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Medina-Rivera M, Cárdenas WB, Erickson D, Mehta S. Gold Nanoshells-Based Lateral Flow Assay for the Detection of Chagas Disease at the Point-of-Care. Am J Trop Med Hyg 2022; 107:323-327. [PMID: 35895419 PMCID: PMC9393437 DOI: 10.4269/ajtmh.21-1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/11/2022] [Indexed: 08/03/2023] Open
Abstract
Chagas disease is a neglected parasitic infection and a major public health problem in the Americas. It remains underdiagnosed in the United States and internationally due to the lack of affordable testing and disparities in healthcare, particularly for those most at risk. We describe a proof-of-concept lateral flow immunoassay employing a recombinant Chagas multiantigen conjugated to gold nanoshells (AuNS) to detect circulating human anti-Chagas IgG antibodies. This is one of the first lateral flow immunoassays to capitalize on the larger surface area of AuNS compared with nanoparticles that can help amplify low-magnitude signals. Results were compared with 42 positive and negative Chagas serum samples, of which a subset of 27 samples was validated against an ELISA (Hemagen®). The sensitivity and specificity of our assay were 83% and 95%, respectively. These results suggest that an AuNS-based rapid testing for Chagas disease could facilitate in-field screening/diagnosis with a performance comparable to commercial methods.
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Affiliation(s)
- Melisa Medina-Rivera
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York
| | - Washington B. Cárdenas
- Laboratorio para Investigaciones Biomédicas, Escuela Superior Politécnica del Litoral, Guayaquil, Guayas, Ecuador
| | - David Erickson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York
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2
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Lynn MK, Dye-Braumuller KC, Beatty NL, Dorn PL, Klotz SA, Stramer SL, Townsend RL, Kamel H, Vannoy JM, Sadler P, Montgomery SP, Rivera HN, Nolan MS. Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors. Transfusion 2022; 62:1808-1817. [PMID: 35895440 PMCID: PMC9543114 DOI: 10.1111/trf.17026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Background Chagas disease is a parasitic infection that can insidiously cause non‐ischemic cardiomyopathy. Given the largely silent nature of this progressive disease, asymptomatic blood donors pose potential blood transfusion risk. Blood donation screening has become an unintentional form of Chagas disease surveillance, with thousands of new cases identified since national surveillance was initiated in 2007. Study Design and Methods We recruited T. cruzi‐positive blood donors identified from California and Arizona blood centers for confirmatory blood screening and assessment of lifetime infection risk. Results Among eight suspected cases, we identified four confirmed US autochthonous infections. The current manuscript details the transmission sources, healthcare‐seeking behaviors post‐blood donation resulting, and clinical course of disease among persons without any history of travel to endemic Latin American countries. Discussion This manuscript presents four additional US‐acquired Chagas disease cases and identifies an opportunity for blood centers to assist in confronting barriers surrounding Chagas disease in the US.
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Affiliation(s)
- Mary K Lynn
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kyndall C Dye-Braumuller
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Norman L Beatty
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Patricia L Dorn
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana, USA
| | - Stephen A Klotz
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | | | - Hany Kamel
- Corporate Medical Affairs, Vitalant, Scottsdale, Arizona, USA
| | | | - Patrick Sadler
- Central California Blood Center, Fresno, California, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilda N Rivera
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa S Nolan
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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3
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Pacheco GJ, Fulton L, Betancourt J, Shanmugam R, Granados PS. Geospatial analysis as a tool to identify target areas for Chagas disease education for healthcare providers. BMC Infect Dis 2022; 22:590. [PMID: 35788197 PMCID: PMC9252050 DOI: 10.1186/s12879-022-07577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Chagas Disease (CD) is a neglected zoonotic disease of the Americas. It can be fatal if not diagnosed and treated in its early stages. Using geospatial and sensitivity analysis, this study focuses on understanding how to better allocate resources and educational information to areas in the United States, specifically Texas, that have the potential for increased risk of CD cases and the associated costs of addressing the disease. ICD-9 and 10 inpatient hospital diagnostic codes were used to illustrate the salience of potentially missed CD diagnoses (e.g., cardiomyopathic diagnoses) and where these are occurring with more frequency. Coding software along with GIS and Microsoft Excel 3D mapping were used to generate maps to illustrate where there may be a need for increased statewide surveillance and screening of populations at greater risk for CD. The CD cases reported to the Texas Department of State Healthcare Services (TxDSHS) are not homogenously dispersed throughout the state but rather, reveal that the incidences are in clusters and primarily in urban areas, where there is increased access to physician care, CD research and diagnostic capabilities.
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Affiliation(s)
- Gerardo J Pacheco
- School of Health Administration, Texas State University, San Marcos, TX, 78666, USA.
| | - Lawrence Fulton
- School of Health Administration, Texas State University, San Marcos, TX, 78666, USA
| | - Jose Betancourt
- School of Health Administration, Texas State University, San Marcos, TX, 78666, USA
| | - Ram Shanmugam
- School of Health Administration, Texas State University, San Marcos, TX, 78666, USA
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4
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Marcus R, Henao-Martínez AF, Nolan M, Livingston E, Klotz SA, Gilman RH, Miranda-Schaeubinger M, Meymandi S. Recognition and screening for Chagas disease in the USA. Ther Adv Infect Dis 2021; 8:20499361211046086. [PMID: 34589212 PMCID: PMC8474340 DOI: 10.1177/20499361211046086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022] Open
Abstract
Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a public health concern, mainly among countries in South and Central America. However, despite the large number of immigrants from endemic countries living in the USA, awareness of CD is poor in the medical community, and therefore it is significantly underdiagnosed. To avoid the catastrophic cardiac complications of CD and to prevent maternal-fetal transmission, widespread educational programs highlighting the need for diagnosis are urgently needed.
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Affiliation(s)
- Rachel Marcus
- LASOCHA, MedStar Union Memorial Hospital,
Baltimore, MD 21218-2829, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa Nolan
- Arnold School of Public Health, University of
South Carolina, Columbia, SC, USA
| | - Elizabeth Livingston
- Department of Obstetrics and Gynecology, Duke
University Medical Center, Durham, NC, USA
| | - Stephen A. Klotz
- Division of Infectious Diseases, University of
Arizona, Tucson, AZ, USA
| | - Robert H. Gilman
- Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheba Meymandi
- Division of Cardiology, David Geffen School of
Medicine at UCLA, Los Angeles, CA, USA
- Center of Excellence for Chagas Disease, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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5
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Kendricks AL, Gray SB, Wilkerson GK, Sands CM, Abee CR, Bernacky BJ, Hotez PJ, Bottazzi ME, Craig SL, Jones KM. Reproductive Outcomes in Rhesus Macaques ( Macaca mulatta) with Naturally-acquired Trypanosoma cruzi Infection. Comp Med 2020; 70:152-159. [PMID: 32183928 DOI: 10.30802/aalas-cm-19-000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chagas disease is a zoonotic vector-borne disease caused by infection with the protozoan parasite Trypanosoma cruzi. T. cruzi is found in Latin America and the Southern United States, where it infects many species, including humans and nonhuman primates (NHPs). NHPs are susceptible to natural infection and can develop clinical symptoms consistent with human disease, including Chagasic cardiomyopathy, gastrointestinal disease and transplacental transmission, leading to congenital infection. Due to evidence of Chagas transmission in Texas, this study hypothesized T. cruzi infection was present in a closed, outdoor-housed breeding colony of rhesus macaques (Macaca mulatta) located at a biomedical research facility in Central Texas. In addition, we questioned whether seropositive female rhesus macaques might experience reproductive complications consistent with maternal-fetal Chagas disease. The seroprevalence of T. cruzi infection in the colony was assessed using an Enzyme Linked Immunosorbant Assay (ELISA) to detect antibodies against Tc24 antigen as a screening assay, and a commercially available immunochromatographic test (Chagas Stat Pak) as a confirmatory assay. Retrospective serologic analysis was performed to confirm the status of all T. cruzi-infected animals between the years 2012 to 2016. The medical history of all seropositive and seronegative breeding females within the colony from 2012 to 2016 was reviewed to determine each animals' level of reproductive fitness. The percentage of T. cruzi-seropositive animals ranged from 6.7% to 9.7% in adult animals and 0% to 0.44% in juveniles or weanling animals, depending on the year. An overall 3.9% seroprevalence of T. cruzi infection was found in the total population. No significant differences in any measure of reproductive outcomes were identified between seropositive and seronegative females from 2012 to 2016. The lack of significant adverse reproductive outcomes reported here may help inform future management decisions regarding seropositive female rhesus macaques within breeding colonies.
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Affiliation(s)
- April L Kendricks
- Southwest Electronic Energy Medical Research Institute, Houston, Texas; Baylor College of Medicine, Houston, Texas;,
| | - Stanton B Gray
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine, Bastrop, Texas
| | - Gregory K Wilkerson
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine, Bastrop, Texas
| | | | - Christian R Abee
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine, Bastrop, Texas
| | | | - Peter J Hotez
- Baylor College of Medicine, Houston, Texas; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital Center for Vaccine Development, Houston, Texas; Department of Biology, Baylor University, Waco, Texas
| | - Maria Elena Bottazzi
- Baylor College of Medicine, Houston, Texas; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital Center for Vaccine Development, Houston, Texas; Department of Biology, Baylor University, Waco, Texas
| | - Suzanne L Craig
- Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn M Jones
- Baylor College of Medicine, Houston, Texas; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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6
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Bern C, Messenger LA, Whitman JD, Maguire JH. Chagas Disease in the United States: a Public Health Approach. Clin Microbiol Rev 2019; 33:e00023-19. [PMID: 31776135 PMCID: PMC6927308 DOI: 10.1128/cmr.00023-19] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.
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Affiliation(s)
- Caryn Bern
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Jeffrey D Whitman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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7
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Abstract
Trypanosoma cruzi, the protozoan that causes Chagas disease, is primarily transmitted by three main Triatomine vectors in endemic areas. However, the infection has become a potential emerging disease because the vector is found in non-endemic areas, there is migration of infected asymptomatic people that can infect the vector, become blood donors, or pass the disease vertically (congenital infections). Lastly, the disease can be acquired through contaminated food (oral transmission). This review will present the different transmission pathways, clinical manifestations, diagnostic modalities and treatment considerations of Chagas disease.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Rd, Atlanta, GA 30322, United States.
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8
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Epidemiology of Chagas Disease in the USA: High-Risk Patient Populations for Screening. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-0169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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9
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Costa HS, Lima MMO, Lage SM, da Costa FSM, Figueiredo PHS, da Costa Rocha MO. Six-minute walk test and incremental shuttle walk test in the evaluation of functional capacity in Chagas heart disease. J Exerc Rehabil 2018; 14:844-850. [PMID: 30443532 PMCID: PMC6222153 DOI: 10.12965/jer.1836326.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/21/2018] [Indexed: 01/04/2023] Open
Abstract
Chagas heart disease (CHD) leads to a progressive functional impairment. Field tests, as the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT), may be inexpensive approaches in the evaluation of functional capacity of these patients. The present study was addressed to compare the 6MWT and the ISWT measures, and to determine the accuracy of these tests in the identification of functional impairment in patients with CHD. Thirty-five patients with CHD (47.1±8.2 years, NYHA I–III) were evaluated by echocardiography, cardiopulmonary exercise test (CPET), 6MWT, and ISWT. Correlations between the CPET (peak oxygen uptake [peak VO2] and the ratio between ventilation and the carbon dioxide production [VE/VCO2 slope]) and the field tests (walking distances) were also performed. The receiver operating characteristic (ROC) curve was selected to identify the best distances related to identify those patients with functional impairment. There was no difference between distances walked during the 6MWT and ISWT (P=0.694). The Bland-Altman analysis showed good agreement between the field tests. Both 6MWT and ISWT correlated with peak VO2 (r=0.577, P<0.001 and r=0.587, P<0.001, respectively) and ISWT correlated with VE/VCO2 slope (r=−0.339, P=0.003). The cutoff distances of 6MWT and ISWT to identify patients with peak VO2 less than 20 mL/kg/min were 520 m and 400 m, respectively, with no difference between the areas under ROC curves (P=0.276). Both the 6MWT and the ISWT demonstrated accuracy in identify functional impairment in patients with CHD, being useful tools for the risk stratification of these patients.
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Affiliation(s)
- Henrique Silveira Costa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Márcia Maria Oliveira Lima
- School of Biological and Health Sciences, School of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Susan Martins Lage
- Rehabilitation Sciences Program, Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Fábio Silva Martins da Costa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- School of Biological and Health Sciences, School of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Manoel Otávio da Costa Rocha
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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10
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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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Genetic Polymorphisms of Manganese-Dependent Superoxide Dismutase in Chagas Disease. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Lemos de Oliveira LF, Thackeray JT, Marin Neto JA, Dias Romano MM, Vieira de Carvalho EE, Mejia J, Tanaka DM, Kelly da Silva G, Abdalla DR, Malamut C, Bengel FM, de Lourdes Higuchi M, Schmidt A, Cunha-Neto E, Simões MV. Regional Myocardial Perfusion Disturbance in Experimental Chronic Chagas Cardiomyopathy. J Nucl Med 2018; 59:1430-1436. [DOI: 10.2967/jnumed.117.205450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
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Abstract
Within the last five years, the State of Texas has experienced either transmission or outbreaks of Ebola, chikungunya, West Nile, and Zika virus infections. Autochthonous transmission of neglected parasitic and bacterial diseases has also become increasingly reported. The rise of such emerging and neglected tropical diseases (NTDs) has not occurred by accident but instead reflects rapidly evolving changes and shifts in a “new” Texas beset by modern and globalizing forces that include rapid expansions in population together with urbanization and human migrations, altered transportation patterns, climate change, steeply declining vaccination rates, and a new paradigm of poverty known as “blue marble health.” Summarized here are the major NTDs now affecting Texas. In addition to the vector-borne viral diseases highlighted above, there also is a high level of parasitic infections, including Chagas disease, trichomoniasis, and possibly leishmaniasis and toxocariasis, as well as typhus-group rickettsiosis, a vector-borne bacterial infection. I also highlight some of the key shifts in emerging and neglected disease patterns, partly due to an altered and evolving economic and ecological landscape in the new Texas, and provide some preliminary disease burden estimates for the major prevalent and incident NTDs.
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Affiliation(s)
- Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
- Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, Texas, United States of America
- * E-mail:
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14
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Acquatella H, Asch FM, Barbosa MM, Barros M, Bern C, Cavalcante JL, Echeverria Correa LE, Lima J, Marcus R, Marin-Neto JA, Migliore R, Milei J, Morillo CA, Nunes MCP, Campos Vieira ML, Viotti R. Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC). J Am Soc Echocardiogr 2018; 31:3-25. [DOI: 10.1016/j.echo.2017.10.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Biter AB, Weltje S, Hudspeth EM, Seid CA, McAtee CP, Chen WH, Pollet JB, Strych U, Hotez PJ, Bottazzi ME. Characterization and Stability of Trypanosoma cruzi 24-C4 (Tc24-C4), a Candidate Antigen for a Therapeutic Vaccine Against Chagas Disease. J Pharm Sci 2017; 107:1468-1473. [PMID: 29274820 DOI: 10.1016/j.xphs.2017.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 12/19/2022]
Abstract
Chagas disease due to chronic infection with Trypanosoma cruzi is a neglected cause of heart disease, affecting approximately 6-10 million individuals in Latin America and elsewhere. T. cruzi Tc24, a calcium-binding protein in the flagellar pocket of the parasite, is a candidate antigen for an injectable therapeutic vaccine as an alternative or a complement to chemotherapy. Previously, we reported that a genetically engineered construct from which all cysteine residues had been eliminated (Tc24-C4) yields a recombinant protein with reduced aggregation and improved analytical purity in comparison to the wild-type form, without compromising antigenicity and immunogenicity. We now report that the established process for producing Escherichia coli-expressed Tc24-C4 protein is robust and reproducibly yields protein lots with consistent analytical characteristics, freeze-thaw, accelerated, and long-term stability profiles. The data indicate that, like most proteins, Tc24-C4 should be stable at -80°C, but also at 4°C and room temperature for at least 30 days, and up to 7-15 days at 37°C. Thus, the production process for recombinant Tc24-C4 is suitable for Current Good Manufacturing Practice production and clinical testing, based on process robustness, analytical characteristics, and stability profile.
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Affiliation(s)
- Amadeo B Biter
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Sarah Weltje
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Elissa M Hudspeth
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Christopher A Seid
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - C Patrick McAtee
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Wen-Hsiang Chen
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Jeroen B Pollet
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Ulrich Strych
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030
| | - Peter J Hotez
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030; Department of Biology, Baylor University, Waco, Texas 76706
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030; Texas Children's Hospital Center for Vaccine Development, Houston, Texas 77030; Department of Biology, Baylor University, Waco, Texas 76706.
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16
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Benznidazole and Posaconazole in Eliminating Parasites in Asymptomatic T. Cruzi Carriers: The STOP-CHAGAS Trial. J Am Coll Cardiol 2017; 69:939-947. [PMID: 28231946 DOI: 10.1016/j.jacc.2016.12.023] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 12/08/2016] [Accepted: 12/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Benznidazole is recommended for treatment of Chagas infection. Effects of combination therapy with benznidazole and posaconazole have not been tested in Trypanosoma cruzi carriers. OBJECTIVES The purpose of this study was to determine whether posaconazole alone or combined with benznidazole were superior to benznidazole monotherapy in eliminating T. cruzi parasites measured by real time polymerase chain reaction (RT-PCR) in asymptomatic Chagas carriers. METHODS A prospective, multicenter randomized placebo-controlled study was conducted in 120 subjects from Latin America and Spain who were randomized to 4 groups: posaconazole 400 mg twice a day (b.i.d.); benznidazole 200 mg + placebo b.i.d.; benznidazole 200 mg b.i.d. + posaconazole 400 mg b.i.d.; or placebo 10 mg b.i.d. T. cruzi deoxyribonucleic acid was detected by RT-PCR at 30, 60, 90, 120, 150, 180, and 360 days. The primary efficacy outcome is the proportion of subjects with persistent negative RT-PCR by day 180; the secondary outcome was negative RT-PCR at 360 days. RESULTS Only 13.3% of those receiving posaconazole and 10% receiving placebo achieved the primary outcome, compared with 80% receiving benznidazole + posaconazole and 86.7% receiving benznidazole monotherapy (p < 0.0001 vs. posaconazole/placebo). Posaconazole monotherapy or posaconazole combined with benznidazole achieved high RT-PCR conversion rates during treatment (30 days; 93.3% and 88.9% and 60 days; 90%, and 92.3%) that were similar to benznidazole (89.7% and 89.3%); all were superior to placebo or posaconazole (10% and 16.7%, p < 0.0001). This was not observed at 360 days; benznidazole + posaconazole and benznidazole monotherapy (both 96%) versus placebo (17%) and posaconazole (16%, p < 0.0001). Serious adverse events were rare (6 patients) and were observed in the benznidazole-treated patients. Permanent discontinuation was reported in 19 patients (31.7%) receiving either benznidazole monotherapy or combined with posaconazole. CONCLUSIONS Posaconazole demonstrated trypanostatic activity during treatment, but it is ineffective long-term in asymptomatic T. cruzi carriers. Benznidazole monotherapy is superior to posaconazole, with high RT-PCR conversion rates sustained at 1 year. Side effects lead to therapy discontinuation in 32%. No advantages were observed with combined therapy versus benznidazole monotherapy. (A Study of the Use of Oral Posaconazole [POS] in the Treatment of Asymptomatic Chronic Chagas Disease [P05267] [STOP CHAGAS]: NCT01377480).
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Garcia MN, Burroughs H, Gorchakov R, Gunter SM, Dumonteil E, Murray KO, Herrera CP. Molecular identification and genotyping of Trypanosoma cruzi DNA in autochthonous Chagas disease patients from Texas, USA. INFECTION GENETICS AND EVOLUTION 2017; 49:151-156. [PMID: 28095298 DOI: 10.1016/j.meegid.2017.01.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 12/27/2022]
Abstract
The parasitic protozoan Trypanosoma cruzi, the causative agent of Chagas disease, is widely distributed throughout the Americas, from the southern United States (US) to northern Argentina, and infects at least 6 million people in endemic areas. Much remains unknown about the dynamics of T. cruzi transmission among mammals and triatomine vectors in sylvatic and peridomestic eco-epidemiological cycles, as well as of the risk of transmission to humans in the US. Identification of T. cruzi DTUs among locally-acquired cases is necessary for enhancing our diagnostic and clinical prognostic capacities, as well as to understand parasite transmission cycles. Blood samples from a cohort of 15 confirmed locally-acquired Chagas disease patients from Texas were used for genotyping T. cruzi. Conventional PCR using primers specific for the minicircle variable region of the kinetoplastid DNA (kDNA) and the highly repetitive genomic satellite DNA (satDNA) confirmed the presence of T. cruzi in 12/15 patients. Genotyping was based on the amplification of the intergenic region of the miniexon gene of T. cruzi and sequencing. Sequences were analyzed by BLAST and phylogenetic analysis by Maximum Likelihood method allowed the identification of non-TcI DTUs infection in six patients, which corresponded to DTUs TcII, TcV or TcVI, but not to TcIII or TcIV. Two of these six patients were also infected with a TcI DTU, indicating mixed infections in those individuals. Electrocardiographic abnormalities were seen among patients with single non-TcI and mixed infections of non-TcI and TcI DTUs. Our results indicate a greater diversity of T. cruzi DTUs circulating among autochthonous human Chagas disease cases in the southern US, including for the first time DTUs from the TcII-TcV-TcVI group. Furthermore, the DTUs infecting human patients in the US are capable of causing Chagasic cardiac disease, highlighting the importance of parasite detection in the population.
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Affiliation(s)
- Melissa N Garcia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Hadley Burroughs
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Rodion Gorchakov
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Sarah M Gunter
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA; Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Autonomous University of Yucatan (UADY), Merida, Yucatan, Mexico
| | - Kristy O Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Claudia P Herrera
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Traina MI, Hernandez S, Sanchez DR, Dufani J, Salih M, Abuhamidah AM, Olmedo W, Bradfield JS, Forsyth CJ, Meymandi SK. Prevalence of Chagas Disease in a U.S. Population of Latin American Immigrants with Conduction Abnormalities on Electrocardiogram. PLoS Negl Trop Dis 2017; 11:e0005244. [PMID: 28056014 PMCID: PMC5242541 DOI: 10.1371/journal.pntd.0005244] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/18/2017] [Accepted: 12/08/2016] [Indexed: 11/19/2022] Open
Abstract
Chagas disease (CD) affects over six million people and is a leading cause of cardiomyopathy in Latin America. Given recent migration trends, there is a large population at risk in the United States (US). Early stage cardiac involvement from CD usually presents with conduction abnormalities on electrocardiogram (ECG) including right bundle branch block (RBBB), left anterior or posterior fascicular block (LAFB or LPFB, respectively), and rarely, left bundle branch block (LBBB). Identification of disease at this stage may lead to early treatment and potentially delay the progression to impaired systolic function. All ECGs performed in a Los Angeles County hospital and clinic system were screened for the presence of RBBB, LAFB, LPFB, or LBBB. Patients were contacted and enrolled in the study if they had previously resided in Latin America for at least 12 months and had no history of cardiac disease. Enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assay (IFA) tests were utilized to screen for Trypanosoma cruzi seropositivity. A total of 327 consecutive patients were screened for CD from January 2007 to December 2010. The mean age was 46.3 years and the mean length of stay in the US was 21.2 years. Conduction abnormalities were as follows: RBBB 40.4%, LAFB 40.1%, LPFB 2.8%, LBBB 5.5%, RBBB and LAFB 8.6%, and RBBB and LPFB 2.8%. Seventeen patients were positive by both ELISA and IFA (5.2%). The highest prevalence rate was among those with RBBB and LAFB (17.9%). There is a significant prevalence of CD in Latin American immigrants residing in Los Angeles with conduction abnormalities on ECG. Clinicians should consider evaluating all Latin American immigrant patients with unexplained conduction disease for CD.
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Affiliation(s)
- Mahmoud I. Traina
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Salvador Hernandez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Daniel R. Sanchez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Jalal Dufani
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Mohsin Salih
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Adieb M. Abuhamidah
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Wilman Olmedo
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
- Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, United States of America
| | - Jason S. Bradfield
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America
| | - Colin J. Forsyth
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
| | - Sheba K. Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center Sylmar, CA, United States of America
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Echeverría LE, Rojas LZ, Calvo LS, Roa ZM, Rueda-Ochoa OL, Morillo CA, Muka T, Franco OH. Profiles of cardiovascular biomarkers according to severity stages of Chagas cardiomyopathy. Int J Cardiol 2017; 227:577-582. [DOI: 10.1016/j.ijcard.2016.10.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 12/28/2022]
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20
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Seid CA, Jones KM, Pollet J, Keegan B, Hudspeth E, Hammond M, Wei J, McAtee CP, Versteeg L, Gutierrez A, Liu Z, Zhan B, Respress JL, Strych U, Bottazzi ME, Hotez PJ. Cysteine mutagenesis improves the production without abrogating antigenicity of a recombinant protein vaccine candidate for human chagas disease. Hum Vaccin Immunother 2016; 13:621-633. [PMID: 27737611 DOI: 10.1080/21645515.2016.1242540] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
A therapeutic vaccine for human Chagas disease is under development by the Sabin Vaccine Institute Product Development Partnership. The aim of the vaccine is to significantly reduce the parasite burden of Trypanosoma cruzi in humans, either as a standalone product or in combination with conventional chemotherapy. Vaccination of mice with Tc24 formulated with monophosphoryl-lipid A (MPLA) adjuvant results in a Th1 skewed immune response with elevated IgG2a and IFNγ levels and a statistically significant decrease in parasitemia following T. cruzi challenge. Tc24 was therefore selected for scale-up and further evaluation. During scale up and downstream process development, significant protein aggregation was observed due to intermolecular disulfide bond formation. To prevent protein aggregation, cysteine codons were replaced with serine codons which resulted in the production of a non-aggregated and soluble recombinant protein, Tc24-C4. No changes to the secondary structure of the modified molecule were detected by circular dichroism. Immunization of mice with wild-type Tc24 or Tc24-C4, formulated with E6020 (TLR4 agonist analog to MPLA) emulsified in a squalene-oil-in-water emulsion, resulted in IgG2a and antigen specific IFNγ production levels from splenocytes that were not significantly different, indicating that eliminating putative intermolecular disulfide bonds had no significant impact on the immunogenicity of the molecule. In addition, vaccination with either formulated wild type Tc24 or Tc24-C4 antigen also significantly increased survival and reduced cardiac parasite burden in mice. Investigations are now underway to examine the efficacy of Tc24-C4 formulated with other adjuvants to reduce parasite burden and increase survival in pre-clinical studies.
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Affiliation(s)
- Christopher A Seid
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Kathryn M Jones
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA.,b Departments of Pediatrics and Molecular Virology and Microbiology , National School of Tropical Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Jeroen Pollet
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA.,b Departments of Pediatrics and Molecular Virology and Microbiology , National School of Tropical Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Brian Keegan
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Elissa Hudspeth
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Molly Hammond
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Junfei Wei
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - C Patrick McAtee
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Leroy Versteeg
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Amanda Gutierrez
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Zhuyun Liu
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA
| | - Bin Zhan
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA.,b Departments of Pediatrics and Molecular Virology and Microbiology , National School of Tropical Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Jonathan L Respress
- d Southwest Electronic Energy Medical Research Institute (SWEMRI) , Missouri City , TX , USA
| | - Ulrich Strych
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA.,b Departments of Pediatrics and Molecular Virology and Microbiology , National School of Tropical Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Maria Elena Bottazzi
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA.,b Departments of Pediatrics and Molecular Virology and Microbiology , National School of Tropical Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Peter J Hotez
- a Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development , Houston , TX , USA.,b Departments of Pediatrics and Molecular Virology and Microbiology , National School of Tropical Medicine, Baylor College of Medicine , Houston , TX , USA.,c James A. Baker III Institute for Public Policy , Rice University , Houston , TX , USA
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21
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Gorchakov R, Trosclair LP, Wozniak EJ, Feria PT, Garcia MN, Gunter SM, Murray KO. Trypanosoma cruzi Infection Prevalence and Bloodmeal Analysis in Triatomine Vectors of Chagas Disease From Rural Peridomestic Locations in Texas, 2013-2014. JOURNAL OF MEDICAL ENTOMOLOGY 2016; 53:911-918. [PMID: 27106934 DOI: 10.1093/jme/tjw040] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
Protozoan pathogen Trypanosoma cruzi (Chagas, 1909) is the etiologic agent of Chagas disease, which affects millions of people in Latin America. Recently, the disease has been gaining attention in Texas and the southern United States. Transmission cycle of the parasite involves alternating infection between insect vectors and vertebrate hosts (including humans, wildlife, and domestic animals). To evaluate vector T. cruzi parasite burden and feeding patterns, we tested triatomine vectors from 23 central, southern, and northeastern counties of Texas. Out of the 68 submitted specimens, the majority were genetically identified as Triatoma gerstaeckeri (Stal, 1859), with a few samples of Triatoma sanguisuga (LeConte, 1855), Triatoma lecticularia (Stal, 1859), Triatoma rubida (Uhler, 1894), and Triatoma protracta woodi (Usinger, 1939). We found almost two-thirds of the submitted insects were polymerase chain reaction-positive for T. cruzi Bloodmeal sources were determined for most of the insects, and 16 different species of mammals were identified as hosts. The most prevalent type of bloodmeal was human, with over half of these insects found to be positive for T. cruzi High infection rate of the triatomine vectors combined with high incidence of feeding on humans highlight the importance of Chagas disease surveillance in Texas. With our previous findings of autochthonous transmission of Chagas disease, urgent measures are needed to increase public awareness, vector control in and around homes, and Chagas screening of residents who present with a history of a triatomine exposure.
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Affiliation(s)
- Rodion Gorchakov
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; )
| | - Lillian P Trosclair
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; )
| | - Edward J Wozniak
- Zoonosis Control Unit, Health Service Region 8, Texas Department of State Health Services, 112 Joe Carper Drive, Uvalde, TX 78801
| | - Patricia T Feria
- Department of Biology, University of Texas Rio Grande Valley, 1201 West University Dr., Edinburg, TX 78539
| | - Melissa N Garcia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; )
| | - Sarah M Gunter
- Center for Infectious Diseases, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030 , and
| | - Kristy O Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; ),
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22
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Status of vaccine research and development of vaccines for Chagas disease. Vaccine 2016; 34:2996-3000. [DOI: 10.1016/j.vaccine.2016.03.074] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 03/09/2016] [Indexed: 12/12/2022]
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Sánchez-González G, Figueroa-Lara A, Elizondo-Cano M, Wilson L, Novelo-Garza B, Valiente-Banuet L, Ramsey JM. Cost-Effectiveness of Blood Donation Screening for Trypanosoma cruzi in Mexico. PLoS Negl Trop Dis 2016; 10:e0004528. [PMID: 27002523 PMCID: PMC4803194 DOI: 10.1371/journal.pntd.0004528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/18/2016] [Indexed: 01/16/2023] Open
Abstract
An estimated 2 million inhabitants are infected with Chagas disease in Mexico, with highest prevalence coinciding with highest demographic density in the southern half of the country. After vector-borne transmission, Trypanosoma cruzi is principally transmitted to humans via blood transfusion. Despite initiation of serological screening of blood donations or donors for T. cruzi since 1990 in most Latin American countries, Mexico only finally included mandatory serological screening nationwide in official Norms in 2012. Most recent regulatory changes and segmented blood services in Mexico may affect compliance of mandatory screening guidelines. The objective of this study was to calculate the incremental cost-effectiveness ratio for total compliance of current guidelines from both Mexican primary healthcare and regular salaried worker health service institutions: the Secretary of Health and the Mexican Institute for Social Security. We developed a bi-modular model to analyze compliance using a decision tree for the most common screening algorithms for each health institution, and a Markov transition model for the natural history of illness and care. The incremental cost effectiveness ratio based on life-years gained is US$ 383 for the Secretary of Health, while the cost for an additional life-year gained is US$ 463 for the Social Security Institute. The results of the present study suggest that due to incomplete compliance of Mexico’s national legislation during 2013 and 2014, the MoH has failed to confirm 15,162 T. cruzi infections, has not prevented 2,347 avoidable infections, and has lost 333,483 life-years. Although there is a vast difference in T. cruzi prevalence between Bolivia and Mexico, Bolivia established mandatory blood screening for T.cruzi in 1996 and until 2002 detected and discarded 11,489 T. cruzi -infected blood units and prevented 2,879 potential infections with their transfusion blood screening program. In the first two years of Mexico’s mandated program, the two primary institutions failed to prevent due to incomplete compliance more potential infections than those gained from the first five years of Bolivia’s program. Full regulatory compliance should be clearly understood as mandatory for the sake of blood security, and its monitoring and analysis in Mexico should be part of the health authority’s responsibility. Chagas disease continues to be a neglected disease in Mexico and Latin-American. Although an estimated 96% of Trypanosoma cruzi transmission to humans occurs via 32 triatomine vector species, the only transmission prevention in Mexico has been sparse and based on heterogeneous blood donation screening. Despite mandating serological screening of blood donations or donors for T. cruzi since 1990 in most Latin American countries, Mexico only finally included mandatory serological screening nationwide in official Norms in 2012. In 2005, a survey of blood donor centers in Mexico was conducted to compare T. cruzi prevalence in donations with that of Mexican migrants in the US. Since there was little coincidence between data from that survey and official screening or confirmed case rates, and screening for the social security system only initiated in 2010, the objective of this study was to calculate the incremental cost-effectiveness ratio for total compliance of current guidelines from both Mexican primary healthcare (the Secretary of Health) and regular salaried worker health services (the Mexican Institute for Social Security). A bi-modular model to analyze compliance was developed using a decision tree for the most common documented screening algorithms for the two principal health institution, and a Markov transition model for the natural history of illness and care. The incremental cost effectiveness ratio based on life-years gained is US$ 383 for the Secretary of Health (MoH), while the cost for an additional life-year gained is US$ 463 for the Social Security Institute (IMSS). Using survey compliance data for MoH, and that published by IMSS, failure to detect current infections, to avoid new infections, and life-years lost were calculated for 2013 and 2014 for both institutions. The MoH has failed to confirm 15,162 T. cruzi infections, did not prevent 2,347 avoidable infections, and lost 333,483 life-years over the two year period. Full regulatory compliance should be mandatory and timely monitoring should be part of the health authority’s responsibilities for the sake of blood security in Mexico.
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Affiliation(s)
| | - Alejandro Figueroa-Lara
- Escuela Militar de Graduados de Sanidad, Mexico City, Mexico
- Division of Innovation and Technology Management, Mexican Social Security Institute, Mexico City, Mexico
| | - Miguel Elizondo-Cano
- Health Economics Division, National Institute of Public Health, Cuernavaca, Mexico
| | - Leslie Wilson
- Departments of Medicine and Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
| | - Barbara Novelo-Garza
- Medical Infrastructure Planning Coordination, Mexican Social Security Institute, Mexico City, Mexico
| | | | - Janine M. Ramsey
- Regional Center for Public Health Research, National Institute for Public Health Research, Tapachula, Chiapas, Mexico
- * E-mail:
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Pecoul B, Batista C, Stobbaerts E, Ribeiro I, Vilasanjuan R, Gascon J, Pinazo MJ, Moriana S, Gold S, Pereiro A, Navarro M, Torrico F, Bottazzi ME, Hotez PJ. The BENEFIT Trial: Where Do We Go from Here? PLoS Negl Trop Dis 2016; 10:e0004343. [PMID: 26913759 PMCID: PMC4767872 DOI: 10.1371/journal.pntd.0004343] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bernard Pecoul
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland and Rio de Janeiro, Brazil
- The Global Chagas Disease Coalition, Barcelona, Spain
| | - Carolina Batista
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland and Rio de Janeiro, Brazil
- The Global Chagas Disease Coalition, Barcelona, Spain
| | - Eric Stobbaerts
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland and Rio de Janeiro, Brazil
- The Global Chagas Disease Coalition, Barcelona, Spain
| | - Isabella Ribeiro
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland and Rio de Janeiro, Brazil
- The Global Chagas Disease Coalition, Barcelona, Spain
| | - Rafael Vilasanjuan
- The Global Chagas Disease Coalition, Barcelona, Spain
- IS Global and the Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Joaquim Gascon
- The Global Chagas Disease Coalition, Barcelona, Spain
- IS Global and the Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Maria Jesus Pinazo
- The Global Chagas Disease Coalition, Barcelona, Spain
- IS Global and the Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Silvia Moriana
- The Global Chagas Disease Coalition, Barcelona, Spain
- IS Global and the Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Silvia Gold
- The Global Chagas Disease Coalition, Barcelona, Spain
- Fundacion Mundo Sano, Buenos Aires, Argentina, and Madrid, Spain
| | - Ana Pereiro
- The Global Chagas Disease Coalition, Barcelona, Spain
- Fundacion Mundo Sano, Buenos Aires, Argentina, and Madrid, Spain
| | - Miriam Navarro
- The Global Chagas Disease Coalition, Barcelona, Spain
- Fundacion Mundo Sano, Buenos Aires, Argentina, and Madrid, Spain
| | - Faustino Torrico
- The Global Chagas Disease Coalition, Barcelona, Spain
- Fundacion Ceades and Universidad Mayor de San Simon (UMSS), Cochabamba, Bolivia
| | - Maria Elena Bottazzi
- The Global Chagas Disease Coalition, Barcelona, Spain
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine at Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter J. Hotez
- The Global Chagas Disease Coalition, Barcelona, Spain
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine at Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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25
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Gunter SM, Jones KM, Zhan B, Essigmann HT, Murray KO, Garcia MN, Gorchakov R, Bottazzi ME, Hotez PJ, Brown EL. Identification and Characterization of the Trypanosoma cruzi B-cell Superantigen Tc24. Am J Trop Med Hyg 2015; 94:114-121. [PMID: 26598565 PMCID: PMC4710414 DOI: 10.4269/ajtmh.15-0438] [Citation(s) in RCA: 11] [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: 06/15/2015] [Accepted: 10/09/2015] [Indexed: 12/22/2022] Open
Abstract
Trypanosoma cruzi causes life-long disease after infection and leads to cardiac disease in 30% of infected individuals. After infection, the parasites are readily detectable in the blood during the first few days before disseminating to infect numerous cell types. Preliminary data suggested that the Tc24 protein that localizes to the T. cruzi membrane during all life stages possesses B-cell superantigenic properties. These antigens facilitate immune escape by interfering with antibody-mediated responses, particularly the avoidance of catalytic antibodies. These antibodies are an innate host defense mechanism present in the naive repertoire, and catalytic antibody–antigen binding results in hydrolysis of the target. We tested the B-cell superantigenic properties of Tc24 by comparing the degree of Tc24 hydrolysis by IgM purified from either Tc24 unexposed or exposed mice and humans. Respective samples were subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis, silver stained, and the degree of hydrolysis was measured. Data presented in this report suggest that the T. cruzi Tc24 is a B-cell superantigen based on the observations that 1) Tc24 was hydrolyzed by IgM present in serum of unexposed mice and humans and 2) exposure to Tc24 eliminated catalytic activity as early as 4 days after T. cruzi infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Eric L. Brown
- *Address correspondence to Eric L. Brown, Center for Infectious Diseases, University of Texas School of Public Health, 1200 Pressler St. Houston, TX 77030. E-mail:
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Garcia MN, Woc-Colburn L, Aguilar D, Hotez PJ, Murray KO. Historical Perspectives on the Epidemiology of Human Chagas Disease in Texas and Recommendations for Enhanced Understanding of Clinical Chagas Disease in the Southern United States. PLoS Negl Trop Dis 2015; 9:e0003981. [PMID: 26540273 PMCID: PMC4634991 DOI: 10.1371/journal.pntd.0003981] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chagas disease (Trypanosoma cruzi infection) has recently been identified as an important neglected tropical disease in the United States. Anecdotally referred to as a "silent killer," it leads to the development of potentially fatal cardiac disease in approximately 30% of those infected. In an attempt to better understand the potential of Chagas disease as a significant underlying cause of morbidity in Texas, we performed a historical literature review to assess disease burden. Human reports of triatomine bites and disease exposure were found to be prevalent in Texas. Despite current beliefs that Chagas disease is a recently emerging disease, we report historical references dating as far back as 1935. Both imported cases and autochthonous transmission contribute to the historical disease burden in Texas. We end by discussing the current knowledge gaps, and recommend priorities for advancing further epidemiologic studies and their policy implications.
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Affiliation(s)
- Melissa N. Garcia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
| | - Laila Woc-Colburn
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - David Aguilar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter J. Hotez
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
| | - Kristy O. Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
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Garcia MN, Aguilar D, Gorchakov R, Rossmann SN, Montgomery SP, Rivera H, Woc-Colburn L, Hotez PJ, Murray KO. Evidence of autochthonous Chagas disease in southeastern Texas. Am J Trop Med Hyg 2015; 92:325-30. [PMID: 25371187 PMCID: PMC4347336 DOI: 10.4269/ajtmh.14-0238] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/10/2014] [Indexed: 01/05/2023] Open
Abstract
Autochthonous transmission of Trypanosoma cruzi in the United States is rarely reported. Here, we describe five newly identified patients with autochthonously acquired infections from a small pilot study of positive blood donors in southeast Texas. Case-patients 1-4 were possibly infected near their residences, which were all in the same region ∼100 miles west of Houston. Case-patient 5 was a young male with considerable exposure from routine outdoor and camping activities associated with a youth civic organization. Only one of the five autochthonous case-patients received anti-parasitic treatment. Our findings suggest an unrecognized risk of human vector-borne transmission in southeast Texas. Education of physicians and public health officials is crucial for identifying the true disease burden and source of infection in Texas.
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Affiliation(s)
- Melissa N Garcia
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - David Aguilar
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Rodion Gorchakov
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Susan N Rossmann
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Susan P Montgomery
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Hilda Rivera
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Laila Woc-Colburn
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Peter J Hotez
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Kristy O Murray
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas; Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas; Gulf Coast Regional Blood Center, Houston, Texas; United States Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
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