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Torres-Vargas J, Jiménez-Coello M, Guzmán-Marín E, Acosta-Viana KY, Yadon ZE, Gutiérrez-Blanco E, Guillermo-Cordero JL, Garg NJ, Ortega-Pacheco A. Quantitative and histological assessment of maternal-fetal transmission of Trypanosoma cruzi in guinea pigs: An experimental model of congenital Chagas disease. PLoS Negl Trop Dis 2018; 12:e0006222. [PMID: 29364882 PMCID: PMC5798842 DOI: 10.1371/journal.pntd.0006222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/05/2018] [Accepted: 01/09/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We evaluated the effect of Trypanosoma cruzi infection on fertility, gestation outcome, and maternal-fetal transmission in guinea pigs (Cavia porcellus). METHODS Animals were infected with T. cruzi H4 strain (TcI lineage) before gestation (IBG) or during gestation (IDG). Tissue and sera samples of dams and fetuses were obtained near parturition. RESULTS All IBG and IDG dams were seropositive by two tests, and exhibited blood parasite load of 1.62±2.2 and 50.1±62 parasites/μl, respectively, by quantitative PCR. Histological evaluation showed muscle fiber degeneration and cellular necrosis in all infected dams. Parasite nests were not detected in infected dams by histology. However, qPCR analysis detected parasites-eq/g heart tissue of 153±104.7 and 169.3±129.4 in IBG and IDG dams, respectively. All fetuses of infected dams were positive for anti-parasite IgG antibodies and tissue parasites by qPCR, but presented a low level of tissue inflammatory infiltrate. Fetuses of IDG (vs. IBG) dams exhibited higher degree of muscle fiber degeneration and cellular necrosis in the heart and skeletal tissues. The placental tissue exhibited no inflammatory lesions and amastigote nests, yet parasites-eq/g of 381.2±34.3 and 79.2±84.9 were detected in IDG and IBG placentas, respectively. Fetal development was compromised, and evidenced by a decline in weight, crow-rump length, and abdominal width in both groups. CONCLUSIONS T. cruzi TcI has a high capacity of congenital transmission even when it was inoculated at a very low dose before or during gestation. Tissue lesions, parasite load, and fetal under development provide evidence for high virulence of the parasite during pregnancy. Despite finding of high parasite burden by qPCR, placentas were protected from cellular damage. Our studies offer an experimental model to study the efficacy of vaccines and drugs against congenital transmission of T. cruzi. These results also call for T. cruzi screening in pregnant women and adequate follow up of the newborns in endemic areas.
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Affiliation(s)
- Jatziri Torres-Vargas
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Matilde Jiménez-Coello
- C.A. Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Eugenia Guzmán-Marín
- C.A. Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Karla Y. Acosta-Viana
- C.A. Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Zaida E. Yadon
- Health Surveillance, Disease Prevention and Control, Pan American Health Organization, Duque de Caxias, Rio de Janeiro, Brazil
| | - Eduardo Gutiérrez-Blanco
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - José Leonardo Guillermo-Cordero
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Nisha J. Garg
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail: (NJG); (AOP)
| | - Antonio Ortega-Pacheco
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
- * E-mail: (NJG); (AOP)
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Chagas disease and transfusion medicine: a perspective from non-endemic countries. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 13:540-50. [PMID: 26513769 DOI: 10.2450/2015.0040-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
Abstract
In the last decades, increasing international migration and travel from Latin America to Europe have favoured the emergence of tropical diseases outside their "historical" boundaries. Chagas disease, a zoonosis endemic in rural areas of Central and South America represents a clear example of this phenomenon. In the absence of the vector, one of the potential modes of transmission of Chagas disease in non-endemic regions is through blood and blood products. As most patients with Chagas disease are asymptomatic and unaware of their condition, in case of blood donation they can inadvertently represent a serious threat to the safety of the blood supply in non-endemic areas. Since the first cases of transfusion-transmitted Chagas disease were described in the last years, non-endemic countries began to develop ad hoc strategies to prevent and control the spread of the infection. United States, Spain, United Kingdom and France first recognised the need for Trypanosoma cruzi screening in at-risk blood donors. In this review, we trace an up-to-date perspective on Chagas disease, describing its peculiar features, from epidemiological, pathological, clinical and diagnostic points of view. Moreover, we describe the possible transmission of Chagas disease through blood or blood products and the current strategies for its control, focusing on non-endemic areas.
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Guindo A, Touré BA, Guindo P, Baraika MA, Sarro YS, Fané B, Tessougué O, Dorie A, Traoré K, Diallo DA. Transmission of Plasmodium falciparum by red blood cell transfusions in the management of sickle cell disease patients in Mali. Transfus Med 2016; 26:153-5. [PMID: 27003788 DOI: 10.1111/tme.12294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/11/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A Guindo
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - B A Touré
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - P Guindo
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - M A Baraika
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Y S Sarro
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - B Fané
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - O Tessougué
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - A Dorie
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali.,International Technical Expert of French Cooperation, Bamako, Mali
| | - K Traoré
- National Malaria Control Program, Ministry of Health, Bamako, Mali
| | - D A Diallo
- Centre de Recherche et de Lutte contre la Drépanocytose (CRLD), Bamako, Mali.,Service d'hématologie oncologie médicale, CHU du Point G, Bamako, Mali
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Garg NJ, Soman KV, Zago MP, Koo SJ, Spratt H, Stafford S, Blell ZN, Gupta S, Nuñez Burgos J, Barrientos N, Brasier AR, Wiktorowicz JE. Changes in Proteome Profile of Peripheral Blood Mononuclear Cells in Chronic Chagas Disease. PLoS Negl Trop Dis 2016; 10:e0004490. [PMID: 26919708 PMCID: PMC4769231 DOI: 10.1371/journal.pntd.0004490] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022] Open
Abstract
Trypanosoma cruzi (Tc) infection causes chagasic cardiomyopathy; however, why 30-40% of the patients develop clinical disease is not known. To discover the pathomechanisms in disease progression, we obtained the proteome signature of peripheral blood mononuclear cells (PBMCs) of normal healthy controls (N/H, n = 30) and subjects that were seropositive for Tc-specific antibodies, but were clinically asymptomatic (C/A, n = 25) or clinically symptomatic (C/S, n = 28) with cardiac involvement and left ventricular dysfunction. Protein samples were labeled with BODIPY FL-maleimide (dynamic range: > 4 orders of magnitude, detection limit: 5 f-mol) and resolved by two-dimensional gel electrophoresis (2D-GE). After normalizing the gel images, protein spots that exhibited differential abundance in any of the two groups were analyzed by mass spectrometry, and searched against UniProt human database for protein identification. We found 213 and 199 protein spots (fold change: |≥ 1.5|, p< 0.05) were differentially abundant in C/A and C/S individuals, respectively, with respect to N/H controls. Ingenuity Pathway Analysis (IPA) of PBMCs proteome dataset identified an increase in disorganization of cytoskeletal assembly and recruitment/activation and migration of immune cells in all chagasic subjects, though the invasion capacity of cells was decreased in C/S individuals. IPA predicted with high probability a decline in cell survival and free radical scavenging capacity in C/S (but not C/A) subjects. The MYC/SP1 transcription factors that regulate hypoxia and oxidative/inflammatory stress were predicted to be key targets in the context of control of Chagas disease severity. Further, MARS-modeling identified a panel of proteins that had >93% prediction success in classifying infected individuals with no disease and those with cardiac involvement and LV dysfunction. In conclusion, we have identified molecular pathways and a panel of proteins that could aid in detecting seropositive individuals at risk of developing cardiomyopathy.
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Affiliation(s)
- Nisha Jain Garg
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, Texas, United States of America
- Department of Pathology, UTMB, Galveston, Texas, United States of America
- Faculty of the Institute for Human Infections and Immunity, and Sealy Center for Vaccine Development, UTMB, Galveston, Texas, United States of America
| | - Kizhake V. Soman
- Department of Biochemistry and Molecular Biology, and the Sealy Center for Molecular Medicine, UTMB, Galveston, Texas, United States of America
| | - Maria P. Zago
- Instituto de Patología Experimental, CONICET-UNSa, Salta, Argentina
| | - Sue-Jie Koo
- Department of Pathology, UTMB, Galveston, Texas, United States of America
| | - Heidi Spratt
- Department of Preventive Medicine and Community Health, UTMB, Galveston, Texas, United States of America
- Institute for Translational Sciences, UTMB, Galveston, Texas, United States of America
| | - Susan Stafford
- Department of Biochemistry and Molecular Biology, and the Sealy Center for Molecular Medicine, UTMB, Galveston, Texas, United States of America
| | - Zinzi N. Blell
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, Texas, United States of America
| | - Shivali Gupta
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, Texas, United States of America
| | | | | | - Allan R. Brasier
- Institute for Translational Sciences, UTMB, Galveston, Texas, United States of America
- Department of Internal Medicine, UTMB, Galveston, Texas, United States of America
| | - John E. Wiktorowicz
- Department of Biochemistry and Molecular Biology, and the Sealy Center for Molecular Medicine, UTMB, Galveston, Texas, United States of America
- Institute for Translational Sciences, UTMB, Galveston, Texas, United States of America
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Melo MF, Moreira OC, Tenório P, Lorena V, Lorena-Rezende I, Júnior WO, Gomes Y, Britto C. Usefulness of real time PCR to quantify parasite load in serum samples from chronic Chagas disease patients. Parasit Vectors 2015; 8:154. [PMID: 25890282 PMCID: PMC4369093 DOI: 10.1186/s13071-015-0770-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/25/2015] [Indexed: 01/10/2023] Open
Abstract
Background Inconclusive results of serological diagnosis in Chagas disease have an important impact on blood banks worldwide, reflecting in the high number of discarded bags or in an increased transmission by blood transfusion. Molecular techniques such as qPCR have been used for diagnosis and to monitor Trypanosoma cruzi load in peripheral blood samples. A promising perspective refers to the possibility of parasite DNA detection in serum, taking advantage in using the same samples collected for serological screening. Methods In order to evaluate the effectiveness of a qPCR strategy for detecting and quantifying T. cruzi DNA in serum, we selected 40 chronic Chagas disease patients presenting different clinical manifestations: Cardiac (23), Digestive (4), Mixed form [cardiodigestive] (7), and asymptomatic (6). Twenty seronegative individuals from non-endemic areas were included as controls. Samples were extracted using QIAamp DNA mini kit (QIAGEN) and qPCR was performed in a multiplex format with TaqMan probes for the nuclear satellite DNA of T. cruzi and for the human RNase P gene. In addition, DNA migration to serum during blood coagulation was assessed using a commercial exogenous control (Exo IPC, Applied Biosystems) in a separate qPCR reaction. Results The comparative duplex qPCR analysis revealed that, even with an increase in Ct values, it was possible to detect all DNA targets in serum. In addition, the same linearity range for T. cruzi quantification (from 105 to 0.5 par. eq./mL) between serum, blood or culture samples (T. cruzi epimastigotes – Cl Brener strain) was found. When patient samples were evaluated, no significant differences in parasite load between the distinct clinical manifestations were found for both blood and serum samples. Moreover, median values of parasite burden were 1.125 and 1.230 par. eq./mL for serum and blood, respectively. Using serology as gold standard, we found 95% sensitivity for T. cruzi detection in serum and 97.5% for blood, and 100% specificity for both samples. Conclusions Taken together, our data indicate the potential of using serum samples for molecular diagnosis and parasite load quantification by qPCR, suggesting its use in reference laboratories for the diagnosis of Chagas disease patients.
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Affiliation(s)
- Myllena F Melo
- Laboratório de Biologia Molecular e Doenças Endêmicas, IOC /Fiocruz, Av. Brasil, 4365. Pavilhão Leônidas Deane, sala 209. Manguinhos, Rio de Janeiro, Brazil. .,Programa Integrado de Doença de Chagas/Fiocruz, Rio de Janeiro, RJ, Brazil.
| | - Otacilio C Moreira
- Laboratório de Biologia Molecular e Doenças Endêmicas, IOC /Fiocruz, Av. Brasil, 4365. Pavilhão Leônidas Deane, sala 209. Manguinhos, Rio de Janeiro, Brazil. .,Programa Integrado de Doença de Chagas/Fiocruz, Rio de Janeiro, RJ, Brazil.
| | - Priscila Tenório
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães-CPqAM /Fiocruz, Recife, PE, Brazil.
| | - Virginia Lorena
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães-CPqAM /Fiocruz, Recife, PE, Brazil. .,Programa Integrado de Doença de Chagas/Fiocruz, Rio de Janeiro, RJ, Brazil.
| | - Izaura Lorena-Rezende
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães-CPqAM /Fiocruz, Recife, PE, Brazil.
| | - Wilson Oliveira Júnior
- Ambulatório de doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE), Recife, PE, Brazil.
| | - Yara Gomes
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães-CPqAM /Fiocruz, Recife, PE, Brazil. .,Programa Integrado de Doença de Chagas/Fiocruz, Rio de Janeiro, RJ, Brazil.
| | - Constança Britto
- Laboratório de Biologia Molecular e Doenças Endêmicas, IOC /Fiocruz, Av. Brasil, 4365. Pavilhão Leônidas Deane, sala 209. Manguinhos, Rio de Janeiro, Brazil. .,Programa Integrado de Doença de Chagas/Fiocruz, Rio de Janeiro, RJ, Brazil.
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Laperche S, Lefrère JJ, Morel P, Pouchol E, Pozzetto B. [Blood transfusion: control of infectious risks]. Presse Med 2014; 44:189-99. [PMID: 25547992 DOI: 10.1016/j.lpm.2014.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2014] [Indexed: 12/15/2022] Open
Abstract
From blood donor collection to transfusion of the recipient, there are several layers of protection of the blood supply. These measures combined with huge progresses over the three past decades in pathogen discovery and blood testing for specific pathogens (human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) viruses, Human T-cell leukemia virus (HTLV)), provide the greatest safety. With the implementation of serological and molecular testing, at least in high-income countries, transfusion-transmitted infections have become extremely rare. However, for pathogen agents, which are not tested and especially those which are responsible for emerging infectious disease, it became apparent that full control of infectious disease had not been achieved. In addition, the immune status of the recipient has also an impact in the outcome of infectious diseases transmitted by transfusion. Blood safety is based on several measures: education and deferral of donors with risk factors for transmissible disease, blood testing, pathogen reduction interventions, and patient blood management. This paper proposes a review of the residual risk of transmission of infectious diseases by transfusion and of the additional interventions able to further reduce it.
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Affiliation(s)
- Syria Laperche
- Centre national de référence des hépatites B et C et du VIH en transfusion, Institut national de la transfusion sanguine, 75015 Paris, France.
| | - Jean-Jacques Lefrère
- Institut national de la transfusion sanguine, 75015 Paris, France; Université Paris 5 (Paris Descartes), 75005 Paris, France
| | - Pascal Morel
- Établissement français du sang Bourgogne Franche-Comté, 25000 Besançon, France
| | - Elodie Pouchol
- Agence nationale de sécurité du médicament et des produits de santé, 93200 Saint-Denis, France
| | - Bruno Pozzetto
- Université de Lyon, faculté de médecine de Saint-Étienne, EA 3064, 42023 Saint-Étienne, France; CHU de Saint-Étienne, service de bactériologie, virologie, hygiène, 42023 Saint-Étienne, France
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Berneman A, Montout L, Goyard S, Chamond N, Cosson A, d’Archivio S, Gouault N, Uriac P, Blondel A, Minoprio P. Combined approaches for drug design points the way to novel proline racemase inhibitor candidates to fight Chagas' disease. PLoS One 2013; 8:e60955. [PMID: 23613764 PMCID: PMC3628851 DOI: 10.1371/journal.pone.0060955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/04/2013] [Indexed: 11/18/2022] Open
Abstract
Chagas' disease is caused by Trypanosoma cruzi, a protozoan transmitted to humans by blood-feeding insects, blood transfusion or congenitally. Previous research led us to discover a parasite proline racemase (TcPRAC) and to establish its validity as a target for the design of new chemotherapies against the disease, including its chronic form. A known inhibitor of proline racemases, 2-pyrrolecarboxylic acid (PYC), is water-insoluble. We synthesized soluble pyrazole derivatives, but they proved weak or inactive TcPRAC inhibitors. TcPRAC catalytic site is too small and constrained when bound to PYC to allow efficient search for new inhibitors by virtual screening. Forty-nine intermediate conformations between the opened enzyme structure and the closed liganded one were built by calculating a transition path with a method we developed. A wider range of chemical compounds could dock in the partially opened intermediate active site models in silico. Four models were selected for known substrates and weak inhibitors could dock in them and were used to screen chemical libraries. Two identified soluble compounds, (E)-4-oxopent-2-enoic acid (OxoPA) and its derivative (E)-5-bromo-4-oxopent-2-enoic acid (Br-OxoPA), are irreversible competitive inhibitors that presented stronger activity than PYC on TcPRAC. We show here that increasing doses of OxoPA and Br-OxoPA hamper T. cruzi intracellular differentiation and fate in mammalian host cells. Our data confirm that through to their binding mode, these molecules are interesting and promising as lead compounds for the development of chemotherapies against diseases where active proline racemases play essential roles.
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Affiliation(s)
- Armand Berneman
- Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, Institut Pasteur, Paris, France
| | - Lory Montout
- Unité de Bioinformatique Structurale, CNRS-UMR 3528, Département de Biologie Structurale et Chimie, Institut Pasteur, Paris, France
| | - Sophie Goyard
- Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, Institut Pasteur, Paris, France
| | - Nathalie Chamond
- Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, Institut Pasteur, Paris, France
| | - Alain Cosson
- Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, Institut Pasteur, Paris, France
| | - Simon d’Archivio
- Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, Institut Pasteur, Paris, France
| | - Nicolas Gouault
- Equipe Produits Naturels, Synthèses et Chimie Médicinale, UMR 6226 Sciences Chimiques de Rennes, Université de Rennes 1, Rennes, France
| | - Philippe Uriac
- Equipe Produits Naturels, Synthèses et Chimie Médicinale, UMR 6226 Sciences Chimiques de Rennes, Université de Rennes 1, Rennes, France
| | - Arnaud Blondel
- Unité de Bioinformatique Structurale, CNRS-UMR 3528, Département de Biologie Structurale et Chimie, Institut Pasteur, Paris, France
| | - Paola Minoprio
- Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, Institut Pasteur, Paris, France
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Abstract
Chagas cardiomyopathy is the most severe and life-threatening manifestation of human Chagas disease--a 'neglected' tropical disease caused by the protozoan parasite Trypanosoma cruzi. The disease is endemic in all continental Latin American countries, but has become a worldwide problem because of migration of infected individuals to developed countries, mainly in Europe and North America. Chagas cardiomyopathy results from the combined effects of persistent parasitism, parasite-driven tissue inflammation, microvascular and neurogenic dysfunction, and autoimmune responses triggered by the infection. Clinical presentation varies widely according to the extent of myocardial damage, and manifests mainly as three basic syndromes that can coexist in an individual patient: heart failure, cardiac arrhythmia, and thromboembolism. NYHA functional class, left ventricular systolic function, and nonsustained ventricular tachycardia are important prognostic markers of the risk of death. Management of Chagas cardiomyopathy focuses on the treatment of the three main syndromes. The use of β-blockers in patients with Chagas disease and heart failure is safe, well tolerated, and should be encouraged. Most specialists and international institutions now recommend specific antitrypanosomal treatment of patients with chronic Chagas disease, even in the absence of evidence obtained from randomized clinical trials. Further research on the management of patients with Chagas cardiomyopathy is necessary.
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Vázquez-Chagoyán JC, Gupta S, Garg NJ. Vaccine development against Trypanosoma cruzi and Chagas disease. ADVANCES IN PARASITOLOGY 2011; 75:121-46. [PMID: 21820554 DOI: 10.1016/b978-0-12-385863-4.00006-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pathology of Chagas disease presents a complicated and diverse picture in humans. The major complications and destructive evolutionary outcomes of chronic infection by Trypanosoma cruzi in humans include ventricular fibrillation, thromboembolism and congestive heart failure. Studies in animal models and human patients have revealed the pathogenic mechanisms during disease progression, pathology of disease and features of protective immunity. Accordingly, several antigens, antigen-delivery vehicles and adjuvants have been tested to elicit immune protection to T. cruzi in experimental animals. This review summarizes the research efforts in vaccine development against Chagas disease during the past decade.
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Affiliation(s)
- Juan C Vázquez-Chagoyán
- Centro de Investigación y Estudios Avanzados en Salud Animal, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Estado de México, Toluca, Mexico
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O'Brien SF, Zou S, Laperche S, Brant LJ, Seed CR, Kleinman SH. Surveillance of transfusion-transmissible infections comparison of systems in five developed countries. Transfus Med Rev 2011; 26:38-57. [PMID: 21944935 PMCID: PMC7134890 DOI: 10.1016/j.tmrv.2011.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Most industrialized countries maintain surveillance programs for monitoring transmissible infection in blood donations, revising approaches to methodology and risk assessment as new threats emerge. A comparison of programs in the United States, Canada, France, the UK, and Australia indicates that they have similar function, although the structure of blood programs vary as does the extent and nature of formal ties with public health. The emergence of HIV in the late 1970s and early 1980s was key in recognizing that surveillance systems specific to blood transfusion were essential. Hence, most industrialized countries monitor transfusion-transmissible infections in donors and evaluate the impact of new testing and of predonation screening strategies. Emerging infections since HIV have had different transmission pathways and challenged blood programs to draw upon resources for a rapid and effective response, with recognition that the original focus on sexual/drug-related risk of HIV and hepatitis was inadequate. The focus of surveillance programs on new and emerging pathogens fulfills a key role in risk assessment and policy formulation. The precise nature of such activities varies by country because of the structure of the blood programs and surveillance systems, the strategic focus of the blood programs, and the epidemiology of disease in each country.
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Affiliation(s)
- Sheila F O'Brien
- National Epidemiology and Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, Canada K1G 4J5. sheila.o'
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11
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Barratt JLN, Harkness J, Marriott D, Ellis JT, Stark D. Importance of nonenteric protozoan infections in immunocompromised people. Clin Microbiol Rev 2010; 23:795-836. [PMID: 20930074 PMCID: PMC2952979 DOI: 10.1128/cmr.00001-10] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.
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Affiliation(s)
- J L N Barratt
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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Ferreira-Silva MM, Pereira GA, Lages-Silva E, Moraes-Souza H. Socioepidemiological screening of serologically ineligible blood donors due to Chagas disease for the definition of inconclusive cases. Mem Inst Oswaldo Cruz 2010; 105:800-5. [DOI: 10.1590/s0074-02762010000600012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 05/13/2010] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Helio Moraes-Souza
- Universidade Federal do Triângulo Mineiro, Brasil; Fundação Hemominas, Brasil
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Wendel S. Transfusion transmitted Chagas disease: is it really under control? Acta Trop 2010; 115:28-34. [PMID: 20044970 DOI: 10.1016/j.actatropica.2009.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 12/12/2009] [Accepted: 12/22/2009] [Indexed: 12/13/2022]
Abstract
Transfusion transmitted Chagas disease was recognized as a medical problem more than 50 years ago. However, little attention was paid to it by Transfusion Medicine, medical authorities or regulatory agencies as a major problem and threat (especially after the advent of HIV/AIDS); perhaps because it was mainly restricted to tropical regions, usually in less developed countries. With the intense human migratory movement from developing to developed countries, it became more common and evident. The scope of this review is to cover the main transfusional aspects of American trypanosomiasis (Chagas disease), including the main strategies to prevent it through donor questionnaires, specific serological testing and alternative methods such as leukofiltration and pathogen reduction procedures, in order to increase the blood safety in both developing and developed countries.
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Diop S, Ndiaye M, Seck M, Chevalier B, Jambou R, Sarr A, Dièye T, Touré A, Thiam D, Diakhaté L. Prévention du paludisme post-transfusionnel en zone d’endémie. Transfus Clin Biol 2009; 16:454-9. [DOI: 10.1016/j.tracli.2009.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 02/16/2009] [Indexed: 11/28/2022]
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Garraud O, Assal A, Pelletier B, Danic B, Kerleguer A, David B, Joussemet M, de Micco P. Overview of revised measures to prevent malaria transmission by blood transfusion in France. Vox Sang 2008; 95:226-31. [DOI: 10.1111/j.1423-0410.2008.01090.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garraud O, Pelletier B, Aznar C. Pourquoi ajourner au don de sang des candidats au motif d’un risque de maladie de Chagas ? Transfus Clin Biol 2008; 15:123-8. [DOI: 10.1016/j.tracli.2008.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 05/05/2008] [Indexed: 10/21/2022]
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Elghouzzi MH, Senegas A, Steinmetz T, Guntz P, Barlet V, Assal A, Gallian P, Volle P, Chuteau C, Beolet M, Berrebi S, Filisetti D, Doderer C, Abdelrahman T, Candolfi E. Multicentric evaluation of the DiaMed enzyme-linked immunosorbent assay malaria antibody test for screening of blood donors for malaria. Vox Sang 2007; 94:33-40. [PMID: 18021184 DOI: 10.1111/j.1423-0410.2007.00998.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of malaria transmission by blood transfusion is critical due to extensive travel from endemic areas to non-endemic areas. An enzyme-linked immunosorbent assay (ELISA) malaria antibody test has been developed that is claimed to perform better than the immunofluorescence assay test (IFAT). The assay contains antigens to both Plasmodium falciparum and Plasmodium vivax. A multicentre study was performed to evaluate the appropriateness of replacing the IFAT by the new ELISA test. MATERIAL AND METHODS Nine French blood banks participated in this multicentre study. Two panels of samples were evaluated. The first included 4163 samples from healthy donors and was used to calculate clinical specificity of the assay. The second involved 10,995 samples, either collected retrospectively or prospectively from malaria-risk donors , was used to assess the comparative performance of the ELISA and IFAT. Discordant samples were further tested using an in-house IFAT and also tested for presence of Plasmodium DNA by polymerase chain reaction. RESULTS The ELISA showed a clinical specificity of 99.02%. In the malaria-risk blood donors groups, the retrospective group showed a concordance rate of 92.6% (k = 0.90), while the prospective group showed a concordance rate of 97% (k = 0.46). After confirming the discordant sample results by an in-house IFAT, the k index increased to 0.81. None of the discordant samples was shown to contain Plasmodium DNA. CONCLUSION The performance of the ELISA test in this study has confirmed its potential as a new screening test for use in blood banks, as an alternative to the IFAT in prevention of transfusion-transmitted malaria in non-endemic countries.
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Affiliation(s)
- M-H Elghouzzi
- Etablissement Français du Sang Ile de France, 94150 Rungis, France
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Tayou Tagny C, Mbanya D, Garraud O, Lefrère JJ. Sécurité transfusionnelle : paludisme et don de sang en Afrique. Transfus Clin Biol 2007; 14:481-6. [DOI: 10.1016/j.tracli.2007.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 12/13/2007] [Indexed: 11/24/2022]
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Rocha MOC, Teixeira MM, Ribeiro AL. An update on the management of Chagas cardiomyopathy. Expert Rev Anti Infect Ther 2007; 5:727-43. [PMID: 17678433 DOI: 10.1586/14787210.5.4.727] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, infects nearly 18 million people in Latin America and mainly affects the heart, causing heart failure, arrhythmias, heart block, thromboembolism, stroke and death. In this review, the clinical diagnosis and management of Chagas cardiomyopathy are discussed. Particular emphasis is placed on the clinical staging of patients and the use of various diagnostic tests that may be useful in individualizing treatment of the two most relevant clinical syndromes, that is, heart failure and arrhythmias. The relevance of specific treatments are discussed, stressing the important role of parasite persistence in disease pathogenesis. We also discuss new therapy modalities that may have a role in the treatment of Chagas cardiomyopathy.
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Affiliation(s)
- Manoel O C Rocha
- Internal Medicine Department and Coordinator, Postgraduate Course of Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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