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Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverría LE, Dutra WO, Gascon J, Morillo CA, Oliveira-Filho J, Ribeiro ALP, Marin-Neto JA. Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e169-e209. [DOI: 10.1161/cir.0000000000000599] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Chagas disease, resulting from the protozoan
Trypanosoma cruzi
, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission.
Methods and Results:
The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of
T cruzi
infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease.
Conclusions:
This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.
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Schijman AG. Molecular diagnosis of Trypanosoma cruzi. Acta Trop 2018; 184:59-66. [PMID: 29476727 DOI: 10.1016/j.actatropica.2018.02.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 01/01/2023]
Abstract
Chagas disease, caused by the kinetoplastid protozoan Trypanosoma cruzi, affects millions of people, most of them neglected populations. The different phases of the disease, the transmission mode and the high genetic variability of the parasite determine that molecular detection methods display different degree of success. Molecular diagnostic tests may be employed during epidemiological surveys of transmission, for early diagnosis of congenital transmission and acute infections due to oral transmission, transfusion or transplantation routes, reactivation due to immunosuppression and monitoring of treatment response in chronically infected patients receiving trypanocidal chemotherapy. This manuscript summarizes the most widely used molecular tools to detect T. cruzi infection in different epidemiological and clinical scenarios.
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Affiliation(s)
- Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Hector Torres" (INGEBI-CONICET), Ciudad de Buenos Aires, Argentina.
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Messenger LA, Gilman RH, Verastegui M, Galdos-Cardenas G, Sanchez G, Valencia E, Sanchez L, Malaga E, Rendell VR, Jois M, Shah V, Santos N, Abastoflor MDC, LaFuente C, Colanzi R, Bozo R, Bern C. Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting. Clin Infect Dis 2018; 65:268-275. [PMID: 28369287 DOI: 10.1093/cid/cix277] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/22/2017] [Indexed: 11/13/2022] Open
Abstract
Background Congenital Trypanosoma cruzi transmission is now estimated to account for 22% of new infections, representing a significant public health problem across Latin America and internationally. Treatment during infancy is highly efficacious and well tolerated, but current assays for early detection fail to detect >50% of infected neonates, and 9-month follow-up is low. Methods Women who presented for delivery at 2 urban hospitals in Santa Cruz Department, Bolivia, were screened by rapid test. Specimens from infants of infected women were tested by microscopy (micromethod), quantitative PCR (qPCR), and immunoglobulin (Ig)M trypomastigote excreted-secreted antigen (TESA)-blots at birth and 1 month and by IgG serology at 6 and 9 months. Results Among 487 infants of 476 seropositive women, congenital T. cruzi infection was detected in 38 infants of 35 mothers (7.8%). In cord blood, qPCR, TESA-blot, and micromethod sensitivities/specificities were 68.6%/99.1%, 58.3%/99.1%, and 16.7%/100%, respectively. When birth and 1-month results were combined, cumulative sensitivities reached 84.2%, 73.7%, and 34.2%, respectively. Low birthweight and/or respiratory distress were reported in 11 (29%) infected infants. Infants with clinical signs had higher parasite loads and were significantly more likely to be detected by micromethod. Conclusions The proportion of T. cruzi-infected infants with clinical signs has fallen since the 1990s, but symptomatic congenital Chagas disease still represents a significant, albeit challenging to detect, public health problem. Molecular methods could facilitate earlier diagnosis and circumvent loss to follow-up but remain logistically and economically prohibitive for routine screening in resource-limited settings.
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Affiliation(s)
- Louisa A Messenger
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manuela Verastegui
- 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, Maryland
| | - Gerardo Sanchez
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edward Valencia
- 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
| | - Edith Malaga
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Malasa Jois
- Division of Internal Medicine, Brown University, Providence, Rhode Island
| | - Vishal Shah
- Department of Medicine, New York University, New York
| | - Nicole Santos
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | | | | | | | - Ricardo Bozo
- Hospital Municipal Camiri, Plurinational State of Bolivia
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
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Rodari P, Angheben A, Gennati G, Trezzi L, Bargiggia G, Maino M, Ruggeri M, Rampello S, Soavi L, Rizzi M. Congenital Chagas disease in a non-endemic area: Results from a control programme in Bergamo province, Northern Italy. Travel Med Infect Dis 2018; 25:31-34. [PMID: 29680285 DOI: 10.1016/j.tmaid.2018.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/30/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In non-endemic countries, one of the most important routes of transmission of Trypanosoma cruzi is vertical transmission. The objective of this work is to report the results of the screening activities for the control of congenital Chagas Disease (CD) implemented in Bergamo province between January 2014 and December 2016. METHODS The programme addressed Bolivian pregnant women settled in Bergamo province. All the eight hospitals offering antenatal and delivery care in that area were involved. We retrospectively calculated the coverage rate of the screening programme, the prevalence of CD in this population, as well as transmission rate to their offspring. RESULTS During the study period, 376 Bolivian women accounted for 387 deliveries. The coverage rate of serologic screening was 85.6%. Confirmed seropositive women were 28, accounting for a prevalence of CD of 8.7% (95% IC 5.9-11.5). Among 29 children born to positive mothers, one infected child was detected (transmission rate of 4.3%, 95% IC 0-12.6) and treated accordingly. Other 13 children previously born from the same mothers were retrieved and tested for CD: no additional congenital cases were diagnosed. DISCUSSION Our screening programme presented a high coverage, although widely variable in the different birthing facilities. National guidelines recommending CD testing in pregnant women would help to increase case detection countrywide.
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Affiliation(s)
- Paola Rodari
- Centro per le Malattie Tropicali, Ospedale Classificato Equiparato Sacro Cuore - Don Calabria, Negrar, Verona, Italy; Malattie Infettive, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy.
| | - Andrea Angheben
- Centro per le Malattie Tropicali, Ospedale Classificato Equiparato Sacro Cuore - Don Calabria, Negrar, Verona, Italy
| | | | | | - Graziano Bargiggia
- SMeL Microbiologia e Virologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marzia Maino
- Patologia Neonatale, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Laura Soavi
- Malattie Infettive, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Marco Rizzi
- Malattie Infettive, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
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Francisco-González L, Gastañaga-Holguera T, Jiménez Montero B, Daoud Pérez Z, Illán Ramos M, Merino Amador P, Herráiz Martínez MÁ, Ramos Amador JT. Seroprevalencia y transmisión vertical de enfermedad de Chagas en una cohorte de gestantes latinoamericanas en un hospital terciario de Madrid. An Pediatr (Barc) 2018; 88:122-126. [DOI: 10.1016/j.anpedi.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022] Open
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Francisco-González L, Gastañaga-Holguera T, Jiménez Montero B, Daoud Pérez Z, Illán Ramos M, Merino Amador P, Herráiz Martínez MÁ, Ramos Amador JT. Seroprevalence and vertical transmission of Chagas disease in a cohort of Latin-American pregnant women in a tertiary hospital in Madrid. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2017.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Chagas disease is an anthropozoonosis from the American continent that has spread from its original boundaries through migration. It is caused by the protozoan Trypanosoma cruzi, which was identified in the first decade of the 20th century. Once acute infection resolves, patients can develop chronic disease, which in up to 30-40% of cases is characterised by cardiomyopathy, arrhythmias, megaviscera, and, more rarely, polyneuropathy and stroke. Even after more than a century, many challenges remain unresolved, since epidemiological control and diagnostic, therapeutic, and prognostic methods must be improved. In particular, the efficacy and tolerability profile of therapeutic agents is far from ideal. Furthermore, the population affected is older and more complex (eg, immunosuppressed patients and patients with cancer). Nevertheless, in recent years, our knowledge of Chagas disease has expanded, and the international networking needed to change the course of this deadly disease during the 21st century has begun.
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Affiliation(s)
- José A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain.
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain; International Health Program of the Catalan Institute of Health, Barcelona, Spain
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Buekens P, Cafferata ML, Alger J, Althabe F, Belizán JM, Bustamante N, Carlier Y, Ciganda A, Del Cid JH, Dumonteil E, Gamboa-León R, García JA, Gibbons L, Graiff O, Maldonado JG, Herrera C, Howard E, Lara LS, López B, Matute ML, Ramírez-Sierra MJ, Robles MC, Sosa-Estani S, Truyens C, Valladares C, Wesson DM, Zúniga C, For The Congenital Chagas Working Group. Congenital Transmission of Trypanosoma cruzi in Argentina, Honduras, and Mexico: An Observational Prospective Study. Am J Trop Med Hyg 2017; 98:478-485. [PMID: 29210352 DOI: 10.4269/ajtmh.17-0516] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Compared with South America, there is a lack of epidemiologic studies about the risk of congenital transmission of Trypanosoma cruzi in Central America and Mexico. It has been suggested that T. cruzi genotypes might differ by region and that congenital transmission might vary according to the parasite's genotype. Our objective was to compare T. cruzi congenital transmission rates in three countries. We performed an observational prospective study in 2011-2014 enrolling women at delivery in one hospital in Argentina, two hospitals in Honduras, and two hospitals in Mexico. Congenital T. cruzi infection was defined as the presence of one or more of the following criteria: presence of parasites in cord blood (direct parasitological microscopic examination) with positive polymerase chain reaction (PCR) in cord blood, presence of parasites in infant's blood at 4-8 weeks (direct parasitological microscopic examination), and persistence of T. cruzi-specific antibodies at 10 months, as measured by at least two tests. Among 28,145 enrolled women, 347 had at least one antibody rapid test positive in cord blood and a positive enzyme-linked immunosorbent assay in maternal blood. PCR in maternal blood was positive in 73.2% of the cases, and genotyping identified a majority of non-TcI in the three countries. We found no (0.0%; 95% confidence interval [CI]: 0.0, 2.0) confirmed congenital case in Honduras. Congenital transmission was 6.6% (95% CI: 3.1, 12.2) in Argentina and 6.3% (95% CI: 0.8, 20.8) in Mexico. Trypanosoma cruzi non-TcI predominated and risks of congenital transmission were similar in Argentina and Mexico.
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Affiliation(s)
- Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - María Luisa Cafferata
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | - Jackeline Alger
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Fernando Althabe
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - José M Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Yves Carlier
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Alvaro Ciganda
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | | | - Eric Dumonteil
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Jorge A García
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Olga Graiff
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Jesús Gurubel Maldonado
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, México
| | - Claudia Herrera
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Elizabeth Howard
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Laura Susana Lara
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | | | - María Luisa Matute
- Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - María Jesús Ramírez-Sierra
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, México
| | - María Cecilia Robles
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben," CONICET, ANLIS, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Carine Truyens
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Valladares
- Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Dawn M Wesson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Concepción Zúniga
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
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Suescún SH, García C, Valdivieso S. Prevalencia de anticuerpos contra Trypanosoma cruzi en mujeres embarazadas de zonas endémicas del departamento de Boyacá, Colombia. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n4a01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Murcia L, Simón M, Carrilero B, Roig M, Segovia M. Treatment of Infected Women of Childbearing Age Prevents Congenital Trypanosoma cruzi Infection by Eliminating the Parasitemia Detected by PCR. J Infect Dis 2017; 215:1452-1458. [PMID: 28201741 DOI: 10.1093/infdis/jix087] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background We evaluated the effectiveness of treating women of childbearing age with benznidazole to prevent congenital Chagas disease (CCD), as well as the usefulness of polymerase chain reaction (PCR) as a tool to predict the risk of transmission. Methods Prospective study involving 144 T. cruzi seropositive pregnant women. The parasitological status was studied by PCR in 159 pregnancies, 38 of which involved a cohort of previously treated mothers. One hundred sixty children were examined by PCR and serologically studied at 0-6, 9 and 12 months and annually after treatment. Results PCR was seen to be useful for predicting the risk of congenital transmission: 18.8% of mothers with a positive PCR result transmitted the infection (16 infected children out of 85 pregnancies). No infected infants were detected among 74 pregnancies when PCR was negative. Of the treated mothers, 92.1% had negative PCR results, compared with 32.2% of untreated mothers. No infected infants were detected from previously treated mothers, compared with 13.2% among untreated mothers (P = .019; χ2). All infants treated before the first year of life were cured. Conclusions Treating infected women of childbearing age prevents congenital Chagas disease. Polymerase chain reaction screening of T. cruzi-infected pregnant women is a useful tool for predicting the risk of congenital transmission.
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Affiliation(s)
- Laura Murcia
- Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, and.,Departamento de Genética y Microbiología, Universidad de Murcia, Espinardo Murcia, Spain
| | - Marina Simón
- Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca,El Palmar, and
| | - Bartolomé Carrilero
- Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca,El Palmar, and
| | - Mercedes Roig
- Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca,El Palmar, and
| | - Manuel Segovia
- Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, and.,Departamento de Genética y Microbiología, Universidad de Murcia, Espinardo Murcia, Spain
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de Souza AS, de Oliveira MT, Andricopulo AD. Development of a pharmacophore for cruzain using oxadiazoles as virtual molecular probes: quantitative structure–activity relationship studies. J Comput Aided Mol Des 2017; 31:801-816. [DOI: 10.1007/s10822-017-0039-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
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62
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Mizzaci CC, Souza TGSE, Targueta GP, Tótora APF, Mateos JCP, Mateos JCP. Pacemaker Implants in Children and Adolescents with Chagas Disease in Brazil: 18-Year Incidence. Arq Bras Cardiol 2017; 108:546-551. [PMID: 28699977 PMCID: PMC5489325 DOI: 10.5935/abc.20170074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/30/2016] [Indexed: 12/01/2022] Open
Abstract
Background: Chagas disease continues to be a serious public health problem, and accounts
for 25-30% of the indications for cardiac stimulation in Brazil. Objective: To assess clinical and epidemiological characteristics of patients with
Chagas disease, younger than 18 years, who had undergone pacemaker
implantation in Brazil between 1994 and 2011, and its temporal trend. Methods: This was a cross-sectional analysis of data from the Brazilian Pacemaker
Registry database. The following variables were analyzed: year when
pacemaker was implanted, location, age, sex, ethnic group, functional class
and the main electrocardiographic findings at baseline. Results: In a total of 183,123 implants performed between 1994 and 2011, 214 implants
of cardiac stimulation device in Chagas disease patients aged younger than
18 years were identified. Mean age at implantation was 5.6 ± 6.2
years. Second- and third-degree atrioventricular blocks corresponded to 71%
of indications for pacemaker implantation. Fifty-six percent of the
procedures were performed in the southeast region. Regarding the total
number of pacemaker implants per year, there was a remarkable increase in
the implants for all causes. However, time series analysis of the implants
in Chagas disease patients younger than 18 years revealed a significant
reduction in the annual number of implants. Conclusion: There has been an important reduction in the number of pacemaker
implantations among children and adolescents with Chagas disease, suggesting
a reduction in the vertical transmission of the parasite.
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63
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Abras A, Muñoz C, Ballart C, Berenguer P, Llovet T, Herrero M, Tebar S, Pinazo MJ, Posada E, Martí C, Fumadó V, Bosch J, Coll O, Juncosa T, Ginovart G, Armengol J, Gascón J, Portús M, Gállego M. Towards a New Strategy for Diagnosis of Congenital Trypanosoma cruzi Infection. J Clin Microbiol 2017; 55:1396-1407. [PMID: 28202792 PMCID: PMC5405257 DOI: 10.1128/jcm.02248-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/07/2017] [Indexed: 01/04/2023] Open
Abstract
The immigration of Latin American women of childbearing age has spread the congenital transmission of Chagas disease to areas of nonendemicity, and the disease is now a worldwide problem. Some European health authorities have implemented screening programs to prevent vertical transmission, but the lack of a uniform protocol calls for the urgent establishment of a new strategy common to all laboratories. Our aims were to (i) analyze the trend of passive IgG antibodies in the newborn by means of five serological tests for the diagnosis and follow-up of congenital Trypanosoma cruzi infection, (ii) assess the utility of these techniques for diagnosing a congenital transmission, and (iii) propose a strategy for a prompt, efficient, and cost-effective diagnosis of T. cruzi infection. In noninfected newborns, a continuous decreasing trend of passive IgG antibodies was observed, but none of the serological assays seroreverted in any the infants before 12 months. From 12 months onwards, serological tests achieved negative results in all the samples analyzed, with the exception of the highly sensitive chemiluminescent microparticle immunoassay (CMIA). In contrast, in congenitally infected infants, the antibody decline was detected only after treatment initiation. In order to improve the diagnosis of congenital T. cruzi infection, we propose a new strategy involving fewer tests that allows significant cost savings. The protocol could start 1 month after birth with a parasitological test and/or a PCR. If negative, a serological test would be carried out at 9 months, which if positive, would be followed by another at around 12 months for confirmation.
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Affiliation(s)
- Alba Abras
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Laboratori d'Ictiologia Genètica, Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Cristina Ballart
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Pere Berenguer
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Llovet
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Mercedes Herrero
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Silvia Tebar
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - María-Jesús Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Elizabeth Posada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Carmen Martí
- Unitat de Microbiologia, Hospital General de Granollers, Granollers, Spain
| | - Victoria Fumadó
- Servei de Pediatria, Unitat de Medicina Importada, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Jordi Bosch
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Servei de Microbiologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Oriol Coll
- Departament de Medicina Materno-Fetal, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Juncosa
- Servei de Microbiologia, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Gemma Ginovart
- Unitat de Neonatologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Armengol
- Servei de Ginecologia i Obstetrícia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquim Gascón
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Montserrat Portús
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gállego
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
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Dias JCP, Ramos Jr. AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, Torres RM, Melo JRDC, Almeida EAD, Oliveira Jr. WD, Silveira AC, Rezende JMD, Pinto FS, Ferreira AW, Rassi A, Fragata Filho AA, Sousa ASD, Correia D, Jansen AM, Andrade GMQ, Britto CFDPDC, Pinto AYDN, Rassi Jr. A, Campos DE, Abad-Franch F, Santos SE, Chiari E, Hasslocher-Moreno AM, Moreira EF, Marques DSDO, Silva EL, Marin-Neto JA, Galvão LMDC, Xavier SS, Valente SADS, Carvalho NB, Cardoso AV, Silva RAE, Costa VMD, Vivaldini SM, Oliveira SM, Valente VDC, Lima MM, Alves RV. 2 nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop 2016; 49Suppl 1:3-60. [DOI: 10.1590/0037-8682-0505-2016] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
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Sears AE, Palczewski K. Lecithin:Retinol Acyltransferase: A Key Enzyme Involved in the Retinoid (visual) Cycle. Biochemistry 2016; 55:3082-91. [PMID: 27183166 DOI: 10.1021/acs.biochem.6b00319] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lecithin:retinol acyltransferase (LRAT) catalyzes the acyl transfer from the sn-1 position of phosphatidylcholine (PC) to all-trans-retinol, creating fatty acid retinyl esters (palmitoyl, stearoyl, and some unsaturated derivatives). In the eye, these retinyl esters are substrates for the 65 kDa retinoid isomerase (RPE65). LRAT is well characterized biochemically, and recent structural data from closely related family members of the NlpC/P60 superfamily and a chimeric protein have established its catalytic mechanism. Mutations in the LRAT gene are responsible for approximately 1% of reported cases of Leber congenital amaurosis (LCA). Lack of functional LRAT, expressed in the retinal pigmented epithelium (RPE), results in loss of the visual chromophore and photoreceptor degeneration. LCA is a rare hereditary retinal dystrophy with an early onset associated with mutations in one of 21 known genes. Protocols have been devised to identify therapeutics that compensate for mutations in RPE65, also associated with LCA. The same protocols can be adapted to combat dystrophies associated with LRAT. Improvement in the visual function of clinical recipients of therapy with recombinant adeno-associated virus (rAAV) vectors incorporating the RPE65 gene provides a proof of concept for LRAT, which functions in the same cell type and metabolic pathway as RPE65. In parallel, a clinical trial that employs oral 9-cis-retinyl acetate to replace the missing chromophore in RPE65 and LRAT causative disease has proven to be effective and free of adverse effects. This article summarizes the biochemistry of LRAT and examines chromophore replacement as a treatment for LCA caused by LRAT mutations.
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Affiliation(s)
- Avery E Sears
- Cleveland Center for Membrane and Structural Biology, Department of Pharmacology, School of Medicine, Case Western Reserve University , 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Krzysztof Palczewski
- Cleveland Center for Membrane and Structural Biology, Department of Pharmacology, School of Medicine, Case Western Reserve University , 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
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Mice with Genetic Deletion of Group VIA Phospholipase A2β Exhibit Impaired Macrophage Function and Increased Parasite Load in Trypanosoma cruzi-Induced Myocarditis. Infect Immun 2016; 84:1137-1142. [PMID: 26857573 DOI: 10.1128/iai.01564-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/20/2022] Open
Abstract
Trypanosoma cruzi infection, which is the etiological agent of Chagas disease, is associated with intense inflammation during the acute and chronic phases. The pathological progression of Chagas disease is influenced by the infiltration and transmigration of inflammatory cells across the endothelium to infected tissues, which are carefully regulated processes involving several molecular mediators, including adhesion molecules and platelet-activating factor (PAF). We have shown that PAF production is dependent upon calcium-independent group VIA phospholipase A2β (iPLA2β) following infection of human coronary artery endothelial cells (HCAECs) with T. cruzi, suggesting that the absence of iPLA2β may decrease the recruitment of inflammatory cells to the heart to manage parasite accumulation. Cardiac endothelial cells isolated from iPLA2β-knockout (iPLA2β-KO) mice infected withT. cruzi demonstrated decreased PAF production compared to that by cells isolated from wild-type (WT) mice but demonstrated increases in adhesion molecule expression similar to those seen in WT mice. Myocardial inflammation in iPLA2β-KO mice infected with T. cruzi was similar in severity to that in WT mice, but the iPLA2β-KO mouse myocardium contained more parasite pseudocysts. Upon activation, macrophages from iPLA2β-KO mice produced significantly less nitric oxide (NO) and caused lessT. cruzi inhibition than macrophages from wild-type mice. Thus, the absence of iPLA2β activity does not influence myocardial inflammation, but iPLA2β is essential forT. cruzi clearance.
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Gastañaga Holguera T, Llorente-Gomez B, Merino P, Illescas T, Villar G, Herraiz MA. Hydrops fetalis in a congenital chagas case in a non-endemic area. J OBSTET GYNAECOL 2016; 36:672-3. [PMID: 26940819 DOI: 10.3109/01443615.2016.1148680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Paloma Merino
- c Department of Microbiology , Hospital Clinico San Carlos , Madrid , Spain
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68
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Use of a Chagas Urine Nanoparticle Test (Chunap) to Correlate with Parasitemia Levels in T. cruzi/HIV Co-infected Patients. PLoS Negl Trop Dis 2016; 10:e0004407. [PMID: 26919324 PMCID: PMC4768913 DOI: 10.1371/journal.pntd.0004407] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early diagnosis of reactivated Chagas disease in HIV patients could be lifesaving. In Latin America, the diagnosis is made by microscopical detection of the T. cruzi parasite in the blood; a diagnostic test that lacks sensitivity. This study evaluates if levels of T. cruzi antigens in urine, determined by Chunap (Chagas urine nanoparticle test), are correlated with parasitemia levels in T. cruzi/HIV co-infected patients. METHODOLOGY/PRINCIPAL FINDINGS T. cruzi antigens in urine of HIV patients (N = 55: 31 T. cruzi infected and 24 T. cruzi serology negative) were concentrated using hydrogel particles and quantified by Western Blot and a calibration curve. Reactivation of Chagas disease was defined by the observation of parasites in blood by microscopy. Parasitemia levels in patients with serology positive for Chagas disease were classified as follows: High parasitemia or reactivation of Chagas disease (detectable parasitemia by microscopy), moderate parasitemia (undetectable by microscopy but detectable by qPCR), and negative parasitemia (undetectable by microscopy and qPCR). The percentage of positive results detected by Chunap was: 100% (7/7) in cases of reactivation, 91.7% (11/12) in cases of moderate parasitemia, and 41.7% (5/12) in cases of negative parasitemia. Chunap specificity was found to be 91.7%. Linear regression analysis demonstrated a direct relationship between parasitemia levels and urine T. cruzi antigen concentrations (p<0.001). A cut-off of > 105 pg was chosen to determine patients with reactivation of Chagas disease (7/7). Antigenuria levels were 36.08 times (95% CI: 7.28 to 64.88) higher in patients with CD4+ lymphocyte counts below 200/mL (p = 0.016). No significant differences were found in HIV loads and CD8+ lymphocyte counts. CONCLUSION Chunap shows potential for early detection of Chagas reactivation. With appropriate adaptation, this diagnostic test can be used to monitor Chagas disease status in T. cruzi/HIV co-infected patients.
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Carlier Y, Truyens C. Congenital Chagas disease as an ecological model of interactions between Trypanosoma cruzi parasites, pregnant women, placenta and fetuses. Acta Trop 2015; 151:103-15. [PMID: 26293886 DOI: 10.1016/j.actatropica.2015.07.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
The aim of this paper is to discuss the main ecological interactions between the parasite Trypanosoma cruzi and its hosts, the mother and the fetus, leading to the transmission and development of congenital Chagas disease. One or several infecting strains of T. cruzi (with specific features) interact with: (i) the immune system of a pregnant woman whom responses depend on genetic and environmental factors, (ii) the placenta harboring its own defenses, and, finally, (iii) the fetal immune system displaying responses also susceptible to be modulated by maternal and environmental factors, as well as his own genetic background which is different from her mother. The severity of congenital Chagas disease depends on the magnitude of such final responses. The paper is mainly based on human data, but integrates also complementary observations obtained in experimental infections. It also focuses on important gaps in our knowledge of this congenital infection, such as the role of parasite diversity vs host genetic factors, as well as that of the maternal and placental microbiomes and the microbiome acquisition by infant in the control of infection. Investigations on these topics are needed in order to improve the programs aiming to diagnose, manage and control congenital Chagas disease.
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Affiliation(s)
- Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), CP 616, Route de Lennik 808, 1070 Bruxelles, Belgium; Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, Suite 2210, 1440 Canal Street, New Orleans, LA 70112-2797, USA.
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), CP 616, Route de Lennik 808, 1070 Bruxelles, Belgium.
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Messenger LA, Miles MA, Bern C. Between a bug and a hard place: Trypanosoma cruzi genetic diversity and the clinical outcomes of Chagas disease. Expert Rev Anti Infect Ther 2015; 13:995-1029. [PMID: 26162928 PMCID: PMC4784490 DOI: 10.1586/14787210.2015.1056158] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the last 30 years, concomitant with successful transnational disease control programs across Latin America, Chagas disease has expanded from a neglected, endemic parasitic infection of the rural poor to an urbanized chronic disease, and now a potentially emergent global health problem. Trypanosoma cruzi infection has a highly variable clinical course, ranging from complete absence of symptoms to severe and often fatal cardiovascular and/or gastrointestinal manifestations. To date, few correlates of clinical disease progression have been identified. Elucidating a putative role for T. cruzi strain diversity in Chagas disease pathogenesis is complicated by the scarcity of parasites in clinical specimens and the limitations of our contemporary genotyping techniques. This article systematically reviews the historical literature, given our current understanding of parasite genetic diversity, to evaluate the evidence for any association between T. cruzi genotype and chronic clinical outcome, risk of congenital transmission or reactivation and orally transmitted outbreaks.
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Affiliation(s)
- Louisa A Messenger
- Department of Pathogen Molecular Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael A Miles
- Department of Pathogen Molecular Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Caryn Bern
- Global Health Sciences, Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Pérez-Molina JA, Perez AM, Norman FF, Monge-Maillo B, López-Vélez R. Old and new challenges in Chagas disease. THE LANCET. INFECTIOUS DISEASES 2015; 15:1347-56. [PMID: 26231478 DOI: 10.1016/s1473-3099(15)00243-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 12/17/2022]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected disease, which can lead to cardiomyopathy, arrhythmias, megaviscera, and more rarely, polyneuropathy in up to 30-40% of patients around 20 to 30 years after acute infection. Although it is endemic in the Americas, global population movements mean that it can be located wherever migrants from endemic areas settle. The disease was first described 100 years ago and still challenges clinicians worldwide, since diagnostic, therapeutic, and prognostic methods remain insufficient. Furthermore, factors such as HIV co-infection, immunosuppressive drugs, transplantation, and neoplastic disease can alter the natural course of the infection. We present the case of a Bolivian woman with chronic T cruzi infection diagnosed at our clinic in Madrid, Spain, who subsequently developed non-Hodgkin lymphoma. Our report illustrates the challenges of an increasingly common infection seen in non-endemic countries, and highlights both daily management dilemmas and associated difficulties that arise.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain.
| | - Angela Martinez Perez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Francesca F Norman
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
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Volta BJ, Russomando G, Bustos PL, Scollo K, De Rissio AM, Sánchez Z, Cardoni RL, Bua J. Diagnosis of congenital Trypanosoma cruzi infection: A serologic test using Shed Acute Phase Antigen (SAPA) in mother-child binomial samples. Acta Trop 2015; 147:31-7. [PMID: 25847262 DOI: 10.1016/j.actatropica.2015.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/21/2015] [Accepted: 03/27/2015] [Indexed: 11/25/2022]
Abstract
Chagas congenital infection is an important health problem in endemic and non-endemic areas in which Trypanosoma cruzi-infected women can transmit the parasite to their offspring. In this study, we evaluated the antibody levels against the T. cruzi Shed Acute Phase Antigen (SAPA) in 91 binomial samples of seropositive pregnant women and their infected and non-infected children by ELISA. In 70 children without congenital T. cruzi transmission, the titers of anti-SAPA antibodies were lower than those of their seropositive mothers. In contrast, 90.5% of 21 congenitally infected children, at around 1 month of age, showed higher anti-SAPA antibody levels than their mothers. Subtracting the SAPA-ELISA mother OD value to the SAPA-ELISA child OD allowed efficient detection of most T. cruzi congenitally infected children immediately after birth, when total anti-parasite antibodies transferred during pregnancy are still present in all children born to seropositive women. A positive correlation was observed between parasitemia levels in mothers and infants evaluated by quantitative DNA amplification and anti-SAPA antibody titers by ELISA. As SAPA serology has proved to be very efficient to detect T. cruzi infection in mother-child binomial samples, it could be of extreme help for early diagnosis of newborns, in maternities and hospitals where DNA amplification is not available. This prompt diagnosis may prevent drop out of the long-term follow-up for future diagnosis and may ensure early trypanocidal treatment, which has proved to be efficient to cure infants with congenital Chagas disease.
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73
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Kaplinski M, Jois M, Galdos-Cardenas G, Rendell VR, Shah V, Do RQ, Marcus R, Pena MSB, Abastoflor MDC, LaFuente C, Bozo R, Valencia E, Verastegui M, Colanzi R, Gilman RH, Bern C. Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia. Clin Infect Dis 2015; 61:918-26. [PMID: 26063720 DOI: 10.1093/cid/civ446] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/02/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women. METHODS Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). RESULTS Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. CONCLUSIONS We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.
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Affiliation(s)
- Michelle Kaplinski
- Department of Cardiology, Children's Hospital of Philadelphia, Pennsylvania
| | - Malasa Jois
- Division of Internal Medicine, Brown University, Providence, Rhode Island
| | - Gerson Galdos-Cardenas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Universidad Católica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | | | - Vishal Shah
- Saint Louis University School of Medicine, Missouri
| | - Rose Q Do
- Department of Cardiology, University of Colorado, Denver
| | - Rachel Marcus
- Department of Cardiology, Washington Hospital Center, Washington, District of Columbia
| | | | | | | | - Ricardo Bozo
- Camiri Municipal Hospital, Camiri, Plurinational State of Bolivia
| | - Edward Valencia
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuela Verastegui
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rony Colanzi
- Universidad Católica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine
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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] [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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Edwards MS, Rench MA, Todd CW, Czaicki N, Steurer FJ, Bern C, Montgomery SP. Perinatal Screening for Chagas Disease in Southern Texas. J Pediatric Infect Dis Soc 2015; 4:67-70. [PMID: 26407360 PMCID: PMC10165846 DOI: 10.1093/jpids/pit056] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 06/11/2013] [Indexed: 11/14/2022]
Abstract
Perinatal screening for Trypanosoma cruzi in a cohort of 4000 predominantly Hispanic women in southern Texas revealed that Chagas disease occurs with sufficient frequency (0.25%) that targeted perinatal screening should be considered to identify infected mothers and infants at risk for congenital infection.
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Affiliation(s)
- Morven S Edwards
- Section of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Marcia A Rench
- Section of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Charles W Todd
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy Czaicki
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Francis J Steurer
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan P Montgomery
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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76
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Pritt BS. Molecular Diagnostics in the Diagnosis of Parasitic Infection. METHODS IN MICROBIOLOGY 2015. [DOI: 10.1016/bs.mim.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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77
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Castro-Sesquen YE, Gilman RH, Galdos-Cardenas G, Ferrufino L, Sánchez G, Valencia Ayala E, Liotta L, Bern C, Luchini A. Use of a novel chagas urine nanoparticle test (chunap) for diagnosis of congenital chagas disease. PLoS Negl Trop Dis 2014; 8:e3211. [PMID: 25275534 PMCID: PMC4183489 DOI: 10.1371/journal.pntd.0003211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background Detection of congenital T. cruzi transmission is considered one of the pillars of control programs of Chagas disease. Congenital transmission accounts for 25% of new infections with an estimated 15,000 infected infants per year. Current programs to detect congenital Chagas disease in Latin America utilize microscopy early in life and serology after 6 months. These programs suffer from low sensitivity by microscopy and high loss to follow-up later in infancy. We developed a Chagas urine nanoparticle test (Chunap) to concentrate, preserve and detect T. cruzi antigens in urine for early, non-invasive diagnosis of congenital Chagas disease. Methodology/Principal Findings This is a proof-of-concept study of Chunap for the early diagnosis of congenital Chagas disease. Poly N-isopropylacrylamide nano-particles functionalized with trypan blue were synthesized by precipitation polymerization and characterized with photon correlation spectroscopy. We evaluated the ability of the nanoparticles to capture, concentrate and preserve T. cruzi antigens. Urine samples from congenitally infected and uninfected infants were then concentrated using these nanoparticles. The antigens were eluted and detected by Western Blot using a monoclonal antibody against T. cruzi lipophosphoglycan. The nanoparticles concentrate T. cruzi antigens by 100 fold (western blot detection limit decreased from 50 ng/ml to 0.5 ng/ml). The sensitivity of Chunap in a single specimen at one month of age was 91.3% (21/23, 95% CI: 71.92%–98.68%), comparable to PCR in two specimens at 0 and 1 month (91.3%) and significantly higher than microscopy in two specimens (34.8%, 95% CI: 16.42%–57.26%). Chunap specificity was 96.5% (71/74 endemic, 12/12 non-endemic specimens). Particle-sequestered T. cruzi antigens were protected from trypsin digestion. Conclusion/Significance Chunap has the potential to be developed into a simple and sensitive test for the early diagnosis of congenital Chagas disease. Congenital Chagas disease is one of the main pillars for the control of Chagas disease because 25% of new infections occur by this route. Conventional diagnosis of congenital Chagas disease is based on microscopy at birth and serology at 9 months. However microscopy misses many infections and many at-risk infants fail to complete serology at six to nine months. We have developed a Chagas urine nanoparticle test (Chunap) for concentration and detection of T. cruzi antigens. Chunap was evaluated in urine samples of 1-month old children. At this age children have the highest levels of parasitemia and therefore also excrete the highest levels of antigen. Parents prefer a urine test to having their baby's blood drawn. Chunap diagnosed congenital infection in a single urine sample as well as PCR in two blood samples. This study also shows that hydrogel/trypan blue particles used in our test efficiently capture, concentrate and protect urinary T. cruzi antigens from enzymatic degradation. Chunap allows for the early diagnosis of congenital Chagas disease, and with appropriate adaptation, may allow early point-of-care intervention.
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Affiliation(s)
- Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins University, Bloomberg School of Hygiene and Public Health, Baltimore, Maryland, United States of America; Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins University, Bloomberg School of Hygiene and Public Health, Baltimore, Maryland, United States of America
| | - Gerson Galdos-Cardenas
- Department of International Health, Johns Hopkins University, Bloomberg School of Hygiene and Public Health, Baltimore, Maryland, United States of America
| | | | - Gerardo Sánchez
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edward Valencia Ayala
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lance Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, Virginia, United States of America
| | - Caryn Bern
- Global Health Sciences, Department of Epidemiology and Biostatistics School of Medicine, University of California, San Francisco, California, United States of America
| | - Alessandra Luchini
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, Virginia, United States of America
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Field evaluation of the InBios Chagas detect plus rapid test in serum and whole-blood specimens in Bolivia. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1645-9. [PMID: 25274804 DOI: 10.1128/cvi.00609-14] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trypanosoma cruzi causes Chagas disease, which affects an estimated 7 million to 8 million people. Chagas disease is endemic throughout Latin America, with the highest prevalence in Bolivia. Conventional diagnosis requires a well-equipped laboratory with experienced personnel. We evaluated the Chagas Detect Plus (CDP) (InBios, Seattle, WA), a rapid immunochromatographic assay for IgG antibodies to T. cruzi. CDP performance was compared to infection status based on results obtained by indirect hemagglutination assay, immunofluorescent-antibody test, and enzyme-linked immunosorbent assay. Confirmed infection required positive results by at least 2 conventional assays. We used specimens from adults of both sexes in a general hospital in the city of Santa Cruz and from pregnant women in a hospital and children in villages in the Bolivian Chaco, an area of hyperendemicity. CDP was performed in paired whole-blood and serum specimens from 385 individuals in the two hospital studies and in 200 serum specimens from the community study. CDP showed sensitivities/specificities of 96.2% (95% confidence interval, 92.7 to 98.4)/98.8% (95.9 to 99.9) in whole blood and 99.3% (97.5 to 99.9)/96.9% (94.2 to 98.6) in serum, with no differences by sex, age group, or study site. CDP showed excellent sensitivity and specificity in our study population, comparable to those of conventional serology. The test is reliable for field surveys, requires no laboratory equipment, and performed well in serum and whole blood. The CDP could also be used for accurate maternal screening to identify neonates at risk of congenital transmission. CDP performance data in diverse geographic areas are needed to strengthen the evidence base for its use.
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Abstract
Among the world's most neglected tropical diseases, Chagas disease is vector-borne and caused by Trypanosoma cruzi. T cruzi infection is endemic to South and Central America as well as Mexico. Due to population migration, T cruzi is increasingly becoming a public health problem in nonendemic settings. Success with vector control strategies has led to a relative increase in the burden attributable to congenital transmission of T cruzi. In endemic settings, approximately 5% of infected pregnant women transmit to their offspring. Congenital T cruzi infection is generally asymptomatic and parasitological and serological testing is required for diagnosis. This review highlights research gaps with a focus on (1) improving screening, diagnostic, and treatment options and (2) designing epidemiologic studies to understand risk factors for congenital T cruzi.
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Affiliation(s)
- Hirut T. Gebrekristos
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Pierre Buekens
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Chagas' disease: pregnancy and congenital transmission. BIOMED RESEARCH INTERNATIONAL 2014; 2014:401864. [PMID: 24949443 PMCID: PMC4052072 DOI: 10.1155/2014/401864] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/11/2014] [Accepted: 04/24/2014] [Indexed: 01/15/2023]
Abstract
Chagas disease is a chronic infection that kills approximately 12,000 people a year. Mass migration of chronically infected and asymptomatic persons has caused globalization of Chagas disease and has made nonvectorial infection, including vertical and blood-borne transmission, more of a threat to human communities than vectorial infection. To control transmission, it is essential to test all pregnant women living in endemic countries and all pregnant women having migrated from, or having lived in, endemic countries. All children born to seropositive mothers should be tested not only within the first month of life but also at ~6 months and ~12 months of age. The diagnosis is made by identification of the parasite in blood before the age of 6 months and by identification of the parasite in blood and/or positive serology after 10 months of age. Follow up for a year is essential as a significant proportion of cases are initially negative and are only detected at a later stage. If the condition is diagnosed and treated early, the clinical response is excellent and the majority of cases are cured.
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Martínez-Tovar JG, Rebollar-Téllez EA, Fernández Salas I. Seroprevalence of T. cruzi infection in blood donors and Chagas cardiomyopathy in patients from the coal mining region of Coahuila, Mexico. Rev Inst Med Trop Sao Paulo 2014; 56:169-74. [PMID: 24626421 PMCID: PMC4085840 DOI: 10.1590/s0036-46652014000200014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/10/2013] [Indexed: 12/03/2022] Open
Abstract
Context and Objective: Chagas disease is considered a worldwide emerging
disease; it is endemic in Mexico and the state of Coahuila and is considered of
little relevance. The objective of this study was to determine the seroprevalence of
T. cruzi infection in blood donors and Chagas cardiomyopathy in
patients from the coal mining region of Coahuila, Mexico. Design and Setting: Epidemiological, exploratory and prospective study
in a general hospital during the period January to June 2011. Methods: We performed laboratory tests ELISA and indirect
hemagglutination in three groups of individuals: 1) asymptomatic voluntary blood
donors, 2) patients hospitalized in the cardiology department and 3) patients with
dilated cardiomyopathy. Results: There were three levels of seroprevalence: 0.31% in
asymptomatic individuals, 1.25% in cardiac patients and in patients with dilated
cardiomyopathy in 21.14%. Conclusions: In spite of having detected autochthonous cases of Chagas
disease, its importance to local public health remains to be established as well as
the details of the dynamics of transmission so that the study is still in
progress.
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Affiliation(s)
- José Gerardo Martínez-Tovar
- Doctoral Student. Hospital General de Zona No 24, Instituto Mexicano del Seguro Social, Nueva RositaCoahuila, México, Doctoral Student. Hospital General de Zona No 24, Instituto Mexicano del Seguro Social, Nueva Rosita, Coahuila, México
| | - Eduardo A Rebollar-Téllez
- Laboratorio de Entomología Médica, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Medical Entomologist. Universidad Autónoma de Nuevo León. Facultad de Ciencias Biológicas. Laboratorio de Entomología Médica
| | - Ildefonso Fernández Salas
- Laboratorio de Entomología Médica, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Medical Entomologist. Universidad Autónoma de Nuevo León. Facultad de Ciencias Biológicas. Laboratorio de Entomología Médica
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Martins-Melo FR, Lima MDS, Ramos AN, Alencar CH, Heukelbach J. Prevalence of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in Brazil: a systematic review and meta-analysis. Trop Med Int Health 2014; 19:943-57. [PMID: 24815954 DOI: 10.1111/tmi.12328] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the prevalence of Chagas disease in pregnant women and the risk of congenital transmission of Trypanosoma cruzi infection in Brazil, through a systematic review and meta-analysis. METHODS We searched electronic databases, grey literature and reference lists of included publications to identify epidemiological studies on the prevalence of Chagas disease in pregnant women and on the congenital transmission rate of T. cruzi infection in Brazil published between January 1980 and June 2013. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using fixed- and random-effects models. RESULTS Sixteen articles were included - 12 studies on the prevalence of Chagas disease in pregnant women (549,359 pregnant women) and nine on congenital transmission rates (1687 children born to infected mothers). Prevalence of Chagas disease in pregnant women ranged from 0.1% to 8.5%, and congenital transmission rates from 0% to 5.2%. The pooled prevalence of Chagas disease among pregnant women across studies was 1.1% (95% CI: 0.6-2.0); the pooled congenital transmission rate was 1.7% (95% CI: 0.9-3.1). In 2010, 34,629 pregnant women were estimated to be infected with T. cruzi, and 312-1073 children born (mean: 589 cases) with congenital infection. CONCLUSION Congenital Chagas disease is a neglected public health problem in Brazil. Systematic congenital Chagas disease control programs through routine prenatal screening for T. cruzi should be widely implemented in Brazil's endemic areas, to identify infected pregnant women and newborns at risk of congenital infection.
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83
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Norman FF, López-Vélez R. Mother-to-child transmission of Trypanosoma cruzi infection (Chagas disease): a neglected problem. Trans R Soc Trop Med Hyg 2014; 108:388-90. [PMID: 24771504 DOI: 10.1093/trstmh/tru062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Congenital Chagas disease may be considered a global health problem and the underdiagnosis of congenital infections should be a matter of concern. Vertical transmission is an important mode of transmission of Trypanosoma cruzi infection in non-endemic areas. Treatment in the early phases of the infection can prevent progression of the disease and is curative in the majority of cases. Prevention strategies should focus on early detection and treatment of congenital cases, screening at-risk women during pregnancy and treatment of non-pregnant women of childbearing age. Management of congenital Chagas disease and T. cruzi infection during pregnancy is discussed.
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Affiliation(s)
- Francesca F Norman
- Tropical Medicine Centre, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Madrid 28034, Spain
| | - Rogelio López-Vélez
- Tropical Medicine Centre, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Madrid 28034, Spain
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Cucunubá ZM, Valencia-Hernández CA, Puerta CJ, Sosa-Estani S, Torrico F, Cortés JA, Ramirez JD, Vera MJ, Acosta BX, Álvarez CA, Muller EÁ, Beltrán M, Bermúdez MI, Berrío M, Camacho Moreno G, Castellanos YZ, Criollo I, Flórez AC, Guerra Morales P, Herazo RA, Hernández DC, León CM, Medina Camargo M, Medina Alfonso M, Pachón E, Paez Fonseca B, Parra ML, Pavia PX, Quiróz FR, Ríos LC, Roa NL, Torres F, Uribe Rivero LM. Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas. INFECTIO 2014. [DOI: 10.1016/j.infect.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Bisio M, Altcheh J, Lattner J, Moscatelli G, Fink V, Burgos JM, Bournissen FG, Schijman AG, Freilij H. Benznidazole treatment of chagasic encephalitis in pregnant woman with AIDS. Emerg Infect Dis 2014; 19:1490-2. [PMID: 23965334 PMCID: PMC3810932 DOI: 10.3201/eid1909.130667] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of chagasic meningoencephalitis reactivation in a pregnant woman co-infected with Trypanosoma cruzi and HIV that was successfully managed with benznidazole and highly active antiretroviral therapy. Early diagnosis enabled rapid specific treatment that improved the health of the patient and her baby.
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86
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Management of Trypanosoma cruzi coinfection in HIV-positive individuals outside endemic areas. Curr Opin Infect Dis 2014; 27:9-15. [DOI: 10.1097/qco.0000000000000023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fumadó V, Juncosa T, Posada E, Fisa R, Gállego M, Gascón J. [Paediatric Chagas in a non-endemic area]. Enferm Infecc Microbiol Clin 2014; 32:293-6. [PMID: 24491481 DOI: 10.1016/j.eimc.2013.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/18/2013] [Accepted: 04/24/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Immigration has introduced new diseases into Spanish society, one of which is Chagas disease. Young women of childbearing age and children infected with Trypanosoma cruzi from endemic areas are at risk of developing the disease years later, and pregnant women can transmit the infection through the placenta. METHODS Serological screening for anti-T.cruzi antibodies was performed on all immigrant children coming from a Chagas endemic area and seen in our Pathology Unit between 2003 and 2008, as well as on newborns of T.cruzi positive infected pregnant women coming from Latin America. Two ELISA tests were used (bioelisa Chagas Biokit® with recombinant antigens, and an 'in house' ELISA with crude antigen). Patients with sufficient sample were also screened by nested PCR (TCZ3/Z4). RESULTS A total of 202 children, aged 1 day to 14 years old were included in the study, of whom 22 (10.8%) were diagnosed with asymptomatic infection, 5 of which were congenital as they were born in this country. All infected patients received treatment with benznidazole, with three of them currently with a serologically negative result after treatment. CONCLUSION Chagas disease is a new imported paediatric disease that can affect children from endemic countries, but can also be acquired in our country by vertical transmission. Therefore, we believe that it is essential to perform serological screening on all children and pregnant women in the prenatal care from endemic areas, and provide specific treatment for those infected patients, given the good results observed in the paediatric population.
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Affiliation(s)
- Victoria Fumadó
- Servicio de Pediatría, Unidad de Medicina Importada, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Teresa Juncosa
- Servicio de Microbiología, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - Elizabet Posada
- Diago Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, España
| | - Roser Fisa
- Laboratorio de Parasitología, Facultad de Farmacia, Universidad de Barcelona, Barcelona, España
| | - Montserrat Gállego
- Laboratorio de Parasitología, Facultad de Farmacia, Universidad de Barcelona, Barcelona, España
| | - Joaquim Gascón
- Diago Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, España
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Oliveira I, Torrico F, Muñoz J, Gascon J. Congenital transmission of Chagas disease: a clinical approach. Expert Rev Anti Infect Ther 2014; 8:945-56. [DOI: 10.1586/eri.10.74] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bottieau E, Vekemans M, Van Gompel A. Therapy of vector-borne protozoan infections in nonendemic settings. Expert Rev Anti Infect Ther 2014; 9:583-608. [DOI: 10.1586/eri.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Howard EJ, Xiong X, Carlier Y, Sosa-Estani S, Buekens P. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG 2014; 121:22-33. [PMID: 23924273 PMCID: PMC3914719 DOI: 10.1111/1471-0528.12396] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chagas disease is caused by the parasite Trypanosoma cruzi and is endemic in much of Latin America. With increased globalisation and immigration, it is a risk in any country, partly through congenital transmission. The frequency of congenital transmission is unclear. OBJECTIVE To assess the frequency of congenital transmission of T. cruzi. SEARCH STRATEGY PubMed, Journals@Ovid Full Text, EMBASE, CINAHL, Fuente Academica and BIREME databases were searched using seven search terms related to Chagas disease or T. cruzi and congenital transmission. SELECTION CRITERIA The inclusion criteria were the following: Dutch, English, French, Portuguese or Spanish language; case report, case series or observational study; original data on congenital T. cruzi infection in humans; congenital infection rate reported or it could be derived. This systematic review included 13 case reports/series and 51 observational studies. DATA COLLECTION AND ANALYSIS Two investigators independently collected data on study characteristics, diagnosis and congenital infection rate. The principal summary measure--the congenital transmission rate--is defined as the number of congenitally infected infants divided by the number of infants born to infected mothers. A random effects model was used. MAIN RESULTS The pooled congenital transmission rate was 4.7% (95% confidence interval: 3.9-5.6%). Countries where T. cruzi is endemic had a higher rate of congenital transmission compared with countries where it is not endemic (5.0% versus 2.7%). CONCLUSIONS Congenital transmission of Chagas disease is a global problem. Overall risk of congenital infection in infants born to infected mothers is about 5%. The congenital mode of transmission requires targeted screening to prevent future cases of Chagas disease.
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Affiliation(s)
- Elizabeth J. Howard
- Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, 1440 Canal Street, Suite 2000, New Orleans, LA 70112
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, 1440 Canal Street, Suite 2022, New Orleans, LA 70112
| | - Yves Carlier
- Université Libre de Bruxelles (ULB), Laboratoire de Parasitologie, Faculté de Médecine (CP 616), Route de Lennik 808, B-1070 Bruxelles, Belgium
- Tulane University School of Public Health and Tropical Medicine, Department of Tropical Medicine, 1440 Canal St., Suite 2210, New Orleans, LA 70112
| | - Sergio Sosa-Estani
- National Institute of Parasitology "Dr. Mario Fatala Chaben" Av. Paseo Colón 568, Buenos Aires, Argentina
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, 1440 Canal Street, Suite 2430, New Orleans, LA 70112
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Bua J, Volta BJ, Perrone AE, Scollo K, Velázquez EB, Ruiz AM, De Rissio AM, Cardoni RL. How to improve the early diagnosis of Trypanosoma cruzi infection: relationship between validated conventional diagnosis and quantitative DNA amplification in congenitally infected children. PLoS Negl Trop Dis 2013; 7:e2476. [PMID: 24147166 PMCID: PMC3798617 DOI: 10.1371/journal.pntd.0002476] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background According to the Chagas congenital transmission guides, the diagnosis of infants, born to Trypanosoma cruzi infected mothers, relies on the detection of parasites by INP micromethod, and/or the persistence of T. cruzi specific antibody titers at 10–12 months of age. Methodology and Principal Findings Parasitemia levels were quantified by PCR in T. cruzi-infected children, grouped according to the results of one-year follow-up diagnosis: A) Neonates that were diagnosed in the first month after delivery by microscopic blood examination (INP micromethod) (n = 19) had a median parasitemia of 1,700 Pe/mL (equivalent amounts of parasite DNA per mL); B) Infants that required a second parasitological diagnosis at six months of age (n = 10) showed a median parasitemia of around 20 Pe/mL and 500 Pe/mL at 1 and 6 months old, respectively, and C) babies with undetectable parasitemia by three blood microscopic observations but diagnosed by specific anti - T. cruzi serology at around 1 year old, (n = 22), exhibited a parasitemia of around 5 Pe/mL, 800 Pe/mL and 20 Pe/mL 1, 6 and 12 month after delivery, respectively. T. cruzi parasites were isolated by hemoculture from 19 congenitally infected children, 18 of which were genotypified as DTU TcV, (former lineage TcIId) and only one as TcI. Significance This report is the first to quantify parasitemia levels in more than 50 children congenitally infected with T. cruzi, at three different diagnostic controls during one-year follow-up after delivery. Our results show that the parasite burden in some children (22 out of 51) is below the detection limit of the INP micromethod. As the current trypanocidal treatment proved to be very effective to cure T. cruzi - infected children, more sensitive parasitological methods should be developed to assure an early T. cruzi congenital diagnosis. Chagas or American Trypanosomiasis is a disease that affects around 8–10 million people in Latin America, and can be transmitted by congenital infection. In areas where the vector insect and blood transfusions are controlled, this mode of transmission is epidemiologically important, as 15,000 Trypanosoma cruzi-infected children are born each year. Parasitological methods are available to detect T. cruzi but our results suggest that more sensitive diagnostic methods should be developed, as not all newborns have high parasite burdens to be detected by microscopy. If congenital infected babies are promptly diagnosed after delivery they can be cured, as the trypanocidal treatment is very effective in children and with no significant side effects.
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Affiliation(s)
- Jacqueline Bua
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
- * E-mail:
| | - Bibiana J. Volta
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
| | - Alina E. Perrone
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
| | - Karenina Scollo
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
| | - Elsa B. Velázquez
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
| | - Andres M. Ruiz
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
| | - Ana M. De Rissio
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
| | - Rita L. Cardoni
- Instituto Nacional de Parasitología (INP) Dr. M. Fatala Chaben, Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Buenos Aires, Argentina
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González-Tomé MI, Rivera M, Camaño I, Norman F, Flores-Chávez M, Rodríguez-Gómez L, Fumadó V, García-López Hortelano M, López-Vélez R, González-Granado LI, García-Burguillo A, Santos MDM, Ávila O. Recomendaciones para el diagnóstico, seguimiento y tratamiento de la embarazada y del niño con enfermedad de Chagas. Enferm Infecc Microbiol Clin 2013; 31:535-42. [DOI: 10.1016/j.eimc.2012.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
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93
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Chippaux JP, Salas-Clavijo AN, Postigo JR, Schneider D, Santalla JA, Brutus L. Evaluation of compliance to congenital Chagas disease treatment: results of a randomised trial in Bolivia. Trans R Soc Trop Med Hyg 2013; 107:1-7. [PMID: 23296694 DOI: 10.1093/trstmh/trs004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A randomised, unblinded, clinical trial comparing two benznidazole regimens for congenital Chagas disease was carried out to determine whether simplification and reduction in the length of treatment could lead to better treatment compliance. METHODS This study was conducted in Santa Cruz, Bolivia. Serological screening was carried out in pregnant women, and parasites were sought in the blood of newborns from seropositive mothers. Infected infants were randomly assigned to two treatment groups. Recovery was assessed by parasite seeking at 1 month and 2 months as well as serological tests at 9 months. Assessment of treatment adherence was based on weekly home visits and use of electronic monitors. RESULTS Benznidazole was given to 63 newborns in group A (5 mg/kg in two daily doses for 60 days) and 61 newborns in group B (7.5 mg/kg in a single daily dose for 30 days). There was no difference in compliance between the two groups. The study confirmed the efficacy and good tolerance of both benznidazole regimens in the treatment of congenital Chagas disease. CONCLUSIONS The short treatment should be preferred as it allows reducing the dose of benznidazole as well as the cost of treatment.
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Affiliation(s)
- Jean-Philippe Chippaux
- UMR 216, Mère et enfant face aux infections tropicales, Institut de recherche pour le développement, Paris, France.
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94
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Achievements and challenges upon the implementation of a program for national control of congenital Chagas in Bolivia: results 2004-2009. PLoS Negl Trop Dis 2013; 7:e2304. [PMID: 23875039 PMCID: PMC3708826 DOI: 10.1371/journal.pntd.0002304] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
Bolivia is one of the most endemic countries for Chagas disease. Data of 2005 shows that incidence is around 1.09‰ inhabitants and seroprevalence in children under 15 ranged from 10% in urban areas to 40% in rural areas. In this article, we report results obtained during the implementation of the congenital Chagas program, one of the biggest casuistry in congenital Chagas disease, led by National Program of Chagas and Belgian cooperation from 2004 to 2009. The program strategy was based on serological results during pregnancy and on the follow up of children born from positive mothers until one year old; if positive, treatment was done with Benznidazole, 10 mg/Kg/day/30 days with one post treatment control 6 months later. Throughout the length of the program, a total of 318,479 pregnant women were screened and 23.31% were detected positive. 42,538 children born from positive mothers were analyzed at birth by micromethod, of which 1.43% read positive. 10,120 children returned for their second micromethod control of which 2.29% read positive, 7,650 children returned for the serological control, of which 3.32% turned out positive. From the 1,093 positive children, 70% completed the 30 day-treatment and 122 returned for post treatment control with 96% showing a negative result. It has been seen that maternal-fetal transmission rates vary between 2% and 4%, with an average of 2.6% (about half of previously reported studies that reached 5%). In this work, we show that it is possible to implement, with limited resources, a National Congenital Chagas Program and to integrate it into the Bolivian health system. Keys of success are population awareness, health personnel motivation, and political commitment at all levels.
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95
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Cencig S, Coltel N, Truyens C, Carlier Y. Fertility, gestation outcome and parasite congenital transmissibility in mice infected with TcI, TcII and TcVI genotypes of Trypanosoma cruzi. PLoS Negl Trop Dis 2013; 7:e2271. [PMID: 23785533 PMCID: PMC3681732 DOI: 10.1371/journal.pntd.0002271] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 05/03/2013] [Indexed: 12/21/2022] Open
Abstract
This work aims to compare the effects of acute or chronic infections with the T. cruzi genotypes TcI (X10 strain), TcII (Y strain) and TcVI (Tulahuen strain) on fertility, gestation, pup growth and the possible vertical transmission of parasites in BALB/c mice. The occurrence of congenital infection was evaluated by microscopic examination of blood and/or qPCR on blood and heart in newborn pups and/or older offspring submitted to cyclophosphamide-induced immunosuppression in order to detect possible cryptic congenital infection. Altogether, the results show that: i) for the three strains tested, acute infection occurring after the embryo implantation in the uterus (parasite inoculation 4 days before mating), or close to delivery (parasite inoculation on day 13 of gestation), prevents or severely jeopardizes gestation outcome (inducing pup mortality and intra-uterine growth retardation); ii) for the three strains tested, gestation during chronic infection results in intra-uterine growth retardation, whereas re-inoculation of TcVI parasites during gestation in such chronically infected mice, in addition, strongly increases pup mortality; iii) congenital infection remains a rare consequence of infection (occurring in approximately 4% of living pups born to acutely infected dams); iv) PCR, detecting parasitic DNA and not living parasites, is not convenient to detect congenial infection close to delivery; v) transmission of parasites by breast milk is unlikely. This study should encourage further investigations using other parasite strains and genotypes to explore the role of virulence and other factors, as well as the mechanisms of such effects on gestation and on the establishment of congenital infection.
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Affiliation(s)
- Sabrina Cencig
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Coltel
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
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96
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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] [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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97
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Duffy T, Cura CI, Ramirez JC, Abate T, Cayo NM, Parrado R, Bello ZD, Velazquez E, Muñoz-Calderon A, Juiz NA, Basile J, Garcia L, Riarte A, Nasser JR, Ocampo SB, Yadon ZE, Torrico F, de Noya BA, Ribeiro I, Schijman AG. Analytical performance of a multiplex Real-Time PCR assay using TaqMan probes for quantification of Trypanosoma cruzi satellite DNA in blood samples. PLoS Negl Trop Dis 2013; 7:e2000. [PMID: 23350002 PMCID: PMC3547845 DOI: 10.1371/journal.pntd.0002000] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/25/2012] [Indexed: 11/18/2022] Open
Abstract
Background The analytical validation of sensitive, accurate and standardized Real-Time PCR methods for Trypanosoma cruzi quantification is crucial to provide a reliable laboratory tool for diagnosis of recent infections as well as for monitoring treatment efficacy. Methods/Principal Findings We have standardized and validated a multiplex Real-Time quantitative PCR assay (qPCR) based on TaqMan technology, aiming to quantify T. cruzi satellite DNA as well as an internal amplification control (IAC) in a single-tube reaction. IAC amplification allows rule out false negative PCR results due to inhibitory substances or loss of DNA during sample processing. The assay has a limit of detection (LOD) of 0.70 parasite equivalents/mL and a limit of quantification (LOQ) of 1.53 parasite equivalents/mL starting from non-boiled Guanidine EDTA blood spiked with T. cruzi CL-Brener stock. The method was evaluated with blood samples collected from Chagas disease patients experiencing different clinical stages and epidemiological scenarios: 1- Sixteen Venezuelan patients from an outbreak of oral transmission, 2- Sixty three Bolivian patients suffering chronic Chagas disease, 3- Thirty four Argentinean cases with chronic Chagas disease, 4- Twenty seven newborns to seropositive mothers, 5- A seronegative receptor who got infected after transplantation with a cadaveric kidney explanted from an infected subject. Conclusions/Significance The performing parameters of this assay encourage its application to early assessment of T. cruzi infection in cases in which serological methods are not informative, such as recent infections by oral contamination or congenital transmission or after transplantation with organs from seropositive donors, as well as for monitoring Chagas disease patients under etiological treatment. Chagas disease, caused by the parasite Trypanosoma cruzi, is endemic in several Latin American countries and still represents a major neglected tropical threat. It is transmitted to humans by blood-sucking triatomine bugs, congenital transmission, blood transfusion, organ transplantation and by consuming food and juice contaminated with the parasite. Tools for accurate diagnosis and surrogate markers of parasitological response to treatment remain key needs in the field. This study focused on the evaluation of a novel quantitative PCR assay for the diagnosis and follow-up of patients with Chagas disease, on the basis of international guidelines for analytical validation of molecular diagnostic methods. The method allows the simultaneous amplification of parasite satellite DNA sequence and a heterologous internal amplification control that permits rule out false negative results due to inhibitory substances or loss of DNA during sample processing. It was evaluated in peripheral blood samples from acute and chronic patients as well as in umbilical cord blood samples from newborns to seropositive mothers. The performing characteristics of this assay position it as a promising candidate for application to clinical trials and kit developments.
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Affiliation(s)
- Tomas Duffy
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Carolina I. Cura
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Juan C. Ramirez
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Teresa Abate
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Nelly M. Cayo
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, Jujuy, Argentina
| | | | - Zoraida Diaz Bello
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Elsa Velazquez
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS, Buenos Aires, Argentina
| | - Arturo Muñoz-Calderon
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Natalia A. Juiz
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Joaquín Basile
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | | | - Adelina Riarte
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS, Buenos Aires, Argentina
| | - Julio R. Nasser
- Laboratorio de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina
| | - Susana B. Ocampo
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, Jujuy, Argentina
| | - Zaida E. Yadon
- Pan-American Health Organization, Washington, D.C., United States of America
| | | | | | - Isabela Ribeiro
- Drugs and Neglected Diseases Initiative, Genève, Switzerland
| | - Alejandro G. Schijman
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
- * E-mail:
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98
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Esch KJ, Petersen CA. Transmission and epidemiology of zoonotic protozoal diseases of companion animals. Clin Microbiol Rev 2013; 26:58-85. [PMID: 23297259 PMCID: PMC3553666 DOI: 10.1128/cmr.00067-12] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Over 77 million dogs and 93 million cats share our households in the United States. Multiple studies have demonstrated the importance of pets in their owners' physical and mental health. Given the large number of companion animals in the United States and the proximity and bond of these animals with their owners, understanding and preventing the diseases that these companions bring with them are of paramount importance. Zoonotic protozoal parasites, including toxoplasmosis, Chagas' disease, babesiosis, giardiasis, and leishmaniasis, can cause insidious infections, with asymptomatic animals being capable of transmitting disease. Giardia and Toxoplasma gondii, endemic to the United States, have high prevalences in companion animals. Leishmania and Trypanosoma cruzi are found regionally within the United States. These diseases have lower prevalences but are significant sources of human disease globally and are expanding their companion animal distribution. Thankfully, healthy individuals in the United States are protected by intact immune systems and bolstered by good nutrition, sanitation, and hygiene. Immunocompromised individuals, including the growing number of obese and/or diabetic people, are at a much higher risk of developing zoonoses. Awareness of these often neglected diseases in all health communities is important for protecting pets and owners. To provide this awareness, this review is focused on zoonotic protozoal mechanisms of virulence, epidemiology, and the transmission of pathogens of consequence to pet owners in the United States.
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99
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Ortiz S, Zulantay I, Solari A, Bisio M, Schijman A, Carlier Y, Apt W. Presence of Trypanosoma cruzi in pregnant women and typing of lineages in congenital cases. Acta Trop 2012; 124:243-6. [PMID: 22906640 DOI: 10.1016/j.actatropica.2012.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/30/2012] [Accepted: 08/03/2012] [Indexed: 10/28/2022]
Abstract
The objective of this study was to determine the presence of Trypanosoma cruzi in blood samples of mothers with chronic Chagas disease and their newborn by conventional PCR targeted to minicircle kinetoplastidic DNA (kDNA), and to determine the lineages in mother/newborn pairs of the congenital cases by hybridization assays with probes belonging to the TcII, TcI and TcV Discrete Typing Units (DTU). In 63 (57.2%) of the mothers the presence of circulating T. cruzi was demonstrated by PCR immediately before delivery and in three newborn (3%) congenital transmission was confirmed by serial PCR and conventional serology between 1 and 16 months of life, at which point treatment was started. The hybridization signals showed that two of the newborn had the same DTU as their mother (TcI, TcII and TcV), whilst in the third congenital case only TcV was detected in the cord blood, suggesting that in this infant TcI and TcII did not cross the placenta or the parasite was not present at a detectable level. Levels T. cruzi DNA was determined by TaqMan Probe based Real Time PCR assay targeted to nuclear satellite sequences in these three pairs of samples.
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100
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Risk Factors and Primary Prevention of Congenital Chagas Disease in a Nonendemic Country. Clin Infect Dis 2012; 56:496-502. [DOI: 10.1093/cid/cis910] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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