternidad Nuestra Señora de la Merced in the city of Tucumán between 1992-1994, the majority of congenital cases were asymptomatic. They were diagnosed through the microhematocrit technique, but a number of cases could only be detected later as a result of the parasitological and/or serological follow-up. Of a total of 32 newborns infected with T. cruzi who were treated with nifurtimox or benznidazole, 30 had a negative microhematocrit and serodiagnosis between 6 months and 2 years post-treatment. The magnitude of congenital transmission, and its associated morbidity and mortalidad, largely justify the efforts needed to detect T. cruzi infection in the mothers and newborns. This project demonstrated that the transmission of T. cruzi can be successfully controlled at a provincial scale through a specific program inserted in the primary health care system or at the first level of attention. The congenital transmission of T. cruzi clearly represents a public health problem in areas that in the past were of active transmission, even years after being under entomologic surveillance.

Long-term effects of a nationwide control program on the seropositivity for Trypanosoma cruzi infection in young men from Argentina

Unselected nationwide cohorts of Argentine men 18 years of age summoned for military service were tested for antibodies to Trypanosoma cruzi each year from 1981 to 1993. After an initial screening using indirect hemagglutination test, the positive sera were retested by titrated indirect hemagglutination and immunofluorescence antibody tests at 39 laboratories or at the national reference center in Buenos Aires. Nearly 1.8 million men were examined for T. cruzi antibodies using the same standardized procedures under a quality assurance program. The prevalence of seropositivity for T. cruzi decreased significantly from 5.8% in 1981 to 1.9% in 1993, but the decrease was not homogeneous among provinces within each region or constant over time. Prior to the nationwide control campaign initiated in 1961-1962, 15 provinces had high (> 20%) percentages of houses with domiciliary infestation by Triatoma infestans bugs, which decreased to nine provinces in 1982, and four provinces in 1992. The observed decrease in the prevalence of seropositivity for T. cruzi may be mostly attributed to the spraying with insecticides to eliminate the domiciliary populations of Triatoma infestans. The lack of a sustainable triatomine surveillance program set a limit to the decrease of seropositivity rates and prompted a revised strategy based on community participation.