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Ramírez JC, Cura CI, da Cruz Moreira O, Lages-Silva E, Juiz N, Velázquez E, Ramírez JD, Alberti A, Pavia P, Flores-Chávez MD, Muñoz-Calderón A, Pérez-Morales D, Santalla J, Marcos da Matta Guedes P, Peneau J, Marcet P, Padilla C, Cruz-Robles D, Valencia E, Crisante GE, Greif G, Zulantay I, Costales JA, Alvarez-Martínez M, Martínez NE, Villarroel R, Villarroel S, Sánchez Z, Bisio M, Parrado R, Maria da Cunha Galvão L, Jácome da Câmara AC, Espinoza B, Alarcón de Noya B, Puerta C, Riarte A, Diosque P, Sosa-Estani S, Guhl F, Ribeiro I, Aznar C, Britto C, Yadón ZE, Schijman AG. Analytical Validation of Quantitative Real-Time PCR Methods for Quantification of Trypanosoma cruzi DNA in Blood Samples from Chagas Disease Patients. J Mol Diagn 2015; 17:605-15. [PMID: 26320872 PMCID: PMC4698797 DOI: 10.1016/j.jmoldx.2015.04.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/01/2015] [Accepted: 04/03/2015] [Indexed: 01/25/2023] Open
Abstract
An international study was performed by 26 experienced PCR laboratories from 14 countries to assess the performance of duplex quantitative real-time PCR (qPCR) strategies on the basis of TaqMan probes for detection and quantification of parasitic loads in peripheral blood samples from Chagas disease patients. Two methods were studied: Satellite DNA (SatDNA) qPCR and kinetoplastid DNA (kDNA) qPCR. Both methods included an internal amplification control. Reportable range, analytical sensitivity, limits of detection and quantification, and precision were estimated according to international guidelines. In addition, inclusivity and exclusivity were estimated with DNA from stocks representing the different Trypanosoma cruzi discrete typing units and Trypanosoma rangeli and Leishmania spp. Both methods were challenged against 156 blood samples provided by the participant laboratories, including samples from acute and chronic patients with varied clinical findings, infected by oral route or vectorial transmission. kDNA qPCR showed better analytical sensitivity than SatDNA qPCR with limits of detection of 0.23 and 0.70 parasite equivalents/mL, respectively. Analyses of clinical samples revealed a high concordance in terms of sensitivity and parasitic loads determined by both SatDNA and kDNA qPCRs. This effort is a major step toward international validation of qPCR methods for the quantification of T. cruzi DNA in human blood samples, aiming to provide an accurate surrogate biomarker for diagnosis and treatment monitoring for patients with Chagas disease.
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Affiliation(s)
- Juan Carlos Ramírez
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Carolina Inés Cura
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Otacilio da Cruz Moreira
- Laboratory of Molecular Biology of Endemic Diseases, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Eliane Lages-Silva
- Laboratory of Discipline of Parasitology, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Natalia Juiz
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Elsa Velázquez
- National Institute of Parasitology "Dr. Mario Fatala Chabén", Buenos Aires, Argentina
| | - Juan David Ramírez
- Center for Research in Tropical Microbiology and Parasitology, Universidad de los Andes, Bogota, Colombia
| | - Anahí Alberti
- Institute of Experimental Pathology, CONICET-Universidad Nacional de Salta, Salta, Argentina
| | - Paula Pavia
- Laboratory of Molecular Parasitology, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Arturo Muñoz-Calderón
- Institute of Tropical Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Deyanira Pérez-Morales
- Biomedical Research Institute, Universidad Nacional Autónoma de México, Mexico DF, Mexico
| | - José Santalla
- Laboratory of Parasitology and Molecular Biology, Instituto Nacional de Laboratorios en Salud, La Paz, Bolivia
| | | | - Julie Peneau
- Hospital and University Laboratory-CH Andrée Rosemon, Cayenne, French Guiana
| | - Paula Marcet
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos Padilla
- National Center for Public Health, Instituto Nacional de Salud, Lima, Peru
| | - David Cruz-Robles
- Laboratory of Genomics, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico DF, Mexico
| | - Edward Valencia
- Laboratory for Research in Infectious Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Gonzalo Greif
- Molecular Biology Unit, Instituto Pasteur de Montevideo, Montevideo, Uruguay
| | - Inés Zulantay
- Basic Clinical Parasitology Laboratory, Universidad de Chile, Santiago, Chile
| | - Jaime Alfredo Costales
- Research Center for Infectious Diseases, Pontificia Universidad Católica de Ecuador, Quito, Ecuador
| | - Miriam Alvarez-Martínez
- Microbiology Department, Hospital Clinic and Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | | | | | - Sandro Villarroel
- Laboratory of Molecular Biology, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Zunilda Sánchez
- Research Institute for Health Sciences, Universidad Nacional de Asunción, Asuncion, Paraguay
| | - Margarita Bisio
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Rudy Parrado
- Laboratory of Molecular Biology, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | | | | | - Bertha Espinoza
- Biomedical Research Institute, Universidad Nacional Autónoma de México, Mexico DF, Mexico
| | | | - Concepción Puerta
- Laboratory of Molecular Parasitology, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Adelina Riarte
- National Institute of Parasitology "Dr. Mario Fatala Chabén", Buenos Aires, Argentina
| | - Patricio Diosque
- Institute of Experimental Pathology, CONICET-Universidad Nacional de Salta, Salta, Argentina
| | - Sergio Sosa-Estani
- National Institute of Parasitology "Dr. Mario Fatala Chabén", Buenos Aires, Argentina
| | - Felipe Guhl
- Center for Research in Tropical Microbiology and Parasitology, Universidad de los Andes, Bogota, Colombia
| | - Isabela Ribeiro
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Christine Aznar
- Hospital and University Laboratory-CH Andrée Rosemon, Cayenne, French Guiana
| | - Constança Britto
- Laboratory of Molecular Biology of Endemic Diseases, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Zaida Estela Yadón
- Communicable Diseases and Health Analysis Department, Pan American Health Organization/World Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Alejandro G Schijman
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina.
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Brima W, Eden DJ, Mehdi SF, Bravo M, Wiese MM, Stein J, Almonte V, Zhao D, Kurland I, Pessin JE, Zima T, Tanowitz HB, Weiss LM, Roth J, Nagajyothi F. The brighter (and evolutionarily older) face of the metabolic syndrome: evidence from Trypanosoma cruzi infection in CD-1 mice. Diabetes Metab Res Rev 2015; 31:346-359. [PMID: 25613819 PMCID: PMC4427523 DOI: 10.1002/dmrr.2636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/21/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Infection with Trypanosoma cruzi, the protozoan parasite that causes Chagas disease, results in chronic infection that leads to cardiomyopathy with increased mortality and morbidity in endemic regions. In a companion study, our group found that a high-fat diet (HFD) protected mice from T. cruzi-induced myocardial damage and significantly reduced post-infection mortality during acute T. cruzi infection. METHODS In the present study metabolic syndrome was induced prior to T. cruzi infection by feeding a high fat diet. Also, mice were treated with anti-diabetic drug metformin. RESULTS In the present study, the lethality of T. cruzi (Brazil strain) infection in CD-1 mice was reduced from 55% to 20% by an 8-week pre-feeding of an HFD to induce obesity and metabolic syndrome. The addition of metformin reduced mortality to 3%. CONCLUSIONS It is an interesting observation that both the high fat diet and the metformin, which are known to differentially attenuate host metabolism, effectively modified mortality in T. cruzi-infected mice. In humans, the metabolic syndrome, as presently construed, produces immune activation and metabolic alterations that promote complications of obesity and diseases of later life, such as myocardial infarction, stroke, diabetes, Alzheimer's disease and cancer. Using an evolutionary approach, we hypothesized that for millions of years, the channeling of host resources into immune defences starting early in life ameliorated the effects of infectious diseases, especially chronic infections, such as tuberculosis and Chagas disease. In economically developed countries in recent times, with control of the common devastating infections, epidemic obesity and lengthening of lifespan, the dwindling benefits of the immune activation in the first half of life have been overshadowed by the explosion of the syndrome's negative effects in later life.
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Affiliation(s)
- Wunnie Brima
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- James J Peters VA Medical Center, Mount Sinai Medical Center Health System, Bronx, NY
- Charles University, Prague, Czech Republic
| | - Daniel J. Eden
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
| | - Syed Faizan Mehdi
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
| | - Michelle Bravo
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
| | - Mohammad M. Wiese
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
| | - Joanna Stein
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
| | - Vanessa Almonte
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Dazhi Zhao
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Irwin Kurland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Jeffrey E. Pessin
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Tomas Zima
- Charles University, Prague, Czech Republic
| | | | - Louis M. Weiss
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Jesse Roth
- Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Hofstra North Shore-LIJ School of Medicine, North Shore-Long Island Jewish Health System, Hempstead, NY
| | - Fnu Nagajyothi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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Teixeira-Carvalho A, Campos FMF, Geiger SM, Rocha RDR, de Araújo FF, Vitelli-Avelar DM, Andrade MC, Araújo MSS, Lemos EM, de Freitas Carneiro Proietti AB, Sabino EC, Caldas RG, Freitas CRC, Campi-Azevedo AC, Elói-Santos SM, Martins-Filho OA. FC-TRIPLEX Chagas/Leish IgG1: a multiplexed flow cytometry method for differential serological diagnosis of chagas disease and leishmaniasis. PLoS One 2015; 10:e0122938. [PMID: 25875961 PMCID: PMC4398351 DOI: 10.1371/journal.pone.0122938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
Differential serological diagnosis of Chagas disease and leishmaniasis is difficult owing to cross-reactivity resulting from the fact that the parasites that cause these pathologies share antigenic epitopes. Even with optimized serological assays that use parasite-specific recombinant antigens, inconclusive test results continue to be a problem. Therefore, new serological tests with high sensitivity and specificity are needed. In the present work, we developed and evaluated the performance of a new flow cytometric serological method, referred to as FC-TRIPLEX Chagas/Leish IgG1, for the all-in-one classification of inconclusive tests. The method uses antigens for the detection of visceral leishmaniasis, localized cutaneous leishmaniasis, and Chagas disease and is based on an inverted detuned algorithm for analysis of anti-Trypanosomatidae IgG1 reactivity. First, parasites were label with fluorescein isothiocyanate or Alexa Fluor 647 at various concentrations. Then serum samples were serially diluted, the dilutions were incubated with suspensions of mixed labeled parasites, and flow cytometric measurements were performed to determine percentages of positive fluorescent parasites. Using the new method, we obtained correct results for 76 of 80 analyzed serum samples (95% overall performance), underscoring the outstanding performance of the method. Moreover, we found that the fluorescently labeled parasite suspensions were stable during storage at room temperature, 4 °C, and -20 °C for 1 year. In addition, two different lots of parasite suspensions showed equivalent antigen recognition; that is, the two lots showed equivalent categorical segregation of anti-Trypanosomatidae IgG1 reactivity at selected serum dilutions. In conclusion, we have developed a sensitive and selective method for differential diagnosis of Chagas disease, visceral leishmaniasis, and localized cutaneous leishmaniasis.
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Affiliation(s)
- Andréa Teixeira-Carvalho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Fernanda Magalhães Freire Campos
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Stefan Michael Geiger
- Laboratório de Helmintoses Intestinais, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Roberta Dias Rodrigues Rocha
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Fernanda Fortes de Araújo
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Danielle Marquete Vitelli-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Mariléia Chaves Andrade
- Departamento de Fisiopatologia, Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, Brasil
| | - Márcio Sobreira Silva Araújo
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Elenice Moreira Lemos
- Núcleo de Doenças Infecciosas, Centro Biomédico, Universidade Federal do Espírito Santo, Vitória, Brasil
| | | | - Ester Cerdeira Sabino
- Departamento de Doenças Infecciosas, Instituto de Medicina Tropical, Universidade de São Paulo—USP, São Paulo, Brasil
| | - Rafaella Gaiotti Caldas
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Carolina Renata Camargos Freitas
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Ana Carolina Campi-Azevedo
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Silvana Maria Elói-Santos
- Departamento de Pós-Graduação em Patologia Geral, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Olindo Assis Martins-Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
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Rendell VR, Gilman RH, Valencia E, Galdos-Cardenas G, Verastegui M, Sanchez L, Acosta J, Sanchez G, Ferrufino L, LaFuente C, Abastoflor MDC, Colanzi R, Bern C. Trypanosoma cruzi-infected pregnant women without vector exposure have higher parasitemia levels: implications for congenital transmission risk. PLoS One 2015; 10:e0119527. [PMID: 25807498 PMCID: PMC4373803 DOI: 10.1371/journal.pone.0119527] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Congenital transmission is a major source of new Trypanosoma cruzi infections, and as vector and blood bank control continue to improve, the proportion due to congenital infection will grow. A major unanswered question is why reported transmission rates from T. cruzi-infected mothers vary so widely among study populations. Women with high parasite loads during pregnancy are more likely to transmit to their infants, but the factors that govern maternal parasite load are largely unknown. Better understanding of these factors could enable prioritization of screening programs to target women most at risk of transmission to their infants. METHODOLOGY/PRINCIPAL FINDINGS We screened pregnant women presenting for delivery in a large urban hospital in Bolivia and followed infants of infected women for congenital Chagas disease. Of 596 women screened, 128 (21.5%) had confirmed T. cruzi infection; transmission occurred from 15 (11.7%) infected women to their infants. Parasite loads were significantly higher among women who transmitted compared to those who did not. Congenital transmission occurred from 31.3% (9/29), 15.4% (4/26) and 0% (0/62) of women with high, moderate and low parasite load, respectively (χx2 for trend 18.2; p<0.0001). Twin births were associated with higher transmission risk and higher maternal parasite loads. Infected women without reported vector exposure had significantly higher parasite loads than those who had lived in an infested house (median 26.4 vs 0 parasites/mL; p<0.001) with an inverse relationship between years of living in an infested house and parasite load. CONCLUSIONS/SIGNIFICANCE We hypothesize that sustained vector-borne parasite exposure and repeated superinfection by T. cruzi may act as an immune booster, allowing women to maintain effective control of the parasite despite the down-regulation of late pregnancy.
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Affiliation(s)
- Victoria R. Rendell
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Edward Valencia
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gerson Galdos-Cardenas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Manuela Verastegui
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Leny Sanchez
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Janet Acosta
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gerardo Sanchez
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lisbeth Ferrufino
- Universidad Catolica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | - Carlos LaFuente
- Hospital Universitario Japones, Santa Cruz, Plurinational State of Bolivia
| | | | - Rony Colanzi
- Universidad Catolica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of San Francisco School of Medicine, San Francisco, CA, United States of America
- * E-mail:
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Hashimoto K, Zúniga C, Nakamura J, Hanada K. Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras. BMC Health Serv Res 2015; 15:116. [PMID: 25889097 PMCID: PMC4383207 DOI: 10.1186/s12913-015-0785-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 03/11/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres. METHODS We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community. RESULTS Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy. CONCLUSIONS We found that Chagas disease vector surveillance can be integrated into the PHC service. Health centres demonstrated capacity to manage vector surveillance and improve performance, children's awareness, vector report-response and seroprevalence, once tasks were simplified to be performed by trained non-specialists and distributed among the stakeholders. Health systems integration requires health workers to perform beyond their usual responsibilities and acquire management skills. Integration of vector control is feasible and can contribute to strengthening the preventive capacity of the PHC service.
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Affiliation(s)
- Ken Hashimoto
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Chagas Disease Control Project 2008-2011, Japan International Cooperation Agency, Tegucigalpa, Honduras.
| | | | - Jiro Nakamura
- Chagas Disease Control Project 2008-2011, Japan International Cooperation Agency, Tegucigalpa, Honduras.
- Project Management Direction, External Cooperation Department, Estrella Inc., Tokyo, Japan.
| | - Kyo Hanada
- Independent consultant, Chiba, Japan.
- Former Senior Advisor, Human Development Department, Japan International Cooperation Agency, Tokyo, Japan.
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Uc-Cetina V, Brito-Loeza C, Ruiz-Piña H. Chagas parasite detection in blood images using AdaBoost. Comput Math Methods Med 2015; 2015:139681. [PMID: 25861375 PMCID: PMC4377374 DOI: 10.1155/2015/139681] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/18/2022]
Abstract
The Chagas disease is a potentially life-threatening illness caused by the protozoan parasite, Trypanosoma cruzi. Visual detection of such parasite through microscopic inspection is a tedious and time-consuming task. In this paper, we provide an AdaBoost learning solution to the task of Chagas parasite detection in blood images. We give details of the algorithm and our experimental setup. With this method, we get 100% and 93.25% of sensitivity and specificity, respectively. A ROC comparison with the method most commonly used for the detection of malaria parasites based on support vector machines (SVM) is also provided. Our experimental work shows mainly two things: (1) Chagas parasites can be detected automatically using machine learning methods with high accuracy and (2) AdaBoost + SVM provides better overall detection performance than AdaBoost or SVMs alone. Such results are the best ones known so far for the problem of automatic detection of Chagas parasites through the use of machine learning, computer vision, and image processing methods.
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Affiliation(s)
- Víctor Uc-Cetina
- Facultad de Matemáticas, Universidad Autónoma de Yucatán, Anillo Periférico Norte, Tablaje Catastral, 13615 Mérida, YUC, Mexico
| | - Carlos Brito-Loeza
- Facultad de Matemáticas, Universidad Autónoma de Yucatán, Anillo Periférico Norte, Tablaje Catastral, 13615 Mérida, YUC, Mexico
| | - Hugo Ruiz-Piña
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Avenida, Itzáes No. 490 x 59, Colonia Centro, 97000 Mérida, YUC, Mexico
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Villagrán-Herrera ME, Sánchez-Moreno M, Rodríguez-Méndez AJ, Hernández-Montiel HL, Dávila-Esquivel FDJ, González-Pérez G, Martínez-Ibarra JA, Diego-Cabrera JAD. Comparative serology techniques for the diagnosis of Trypanosoma cruzi infection in a rural population from the state of Querétaro, Mexico. Mem Inst Oswaldo Cruz 2014; 109:967-972. [PMID: 25411005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/18/2014] [Indexed: 06/04/2023] Open
Abstract
Immunological diagnostic methods for Trypanosoma cruzi depend specifically on the presence of antibodies and parasitological methods lack sensitivity during the chronic and "indeterminate" stages of the disease. This study performed a serological survey of 1,033 subjects from 52 rural communities in 12 of the 18 municipalities in the state of Querétaro, Mexico. We detected anti-T. cruzi antibodies using the following tests: indirect haemagglutination assay (IHA), indirect immunofluorescence assay (IFA), ELISA and recombinant ELISA (rELISA). We also performed Western blot (WB) analysis using iron superoxide dismutase (FeSOD), a detoxifying enzyme excreted by the parasite, as the antigen. Positive test results were distributed as follows: ELISA 8%, rELISA 6.2%, IFA and IHA 5.4% in both cases and FeSOD 8%. A comparative study of the five tests was undertaken. Sensitivity levels, specificity, positive and negative predictive values, concordance percentage and kappa index were considered. Living with animals, trips to other communities, gender, age, type of housing and symptomatology at the time of the survey were statistically analysed using SPSS software v.11.5. Detection of the FeSOD enzyme that was secreted by the parasite and used as an antigenic fraction in WBs showed a 100% correlation with traditional ELISA tests.
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Affiliation(s)
- María Elena Villagrán-Herrera
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, Querétaro, México
| | - Manuel Sánchez-Moreno
- Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada, Granada, España
| | - Adriana Jheny Rodríguez-Méndez
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, Querétaro, México
| | - Hebert Luis Hernández-Montiel
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, Querétaro, México
| | - Felipe de Jesús Dávila-Esquivel
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, Querétaro, México
| | - Germán González-Pérez
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, Querétaro, México
| | | | - José Antonio de Diego-Cabrera
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
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Altcheh J, Moscatelli G, Mastrantonio G, Moroni S, Giglio N, Marson ME, Ballering G, Bisio M, Koren G, García-Bournissen F. Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults. PLoS Negl Trop Dis 2014; 8:e2907. [PMID: 24853169 PMCID: PMC4031103 DOI: 10.1371/journal.pntd.0002907] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to long term cardiac morbidity. Treatment of children with benznidazole is effective, but no pediatric pharmacokinetics data are available and clinical pharmacology information on the drug is scarce. PATIENTS AND METHODS Prospective population pharmacokinetic (PK) cohort study in children 2-12 years old with Chagas disease treated with oral benznidazole 5-8 mg/kg/day BID for 60 days. (clinicaltrials.gov #NCT00699387). RESULTS Forty children were enrolled in the study. Mean age was 7.3 years. A total of 117 samples were obtained from 38 patients for PK analysis. A one compartment model best fit the data. Weight-corrected clearance rate (CL/F) showed a good correlation with age, with younger patients having a significantly higher CL/F than older children and adults. Simulated median steady-state benznidazole concentrations, based on model parameters, were lower for children in our study than for adults and lowest for children under 7 years of age. Treatment was efficacious in the 37 patients who completed the treatment course, and well tolerated, with few, and mild, adverse drug reactions (ADRs). DISCUSSION Observed benznidazole plasma concentrations in children were markedly lower than those previously reported in adults (treated with comparable mg/kg doses), possibly due to a higher CL/F in smaller children. These lower blood concentrations were nevertheless associated to a high therapeutic response in our cohort. Unlike adults, children have few adverse reactions to the drug, suggesting that there may be a direct correlation between drug concentrations and incidence of ADRs. Our results suggest that studies with lower doses in adults may be warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT00699387.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guido Mastrantonio
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Norberto Giglio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Maria Elena Marson
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Gideon Koren
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Facundo García-Bournissen
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Gonzalez-Mejia ME, Torres-Rasgado E, Porchia LM, Salgado HR, Totolhua JL, Ortega A, Hernández-Kelly LCR, Ruiz-Vivanco G, Báez-Duarte BG, Pérez-Fuentes R. Metallothionein-1 and nitric oxide expression are inversely correlated in a murine model of Chagas disease. Mem Inst Oswaldo Cruz 2014; 109:174-81. [PMID: 24676665 PMCID: PMC4015253 DOI: 10.1590/0074-0276140339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/05/2014] [Indexed: 12/13/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, represents an endemic among Latin America countries. The participation of free radicals, especially nitric oxide (NO), has been demonstrated in the pathophysiology of seropositive individuals with T. cruzi. In Chagas disease, increased NO contributes to the development of cardiomyopathy and megacolon. Metallothioneins (MTs) are efficient free radicals scavengers of NO in vitro and in vivo. Here, we developed a murine model of the chronic phase of Chagas disease using endemic T. cruzi RyCH1 in BALB/c mice, which were divided into four groups: infected non-treated (Inf), infected N-monomethyl-L-arginine treated (Inf L-NAME), non-infected L-NAME treated and non-infected vehicle-treated. We determined blood parasitaemia and NO levels, the extent of parasite nests in tissues and liver MT-I expression levels. It was observed that NO levels were increasing in Inf mice in a time-dependent manner. Inf L-NAME mice had fewer T. cruzi nests in cardiac and skeletal muscle with decreased blood NO levels at day 135 post infection. This affect was negatively correlated with an increase of MT-I expression (r = -0.8462, p < 0.0001). In conclusion, we determined that in Chagas disease, an unknown inhibitory mechanism reduces MT-I expression, allowing augmented NO levels.
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Affiliation(s)
| | | | - Leonardo M Porchia
- Laboratorio de Fisiopatología de Enfermedades Crónicas, Centro de
Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Puebla,
México
| | - Hilda Rosas Salgado
- Laboratorio de Fisiopatología de Enfermedades Crónicas, Centro de
Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Puebla,
México
| | - José-Luis Totolhua
- Laboratorio de Fisiopatología de Enfermedades Crónicas, Centro de
Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Puebla,
México
| | - Arturo Ortega
- Departamento de Genética y Biología Molecular, Centro de Investigación y
de Estudios Avanzados, Unidad Zacatenco, México DF,México
| | | | | | | | - Ricardo Pérez-Fuentes
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla,
México
- Laboratorio de Fisiopatología de Enfermedades Crónicas, Centro de
Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Puebla,
México
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Moreira NM, de Moraes SMF, Dalálio MMO, Gomes ML, Sant'ana DMG, de Araújo SM. Moderate physical exercise protects myenteric metabolically more active neurons in mice infected with Trypanosoma cruzi. Dig Dis Sci 2014; 59:307-14. [PMID: 24185679 DOI: 10.1007/s10620-013-2901-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 09/25/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Trypanosoma cruzi causes neuronal myenteric depopulation compromising intestinal function. AIM The purpose of this study was to evaluate the influence of moderate physical exercise on NADH diaphorase (NADH-d)-positive neurons in the myenteric plexus and intestinal wall of the colon in mice infected with T. cruzi. MATERIALS AND METHODS Forty 30-day-old male Swiss mice were divided into the following groups: trained infected (TI), sedentary infected (SI), trained control (TC), and sedentary control. The TC and TI groups were subjected to a moderate physical exercise program on a treadmill for 8 weeks. Three days after finishing physical exercise, the TI and SI groups were intraperitoneally inoculated with 1,300 blood trypomastigotes of the Y strain of Trypanosoma cruzi. Parasitemia was evaluated from days 4 to 61 after inoculation. On day 75 of infection, myenteric neurons in the colon were quantified (NADH-d), and inflammatory foci were counted. Tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) levels were evaluated in plasma. The results were compared using analysis of variance and the Kruskal-Wallis test at a 5 % significance level. RESULTS Moderate physical exercise reduced the parasite peak on day 8 of infection (p = 0.0132) and total parasitemia (p = 0.0307). It also prevented neuronal depopulation (p < 0.01), caused hypertrophy of these cells (p < 0.05), prevented the formation of inflammatory foci (p < 0.01), and increased the synthesis of TNF-α (p < 0.01) and TGF-β (p > 0.05). CONCLUSION These results reinforce the therapeutic benefits of moderate physical exercise for T. cruzi infection.
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Affiliation(s)
- Neide Martins Moreira
- Graduate Program in Health Sciences, State University of Maringa, Columbus Avenue, 5790, Zone 07, Maringá, PR, 87020-900, Brazil,
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61
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Fong DL, Torrence AE, Vogel KW, Stockinger DE, Nelson V, Murnane RD, Baldessari A, Kuller L, Agy M, Kiem HP, Hotchkiss CE. Transmission of Chagas disease via blood transfusions in 2 immunosuppressed pigtailed macaques (Macaca nemestrina). Comp Med 2014; 64:63-67. [PMID: 24512963 PMCID: PMC3929221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/04/2013] [Accepted: 09/11/2013] [Indexed: 06/03/2023]
Abstract
A 2.25-y-old male pigtailed macaque (Macaca nemestrina) was experimentally irradiated and received a bone marrow transplant. After transplantation and engraftment, the macaque had unexpected recurring pancytopenia and dependent edema of the prepuce, scrotum, and legs. The diagnostic work-up included a blood smear, which revealed a trypomastigote consistent with Trypanosoma cruzi, the causative agent of Chagas disease (CD). We initially hypothesized that the macaque had acquired the infection when it lived in Georgia. However, because the animal had received multiple blood transfusions, all blood donors were screened for CD. One male pigtailed macaque blood donor, which was previously housed in Louisiana, was positive for T. cruzi antibodies via serology. Due to the low prevalence of infection in Georgia, the blood transfusion was hypothesized to be the source of T. cruzi infection. The transfusion was confirmed as the mechanism of transmission when screening of archived serum revealed seroconversion after blood transfusion from the seropositive blood donor. The macaque made a full clinical recovery, and further follow-up including thoracic radiography, echocardiography, and gross necropsy did not show any abnormalities associated with CD. Other animals that received blood transfusions from the positive blood donor were tested, and one additional pigtailed macaque on the same research protocol was positive for T. cruzi. Although CD has been reported to occur in many nonhuman primate species, especially pigtailed macaques, the transmission of CD via blood transfusion in nonhuman primates has not been reported previously.
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Affiliation(s)
- Derek L Fong
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA.
| | - Annie E Torrence
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Keith W Vogel
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Diane E Stockinger
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Veronica Nelson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Robert D Murnane
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA; Department of Comparative Medicine, University of Washington, Seattle, Washington, USA
| | - Audrey Baldessari
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA; Department of Comparative Medicine, University of Washington, Seattle, Washington, USA
| | - LaRene Kuller
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Michael Agy
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Hans-Peter Kiem
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Charlotte E Hotchkiss
- Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
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Soberanis-Mukul R, Uc-Cetina V, Brito-Loeza C, Ruiz-Piña H. An automatic algorithm for the detection of Trypanosoma cruzi parasites in blood sample images. Comput Methods Programs Biomed 2013; 112:633-639. [PMID: 24028798 DOI: 10.1016/j.cmpb.2013.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/10/2013] [Accepted: 07/22/2013] [Indexed: 06/02/2023]
Abstract
Chagas disease is a tropical parasitic disease caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi) and currently affecting large portions of the Americas. One of the standard laboratory methods to determine the presence of the parasite is by direct visualization in blood smears stained with some colorant. This method is time-consuming, requires trained microscopists and is prone to human mistakes. In this article we propose a novel algorithm for the automatic detection of T. cruzi parasites, in microscope digital images obtained from peripheral blood smears treated with Wright's stain. Our algorithm achieved a sensitivity of 0.98 and specificity of 0.85 when evaluated against a dataset of 120 test images. Experimental results show the versatility of the method for parasitemia determination.
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Affiliation(s)
- Roger Soberanis-Mukul
- Facultad de Matemáticas, Universidad Autónoma de Yucatán, C.P. 97119, Mérida, Mexico
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63
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Affiliation(s)
- R L Cardoni
- Instituto Nacional de Parasitología Dr M. Fatala Chabén, ANLIS 'Dr C. G. Malbrán', Av. Paseo Colón 568, 1063 Buenos Aires, Argentina.
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64
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Santos JPD, Lima-Costa MF, Peixoto SV. [Nutritional aspects associated with chronic Trypanosoma cruzi (Chagas 1909) infection among older adults: Bambuí Project]. CAD SAUDE PUBLICA 2013; 29:1141-1148. [PMID: 23778546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/28/2013] [Indexed: 06/02/2023] Open
Abstract
The aim of the study was to verify nutritional aspects associated with chronic Trypanosoma cruzi infection among baseline participants from the Bambuí cohort study on aging. The analysis included 84.9% (1,479) of residents of Bambuí, Minas Gerais State, Brazil, who were 60 years or older in 1997. T. cruzi infection was investigated by three serological tests, and nutritional status was assessed by anthropometric and biochemical variables. Associations were evaluated by prevalence ratios and confidence intervals (95%CI) using Poisson regression. T. cruzi infection was present in 38.1% of patients. All anthropometric variables were significantly associated with infection, showing lower values among patients with positive serology. No biochemical variables were associated with infection. The results showed the coexistence of chronic Chagas disease and poor nutritional status in the study population, reinforcing the importance of nutritional evaluation among elderly people presenting chronic T. cruzi infection.
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Villar SR, Ronco MT, Fernández Bussy R, Roggero E, Lepletier A, Manarin R, Savino W, Pérez AR, Bottasso O. Tumor necrosis factor-α regulates glucocorticoid synthesis in the adrenal glands of Trypanosoma cruzi acutely-infected mice. the role of TNF-R1. PLoS One 2013; 8:e63814. [PMID: 23717489 PMCID: PMC3661674 DOI: 10.1371/journal.pone.0063814] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 04/07/2013] [Indexed: 11/30/2022] Open
Abstract
Adrenal steroidogenesis is under a complex regulation involving extrinsic and intrinsic adrenal factors. TNF-α is an inflammatory cytokine produced in response to tissue injury and several other stimuli. We have previously demonstrated that TNF-R1 knockout (TNF-R1−/−) mice have a dysregulated synthesis of glucocorticoids (GCs) during Trypanosoma cruzi acute infection. Since TNF-α may influence GCs production, not only through the hypothalamus-pituitary axis, but also at the adrenal level, we now investigated the role of this cytokine on the adrenal GCs production. Wild type (WT) and TNF-R1−/− mice undergoing acute infection (Tc-WT and Tc-TNF-R1−/− groups), displayed adrenal hyperplasia together with increased GCs levels. Notably, systemic ACTH remained unchanged in Tc-WT and Tc-TNF-R1−/− compared with uninfected mice, suggesting some degree of ACTH-independence of GCs synthesis. TNF-α expression was increased within the adrenal gland from both infected mouse groups, with Tc-WT mice showing an augmented TNF-R1 expression. Tc-WT mice showed increased levels of P-p38 and P-ERK compared to uninfected WT animals, whereas Tc-TNF-R1−/− mice had increased p38 and JNK phosphorylation respect to Tc-WT mice. Strikingly, adrenal NF-κB and AP-1 activation during infection was blunted in Tc-TNF-R1−/− mice. The accumulation of mRNAs for steroidogenic acute regulatory protein and cytochrome P450 were significantly increased in both Tc-WT and Tc-TNF-R1−/− mice; being much more augmented in the latter group, which also had remarkably increased GCs levels. TNF-α emerges as a potent modulator of steroidogenesis in adrenocortical cells during T. cruzi infection in which MAPK pathways, NF-κB and AP-1 seem to play a role in the adrenal synthesis of pro-inflammatory cytokines and enzymes regulating GCs synthesis. These results suggest the existence of an intrinsic immune-adrenal interaction involved in the dysregulated synthesis of GCs during murine Chagas disease.
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Affiliation(s)
- Silvina R Villar
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina.
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Luz PR, Boldt ABW, Grisbach C, Kun JFJ, Velavan TP, Messias-Reason IJT. Association of L-ficolin levels and FCN2 genotypes with chronic Chagas disease. PLoS One 2013; 8:e60237. [PMID: 23593180 PMCID: PMC3617223 DOI: 10.1371/journal.pone.0060237] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/23/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND L-ficolin (encoded by FCN2) binds to acetylated sugar moieties of many pathogens, including Trypanosoma cruzi, promoting their phagocytosis and lysis by the complement system. METHODS We investigated L-ficolin levels in 160 T. cruzi infected patients with chronic Chagas disease and 71 healthy individuals, and FCN2 polymorphisms (-986 G>A, -602 G>A, and -4 A>G in the promoter and A258S in exon 8) in 243 patients, being 88 indeterminate (asymptomatic), 96 with cardiac, 23 with digestive and 33 with cardiodigestive manifestations (two were unspecified) and 305 controls (135 for A258S). RESULTS Patients presented lower L-ficolin plasma levels than controls (p<0.0001). Among the different groups of cardiac commitment, individuals with moderate forms had higher L-ficolin levels than the severe forms (P = 0.039). Lower L-ficolin levels were found associated with the 258S variant in the patients (P = 0.034). We found less -4A/G heterozygotes in the cardiac patients, than in the controls (OR = 0.56 [95% CI = 0.33-0.94], P = 0.034). Heterozygote -4A/G genotypes with the 258S variant and 258SS homozygotes were nevertheless more frequent among cardiodigestive patients than in controls (OR = 14.1 [95% CI = 3.5-56.8], P = 0.0001) and in indeterminate patients (OR = 3.2 [95% CI = 1.1-9.4], P = 0.037). We also found an association of the allelic frequency of the 258S variant with cardiodigestive Chagas disease compared to controls (OR = 2.24 [95% CI = 1.1-4.5], P = 0.037). Thus, decreased patient levels of L-ficolin reflect not only protein consumption due to the disease process, but also the higher frequency of the 258S variant in patients with cardiodigestive symptoms. CONCLUSION The very first study on Brazilian cohort associates both L-ficolin plasma levels and FCN2 variants to Chagas disease and subsequent disease progression. The prognostic value of L-ficolin levels and the FCN2*A258S polymorphism should be further evaluated in other settings.
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Affiliation(s)
- Paola R. Luz
- Laboratório de Imunopatologia Molecular – Departamento de Patologia Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Angelica B. W. Boldt
- Laboratório de Imunopatologia Molecular – Departamento de Patologia Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Caroline Grisbach
- Laboratório de Imunopatologia Molecular – Departamento de Patologia Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Jürgen F. J. Kun
- Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany
| | | | - Iara J. T. Messias-Reason
- Laboratório de Imunopatologia Molecular – Departamento de Patologia Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
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Berrizbeitia M, Concepción JL, Carzola V, Rodríguez J, Cáceres A, Quiñones W. [Seroprevalence of T. cruzi infection in Canis familiaris, state of Sucre, Venezuela]. Biomedica 2013; 33:214-225. [PMID: 24652131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 11/20/2012] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Trypanosoma cruzi infection in humans has been extensively studied in Venezuela; however, in reservoirs it has been less investigated. OBJECTIVE The objective of this study was to determine the seroepidemiology of T. cruzi in the state of Sucre, Venezuela. MATERIALS AND METHODS A cross-sectional and prospective study conducted in 95 towns and 577 dwellings in the 15 municipalies of the state of Sucre, Venezuela, from August to November, 2008. The evaluation of serum samples was performed with the CruziELISA kit and the multiple antigens binding assays (MABA). Furthermore, epidemiological surveys were applied to evaluate the risk factors. RESULTS A total of dogs (average age of 2, 6 + 2.2 years, 226 males and 137 females) was evaluated. The combination of the ELISA / MABA tests detected 78 positive sera, sixty-nine negative and 10 of inconclusive results. The seroprevalence of the T. cruzi infection in dogs in the state of Sucre, was 22.1% (CI 95%: 20.58-22.4%). No significant statistic association was found between the T. cruzi infection in dogs and the evaluated epidemiological variables: hunting dogs that slept oudoors roaming freely in the populated center, sex of the animal and eating habits. The T. cruzi infection was associated to the age of canines, being significantly higher in the group of 0 to 3 years, when compared with older dogs. CONCLUSIONS The high T. cruzi seroprevalence dected in dogs shows that in this región of Venezuela there prevails an important risk factor of transmissibility of this parasite to human populations.
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Affiliation(s)
- Mariolga Berrizbeitia
- Instituto de Biomedicina y Ciencias Aplicadas, Universidad de Oriente, Cumaná, Venezuela
| | | | - Valentina Carzola
- Departamento de Bioanálisis, Universidad de Oriente, Cumaná, Venezuela
| | - Jéssicca Rodríguez
- Posgrado en Biología Aplicada, Núcleo de Sucre, Universidad de Oriente, Cumaná, Venezuela
| | - Ana Cáceres
- Instituto de Biomedicina y Ciencias Aplicadas, Universidad de los Andes
| | - Wilfredo Quiñones
- Instituto de Biomedicina y Ciencias Aplicadas, Universidad de los Andes
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Castro-Sesquen YE, Gilman RH, Yauri V, Cok J, Angulo N, Escalante H, Bern C. Detection of soluble antigen and DNA of Trypanosoma cruzi in urine is independent of renal injury in the guinea pig model. PLoS One 2013; 8:e58480. [PMID: 23520515 PMCID: PMC3592799 DOI: 10.1371/journal.pone.0058480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 02/05/2013] [Indexed: 12/28/2022] Open
Abstract
The diagnosis of Chagas disease in humans is generally limited to the detection of specific antibodies. Detection of T. cruzi antigens in urine has been reported previously, but is not used in the diagnosis. In this study, soluble T. cruzi antigens and DNA were detected in urine samples and were associated with kidney injury and systemic detection of the parasite. We used 72 guinea pigs infected with T. cruzi Y strain and 18 non-infected guinea pigs. Blood, kidney, heart and urine samples were collected during the acute phase and chronic phase. Urine samples were concentrated by ultrafiltration. Antigens were detected by Western Blot using a polyclonal antibody against trypomastigote excretory-secretory antigen (TESA). T. cruzi DNA was detected by PCR using primers 121/122 and TcZ1/TcZ2. Levels of T. cruzi DNA in blood, heart and kidney were determined by quantitative PCR. T. cruzi antigens (75 kDa, 80 kDa, 120 kDa, 150 kDa) were detected in the acute phase (67.5%) and the chronic phase (45%). Parasite DNA in urine was detected only in the acute phase (45%). Kidney injury was characterized by high levels of proteinuria, kidney injury molecule-1 (KIM-1) and urea, and some histopathological changes such as inflammation, necrosis, fibrosis and scarce parasites. The detection of antigens and DNA in urine was associated with the presence of parasite DNA in blood and heart and with high levels of parasite DNA in blood, but not with the presence of parasite in kidney or kidney injury. These results suggest that the detection of T. cruzi in urine could be improved to be a valuable method for the diagnosis of Chagas disease, particularly in congenital Chagas disease and in immunocompromised patients.
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Affiliation(s)
- Yagahira E. Castro-Sesquen
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Bloomberg School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Verónica Yauri
- Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Jaime Cok
- Department of Pathology, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Noelia Angulo
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hermes Escalante
- Facultad de Ciencias Biológicas, Universidad Nacional de Trujillo, Trujillo, Peru
- Departamento de Investigación y Producción, Centro de Análisis e Investigación Escalabs, Trujillo, Peru
| | - Caryn Bern
- Global Health Sciences, Department of Epidemiology and Biostatistics School of Medicine, University of California San Francisco, San Francisco, California, United States of America
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69
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Farfán-García AE, Castellanos-Domínguez YZ, Luna-Marín KP, Angulo-Silva VM. [Concordance of two serological tests for the diagnosis of Chagas disease]. Rev Salud Publica (Bogota) 2013; 15:208-219. [PMID: 24892663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 08/08/2012] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Establish the concordance between in-house ELISA and IIF for the diagnosis of infection with T. cruzi using blood eluates. METHODOLOGY A study of diagnostic technology evaluation and cross-sectional sample of 650 residents of an endemic area of Colombia was conducted. It was determined the Receiver Operating Characteristic curve (ROC) and IIF was used as a gold standard. It was established the cutoff for the ELISA and the correlation between readings. RESULTS The in-house ELISA it was an agreement of 0.99 (95 % CI: 0.989 to 0.992) between the two readings taken and the area for the ROC curve was 0.9795. The cutoff was set at 0.5 absorbance in the ELISA test. 16.6 % were positive by ELISA and 10.9 % by IIF. CONCLUSIONS The in-house ELISA showed good concordance compared to the IIF, so it is a good choice diagnostic for the population living in remote areas.
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Affiliation(s)
- Ana E Farfán-García
- Centro de Investigaciones en Enfermedades Tropicales -CINTROP-, Universidad Industrial de Santander, Colombia
| | | | - Katherine P Luna-Marín
- Centro de Investigaciones en Enfermedades Tropicales -CINTROP-, Universidad Industrial de Santander, Colombia
| | - Víctor M Angulo-Silva
- Centro de Investigaciones en Enfermedades Tropicales -CINTROP-, Universidad Industrial de Santander, Colombia
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70
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Cutrullis RA, Petray PB, Schapachnik E, Sánchez R, Postan M, González MN, Martín V, Corral RS. Elevated serum levels of macrophage migration inhibitory factor are associated with progressive chronic cardiomyopathy in patients with Chagas disease. PLoS One 2013; 8:e57181. [PMID: 23451183 PMCID: PMC3579792 DOI: 10.1371/journal.pone.0057181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/18/2013] [Indexed: 12/27/2022] Open
Abstract
Clinical symptoms of chronic Chagas disease occur in around 30% of the individuals infected with Trypanosoma cruzi and are characterized by heart inflammation and dysfunction. The pathogenesis of chronic chagasic cardiomyopathy (CCC) is not completely understood yet, partially because disease evolution depends on complex host-parasite interactions. Macrophage migration inhibitory factor (MIF) is a pleiotropic proinflammatory cytokine that promotes numerous pathophysiological processes. In the current study, we investigated the link between MIF and CCC progression. Immunohistochemical analysis demonstrated MIF overexpression in the hearts from chronically T. cruzi-infected mice, particularly those showing intense inflammatory infiltration. We also found that MIF exogenously added to parasite-infected murine macrophage cultures is capable of enhancing the production of TNF-α and reactive oxygen species, both with pathogenic roles in CCC. Thus, the integrated action of MIF and other cytokines and chemokines may account for leukocyte influx to the infected myocardium, accompanied by enhanced local production of multiple inflammatory mediators. We further examined by ELISA the level of MIF in the sera from chronic indeterminate and cardiomyopathic chagasic patients, and healthy subjects. CCC patients displayed significantly higher MIF concentrations than those recorded in asymptomatic T. cruzi-infected and uninfected individuals. Interestingly, increased MIF levels were associated with severe progressive Chagas heart disease, in correlation with elevated serum concentration of high sensitivity C-reactive protein and also with several echocardiographic indicators of left ventricular dysfunction, one of the hallmarks of CCC. Our present findings represent the first evidence that enhanced MIF production is associated with progressive cardiac impairment in chronic human infection with T. cruzi, strengthening the relationship between inflammatory response and parasite-driven pathology. These observations contribute to unravel the elements involved in the pathogenesis of CCC and may also be helpful for the design of novel therapies aimed to control long-term morbidity in chagasic patients.
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Affiliation(s)
- Romina A. Cutrullis
- Servicio de Parasitología-Chagas, Hospital de Niños ‘Dr. Ricardo Gutiérrez’, Buenos Aires, Argentina
| | - Patricia B. Petray
- Servicio de Parasitología-Chagas, Hospital de Niños ‘Dr. Ricardo Gutiérrez’, Buenos Aires, Argentina
| | - Edgardo Schapachnik
- Servicio de Cardiología, Hospital General de Agudos ‘Dr. Cosme Argerich’, Buenos Aires, Argentina
| | - Rubén Sánchez
- Servicio de Cardiología, Hospital General de Agudos ‘Dr. José María Ramos Mejía’, Buenos Aires, Argentina
| | - Miriam Postan
- Instituto Nacional de Parasitología ‘Dr. Mario Fatala Chabén’/ANLIS/Malbrán, Buenos Aires, Argentina
| | - Mariela N. González
- Instituto Nacional de Parasitología ‘Dr. Mario Fatala Chabén’/ANLIS/Malbrán, Buenos Aires, Argentina
| | - Valentina Martín
- Laboratorio de Inmunología, Centro de Salud y Medio Ambiente (CESyMA), Escuela de Ciencia y Tecnología (ECyT), Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Ricardo S. Corral
- Servicio de Parasitología-Chagas, Hospital de Niños ‘Dr. Ricardo Gutiérrez’, Buenos Aires, Argentina
- * E-mail:
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71
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Abstract
Due to current trends in human population movements, there has been an increase in the number of individuals with Chagas’ disease (CD) living in non-endemic regions; as such, there is a high probability that we will face an increase in cases of CD, both in patients requiring renal replacement therapy and in potential donors. We present the case of an organ donor with positive serology for Trypanosoma cruzi, whose kidneys were implanted into two different recipients. Prophylaxis was administered with benznidazole for 3 weeks. Over the course of two years of serological and clinical follow-up, no evidence of Chagas’ transmission or infection was observed. This positive evolution suggests that renal transplants derived from donors with positive serology results and no signs of acute or chronic disease may be acceptable. We also provide a review of the evidence supporting this conclusion and the available recommendations in the medical literature.
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Affiliation(s)
- Eva Márquez
- Servicio de Nefrología, Hospital del Mar. Barcelona, Spain
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72
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Rothfuchs AG, Roffê E, Gibson A, Cheever AW, Ezekowitz RAB, Takahashi K, Steindel M, Sher A, Báfica A. Mannose-binding lectin regulates host resistance and pathology during experimental infection with Trypanosoma cruzi. PLoS One 2012; 7:e47835. [PMID: 23139754 PMCID: PMC3490958 DOI: 10.1371/journal.pone.0047835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/21/2012] [Indexed: 01/19/2023] Open
Abstract
Mannose-binding lectin (MBL) is a humoral pattern-recognition molecule important for host defense. Although recent genetic studies suggest an involvement of MBL/MASP2-associated pathways in Chagas’ disease, it is currently unknown whether MBL plays a role in host resistance to the intracellular protozoan Trypanosoma cruzi, the causative agent of Chagas’ disease. In this study we employed MBL−/− mice to assess the role of MBL in resistance to experimental infection with T. cruzi. T. cruzi infection enhanced tissue expression of MBL both at the mRNA and protein level. Similarly, symptomatic acute Chagas’ disease patients displayed increased serum concentrations of MBL compared to patients with indeterminate, asymptomatic forms of the disease. Furthermore, increased parasite loads in the blood and/or tissue were observed in MBL−/− mice compared to WT controls. This was associated with reduced systemic levels of IL-12/23p40 in MBL−/− mice. Importantly, MBL−/− mice infected with a cardiotropic strain of T. cruzi displayed increased myocarditis and cardiac fibrosis compared to WT controls. The latter was accompanied by elevated hydroxyproline content and mRNA levels of collagen-1 and -6 in the heart. These observations point to a previously unappreciated role for MBL in regulating host resistance and cardiac inflammation during infection with a major human pathogen.
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Affiliation(s)
- Antonio Gigliotti Rothfuchs
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden
- * E-mail: (AGR); (AB)
| | - Ester Roffê
- Molecular Signaling Section, Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Amanda Gibson
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Allen W. Cheever
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Biomedical Research Institute, Rockville, Maryland, United States of America
| | - R. Alan B. Ezekowitz
- Laboratory of Developmental Immunology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kazue Takahashi
- Laboratory of Developmental Immunology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mario Steindel
- Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - André Báfica
- Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- * E-mail: (AGR); (AB)
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73
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Angheben A, Giaconi E, Menconi M, Casazza G, Najajreh M, Anselmi M, Gobbi F, Bisoffi Z, Tascini C, Favre C. Reactivation of Chagas disease after a bone marrow transplant in Italy: first case report. Blood Transfus 2012; 10:542-544. [PMID: 22790268 PMCID: PMC3496236 DOI: 10.2450/2012.0015-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/09/2012] [Indexed: 06/01/2023]
Affiliation(s)
- Andrea Angheben
- Centre for Tropical Diseases, S. Cuore-Don Calabria Hospital, Negrar, Italy.
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74
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Cimino RO, Diosque P, López Quiroga IR, Gil JF, Nasser JR. [Immunoenzymatic evaluation of the recombinant SAPA protein of Trypanosoma cruzi in naturally infected dogs]. Rev Argent Microbiol 2012; 44:177-181. [PMID: 23102466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We evaluated the recombinant antigen SAPA (Shed Acute Phase Antigen) for the detection of Trypanosoma cruzi antibodies in sera from naturally infected dogs. The technique used was ELISA and the antigens were a homogenate of parasite T. cruzi (ELISA-H) and the recombinant SAPA (ELISA-SAPA). We analyzed 93 sera from dogs by ELISA-H and ELISA-SAPA, which were grouped as follows: G1: 11 negative control sera from the city of Salta, G2: 11 positive control sera from dogs naturally infected with T. cruzi and G3: 71 samples of dogs belonging to a Chagas disease-endemic area. The sensitivity and specificity of ELISA-SAPA were 100 %. The kappa index between ELISA-H and ELISA-SAPA was 0,85. These results confirm the use of SAPA antigen in the diagnosis of infection with T. cruzi in dogs.
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Affiliation(s)
- Rubén O Cimino
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Argentina.
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75
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Riera C, Verges M, Iniesta L, Fisa R, Gállego M, Tebar S, Portús M. Identification of a Western blot pattern for the specific diagnosis of Trypanosoma cruzi infection in human sera. Am J Trop Med Hyg 2012; 86:412-416. [PMID: 22403310 PMCID: PMC3284355 DOI: 10.4269/ajtmh.2012.10-0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 07/25/2011] [Indexed: 11/08/2023] Open
Abstract
A Western blot (WB) method using a lysate from Trypanosoma cruzi (Maracay strain) epimastigotes was evaluated. Serum samples from 37 patients with confirmed Chagas disease (cohort I), 27 Spanish patients with visceral leishmaniasis caused by Leishmania infantum (cohort II), and 28 Colombian patients with cutaneous leishmaniasis caused by L. panamensis and negative serology for Chagas disease (cohort III) were tested. The negative controls were 55 healthy seronegative subjects for T. cruzi and Leishmania; 28 of the negative controls were from a region endemic for Chagas disease and Leishmania (cohort IV), and 27 of the negative controls were from a non-endemic area for Leishmania and T. cruzi (cohort V). A homogeneous standard band pattern consisting of six antigenic bands corresponding to 28, 32, 38, 39, 40, and 48 kDa was recognized simultaneously for all Chagasic patients' sera. Sera from Leishmania-infected patients showed a heterogeneous band pattern that was easily differentiated from the pattern of patients with Chagas disease. WB with T. cruzi epimastigote antigen is an efficient method for diagnosis and may be used as an alternative to confirm T. cruzi and detect cross-reactivity with Leishmania.
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Affiliation(s)
- Cristina Riera
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Spain.
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76
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Riera C, Verges M, Iniesta L, Fisa R, Gállego M, Tebar S, Portús M. Identification of a Western blot pattern for the specific diagnosis of Trypanosoma cruzi infection in human sera. Am J Trop Med Hyg 2012; 86:412-6. [PMID: 22403310 PMCID: PMC3284355 DOI: 10.4269/ajtmh.2012.11-0111] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 07/25/2011] [Indexed: 04/07/2024] Open
Abstract
A Western blot (WB) method using a lysate from Trypanosoma cruzi (Maracay strain) epimastigotes was evaluated. Serum samples from 37 patients with confirmed Chagas disease (cohort I), 27 Spanish patients with visceral leishmaniasis caused by Leishmania infantum (cohort II), and 28 Colombian patients with cutaneous leishmaniasis caused by L. panamensis and negative serology for Chagas disease (cohort III) were tested. The negative controls were 55 healthy seronegative subjects for T. cruzi and Leishmania; 28 of the negative controls were from a region endemic for Chagas disease and Leishmania (cohort IV), and 27 of the negative controls were from a non-endemic area for Leishmania and T. cruzi (cohort V). A homogeneous standard band pattern consisting of six antigenic bands corresponding to 28, 32, 38, 39, 40, and 48 kDa was recognized simultaneously for all Chagasic patients' sera. Sera from Leishmania-infected patients showed a heterogeneous band pattern that was easily differentiated from the pattern of patients with Chagas disease. WB with T. cruzi epimastigote antigen is an efficient method for diagnosis and may be used as an alternative to confirm T. cruzi and detect cross-reactivity with Leishmania.
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Affiliation(s)
- Cristina Riera
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Spain.
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77
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Cutrullis RA, Moscatelli GF, Moroni S, Volta BJ, Cardoni RL, Altcheh JM, Corral RS, Freilij HL, Petray PB. Benzonidazole therapy modulates interferon-γ and M2 muscarinic receptor autoantibody responses in Trypanosoma cruzi-infected children. PLoS One 2011; 6:e27133. [PMID: 22066031 PMCID: PMC3205037 DOI: 10.1371/journal.pone.0027133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 10/11/2011] [Indexed: 02/05/2023] Open
Abstract
Objective The presence of autoantibodies with adrenergic and cholinergic activity, capable of triggering neurotransmitter receptor-mediated effects, has been associated with pathogenesis in T. cruzi-infected hosts. The goal of this study was to investigate the production of anti-M2 muscarinic receptor autoantibodies (Anti-M2R AAbs) as well as the IFN-γ profile in children at the early stage of Chagas disease, and to examine whether trypanocidal chemotherapy with benznidazole (BZ) could modify both response patterns. Methods This study comprised 30 T. cruzi-infected children (mean age: 13.8 years) and 19 uninfected controls (mean age: 12.7 years). Infected patients were treated with BZ and followed-up. Blood samples collected at diagnosis-T0, end of treatment-T1, and six months later-T2 were analysed by ELISA for detection of Anti-M2R AAbs and circulating levels of IFN-γ. Results At T0, anti-M2R AAbs were demonstrated in 56.7% of T. cruzi-infected patients, whereas uninfected controls were 100% negative. The average age of Anti-M2R AAbs+ patients was higher than that from negative population. Infected children also displayed significantly stronger serum IFN-γ responses than controls. Upon BZ treatment, a significant linear decreasing trend in Anti-M2R AAb reactivity was recorded throughout the follow-up, with 29.7–88.1% decrease at T2. IFN-γ circulating levels also declined by T2. Conclusion Anti-M2R AAbs and IFN-γ raise early during chagasic infection in children and are downmodulated by BZ therapy. These findings reinforce the usefulness of early BZ treatment not only to eliminate the parasite but also to reduce potentially pathogenic immune responses.
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Affiliation(s)
- Romina A. Cutrullis
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Guillermo F. Moscatelli
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Bibiana J. Volta
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén, Administración Nacional de Laboratorios e Institutos de Salud Dr. C.G. Malbrán, Buenos Aires, Argentina
| | - Rita L. Cardoni
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén, Administración Nacional de Laboratorios e Institutos de Salud Dr. C.G. Malbrán, Buenos Aires, Argentina
| | - Jaime M. Altcheh
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ricardo S. Corral
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Héctor L. Freilij
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Patricia B. Petray
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
- * E-mail:
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78
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Beleigoli AM, Lima-Costa MF, Diniz MDFH, Ribeiro AL. B-type natriuretic peptide and anthropometric measures in a Brazilian elderly population with a high prevalence of Trypanosoma cruzi infection. Peptides 2011; 32:1787-92. [PMID: 21884743 DOI: 10.1016/j.peptides.2011.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 11/30/2022]
Abstract
B-type natriuretic peptide (BNP) is a diagnostic and prognostic tool in heart failure and also in Chagas disease, which is caused by the protozoan Trypanosoma cruzi and has cardiomyopathy as a main feature. BNP lipolytic actions and T. cruzi infection in the adipose tissue have been recently described. We aim to investigate the relationship between BNP and anthropometric measures and whether it is influenced by T. cruzi infection. We measured BNP, body mass index (BMI), waist circumference (WC), triceps skin-fold thickness (TSF) and performed serological, biochemical and electrocardiographic exams in 1398 subjects (37.5% infected with T. cruzi) in a community-dwelling elderly population in Bambui city, Brazil. Linear multivariate regression analysis was performed to investigate determinants of BNP levels. BNP levels were significantly (p<0.05) higher in T. cruzi-infected subjects than in the non-infected group (median=121 and 64pg/mL, respectively). BMI, WC and TSF in infected subjects were significantly lower than those in non-infected subjects (24.3 vs. 25.5kg/m2; 89.2 vs. 92.4cm; and 14.5 vs. 16.0mm, respectively). There was an inverse relationship between BNP levels and BMI (b=-0.018), WC (b=-0.005) and TSF (b=-0.193) levels. Infected and non-infected groups showed similar inverse relationships between BNP and BMI (b=-0.021 and b=-0.015, respectively). In conclusion, there was an inverse relationship between BNP levels and the anthropometric measures. Despite the actions in the adipose tissue, T. cruzi infection did not modify the associations between BNP and BMI, suggesting that body mass does not modify the accuracy of BNP in Chagas disease.
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Affiliation(s)
- Alline Maria Beleigoli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30130-100, Brazil.
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79
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Blum-Domínguez S, Espinoza B, Martínez-Martínez I, Maldonado-Velázquez G, Tamay-Segovia P. [A Trypanosoma cruzi infection without serologic evidence]. Rev Med Inst Mex Seguro Soc 2011; 49:537-539. [PMID: 22185857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Trypanosoma cruzi was isolated from a 20 year old male with no evidence of antibodies against this parasite until 12 months after the isolation and with no electrocardiographic alterations. The isolated sample obtained was characterized as T. cruzi I through PCR mini-exon. It had been reported without serologic reactivity to T. cruzi. It is the first case with lack reactivity reported in Mexico.
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Affiliation(s)
- Selene Blum-Domínguez
- Centro de Investigaciones Biomédicas, Universidad Autónoma de Campeche, Campeche, México
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80
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Marín C, Ramírez-Macías I, López-Céspedes A, Olmo F, Villegas N, Díaz JG, Rosales MJ, Gutiérrez-Sánchez R, Sánchez-Moreno M. In vitro and in vivo trypanocidal activity of flavonoids from Delphinium staphisagria against Chagas disease. J Nat Prod 2011; 74:744-750. [PMID: 21466157 DOI: 10.1021/np1008043] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The in vitro and in vivo trypanocidal activities of nine flavonoids (1-9) isolated from the aerial parts of Delphinium staphisagria have been studied in both the acute and chronic phases of Chagas disease. The antiproliferative activity of these substances against Trypanosoma cruzi (epimastigote, amastigote, and trypomastigote forms) in some cases exhibited more potent antitrypanosomatid activity and lower toxicity than the reference drug, benznidazole. Studies in vitro using ultrastructural analysis together with metabolism-excretion studies were also performed in order to identify the possible action mechanism of the compounds tested. Alterations mainly at the level of the mitochondria may explain metabolic changes in succinate and acetate production, perhaps due to the disturbance of the enzymes involved in sugar metabolism within the mitochondrion. In vivo studies provided results consistent with those observed in vitro. No signs of toxicity were detected in mice treated with the flavonoids tested, and the parasitic charge was significantly lower than in the control assay with benznidazole. The effects of these compounds were also demonstrated with the change in the anti-T. cruzi antibody levels during the chronic stage.
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Affiliation(s)
- Clotilde Marín
- Department of Parasitology, University of Granada, Severo Ochoa s/n, E-18071 Granada, Spain
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81
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Sabino EC, Salles NA, Sarr M, Barreto AM, Oikawa M, Oliveira CD, Leao SC, Carneiro-Proietti AB, Custer B, Busch MP. Enhanced classification of Chagas serologic results and epidemiologic characteristics of seropositive donors at three large blood centers in Brazil. Transfusion 2010; 50:2628-37. [PMID: 20576017 PMCID: PMC2997114 DOI: 10.1111/j.1537-2995.2010.02756.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A major problem in Chagas disease donor screening is the high frequency of samples with inconclusive results. The objective of this study was to describe patterns of serologic results among donors to the three Brazilian REDS-II blood centers and correlate with epidemiologic characteristics. STUDY DESIGN AND METHODS The centers screened donor samples with one Trypanosoma cruzi lysate enzyme immunoassay (EIA). EIA-reactive samples were tested with a second lysate EIA, a recombinant-antigen based EIA, and an immunfluorescence assay. Based on the serologic results, samples were classified as confirmed positive (CP), probable positive (PP), possible other parasitic infection (POPI), and false positive (FP). RESULTS In 2007 to 2008, a total of 877 of 615,433 donations were discarded due to Chagas assay reactivity. The prevalences (95% confidence intervals [CIs]) among first-time donors for CP, PP, POPI, and FP patterns were 114 (99-129), 26 (19-34), 10 (5-14), and 96 (82-110) per 100,000 donations, respectively. CP and PP had similar patterns of prevalence when analyzed by age, sex, education, and location, suggesting that PP cases represent true T. cruzi infections; in contrast the demographics of donors with POPI were distinct and likely unrelated to Chagas disease. No CP cases were detected among 218,514 repeat donors followed for a total of 718,187 person-years. CONCLUSION We have proposed a classification algorithm that may have practical importance for donor counseling and epidemiologic analyses of T. cruzi-seroreactive donors. The absence of incident T. cruzi infections is reassuring with respect to risk of window phase infections within Brazil and travel-related infections in nonendemic countries such as the United States.
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Affiliation(s)
- Ester C Sabino
- Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil.
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82
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Ribeiro ALP, de Carvalho ACC, Lombardi F, Talvani A, Teixeira MM, Rocha MOC. In vivo inhibitory effect of anti-muscarinic autoantibodies on the parasympathetic function in Chagas disease. Int J Cardiol 2010; 145:339-340. [PMID: 20051298 DOI: 10.1016/j.ijcard.2009.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/04/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Antonio Luiz P Ribeiro
- Hospital das Clínicas e Pós-Graduação em Clínica Médica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190 - Campus Saúde, 30130-100, Belo Horizonte, Brazil.
| | - Antonio Carlos Campos de Carvalho
- Laboratório de Cardiologia Celular e Molecular, Instituto de Biofísica Carlos Chagas Filho, CCS, Universidade Federal do Rio de Janeiro, Bloco G,Sala G2-045. Cidade Universitária - Ilha do Fundão, 21949-900, Rio de Janeiro, RJ, Brazil
| | - Federico Lombardi
- Cardiologia, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano, Via A. De Rudini, 8, 20142, Milano, Italy
| | - André Talvani
- Laboratório de Doença de Chagas, Departamento de Ciências Biológicas & Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Campus Universitário, Ouro Preto, MG, 35400-000, Brazil
| | - Mauro Martins Teixeira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, 31270-910. Belo Horizonte, Brazil
| | - Manoel Otávio Costa Rocha
- Hospital das Clínicas e Pós-Graduação em Clínica Médica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190 - Campus Saúde, 30130-100, Belo Horizonte, Brazil
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Guerrero L, Pinazo MJ, Posada E, Gascón J, Ribas J, Soy D. A high-performance liquid chromatographic method for benznidazole quantitation in plasma of patients with Chagas disease. Clin Chem Lab Med 2010; 49:77-82. [PMID: 21083440 DOI: 10.1515/cclm.2011.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chagas disease is endemic in Latin America, affecting 16-18 million people with more than 100 million exposed to risk of infection. Its etiological agent is Trypanosoma cruzi. To date, benznidazole is the only treatment of Chagas disease available in Europe. METHODS A high-performance reversed-phase isocratic liquid chromatographic method for benznidazole analysis in human plasma is described. The mobile phase consists of 60% ultrafiltered water and 40% acetonitrile. Samples were precipitated with trichloroacetic acid (0.3 M) (1/1, v/v). The injection volume was 100 μL. Benzocaine was used as internal standard. RESULTS The assay was linear over a benznidazole concentration range of 1.6-100 μg/mL. The method showed good agreement of results (n=15): inaccuracy (5.6%), intra- and inter-day variability (1.1% and 3.9%, respectively), recovery (94.9%), limit of detection (0.8 μg/mL), lower limit of quantitation (1.6 μg/mL) and acceptable stability over 24 h in the auto-sampler. Only 25 samples (58%) showed values within the therapeutic range. Three samples were subtherapeutic and 15 were in the toxic range. CONCLUSIONS The method offers a fast and simple approach to determining benznidazole in human plasma which could be of use in pharmacokinetic and safety studies.
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Affiliation(s)
- Laura Guerrero
- Pharmacy Service, Hospital Clínic Barcelona/IDIBAPS, University of Barcelona, Barcelona, Spain
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84
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Hernández JL, Rebollar-Téllez EA, Infante F, Morón A, Castillo A. [Indicators of infestation, colonization and infection of Triatoma dimidiata (Latreille) (Hemiptera: Reduviidae) in Campeche, México]. Neotrop Entomol 2010; 39:1024-1031. [PMID: 21271074 DOI: 10.1590/s1519-566x2010000600027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 07/02/2009] [Indexed: 05/30/2023]
Abstract
Triatoma dimidiata (Latreille) is considered to be one of the primary vectors of Chagas disease in Southern Mexico and Central America. The objective of the present study was to obtain ecological information on T. dimidiata in two rural communities of Campeche, Mexico, where the vector is poorly studied. Our work consisted of monthly samplings carried out during one-year time at three levels: sylvatic, peridomestic and intradomestic, in order to estimate the population abundance of this species and its rate of infection with Trypanosoma cruzi. Triatoma dimidiata was the unique vector of this disease collected in San Juan Bautista Sakcabchen (SJBS) and Crucero San Luis (CSL). The total of 145 individuals were captured in SJBS; from these, 26.9%, 20% and 53.1% were collected in the sylvatic, peridomestic and intradomestic area, respectively. In CSL captures yielded 108 individuals: 40.7% in the sylvatic area, 20.4% peridomestic and 38.9% intradomestic. We found no correlation between climatic variables and population abundance of T. dimidiata. Dataset obtained suggests that individuals from the sylvatic area exhibit a high rate of natural infection by T. cruzi, with monthly percentages up to 61.5% for SJBS and 50% for CSL. At the peri and intradomestic level, the reservoirs apparently play an important role in the transmission, as the seroprevalence in dogs was 61.5% y 65.4%, for SJBS y CSL, respectively. Based on these findings, it was concluded that inhabitants of both communities are at a high risk of Chagas disease infection.
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85
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Lima-Costa MF, Cesar CC, Peixoto SV, Ribeiro ALP. Plasma B-type natriuretic peptide as a predictor of mortality in community-dwelling older adults with Chagas disease: 10-year follow-up of the Bambui Cohort Study of Aging. Am J Epidemiol 2010; 172:190-6. [PMID: 20581155 DOI: 10.1093/aje/kwq106] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In this study, the authors aimed to investigate the prognostic value of brain-type natriuretic peptide (BNP) for all-cause mortality among persons with Chagas disease, a parasitic disease caused by the protozoan Trypanosoma cruzi. The authors used data on 1,398 participants (37.5% infected with T. cruzi) aged 60 years and over from the Bambuí Cohort Study of Aging in Brazil. From 1997 to 2007, 512 participants died, leading to 12,406 person-years of observation. The hazard ratio for death was 1.27 for each unit of log-transformed BNP level (95% confidence interval (CI: 1.11, 1.45) among infected persons, independent of potentially confounding factors. Infected persons with baseline BNP levels in the top quartile had a risk of death twice that of persons in the bottom quartile (hazard ratio = 2.07, 95% CI: 1.29, 3.32). The discriminatory ability of BNP in predicting mortality (C = 0.69, 95% CI: 0.66, 0.71) was similar to that of an electrocardiogram (C = 0.68, 95% CI: 0.65, 0.71), with reasonably stable risk discrimination over time. BNP is a strong predictor of mortality in older adults with Chagas disease. Although the usefulness of BNP for risk stratification in this parasitic disease remains a topic of debate, this study found that BNP-based risk discrimination is at least comparable to that of an electrocardiogram.
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86
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Briceño L, Rodríguez EM, Medina M, Campos Y, Mosca W, Briceño A, León G. An inexpensive antigen for serodiagnosis of Chagas' disease. Invest Clin 2010; 51:101-113. [PMID: 20815160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED In this prospective study we evaluated the performance characteristics of a specific and sensitive antigen preparation (AgA) used in an enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Trypanosoma cruzi antibodies in serum samples, for Chagas' disease diagnosis. The antigen production was achieved by combination of nutritional stress and autoclaving the parasites. Specificity and sensitivity were evaluated in two separate tests, using 152 sera from healthy individuals and 175 sera from Chagas' patients (70 by xenodiagnosis). Cross-reactivity was tested using 289 sera from patients who had a parasitological diagnosis of a disease known to induce antigenic responses towards T. cruzi. All of these sera were tested with our AgA-ELISA and with 3 commercial diagnosis kits. To evaluate the agreement of results between our AgA-ELISA and a "gold standard" test for Chagas, we tested 566 sera from an endemic area. RESULTS sensitivity and specificity were 100%; cross-reactivity was the lowest compared with commercial kits. Overall agreement with the gold standard test was excellent (kappa = 0.92). AgA-ELISA exhibits levels of sensitivity, specificity and cross-reactivity comparable or superior to those shown, obtained with the commercial kits used in our country, while being at least 10 times less expensive. This balance between diagnostic accuracy and cost makes AgA-ELISA useful for blood bank screening in poor regions of the world suffering from Chagas' disease. Further validations of this antigenic formulation in other countries are necessary.
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Affiliation(s)
- Luis Briceño
- Laboratory of Physiopathology, Institute of Biomedicine, Faculty of Medicine, Central University of Venezuela.
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87
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88
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Chagas C. [New type of human trypanosomiasis]. Bull Soc Pathol Exot 2009; 102:352-355. [PMID: 20131433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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89
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Bern C, Verastegui M, Gilman RH, LaFuente C, Galdos-Cardenas G, Calderon M, Pacori J, Abastoflor MDC, Aparicio H, Brady MF, Ferrufino L, Angulo N, Marcus S, Sterling C, Maguire JH. Congenital Trypanosoma cruzi transmission in Santa Cruz, Bolivia. Clin Infect Dis 2009; 49:1667-74. [PMID: 19877966 PMCID: PMC5454522 DOI: 10.1086/648070] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We conducted a study of congenital Trypanosoma cruzi infection in Santa Cruz, Bolivia. Our objective was to apply new tools to identify weak points in current screening algorithms, and find ways to improve them. METHODS Women presenting for delivery were screened by rapid and conventional serological tests. For infants of infected mothers, blood specimens obtained on days 0, 7, 21, 30, 90, 180, and 270 were concentrated and examined microscopically; serological tests were performed for the day 90, 180, and 270 specimens. Maternal and infant specimens, including umbilical tissue, were tested by polymerase chain reaction (PCR) targeting the kinetoplast minicircle and by quantitative PCR. RESULTS Of 530 women, 154 (29%) were seropositive. Ten infants had congenital T. cruzi infection. Only 4 infants had positive results of microscopy evaluation in the first month, and none had positive cord blood microscopy results. PCR results were positive for 6 (67%) of 9 cord blood and 7 (87.5%) of 8 umbilical tissue specimens. PCR-positive women were more likely to transmit T. cruzi than were seropositive women with negative PCR results (P < .05). Parasite loads determined by quantitative PCR were higher for mothers of infected infants than for seropositive mothers of uninfected infants P < .01). Despite intensive efforts, only 58% of at-risk infants had a month 9 specimen collected. CONCLUSIONS On the basis of the low sensitivity of microscopy in cord blood and high rate of loss to follow-up, we estimate that current screening programs miss one-half of all infected infants. Molecular techniques may improve early detection.
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Affiliation(s)
- Caryn Bern
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta Georgia
| | | | - Robert H. Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Universidad Peruana Cayetano Heredia
| | | | - Gerson Galdos-Cardenas
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Hugo Aparicio
- Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura, Lima, Perú
| | - Mark F. Brady
- Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura, Lima, Perú
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90
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Galavíz-Silva L, Molina-Garza DP, González-Santos MA, Mercado-Hernández R, González-Galavíz JR, Rosales-Encina JL, Molina-Garza ZJ. Update on seroprevalence of anti-Trypanosoma cruzi antibodies among blood donors in northeast Mexico. Am J Trop Med Hyg 2009; 81:404-406. [PMID: 19706904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Chagas disease has become frequent in non-endemic areas, where it can be transmitted by blood transmission. Therefore, we explored seroprevalence of anti-Trypanosoma cruzi antibodies among blood donors at the Cardiology Hospital, Mexican Institute of Social Security at Monterrey, Nuevo León, by both an enzyme-linked immunosorbent assay and indirect hemagglutination. Blood samples from 1,000 healthy blood donors were selected. A seropositivity of 2.8% was shown among the studied population, of which 2.59% (21/809) were inhabitants of Nuevo León, whereas 3.07% (2/65) and 3.96% (5/126) were from Coahuila and Tamaulipas, respectively. Our result is higher than that of a previous study from 1998, where a prevalence of 0.5% was reported. This once again corroborates the importance of installing a surveillance program to detect and prevent the transfusion of T. cruzi from asymptomatic blood donors in blood banks located in urban cities recognized as non-endemic.
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Affiliation(s)
- Lucio Galavíz-Silva
- Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, Mexico.
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91
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Juarez-Tobias S, Vaughan G, Torres-Montoya A, Escobar-Gutierrez A. Seroprevalence of Trypanosoma cruzi among Teenek Amerindian residents of the Huasteca region in San Luis Potosi, Mexico. Am J Trop Med Hyg 2009; 81:219-222. [PMID: 19635873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Scarce information on the seroprevalence of Trypanosoma cruzi among Amerindians is available, and the distribution of this disease in Mexican Indian populations is unknown. In this study, the presence of specific antibodies against T. cruzi among Teenek Amerindians in nine different communities located in San Luis Potosi State was analyzed. An average seroprevalence of 6.5% was found in these populations, suggesting that active transmission of disease occurs in this relatively isolated population in Mexico, and therefore, further studies should be conducted to identify risk factor associated to Chagas disease in other isolated populations across the country to determine the prevalence of Chagas disease in Mexican Amerindians.
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Affiliation(s)
- Soledad Juarez-Tobias
- Laboratorio Estatal de Salud Pública de San Luis Potosí, Servicios de Salud de San Luis Potosí, Mexico, San Luis Potosí, Mexico.
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92
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Fitzwater S, Calderon M, Lafuente C, Galdos-Cardenas G, Ferrufino L, Verastegui M, Gilman RH, Bern C. Polymerase chain reaction for chronic Trypanosoma cruzi infection yields higher sensitivity in blood clot than buffy coat or whole blood specimens. Am J Trop Med Hyg 2008; 79:768-770. [PMID: 18981520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Trypanosoma cruzi polymerase chain reaction (PCR) is widely used, but sensitivity varies widely. We compared PCR using 121/122 primers targeting kinetoplast minicircle DNA in whole blood, buffy coat, and clot from Bolivian women. Sensitivity was significantly higher in clot (60.1%) than buffy coat (46.5%) or whole blood (40%). The use of clot could simplify specimen collection while improving sensitivity.
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Affiliation(s)
- Sean Fitzwater
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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93
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Pizarro JC, Stevens L. A new method for forensic DNA analysis of the blood meal in chagas disease vectors demonstrated using Triatoma infestans from Chuquisaca, Bolivia. PLoS One 2008; 3:e3585. [PMID: 18974787 PMCID: PMC2570791 DOI: 10.1371/journal.pone.0003585] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 09/17/2008] [Indexed: 11/18/2022] Open
Abstract
Background Feeding patterns of the vector are important in the epidemiology of Chagas disease, the leading cause of heart disease in Latin America. Chagas disease is caused by the parasite, Trypanasoma cruzi, which is transmitted by blood feeding insects. Historically, feeding behaviours of haematophagous insects have been investigated using serological reactions, which have detection limits in terms of both taxonomic resolution, and quantity and quality of the blood meal. They are labor intensive, require technical expertise, need fresh or frozen samples and antibodies often are either not available commercially or the resources for synthesis and purification are not available. We describe an assay to identify vertebrate blood meal sources, and the parasite T. cruzi using species-specific PCR assays from insect vectors and use the method to provide information regarding three questions: (1) Do domestic and peri-domestic (chicken coop and animal corral) habitats vary in the blood meals detected in the vectors? (2) What is the pattern of multiple blood meals? (3) Does the rate of T. cruzi infection vary among habitats and is it associated with specific blood meal types? Methodology/Principal Findings Assays based on the polymerase chain reaction were evaluated for identification of the blood meal source in the heamatophagous Chagas disease vector Triatoma infestans. We evaluate a technique to identify 11 potential vertebrate food sources from the complex mixture extracted from the vector's abdomen. We tested the assay on 81 T. infestans specimens collected from the Andean highlands in the department of Chuquisaca, located in central Bolivia, one of the regions in South America where sylvatic T. infestans have been reported. This area is suggested to be the geographic origin of T. infestans and has very high human infection rates that may be related to sylvatic vector populations. Conclusion/Significance The results of the assays revealed that a high percentage of insects collected in human dwellings had fed on peri-domestic animals. In contrast, one insect from a chicken coop but no bugs from corrals tested positive for human blood. Forty-eight percent of insects tested positive for more than one vertebrate species. T. cruzi infection was detected in 42% of the specimens. From the epidemiological point of view, the results reveal an overall pattern of movement from peri-domestic structures to human habitations for T. infestans in this region of Bolivia as well as the important role of pigs, dogs, chickens and guinea pigs in the dynamics of T. cruzi infection.
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Affiliation(s)
- Juan Carlos Pizarro
- Department of Biology, University of Vermont, Burlington, Vermont, United States of America
- Facultad de Bioquímica, Universidad de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Lori Stevens
- Department of Biology, University of Vermont, Burlington, Vermont, United States of America
- * E-mail:
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Blejer JL, Sartor PA, Bottasso O, Salamone HJ, Leguizamón MS. Trans-sialidase inhibition assay for the detection of Trypanosoma cruzi infection in blood donor samples from Argentina. Vox Sang 2008; 95:189-96. [PMID: 19121183 DOI: 10.1111/j.1423-0410.2008.01088.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Conventional serology tests for Trypanosoma cruzi blood banks screening are neither sensitive nor specific enough, and currently no gold standard assay is available. Trans-sialidase inhibition assay (TIA) detects neutralizing antibodies against T. cruzi trans-sialidase. Conventional serology inconclusive, positive and negative blood donor samples were evaluated by employing TIA as a supplementary test. MATERIALS AND METHODS Three hundred and twenty-one blood donor samples were tested using a combination of assays. Based on the results of testing, these were divided into a number of groups. All samples were tested by TIA. RESULTS In conventional serology inconclusive samples 48.1% were TIA-positive, 1/54 conventional serology positive samples was TIA-negative. All negative samples from donors without epidemiological risks were TIA-negative; 1/48 was positive in those with epidemiological risk. CONCLUSION Trans-sialidase inhibition assay application in blood banks may be useful to resolve inconclusive samples, and thus improves donor counseling and allows individual re-entry. The use of TIA in samples from negative conventional test donors but positive epidemiological antecedents may contribute to decrease transfusional risk.
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Affiliation(s)
- J L Blejer
- Transfusional Medicine Center, Favaloro Foundation, Buenos Aires, Argentina
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95
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Manoel-Caetano FDS, Carareto CMA, Borim AA, Miyazaki K, Silva AE. kDNA gene signatures of Trypanosoma cruzi in blood and oesophageal mucosa from chronic chagasic patients. Trans R Soc Trop Med Hyg 2008; 102:1102-7. [PMID: 18617206 DOI: 10.1016/j.trstmh.2008.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/28/2008] [Accepted: 05/29/2008] [Indexed: 11/18/2022] Open
Abstract
Trypanosoma cruzi presents a high degree of intraspecific variability, with possible implications for the pathogenesis of Chagas disease. The aim of this study was to evaluate T. cruzi kDNA minicircle gene signatures using the low-stringency single-specific-primer PCR technique in both peripheral blood and oesophageal mucosa from chronic chagasic patients, with or without megaesophagus, alone or in combination with cardiopathy and megacolon. It was not possible to identify a uniform pattern of shared bands between blood and oesophageal mucosa samples from individuals with the same clinical form or mixed forms, suggesting multiple T. cruzi infections with differential tissue tropism. Thus, the results indicate that there is an intense intraspecific variability in the hypervariable regions of T. cruzi kDNA, which has so far made it impossible to correlate the genetic profile of this structure with the clinical manifestations of Chagas disease.
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96
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Wilson LS, Ramsey JM, Koplowicz YB, Valiente-Banuet L, Motter C, Bertozzi SM, Tobler LH. Cost-effectiveness of implementation methods for ELISA serology testing of Trypanosoma cruzi in California blood banks. Am J Trop Med Hyg 2008; 79:53-68. [PMID: 18606764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The first U.S. ELISA test for T. cruzi antibodies was licensed by the Food and Drug Administration (FDA) on December 13, 2006. Blood banks have begun screening in absence of FDA recommendations for best implementation methods. We surveyed 2,029 blood donors at five California sites with three risk-based Chagas risk-screening questions. Semi-Markov models compared the cost-effectiveness of three testing strategies. 30% of donors screened positively. Screening all dominated doing nothing, being less costly, and saving more lives. The choice to "screen and test" compared with "testing all" varied by Chagas prevalence, "screening and testing" being cost-effective for high (0.004) and low (0.00004) prevalences, and "testing all" cost-effective for moderate risk (0.0004). It is cost-effective to screen by ELISA rather than do nothing. The best strategy depends on site-specific risk. Census estimates of Hispanics do not predict donor risk well. We suggest using our screening questions to determine risk level and most cost-effective testing strategy.
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Affiliation(s)
- Leslie S Wilson
- University of California, San Francisco, California 94010-0613, USA.
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97
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Díaz-Bello Z, Zavala-Jaspe R, Díaz-Villalobos M, Mauriello L, Maekelt A, de Noya BA. [A confirmatory diagnosis of antibodies anti-Trypanosoma cruzi in donors referred by blood banks in Venezuela]. Invest Clin 2008; 49:141-150. [PMID: 18717262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
To establish the confirmatory diagnosis of Trypanosoma cruzi infection, at least two immunoserological tests (ELISA, Indirect hamaglutination, IH, Complement Fixation Test, CFT) were carried out in 254 donors, from public and private blood banks of Venezuela, during 48 months between 1997-1998 and 2003-2004, referred to the Immunology Section of the Tropical Medicine Institute in Caracas. Antibodies anti-T. cruzi were detected in 129/254 (50,79%) by ELISA-IgG or IH and CFT. The "artificial xenodiagnosis" was positive in 10/118 persons with positive confirmed serology. Of 129 donors found positive by the serological tests, 68 were living in the capital region and 61 in the interior of the country. Likewise 113 were born in the interior of the country, 8 in Caracas and 8 in Colombia. Of them, 12 individuals serologically confirmed declared to have donated blood in a minimum of 4 occasions before diagnosis. The present study emphasizes the importance of detection of antibodies against T. cruzi in the integral evaluation of blood donors, since many of them with antibodies anti-T. cruzi, have donated blood several times previous to diagnosis.
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Affiliation(s)
- Zoraida Díaz-Bello
- Sección de Inmunología, Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
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98
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Abstract
The Chagas' disease parasite Trypanosoma cruzi promotes survival and differentiation of neurones by binding and activating nerve growth factor (NGF) receptor TrkA. The functional mimic of NGF in T. cruzi is a surface-bound and shed immunogenic protein [neurotrophic factor/trans-sialidase (TS)], which raised the possibility that immune response to T. cruzi in general and to neurotrophic factor/TS in particular leads to loss of immunological tolerance to host NGF and/or the NGF-binding partner TrkA. In testing this hypothesis, we found that sera of individuals with chronic Chagas' disease bear unique IgG2 autoantibodies that bind TrkA and TrkA family members TrkB and TrkC (ATA). Binding of ATA to Trk receptors is specific because the autoantibodies did not cross-react with five other growth factor receptors, NGF and other neurotrophins, and T. cruzi. Thus, individuals with chronic Chagas' disease produce unique antibodies that react with pan-Trk receptors, one of which (TrkA) T. cruzi exploits to inhibit host cell apoptosis and to promote cellular invasion.
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Affiliation(s)
- B Lu
- Department of Pathology, Parasitology Research Center, Tufts University School of Medicine, Boston, MA 02111, USA
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99
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Diez CN, Manattini S, Zanuttini JC, Bottasso O, Marcipar I. The value of molecular studies for the diagnosis of congenital Chagas disease in northeastern Argentina. Am J Trop Med Hyg 2008; 78:624-627. [PMID: 18385359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Polymerase chain reaction (PCR) as a diagnostic tool for congenital Chagas disease is scarcely used. To assess the usefulness of PCR, a study in neonates was carried out to compare PCR with standard methods; that is bloodstream parasites by microhematocrit, and/or seroconversion by two conventional procedures. Seventeen neonates, born to mothers with positive Trypanosoma cruzi serology were analyzed by serologic, parasitological and molecular procedures, in blood samples taken at birth, and when aged 2-4 and 9 months. For a better comparison of sensitivity between both parasitological methods (microhematocrit and PCR), the number of samples of neonates studied at birth extended to 121. In children followed-up until 9 months of age, a 100% correlation between PCR and routine diagnosis was found, with PCR showing its highest sensitivity from Month 2 onwards. Comparative analysis between both parasitological methods, on samples taken at birth, showed a higher sensitivity of PCR respect the microhematocrit (P < 0.0008).
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Affiliation(s)
- Cristina N Diez
- Laboratorio de Tecnología Inmunológica, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina.
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100
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Serrano O, Mendoza F, Suárez B, Soto A. [Seroepidemiology of Chagas disease in two rural populations in the municipality of Costa de Oro, at Aragua State, northern Venezuela]. Biomedica 2008; 28:108-115. [PMID: 18645666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Chagas disease has been a public health problem in Latin America for many years. In Venezuela the disease is mainly distributed in the rural populations and endemic areas with an overall seroprevalence index of 8,3% for the year 2000. OBJECTIVE The infection seroprevalence of Trypanosoma cruzi was determined in the human population younger than 16 years. An the entomological index was obtained and the grade of knowledge of the Chagas disease was surveyed in the local inhabitants. MATERIALS AND METHODS A descriptive cross-sectional field study was performed in two rural communities of the municipality Costa de Oro, State Aragua, Venezuela. Here, T. cruzi-seropositive testing was conducted in subjects younger than 16 years. The samples were processed using indirect hemagglutination and by ELISA (enzyme-linked immunosorbent assay). A questionnaire was administered to assess household risk factors, and knowledge about vectors and disease held by the local population. Searches for triatomines were conducted inside of dwellings. RESULTS Seroprevalence in children less than 16 years old was 1.02%. Sixteen specimens of triatominae adults were captured. The vector species recognized were Panstrongylus geniculatus, Rhodnius pictipes, and Eratyrus mucronatus. The index of triatomid infestation with respect to site and house was respectively, 100% and 10.9%. No association was found between the seropositives and the other variables. Of the interviewed individuals, 95% knew that insects transmit diseases, but less than 46% knew that triatominds transmit Chagas disease or were aware of the disease pathology. CONCLUSION The discovery of secondary vectors in the area outlines the necessity to carry out epidemiological and entomological studies that associate environmental variables with the habitat of these insects. This will allow the identification of risk factors responsible for the transmission of Chagas disease in this region.
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Affiliation(s)
- Olga Serrano
- Corporación de Salud del Estado Aragua, Aragua, Venezuela
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