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Gonzalez-Sanz M, Crespillo-Andújar C, Chamorro-Tojeiro S, Monge-Maillo B, Perez-Molina JA, Norman FF. Chagas Disease in Europe. Trop Med Infect Dis 2023; 8:513. [PMID: 38133445 PMCID: PMC10747626 DOI: 10.3390/tropicalmed8120513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Chagas disease is currently present in many non-endemic countries and remains a neglected tropical disease globally. A review of the literature identified significant gaps and scarcity of updated information from European countries, with most studies reporting data from Spain and Italy. The index of underdiagnosis may be as high as 70%, affecting mainly females of child-bearing age. Standardized screening of fertile, non-pregnant, women from endemic countries and subsequent treatment is considered an essential strategy to control transmission and prevent new cases, yet no uniform legislation for screening risk groups exists. There is heterogeneity in Europe in terms of preventive strategies to avoid transfusion-related transmission of Chagas disease, not necessarily in line with the European directives, with some countries conducting systematic screening for T. cruzi infection in blood donors, whilst others rely on pre-transfusion questionnaires. The growing burden of the infection in resource-rich areas may provide an opportunity for progress in certain aspects of control and prevention. Options for improving screening strategies, management and linkage to care are reviewed.
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Affiliation(s)
- Marta Gonzalez-Sanz
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sandra Chamorro-Tojeiro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - Jose A. Perez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francesca F. Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universidad de Alcalá, 28801 Alcalá de Henares, Spain
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Proaño A, Dumonteil E, Herrera C. Chagas Disease Diagnostic Testing in Two Academic Hospitals in New Orleans, Louisiana: A Call to Action. Trop Med Infect Dis 2023; 8:tropicalmed8050277. [PMID: 37235325 DOI: 10.3390/tropicalmed8050277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Chagas disease, caused by the protozoa parasite Trypanosoma cruzi, is an anthropozoonosis that represents a major public health problem in the Americas, affecting 7 million people with at least 65 million at risk. We sought to assess the intensity of disease surveillance based on diagnostic test requests from hospitals in New Orleans, Louisiana. We extracted information from send-out labs at two major tertiary academic hospitals in New Orleans, Louisiana, USA, from 1 January 2018 to 1 December 2020. We found that in these three years there were 27 patients for whom Chagas disease testing was ordered. Most of these patients were male (70%), with a median age of 40 years old, and their most common ethnical background was Hispanic (74%). These findings demonstrate undertesting of this neglected disease in our region. Given the low Chagas disease surveillance, we need to increase awareness, health promotion, and education among healthcare workers.
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Affiliation(s)
- Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
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Macaluso G, Grippi F, Di Bella S, Blanda V, Gucciardi F, Torina A, Guercio A, Cannella V. A Review on the Immunological Response against Trypanosoma cruzi. Pathogens 2023; 12:pathogens12020282. [PMID: 36839554 PMCID: PMC9964664 DOI: 10.3390/pathogens12020282] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Chagas disease is a chronic systemic infection transmitted by Trypanosoma cruzi. Its life cycle consists of different stages in vector insects and host mammals. Trypanosoma cruzi strains cause different clinical manifestations of Chagas disease alongside geographic differences in morbidity and mortality. Natural killer cells provide the cytokine interferon-gamma in the initial phases of T. cruzi infection. Phagocytes secrete cytokines that promote inflammation and activation of other cells involved in defence. Dendritic cells, monocytes and macrophages modulate the adaptive immune response, and B lymphocytes activate an effective humoral immune response to T. cruzi. This review focuses on the main immune mechanisms acting during T. cruzi infection, on the strategies activated by the pathogen against the host cells, on the processes involved in inflammasome and virulence factors and on the new strategies for preventing, controlling and treating this disease.
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Abstract
Chagas disease, which is caused by infection with the parasite Trypanosoma cruzi, is a leading neglected tropical disease in the United States. An estimated 240 000 to 350 000 persons in the United States are infected, primarily immigrants from Mexico, Central America, and South America, where the disease is endemic. The parasite is transmitted by the triatomine bug but can also be passed through blood transfusion, via organ transplant, or congenitally. Approximately 30% of infected persons later develop cardiac and/or gastrointestinal complications. Health care providers should consider screening at-risk patients with serologic testing. Early diagnosis and treatment with benznidazole or nifurtimox can help prevent complications.
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Affiliation(s)
- Natasha S Hochberg
- Boston University School of Medicine, Boston University School of Public Health, and Boston Medical Center, Boston, Massachusetts (N.S.H.)
| | - Susan P Montgomery
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia (S.P.M.)
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Our Current Understanding of Chagas Disease and Trypanosoma cruzi Infection in the State of Florida — an Update on Research in this Region of the USA. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose of Review
Chagas disease (CD) is a neglected tropical disease caused by the protozoan parasite, Trypanosoma cruzi. Parasite transmission primarily occurs through direct interaction with an infected triatomine insect vector (kissing bug), but other routes are known. We aim to review the literature and discuss the unique circumstances of CD in the US state of Florida.
Recent Findings
Florida is home to naturally occurring kissing bugs that are invading homes and harbor T. cruzi. The state is also home to a diverse population of immigrants from Chagas-endemic regions in Latin America. In the USA, Florida is the state with the third highest estimated burden of CD, although the true prevalence is unknown.
Summary
Chagas disease is a chronic infection that often remains silent for decades. Those who manifest chronic disease may eventually die from debilitating cardiac and/or gastrointestinal manifestations. Florida is an opportune region of the USA for the study of CD, due to the existence of endemic transmission cycles in addition to the burden among people born in Chagas-endemic regions.
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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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Lopez JR, Linares N, Adams JA, Mijares A. The Role of the Na+/Ca2+ Exchanger in Aberrant Intracellular Ca2+ in Cardiomyocytes of Chagas-Infected Rodents. Front Cell Infect Microbiol 2022; 12:890709. [PMID: 35903196 PMCID: PMC9318578 DOI: 10.3389/fcimb.2022.890709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022] Open
Abstract
Chagas disease is produced by the parasite Trypanosoma cruzi (T. cruzi), which is the leading cause of death and morbidity in Latin America. We have shown that in patients with Chagas cardiomyopathy, there is a chronic elevation of diastolic Ca2+ concentration ([Ca2+]d), associated with deterioration to further address this issue, we explored the role Na+/Ca2+ exchanger (NCX). Experiments were carried out in noninfected C57BL/6 mice and infected with blood-derived trypomastigotes of the T. cruzi Y strain. Anesthetized mice were sacrificed and the cardiomyocytes were enzymatically dissociated. Diastolic [Ca2+] ([Ca2+]d) was measured using Ca2+ selective microelectrodes in cardiomyocytes from control mice (CONT) and cardiomyocytes from T. cruzi infected mice in the early acute phase (EAP) at 20 dpi, in the acute phase (AP) at 40 dpi, and in the chronic phase (CP) at 120 dpi. [Ca2+]d was 1.5-times higher in EAP, 2.6-times in AP, and 3.4-times in CP compared to CONT. Exploring the reverse mode activity of NCX, we replaced extracellular Na+ in equivalent amounts with N-methyl-D-glucamine. Reduction of [Na+]e to 65 mM caused an increase in [Ca2+]d of 1.7 times in cardiomyocytes from CONT mice, 2 times in EAP infected mice, 2.4 times in AP infected mice and 2.8 in CP infected mice. The Na+ free solution caused a further elevation of [Ca2+]d of 2.5 times in cardiomyocytes from CONT, 2.8 times in EAP infected mice, 3.1 times in AP infected mice, and 3.3 times in CP infected mice. Extracellular Ca2+ withdrawal reduced [Ca2+]d in both CONT and cardiomyocytes from Chagas-infected mice and prevented the increase in [Ca2+]d induced by Na+ depletion. Preincubation with 10µM KB-R7943 or in 1µM YM-244769 reduced [Ca2+]d in cardiomyocytes from infected mice, but not control mice. Furthermore, both NCX blockers prevented the increase in [Ca2+]d associated with exposure to a solution without Na+. These results suggest that Ca2+ entry through the reverse NCX mode plays a significant role in the observed [Ca2+]d dyshomeostasis in Chagas infected cardiomyocytes. Additionally, NCX inhibitors may be a viable therapeutic approach for treating patients with Chagas cardiomyopathy.
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Affiliation(s)
- Jose R. Lopez
- Department of Research, Mount Sinai, Medical Center, Miami, FL, United States
| | - Nancy Linares
- Centro de Biofísica y Bioquímica, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
| | - Jose A. Adams
- Division of Neonatology, Mount Sinai, Medical Center, Miami, FL, United States
| | - Alfredo Mijares
- Centro de Biofísica y Bioquímica, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
- *Correspondence: Alfredo Mijares,
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Berto CG, Coyle CM, Friedman L, Walker PF. Where was my patient born? The Intersection of tropical medicine and migrant health. Curr Opin Infect Dis 2021; 34:447-454. [PMID: 34267044 DOI: 10.1097/qco.0000000000000773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is unprecedented movement of people across international borders and parasitic infections, previously restricted to endemic regions, are now encountered in nonendemic areas of the world. RECENT FINDINGS Migrants may import parasitic infections acquired in their countries of origin. Increasingly, clinicians in nonendemic regions are faced with patients with neglected diseases such as Chagas disease, malaria and strongyloidiasis. There are gaps in knowledge among physicians in nonendemic regions, which lead to missed opportunities for preventive strategies and early treatment. Both primary care and infectious disease physicians should have a broad knowledge of common parasitic infections to improve health outcomes and decrease healthcare disparities through early identification and treatment of disease encountered in migrants. SUMMARY Migrant health is still a young field in medicine; clinicians should be aware of diseases seen in migrants, and access both educational and clinical resources, including experts in tropical medicine, in order to reduce health disparities among migrants. Collaboration between primary care and infectious disease/tropical medicine experts should be strengthened.
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Affiliation(s)
- Cesar G Berto
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
| | - Christina M Coyle
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
- Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, New York
| | | | - Patricia F Walker
- Department of Medicine, Global Medicine, University of Minnesota, Minneapolis
- Health Partners Institute, Bloomington
- HealthPartners Travel and Tropical Medicine Center, St Paul, Minnesota, USA
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Crowder LA, Wendel S, Bloch EM, O'Brien SF, Delage G, Sauleda S, Leiby DA. International survey of strategies to mitigate transfusion-transmitted Trypanosoma cruzi in non-endemic countries, 2016-2018. Vox Sang 2021; 117:58-63. [PMID: 34111301 DOI: 10.1111/vox.13164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Chagas disease, caused by Trypanosoma cruzi, is endemic to Mexico, Central and South America. While initially limited to the Americas, emigration of infected persons triggered geographically broader blood safety challenges. To mitigate transfusion-transmitted Chagas (TTC), transfusion services implemented approaches including risk factor questions and serologic testing. We sought to understand and compare strategies in non-endemic countries. MATERIALS AND METHODS Transfusion services in International Society of Blood Transfusion (ISBT)-affiliated organizations and members of the ISBT Working Party on Transfusion-Transmitted Infectious Diseases were invited to complete an online survey on T. cruzi mitigation strategies. The survey queried about cases of TTC, risk factors, testing methodology, educational materials, pathogen reduction, donor/product management, donor deferral and perceived public health concerns surrounding TTC. RESULTS Responses were received from 27 institutions in 22 countries. Most countries (77.3%) reported no historical TTC cases, while 18.2% reported 1-5 cases and 4.5% reported 6-10 cases. Concern about Chagas among the general public and public health authorities was low, but 12 of 25 blood centres reported moderate/high concern. Overall, 17 countries mitigated for TTC: 15 used risk factor questions and 10tested for T. cruzi antibodies. Ten countries used pathogen reduction but not specifically to prevent TTC. CONCLUSION While Chagas is rarely cited as a public health concern, blood centres in many non-endemic countries, including those outside the Americas, implemented measures to mitigate risk. Mitigation focussed on risk factors associated with Latin American immigrants and serologic testing. Thus, despite the rarity of TTC, many non-endemic countries continue to address it as an ongoing blood safety risk.
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Affiliation(s)
- Lauren A Crowder
- American Red Cross, Scientific Affairs, Rockville, Maryland, USA
| | | | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Gilles Delage
- Medical Affairs - Microbiology, Héma-Québec, Montreal, Quebec, Canada
| | - Silvia Sauleda
- Transfusion Safety Laboratory, Catalonian Blood Bank (Banc de Sang i Teixits de Catalunya), Barcelona, Spain
| | - David A Leiby
- US Food and Drug Administration, CBER/OBRR, Silver Spring, Maryland, USA
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McCullough J. Transfusion‐Transmitted Diseases. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Omolabi KF, Odeniran PO, Olotu FA, S Soliman ME. A Mechanistic Probe into the Dual Inhibition of T. cruzi Glucokinase and Hexokinase in Chagas Disease Treatment - A Stone Killing Two Birds? Chem Biodivers 2021; 18:e2000863. [PMID: 33411971 DOI: 10.1002/cbdv.202000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/07/2021] [Indexed: 01/15/2023]
Abstract
Glucokinase (GLK) and Hexokinase (HK) have been characterized as essential targets in Trypanosoma cruzi (Tc)-mediated infection. A recent study reported the propensity of the concomitant inhibition of TcGLK and TcHK by compounds GLK2-003 and GLK2-004, thereby presenting an efficient approach in Chagas disease treatment. We investigated this possibility using atomic and molecular scaling methods. Sequence alignment of TcGLK and TcHK revealed that both proteins shared approximately 33.3 % homology in their glucose/inhibitor binding sites. The total binding free energies of GLK2-003 and GLK2-004 were favorable in both proteins. PRO92 and THR185 were pivotal to the binding and stabilization of the ligands in TcGLK, likewise their conserved counterparts, PRO163 and THR237 in TcHK. Both compounds also induced a similar pattern of perturbations in both TcGLK and TcHK secondary structure. Findings from this study therefore provide insights into the underlying mechanisms of dual inhibition exhibited by the compounds. These results can pave way to discover and optimize novel dual Tc inhibitors with favorable pharmacokinetics properties eventuating in the mitigation of Chagas disease.
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Affiliation(s)
- Kehinde F Omolabi
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Paul O Odeniran
- Department of Veterinary Parasitology and Entomology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, 200001, Nigeria
| | - Fisayo A Olotu
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Mahmoud E S Soliman
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
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Costa ACD, Rocha EA, Silva Filho JDD, Fidalgo ASODBV, Nunes FMM, Viana CEM, Gomes VBAF, Oliveira MDF. Prevalence of Trypanosoma Cruzi Infection in Blood Donors. Arq Bras Cardiol 2021; 115:1082-1091. [PMID: 33470305 PMCID: PMC8133715 DOI: 10.36660/abc.20190285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
Fundamento A doença de Chagas (DC) é considerada um problema de saúde pública na América Latina. A região nordeste, principalmente o estado do Ceará, ainda representa grande preocupação em termos de risco de transmissão da doença. Objetivo Estimar a prevalência de T. cruzi em doadores de sangue do estado do Ceará. Métodos Trata-se um de estudo retrospectivo descritivo realizado no período de 2010 a 2015, a partir de dados registrados no sistema informatizado do Centro de Hematologia e Hemoterapia do Ceará (HEMOCE). Resultados Dos 763.731 potenciais doadores de sangue, 14.159 foram considerados impedidos de fazer a doação devido à sorologia, sendo que 1.982 (0,33%) o foram devido à positividade/inconclusão para doença de Chagas. Compareceram à Hemorrede para a repetição 425 indivíduos, sendo confirmados 28,2% (120/425) como impedidos de doar devido a DC. Conclusão Não houve redução significativa das sorologias positivas/inconclusivas no período entre 2010-2015, porém foi observada redução em relação a 1996/1997 no estado. A determinação da prevalência da doença de Chagas em bancos de sangue pode ser relevante como indicador do risco de transmissão transfusional em determinada região. Novos testes sorológicos para triagem com melhor acurácia são necessários, reduzindo o descarte desnecessário de bolsas de sangue, os custos para o Sistema Único de Saúde e a insegurança para os pacientes e familiares. (Arq Bras Cardiol. 2020; 115(6):1082-1091)
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Zaib S, Khan I. Synthetic and medicinal chemistry of phthalazines: Recent developments, opportunities and challenges. Bioorg Chem 2020; 105:104425. [PMID: 33157344 DOI: 10.1016/j.bioorg.2020.104425] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
Fused diaza-heterocycles constitute the core structure of numerous bioactive natural products and effective therapeutic drugs. Among them, phthalazines have been recognized as remarkable structural leads in medicinal chemistry due to their wide application in pharmaceutical and agrochemical industries. Accessing such challenging pharmaceutical agents/drug candidates with high chemical complexity through synthetically efficient approaches remains an attractive goal in the contemporary medicinal chemistry and drug discovery arena. In this review, we focus on the recent developments in the synthetic routes towards the generation of phthalazine-based active pharmaceutical ingredients and their biological potential against various targets. The general reaction scope of these innovative and easily accessible strategies was emphasized focusing on the functional group tolerance, substrate and coupling partner compatibility/limitation, the choice of catalyst, and product diversification. These processes were also accompanied by the mechanistic insights where deemed appropriate to demonstrate meaningful information. Moreover, the rapid examination of the structure-activity relationship analyses around the phthalazine core enabled by the pharmacophore replacement/integration revealed the generation of robust, efficient, and more selective compounds with pronounced biological effects. A large variety of in silico methods and ADME profiling tools were also employed to provide a global appraisal of the pharmacokinetics profile of diaza-heterocycles. Thus, the discovery of new structural leads offers the promise of improving treatments for various tropical diseases such as tuberculosis, leishmaniasis, malaria, Chagas disease, among many others including various cancers, atherosclerosis, HIV, inflammatory, and cardiovascular diseases. We hope this review would serve as an informative collection of structurally diverse molecules enabling the generation of mature, high-quality, and innovative routes to support the drug discovery endeavors.
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Affiliation(s)
- Sumera Zaib
- Department of Biochemistry, Faculty of Life Sciences, University of Central Punjab, Lahore 54590, Pakistan
| | - Imtiaz Khan
- Department of Chemistry and Manchester Institute of Biotechnology, The University of Manchester, 131 Princess Street, Manchester M1 7DN, United Kingdom.
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Chagas cardiomyopathy and heart failure: From epidemiology to treatment. Rev Port Cardiol 2020; 39:279-289. [PMID: 32532535 DOI: 10.1016/j.repc.2019.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/10/2019] [Accepted: 12/01/2019] [Indexed: 12/28/2022] Open
Abstract
Chagas disease is among the neglected tropical diseases recognized by the World Health Organization that have received insufficient attention from governments and health agencies. Chagas disease is endemic in 21 Latin America regions. Due to globalization and increased migration, it has crossed borders and reached other regions including North America and Europe. The clinical presentation of the disease is highly variable, from general symptoms to severe cardiac involvement that can culminate in heart failure. Chagas heart disease is multifactorial, and can include dilated cardiomyopathy, thromboembolic phenomena, and arrhythmias that may lead to sudden death. Diagnosis is by methods such as enzyme-linked immunosorbent assay (ELISA) and the degree of cardiac involvement should be investigated with complementary exams including ECG, chest radiography and electrophysiological study. There have been insufficient studies on which to base specific treatment for heart failure due to Chagas disease. Treatment should therefore be derived from guidelines for heart failure that are not specific for this disease. Heart transplantation is a viable option with satisfactory success rates that has improved survival.
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Santos É, Menezes Falcão L. Chagas cardiomyopathy and heart failure: From epidemiology to treatment. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Herrick JA, Nordstrom M, Maloney P, Rodriguez M, Naceanceno K, Gallo G, Mejia R, Hershow R. Parasitic infections represent a significant health threat among recent immigrants in Chicago. Parasitol Res 2020; 119:1139-1148. [PMID: 32008064 PMCID: PMC7075846 DOI: 10.1007/s00436-020-06608-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
Abstract
Parasitic infections are likely under-recognized among immigrant populations in the USA. We conducted a cross-sectional study to evaluate if such infections have health impacts among recent immigrants in Chicago and to identify predictive factors for parasitic infections. A total of 133 recent immigrants were enrolled, filling out a standardized medical questionnaire and providing blood and stool samples. Appriximately 12% of subjects (15/125) who provided a blood or stool sample for testing were found to have evidence of current or prior infection with a pathogenic parasite, of which Toxocara spp. (8 subjects, 6.4%) and Strongyloides stercoralis (5 subjects, 4%) were most commonly identified. Parasitic infection was more likely among subjects who had immigrated within the previous 2 years and those with a self-reported history of worms in the stool. The most useful surrogate markers identified for parasitic infections were an elevated immunoglobulin E level (seen in 46.7% (7/15) of subjects with parasitic infections and 20% (22/110) of uninfected individuals, p = 0.04) and the presence of Blastocystis hominis cysts on Ova & Parasite exam (detected in 38.5% (5/13) of subjects with parasitic infections who provided a stool sample and 5.1% (5/98) of uninfected subjects, p = 0.002). Our study found that parasitic infections may be common in recent US immigrants, which highlights an important health disparity among a vulnerable population that merits further study. Additionally, clinical risk factors, symptoms, and laboratory findings traditionally thought to be associated with parasites were commonly found but not predictive of infection in this study population.
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Affiliation(s)
- Jesica A. Herrick
- grid.185648.60000 0001 2175 0319Department of Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, 808 South Wood, M/C 735, Chicago, IL 60612 USA
| | - Monica Nordstrom
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
| | - Patrick Maloney
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
| | - Miguel Rodriguez
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
| | - Kevin Naceanceno
- grid.39382.330000 0001 2160 926XDepartment of Medicine, Section of Infectious Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
| | - Gloria Gallo
- grid.39382.330000 0001 2160 926XDepartment of Medicine, Section of Infectious Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
- grid.411249.b0000 0001 0514 7202Science and Technology Institute, Federal University of São Paulo, São José dos Campos, São Paulo, Brazil
| | - Rojelio Mejia
- grid.39382.330000 0001 2160 926XDepartment of Medicine, Section of Infectious Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
| | - Ron Hershow
- grid.185648.60000 0001 2175 0319Department of Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, 808 South Wood, M/C 735, Chicago, IL 60612 USA
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
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17
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Behrens-Bradley N, Smith S, Beatty NL, Love M, Ahmad N, Dorn PL, Schmidt JO, Klotz SA. Kissing Bugs Harboring Trypanosoma cruzi, Frequently Bite Residents of the US Southwest But Do Not Cause Chagas Disease. Am J Med 2020; 133:108-114.e13. [PMID: 31295438 DOI: 10.1016/j.amjmed.2019.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kissing bugs are common household pests in the Desert Southwest of the United States. These hematophagous bugs enter homes and suck blood from resident humans and pets. They are vectors of Trypanosoma cruzi, an enzootic parasite in small mammals and the cause of Chagas disease in humans. Autochthonous cases of Chagas disease are rare in the United States despite the presence of the vector and parasite. Environmental and biological factors accounting for this phenomenon need studying. METHODS Homeowners in Bisbee and Tucson, Arizona captured kissing bugs inside homes during 2017-2018. Bugs were tested for presence of T. cruzi by polymerase chain reaction. Residents bitten by kissing bugs were tested for Chagas disease by serology. We evaluated invaded homes in the 2 cities. RESULTS Three species of kissing bugs (n = 521) were collected in or near homes. Triatoma rubida was the most common triatomine in Tucson; T. recurva in Bisbee. T. protracta was uncommon. Seventeen percent of bugs captured in Bisbee and 51.1% in Tucson harbored T. cruzi. Bite victims (n = 105) recalled more than 2200 bites. Reactions to bites were common, including 32 episodes of anaphylaxis in 11 people (10.5%). Tests for Chagas disease (n = 116) were negative. Median age of houses was 91 years in Bisbee and 7 years in Tucson. Bisbee houses had pier and beam foundations. Tucson houses were built on concrete slabs. CONCLUSIONS Kissing bugs harboring T. cruzi readily entered new and old homes. Bites of humans caused severe, life-threatening reactions. There was no serological evidence of Chagas disease among those bitten.
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Affiliation(s)
| | - Shannon Smith
- Department of Medicine, University of Arizona, Tucson
| | | | - Maria Love
- Department of Immunobiology, University of Arizona, Tucson
| | - Nafees Ahmad
- Department of Immunobiology, University of Arizona, Tucson
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18
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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: 131] [Impact Index Per Article: 26.2] [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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19
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Edwards MS, Stimpert KK, Bialek SR, Montgomery SP. Evaluation and Management of Congenital Chagas Disease in the United States. J Pediatric Infect Dis Soc 2019; 8:461-469. [PMID: 31016324 PMCID: PMC10186111 DOI: 10.1093/jpids/piz018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/26/2019] [Indexed: 01/18/2023]
Abstract
Chagas disease is underappreciated as a health concern in the United States. Approximately 40 000 women of childbearing age living in the United States have chronic Chagas disease. Most of them are unaware that they have an infection that is transmissible to their offspring. The estimated US maternal-to-infant transmission rate of Trypanosoma cruzi is 1% to 5%. Ten percent to 40% of neonates with congenital T cruzi infection have clinical signs consistent with a congenital infection but no findings are unique to Chagas disease. If left untreated, 20% to 40% of infants with Chagas disease will later develop potentially fatal cardiac manifestations. Molecular testing can confirm the diagnosis in neonates. Treatment is well tolerated in infancy and usually results in cure. Screening of at-risk women during pregnancy can identify maternal infection and allow early assessment and treatment for congenital T cruzi infection.
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Affiliation(s)
- Morven S Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kelly K Stimpert
- IHRC, Inc, Atlanta, Georgia.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie R Bialek
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lidani KCF, Andrade FA, Bavia L, Damasceno FS, Beltrame MH, Messias-Reason IJ, Sandri TL. Chagas Disease: From Discovery to a Worldwide Health Problem. Front Public Health 2019; 7:166. [PMID: 31312626 PMCID: PMC6614205 DOI: 10.3389/fpubh.2019.00166] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
Carlos Chagas discovered American trypanosomiasis, also named Chagas disease (CD) in his honor, just over a century ago. He described the clinical aspects of the disease, characterized by its etiological agent (Trypanosoma cruzi) and identified its insect vector. Initially, CD occurred only in Latin America and was considered a silent and poorly visible disease. More recently, CD became a neglected worldwide disease with a high morbimortality rate and substantial social impact, emerging as a significant public health threat. In this context, it is crucial to better understand better the epidemiological scenarios of CD and its transmission dynamics, involving people infected and at risk of infection, diversity of the parasite, vector species, and T. cruzi reservoirs. Although efforts have been made by endemic and non-endemic countries to control, treat, and interrupt disease transmission, the cure or complete eradication of CD are still topics of great concern and require global attention. Considering the current scenario of CD, also affecting non-endemic places such as Canada, USA, Europe, Australia, and Japan, in this review we aim to describe the spread of CD cases worldwide since its discovery until it has become a global public health concern.
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Affiliation(s)
| | - Fabiana Antunes Andrade
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Lorena Bavia
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Flávia Silva Damasceno
- Laboratory of Biochemistry of Tryps-LaBTryps, Department of Parasitology, Institute for Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcia Holsbach Beltrame
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Iara J. Messias-Reason
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Thaisa Lucas Sandri
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
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21
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La Hoz RM, Morris MI. Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients- Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13546. [PMID: 30900295 DOI: 10.1111/ctr.13546] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tissue and blood protozoal infections in the pre- and post-transplant period. Significant new developments in the field have made it necessary to divide the previous single guideline published in 2013 into two sections, with the intestinal parasites separated from this guideline devoted to tissue and blood protozoa. The current update reflects the increased focus on donor screening and risk-based recipient monitoring for parasitic infections. Increased donor testing has led to new recommendations for recipient management of Toxoplasma gondii and Trypanosoma cruzi. Molecular diagnostics have impacted the field, with access to rapid diagnostic testing for malaria and polymerase chain reaction testing for Leishmania. Changes in Babesia treatment regimens in the immunocompromised host are outlined. The risk of donor transmission of free-living amebae infection is reviewed. Changing immigration patterns and the expansion of transplant medicine in developing countries has contributed to the recognition of parasitic infections as an important threat to transplant outcomes. Medications such as benznidazole and miltefosine are now available to US prescribers as access to treatment of tissue and blood protozoa is increasingly prioritized.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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Cytosolic Fe-superoxide dismutase safeguards Trypanosoma cruzi from macrophage-derived superoxide radical. Proc Natl Acad Sci U S A 2019; 116:8879-8888. [PMID: 30979807 DOI: 10.1073/pnas.1821487116] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease (CD), contains exclusively Fe-dependent superoxide dismutases (Fe-SODs). During T. cruzi invasion to macrophages, superoxide radical (O2 •-) is produced at the phagosomal compartment toward the internalized parasite via NOX-2 (gp91-phox) activation. In this work, T. cruzi cytosolic Fe-SODB overexpressers (pRIBOTEX-Fe-SODB) exhibited higher resistance to macrophage-dependent killing and enhanced intracellular proliferation compared with wild-type (WT) parasites. The higher infectivity of Fe-SODB overexpressers compared with WT parasites was lost in gp91-phox -/- macrophages, underscoring the role of O2 •- in parasite killing. Herein, we studied the entrance of O2 •- and its protonated form, perhydroxyl radical [(HO2 •); pKa = 4.8], to T. cruzi at the phagosome compartment. At the acidic pH values of the phagosome lumen (pH 5.3 ± 0.1), high steady-state concentrations of O2 •- and HO2 • were estimated (∼28 and 8 µM, respectively). Phagosomal acidification was crucial for O2 •- permeation, because inhibition of the macrophage H+-ATPase proton pump significantly decreased O2 •- detection in the internalized parasite. Importantly, O2 •- detection, aconitase inactivation, and peroxynitrite generation were lower in Fe-SODB than in WT parasites exposed to external fluxes of O2 •- or during macrophage infections. Other mechanisms of O2 •- entrance participate at neutral pH values, because the anion channel inhibitor 5-nitro-2-(3-phenylpropylamino) benzoic acid decreased O2 •- detection. Finally, parasitemia and tissue parasite burden in mice were higher in Fe-SODB-overexpressing parasites, supporting the role of the cytosolic O2 •--catabolizing enzyme as a virulence factor for CD.
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Dodd RY, Groves JA, Townsend RL, Notari EP, Foster GA, Custer B, Busch MP, Stramer SL. Impact of one-time testing for Trypanosoma cruzi
antibodies among blood donors in the United States. Transfusion 2018; 59:1016-1023. [DOI: 10.1111/trf.15118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Roger Y. Dodd
- Scientific Affairs; American Red Cross; Gaithersburg Maryland
| | - Jamel A. Groves
- Scientific Affairs; American Red Cross; Gaithersburg Maryland
| | | | | | | | - Brian Custer
- Vitalant Research Institute; San Francisco California
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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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Santana MP, Souza-Santos R, Almeida ASD. Factors associated with Chagas disease among blood donors in Brazilian Northeast region. J Infect Public Health 2018; 11:817-820. [PMID: 30017805 DOI: 10.1016/j.jiph.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the intensification of Chagas disease control in Brazil, around 1980s and 1990s, the transmission still occurs. The aim of this study was to identify the factors associated with Chagas disease among blood donors in Piaui State, Brazilian Northeast Region from 2004 to 2013. METHODOLOGY Records of 597 blood donors from Management System in Hemotherapy Services and Laboratory Environment Manager System of Piaui were studied. Sociodemographic variables and serological tests results for Chagas disease's confirmation were analyzed using adjusted multiple logistic regression and odds ratio (OR) evaluation. RESULTS The frequency of serological test confirming Chagas disease was 15.6%. Multivariate analysis showed that the most important associated factors were among blood donors who were born until 1960 (OR 5.1; 95%; CI 1.95-13.14), with low educational level (OR 2.8; 95%; CI 0.75-10.29), who lives in cities with ≤50% of urbanization rate (OR 3.5; 95%; CI 1.42-8.72) and first-time blood donors (OR 3.0; 95%; CI 1.74-5.23). CONCLUSIONS Unfortunately, the factors associated with Chagas disease are still the same pointed out in the scientific literature of decades ago. Our results are in line with the postulate of the 2nd Brazilian Consensus on Chagas disease, regarding the need to develop research that presents new scientific evidence, contributing not only to the Brazilian scenario but also to Latin America.
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Canonical PI3Kγ signaling in myeloid cells restricts Trypanosoma cruzi infection and dampens chagasic myocarditis. Nat Commun 2018; 9:1513. [PMID: 29666415 PMCID: PMC5904108 DOI: 10.1038/s41467-018-03986-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
Chagas disease is caused by infection with the protozoan Trypanosoma cruzi (T. cruzi) and is an important cause of severe inflammatory heart disease. However, the mechanisms driving Chagas disease cardiomyopathy have not been completely elucidated. Here, we show that the canonical PI3Kγ pathway is upregulated in both human chagasic hearts and hearts of acutely infected mice. PI3Kγ-deficient mice and mutant mice carrying catalytically inactive PI3Kγ are more susceptible to T. cruzi infection. The canonical PI3Kγ signaling in myeloid cells is essential to restrict T. cruzi heart parasitism and ultimately to avoid myocarditis, heart damage, and death of mice. Furthermore, high PIK3CG expression correlates with low parasitism in human Chagas’ hearts. In conclusion, these results indicate an essential role of the canonical PI3Kγ signaling pathway in the control of T. cruzi infection, providing further insight into the molecular mechanisms involved in the pathophysiology of chagasic heart disease. Trypanosoma cruzi infection causes Chagas disease, but mechanisms underlying pathogenesis are unclear. Here, Silva et al. show that canonical PI3Kγ signaling in myeloid cells restricts T. cruzi infection in mice and that high PIK3CG expression correlates with low parasite levels in human Chagas’ hearts.
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Abstract
Chagas disease is an anthropozoonosis from the American continent that has spread from its original boundaries through migration. It is caused by the protozoan Trypanosoma cruzi, which was identified in the first decade of the 20th century. Once acute infection resolves, patients can develop chronic disease, which in up to 30-40% of cases is characterised by cardiomyopathy, arrhythmias, megaviscera, and, more rarely, polyneuropathy and stroke. Even after more than a century, many challenges remain unresolved, since epidemiological control and diagnostic, therapeutic, and prognostic methods must be improved. In particular, the efficacy and tolerability profile of therapeutic agents is far from ideal. Furthermore, the population affected is older and more complex (eg, immunosuppressed patients and patients with cancer). Nevertheless, in recent years, our knowledge of Chagas disease has expanded, and the international networking needed to change the course of this deadly disease during the 21st century has begun.
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Affiliation(s)
- José A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain.
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain; International Health Program of the Catalan Institute of Health, Barcelona, Spain
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Romero AH, López SE. In silico molecular docking studies of new potential 4-phthalazinyl-hydrazones on selected Trypanosoma cruzi and Leishmania enzyme targets. J Mol Graph Model 2017; 76:313-329. [DOI: 10.1016/j.jmgm.2017.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023]
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Aryl- or heteroaryl-based hydrazinylphthalazine derivatives as new potential antitrypanosomal agents. Bioorg Chem 2017; 72:51-56. [DOI: 10.1016/j.bioorg.2017.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/14/2017] [Accepted: 03/13/2017] [Indexed: 11/23/2022]
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Monge-Maillo B, López-Vélez R. Challenges in the management of Chagas disease in Latin-American migrants in Europe. Clin Microbiol Infect 2017; 23:290-295. [PMID: 28428122 DOI: 10.1016/j.cmi.2017.04.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 12/27/2022]
Abstract
Chagas disease is endemic in Latin America. Due to migration the infection has crossed borders and it is estimated that 68,000-120,000 people with Chagas disease are currently living in Europe and 30% of them may develop visceral involvement. However, up to 90% of Chagas disease cases in Europe remain undiagnosed. The challenges which have to be overcome in Chagas disease in non-endemic countries are focused on related downing barriers to health care access, and related to screening, diagnostic tools and therapeutic management. The aim of this review is to highlight how healthcare management for Latin American migrants with Chagas disease in Europe may be improved. Medical literature was searched using PubMed. No limits were placed with respect to the language or date of publication although most of the articles selected were articles published in the last five years. Chosen search terms were "Chagas disease" AND ("migrants" OR "screening" OR "transmission" OR "treatment"; OR "knowledge" OR "non-endemic countries"); migrants AND ("Public health" OR "Health Service Accessibility" OR "Delivery of Health care"); and "Congenital Chagas disease". Healthcare management of migrant populations with Chagas disease in Europe has to be improved: -Surveillance programmes are needed to measure the burden of the disease; -screening programmes are needed; -administrative and cultural barriers in the access to health care for migrants should be reduced; -education programmes on Chagas disease should be performed -research on new diagnostic tools and therapeutic options are required. This review highlights the needs of profound changes in the health care of Latin American migrants with Chagas disease in Europe.
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Affiliation(s)
- B Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Madrid, Spain
| | - R López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Madrid, Spain.
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Hernandez S, Flores CA, Viana GM, Sanchez DR, Traina MI, Meymandi SK. Autochthonous Transmission of Trypanosoma Cruzi in Southern California. Open Forum Infect Dis 2016; 3:ofw227. [PMID: 28018928 PMCID: PMC5170498 DOI: 10.1093/ofid/ofw227] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/19/2016] [Indexed: 11/12/2022] Open
Abstract
Trypanosoma cruzi usually infects humans via triatomine insects in Latin America. Vector-borne transmission in the United States is exceedingly rare. We describe (1) the first case of probable autochthonous transmission reported in California in more than 30 years and (2) the first ever reported case in the greater Los Angeles area.
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Affiliation(s)
- Salvador Hernandez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center , Sylmar, California
| | - Carmen A Flores
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center , Sylmar, California
| | - Gracia M Viana
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center , Sylmar, California
| | - Daniel R Sanchez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center , Sylmar, California
| | - Mahmoud I Traina
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center , Sylmar, California
| | - Sheba K Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center , Sylmar, California
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Transfusion-Transmitted Diseases. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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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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Souza ALA, Faria RX, Calabrese KS, Hardoim DJ, Taniwaki N, Alves LA, De Simone SG. Temporizin and Temporizin-1 Peptides as Novel Candidates for Eliminating Trypanosoma cruzi. PLoS One 2016; 11:e0157673. [PMID: 27384541 PMCID: PMC4934777 DOI: 10.1371/journal.pone.0157673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/02/2016] [Indexed: 12/21/2022] Open
Abstract
Tropical diseases caused by parasitic infections continue to cause socioeconomic distress worldwide. Among these, Chagas disease has become a great concern because of globalization. Caused by Trypanosoma cruzi, there is an increasing need to discover new, more effective methods to manage infections that minimize disease onset. Antimicrobial peptides represent a possible solution to this challenge. As effector molecules of the innate immune response against pathogens, they are the first line of defense found in all multi-cellular organisms. In amphibians, temporins are a large family of antimicrobial peptides found in skin secretions. Their functional roles and modes of action present unique properties that indicate possible candidates for therapeutic applications. Here, we investigated the trypanocide activity of temporizin and temporizin-1. Temporizin is an artificial, hybrid peptide containing the N-terminal region of temporin A, the pore-forming region of gramicidin and a C-terminus consisting of alternating leucine and lysine. Temporizin-1 is a modification of temporizin with a reduction in the region responsible for insertion into membranes. Their activities were evaluated in a cell permeabilization assay by flow cytometry, an LDH release assay, electron microscopy, an MTT assay and patch clamp experiments. Both temporizin and temporizin-1 demonstrated toxicity against T. cruzi with temporizin displaying slightly more potency. At concentrations up to 100 μg/ ml, both peptides exhibited low toxicity in J774 cells, a macrophage lineage cell line, and no toxicity was observed in mouse primary peritoneal macrophages. In contrast, the peptides showed some toxicity in rat adenoma GH3 cells and Jurkat human lymphoma cells with temporizin-1 displaying lower toxicity. In summary, a shortened form of the hybrid temporizin peptide, temporizin-1, was efficient at killing T. cruzi and it has low toxicity in wild-type mammalian cells. These data suggest that temporizin-1 might be a candidate for Chagas disease therapy.
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Affiliation(s)
- André L. A. Souza
- FIOCRUZ, Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation on Neglected Diseases (INCT-IDN), Rio de Janeiro, RJ, Brazil
- FIOCRUZ, Oswaldo Cruz Institute, Laboratory of Experimental and Computational Biochemistry of Pharmaceuticals, Rio de Janeiro, RJ, Brazil
| | - Robson X. Faria
- FIOCRUZ, Oswaldo Cruz Institute, Laboratory of Toxoplasmosis and other Protozoosis, Rio de Janeiro, RJ, Brazil
| | - Kátia S. Calabrese
- FIOCRUZ, Oswaldo Cruz Institute, Laboratory of Imunomodulation and Protozoology, Rio de Janeiro, RJ, Brazil
| | - Daiane J. Hardoim
- FIOCRUZ, Oswaldo Cruz Institute, Laboratory of Imunomodulation and Protozoology, Rio de Janeiro, RJ, Brazil
| | - Noemi Taniwaki
- FIOCRUZ, Adolfo Lutz Institute, Electronic Microscopy section, Araçatuba, São Paulo, SP, Brazil
| | - Luiz A. Alves
- FIOCRUZ, Oswaldo Cruz Institute, Laboratory of Cellular Communication, Rio de Janeiro, RJ, Brazil
| | - Salvatore G. De Simone
- FIOCRUZ, Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation on Neglected Diseases (INCT-IDN), Rio de Janeiro, RJ, Brazil
- Federal Fluminense University, Biology Institute, Department of Cellular and Molecular Biology, Niterói, RJ, Brazil
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Cancino-Faure B, Fisa R, Alcover MM, Jimenez-Marco T, Riera C. Detection and Quantification of Viable and Nonviable Trypanosoma cruzi Parasites by a Propidium Monoazide Real-Time Polymerase Chain Reaction Assay. Am J Trop Med Hyg 2016; 94:1282-9. [PMID: 27139452 PMCID: PMC4889745 DOI: 10.4269/ajtmh.15-0693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/07/2016] [Indexed: 01/06/2023] Open
Abstract
Molecular techniques based on real-time polymerase chain reaction (qPCR) allow the detection and quantification of DNA but are unable to distinguish between signals from dead or live cells. Because of the lack of simple techniques to differentiate between viable and nonviable cells, the aim of this study was to optimize and evaluate a straightforward test based on propidium monoazide (PMA) dye action combined with a qPCR assay (PMA-qPCR) for the selective quantification of viable/nonviable epimastigotes of Trypanosoma cruzi PMA has the ability to penetrate the plasma membrane of dead cells and covalently cross-link to the DNA during exposure to bright visible light, thereby inhibiting PCR amplification. Different concentrations of PMA (50-200 μM) and epimastigotes of the Maracay strain of T. cruzi (1 × 10(5)-10 parasites/mL) were assayed; viable and nonviable parasites were tested and quantified by qPCR with a TaqMan probe specific for T. cruzi. In the PMA-qPCR assay optimized at 100 μM PMA, a significant qPCR signal reduction was observed in the nonviable versus viable epimastigotes treated with PMA, with a mean signal reduction of 2.5 logarithm units and a percentage of signal reduction > 98%, in all concentrations of parasites assayed. This signal reduction was also observed when PMA-qPCR was applied to a mixture of live/dead parasites, which allowed the detection of live cells, except when the concentration of live parasites was low (10 parasites/mL). The PMA-qPCR developed allows differentiation between viable and nonviable epimastigotes of T. cruzi and could thus be a potential method of parasite viability assessment and quantification.
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Affiliation(s)
- Beatriz Cancino-Faure
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain; Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca, Balearic Islands, Spain; IUNICS Institut Universitari d'Investigació en Ciències de la Salut, Universitat de les Illes Balears, Spain
| | - Roser Fisa
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain; Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca, Balearic Islands, Spain; IUNICS Institut Universitari d'Investigació en Ciències de la Salut, Universitat de les Illes Balears, Spain
| | - M Magdalena Alcover
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain; Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca, Balearic Islands, Spain; IUNICS Institut Universitari d'Investigació en Ciències de la Salut, Universitat de les Illes Balears, Spain
| | - Teresa Jimenez-Marco
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain; Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca, Balearic Islands, Spain; IUNICS Institut Universitari d'Investigació en Ciències de la Salut, Universitat de les Illes Balears, Spain
| | - Cristina Riera
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain; Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca, Balearic Islands, Spain; IUNICS Institut Universitari d'Investigació en Ciències de la Salut, Universitat de les Illes Balears, Spain
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Shender LA, Lewis MD, Rejmanek D, Mazet JAK. Molecular Diversity of Trypanosoma cruzi Detected in the Vector Triatoma protracta from California, USA. PLoS Negl Trop Dis 2016; 10:e0004291. [PMID: 26797311 PMCID: PMC4721664 DOI: 10.1371/journal.pntd.0004291] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/19/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi, causative agent of Chagas disease in humans and dogs, is a vector-borne zoonotic protozoan parasite that can cause fatal cardiac disease. While recognized as the most economically important parasitic infection in Latin America, the incidence of Chagas disease in the United States of America (US) may be underreported and even increasing. The extensive genetic diversity of T. cruzi in Latin America is well-documented and likely influences disease progression, severity and treatment efficacy; however, little is known regarding T. cruzi strains endemic to the US. It is therefore important to expand our knowledge on US T. cruzi strains, to improve upon the recognition of and response to locally acquired infections. METHODOLOGY/PRINCIPLE FINDINGS We conducted a study of T. cruzi molecular diversity in California, augmenting sparse genetic data from southern California and for the first time investigating genetic sequences from northern California. The vector Triatoma protracta was collected from southern (Escondido and Los Angeles) and northern (Vallecito) California regions. Samples were initially screened via sensitive nuclear repetitive DNA and kinetoplast minicircle DNA PCR assays, yielding an overall prevalence of approximately 28% and 55% for southern and northern California regions, respectively. Positive samples were further processed to identify discrete typing units (DTUs), revealing both TcI and TcIV lineages in southern California, but only TcI in northern California. Phylogenetic analyses (targeting COII-ND1, TR and RB19 genes) were performed on a subset of positive samples to compare Californian T. cruzi samples to strains from other US regions and Latin America. Results indicated that within the TcI DTU, California sequences were similar to those from the southeastern US, as well as to several isolates from Latin America responsible for causing Chagas disease in humans. CONCLUSIONS/SIGNIFICANCE Triatoma protracta populations in California are frequently infected with T. cruzi. Our data extend the northern limits of the range of TcI and identify a novel genetic exchange event between TcI and TcIV. High similarity between sequences from California and specific Latin American strains indicates US strains may be equally capable of causing human disease. Additional genetic characterization of Californian and other US T. cruzi strains is recommended.
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Affiliation(s)
- Lisa A. Shender
- Wildlife Health Center; One Health Institute; School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
- * E-mail:
| | - Michael D. Lewis
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Daniel Rejmanek
- Wildlife Health Center; One Health Institute; School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Jonna A. K. Mazet
- Wildlife Health Center; One Health Institute; School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
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Liu Q, Zhou XN. Preventing the transmission of American trypanosomiasis and its spread into non-endemic countries. Infect Dis Poverty 2015; 4:60. [PMID: 26715535 PMCID: PMC4693433 DOI: 10.1186/s40249-015-0092-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
American trypanosomiasis, commonly known as Chagas disease, is caused by the flagellate protozoan parasite Trypanosoma cruzi. An estimated eight million people infected with T. cruzi currently reside in the endemic regions of Latin America. However, as the disease has now been imported into many non-endemic countries outside of Latin America, it has become a global health issue. We reviewed the transmission patterns and current status of disease spread pertaining to American trypanosomiasis at the global level, as well as recent advances in research. Based on an analysis of the gaps in American trypanosomiasis control, we put forward future research priorities that must be implemented to stop the global spread of the disease.
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Affiliation(s)
- Qin Liu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health;, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, P. R. China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health;, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, P. R. China.
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The importance of the multidisciplinary approach to deal with the new epidemiological scenario of Chagas disease (global health). Acta Trop 2015; 151:16-20. [PMID: 26187358 DOI: 10.1016/j.actatropica.2015.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 01/28/2023]
Abstract
There are currently two major factors that have modified the epidemiology of Chagas disease in the last decades: climate change and migration flows. In this new scenario, there are new challenges to control and prevent Trypanosoma cruzi infection in endemic countries, such as the control of a wider distribution of triatomine vectors or the reinforcement of vertical transmission programs. In non-endemic areas, few countries are aware of the emergence of this new disease and have established changes in their health systems. To address this new public health challenge, the priorities should be control programs to avoid new cases of T. cruzi infection acquired through vertical transmission, blood transfusion or organ transplant. In both, endemic and non-endemic areas, the international community and all the actors involved in Chagas disease must join efforts mainly in two directions: better management of the infection in affected individuals and more research to cover the knowledge gap mainly in physiopathology, diagnosis and treatment.
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Traina MI, Sanchez DR, Hernandez S, Bradfield JS, Labedi MR, Ngab TA, Steurer F, Montgomery SP, Meymandi SK. Prevalence and Impact of Chagas Disease Among Latin American Immigrants With Nonischemic Cardiomyopathy in Los Angeles, California. Circ Heart Fail 2015; 8:938-43. [PMID: 26206855 PMCID: PMC10108371 DOI: 10.1161/circheartfailure.115.002229] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Abstract
Background—
Chagas disease is a well-known cause of cardiomyopathy in Latin America; however, 300 000 individuals are estimated to have Chagas disease in the United States. This study examined the prevalence and impact of Chagas cardiomyopathy (CCM) in a US population. We hypothesized that patients with CCM would have increased morbidity and mortality when compared with patients with non-CCM.
Methods and Results—
This is a single-center, prospective cohort study. Enrollment criteria were new diagnosis of nonischemic cardiomyopathy (left ventricular ejection fraction ≤40%) and previous residence in Latin America for at least 12 months. Serological testing for
Trypanosoma cruzi
was performed at enrollment. The primary end point was all-cause mortality or heart transplantation. The secondary end point was heart failure–related hospitalization. A total of 135 patients were enrolled, with a median of 43 months of follow-up. Chagas disease was diagnosed in 25 (19%) patients. The primary end point occurred in 9 patients (36%) in the CCM group and in 11 patients (10%) in the non-CCM group (hazard ratio [HR], 4.46; 95% confidence interval, 1.8–10.8;
P
=0.001). The secondary end point occurred in 13 patients (52%) in the CCM group and in 35 patients (32%) in the non-CCM group (HR, 2.22; 95% confidence interval, 1.2–4.2;
P
=0.01).
Conclusions—
There is a high prevalence of Chagas disease among Latin American immigrants diagnosed with nonischemic cardiomyopathy in Los Angeles. Advanced CCM portends a poor prognosis and is associated with increased all-cause mortality/heart transplantation and heart failure–related hospitalization.
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Affiliation(s)
- Mahmoud I. Traina
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Daniel R. Sanchez
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Salvador Hernandez
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Jason S. Bradfield
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Mohamed R. Labedi
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Tarik A. Ngab
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Frank Steurer
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Susan P. Montgomery
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
| | - Sheba K. Meymandi
- From the Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, CA (M.I.T., D.R.S., S.H., J.S.B., M.R.L., T.A.N., S.K.M.); UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.S.B.); and Centers for Disease Control and Prevention, Atlanta, GA (F.S., S.P.M.)
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Pérez-Molina JA, Perez AM, Norman FF, Monge-Maillo B, López-Vélez R. Old and new challenges in Chagas disease. THE LANCET. INFECTIOUS DISEASES 2015; 15:1347-56. [PMID: 26231478 DOI: 10.1016/s1473-3099(15)00243-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 12/17/2022]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected disease, which can lead to cardiomyopathy, arrhythmias, megaviscera, and more rarely, polyneuropathy in up to 30-40% of patients around 20 to 30 years after acute infection. Although it is endemic in the Americas, global population movements mean that it can be located wherever migrants from endemic areas settle. The disease was first described 100 years ago and still challenges clinicians worldwide, since diagnostic, therapeutic, and prognostic methods remain insufficient. Furthermore, factors such as HIV co-infection, immunosuppressive drugs, transplantation, and neoplastic disease can alter the natural course of the infection. We present the case of a Bolivian woman with chronic T cruzi infection diagnosed at our clinic in Madrid, Spain, who subsequently developed non-Hodgkin lymphoma. Our report illustrates the challenges of an increasingly common infection seen in non-endemic countries, and highlights both daily management dilemmas and associated difficulties that arise.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain.
| | - Angela Martinez Perez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Francesca F Norman
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
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Edwards MS, Rench MA, Todd CW, Czaicki N, Steurer FJ, Bern C, Montgomery SP. Perinatal Screening for Chagas Disease in Southern Texas. J Pediatric Infect Dis Soc 2015; 4:67-70. [PMID: 26407360 PMCID: PMC10165846 DOI: 10.1093/jpids/pit056] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 06/11/2013] [Indexed: 11/14/2022]
Abstract
Perinatal screening for Trypanosoma cruzi in a cohort of 4000 predominantly Hispanic women in southern Texas revealed that Chagas disease occurs with sufficient frequency (0.25%) that targeted perinatal screening should be considered to identify infected mothers and infants at risk for congenital infection.
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Affiliation(s)
- Morven S Edwards
- Section of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Marcia A Rench
- Section of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Charles W Todd
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy Czaicki
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Francis J Steurer
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan P Montgomery
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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43
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Cancino-Faure B, Fisa R, Riera C, Bula I, Girona-Llobera E, Jimenez-Marco T. Evidence of meaningful levels ofTrypanosoma cruziin platelet concentrates from seropositive blood donors. Transfusion 2015; 55:1249-55. [DOI: 10.1111/trf.12989] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Beatriz Cancino-Faure
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Roser Fisa
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Cristina Riera
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Ibeth Bula
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Enrique Girona-Llobera
- Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca; Balearic Islands
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS); Universitat de les Illes Balears, Mallorca; Balearic Islands Spain
| | - Teresa Jimenez-Marco
- Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca; Balearic Islands
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS); Universitat de les Illes Balears, Mallorca; Balearic Islands Spain
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Abstract
This review addresses relevant aspects of Chagas disease in the immunocompromised host. Chagas disease--one of the world's most neglected diseases-has become a global public health concern. Novel transmission modalities, such as organ transplantation, evidence of parasite persistence in chronically infected individuals--with the potential for reactivation under immunosuppression--and the prolonged survival of immunosuppressed patients call for an appraisal of the disease in this particular setting. The management and outcome of solid organ transplantation in the infected recipient with special focus on heart transplantation is addressed. The guidelines for management and the outcome of the recipients of organs from infected donors are discussed, and comments on haematopoietic stem cell transplantation are included. Finally, Chagas disease in other situations of impairment of the immune system, such as HIV/AIDS and autoimmune diseases, are considered. Immunosuppression has become an increasingly frequent condition that might modify the natural history of Trypanosoma cruzi infection. A number of strategies are available for Chagas disease management in the immunosuppressed patient. First, according to recent recommendations from the health authorities in Argentina, most infected patients would benefit from being treated at diagnosis. This has not been validated for patients with different immunosuppressive disorders. A different strategy would involve treating only patients with documented reactivation (either parasitaemia or clinical manifestations). These different approaches are discussed. To reach a diagnosis of parasitaemia, monitoring is essential, either with conventional methods or with molecular techniques that are not yet available in all centres. Collaborative studies are needed to improve the level of evidence, which will allow for better guidelines.
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Affiliation(s)
- R Lattes
- Transplant infectious Disease, Department of Transplantation, Instituto de Nefrología/Nephrology, Buenos Aires, Argentina
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Sanchez DR, Traina MI, Hernandez S, Smer AM, Khamag H, Meymandi SK. Chagas disease awareness among Latin American immigrants living in Los Angeles, California. Am J Trop Med Hyg 2014; 91:915-9. [PMID: 25200261 DOI: 10.4269/ajtmh.14-0305] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approximately 300,000 persons have Chagas disease in the United States, although almost all persons acquired the disease in Latin America. We examined awareness of Chagas disease among Latin American immigrants living in Los Angeles, California. We surveyed 2,677 persons (age range = 18-60 years) in Los Angeles who resided in Latin America for at least six months. A total of 62% of the participants recalled seeing triatomines in Latin America, and 27% of the participants reported triatomine bites at least once per year while living abroad. A total of 86% of the participants had never heard of Chagas disease. Of persons who had heard of Chagas disease, 81% believed that it was not serious. More than 95% of those who had heard of Chagas disease would want to be tested and treated. Most Latin American immigrants living in Los Angeles recalled exposure to vectors of Chagas disease. However, they have little knowledge of this disease. Increasing awareness of Chagas disease is needed in this high-risk population.
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Affiliation(s)
- Daniel R Sanchez
- Center of Excellence for the Diagnosis and Treatment of Chagas Disease Olive View-UCLA Medical Center, Sylmar, California
| | - Mahmoud I Traina
- Center of Excellence for the Diagnosis and Treatment of Chagas Disease Olive View-UCLA Medical Center, Sylmar, California
| | - Salvador Hernandez
- Center of Excellence for the Diagnosis and Treatment of Chagas Disease Olive View-UCLA Medical Center, Sylmar, California
| | - Aiman M Smer
- Center of Excellence for the Diagnosis and Treatment of Chagas Disease Olive View-UCLA Medical Center, Sylmar, California
| | - Haneen Khamag
- Center of Excellence for the Diagnosis and Treatment of Chagas Disease Olive View-UCLA Medical Center, Sylmar, California
| | - Sheba K Meymandi
- Center of Excellence for the Diagnosis and Treatment of Chagas Disease Olive View-UCLA Medical Center, Sylmar, California
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Oliveira I, Torrico F, Muñoz J, Gascon J. Congenital transmission of Chagas disease: a clinical approach. Expert Rev Anti Infect Ther 2014; 8:945-56. [DOI: 10.1586/eri.10.74] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Viotti R, Vigliano C, Lococo B, Alvarez MG, Petti M, Bertocchi G, Armenti A. Side effects of benznidazole as treatment in chronic Chagas disease: fears and realities. Expert Rev Anti Infect Ther 2014; 7:157-63. [DOI: 10.1586/14787210.7.2.157] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bottieau E, Vekemans M, Van Gompel A. Therapy of vector-borne protozoan infections in nonendemic settings. Expert Rev Anti Infect Ther 2014; 9:583-608. [DOI: 10.1586/eri.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jackson Y, Pinto A, Pett S. Chagas disease in Australia and New Zealand: risks and needs for public health interventions. Trop Med Int Health 2013; 19:212-8. [PMID: 24299280 DOI: 10.1111/tmi.12235] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE International migration has changed the global distribution of Chagas disease, with the emerging importance of non-endemic regions. We aimed at better documenting the Australia and New Zealand risk of Chagas disease and needs for interventions. METHODS We reviewed Chagas disease-related evidences, policies and practices in Australia and New Zealand and calculated the estimated prevalence. RESULTS Australia hosts a rapidly growing population at risk and had 1928 infected residents in 2011; New Zealand had 98 in 2006. These figures underestimate the real situation, as they do not consider non-permanent residents. The only existing policy in both countries is the identification of blood donors with a history of or a risk of infection via questionnaire. There is no programme of detection and care of patients. The lifetime economic burden of disease for society is potentially very high. CONCLUSION Chagas disease is an emerging health risk with potential high human and economic costs in Australia and New Zealand in the absence of public health attention. Implementing strategies to screen high-risk groups and prevent transmission should be considered. Moreover, migration between the Western Pacific and Chagas endemic regions and the presence of vectors means this risk applies in the whole region.
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Affiliation(s)
- Yves Jackson
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia; Division of Primary Care, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Walker DM, Oghumu S, Gupta G, McGwire BS, Drew ME, Satoskar AR. Mechanisms of cellular invasion by intracellular parasites. Cell Mol Life Sci 2013; 71:1245-63. [PMID: 24221133 DOI: 10.1007/s00018-013-1491-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 12/22/2022]
Abstract
Numerous disease-causing parasites must invade host cells in order to prosper. Collectively, such pathogens are responsible for a staggering amount of human sickness and death throughout the world. Leishmaniasis, Chagas disease, toxoplasmosis, and malaria are neglected diseases and therefore are linked to socio-economical and geographical factors, affecting well-over half the world's population. Such obligate intracellular parasites have co-evolved with humans to establish a complexity of specific molecular parasite-host cell interactions, forming the basis of the parasite's cellular tropism. They make use of such interactions to invade host cells as a means to migrate through various tissues, to evade the host immune system, and to undergo intracellular replication. These cellular migration and invasion events are absolutely essential for the completion of the lifecycles of these parasites and lead to their for disease pathogenesis. This review is an overview of the molecular mechanisms of protozoan parasite invasion of host cells and discussion of therapeutic strategies, which could be developed by targeting these invasion pathways. Specifically, we focus on four species of protozoan parasites Leishmania, Trypanosoma cruzi, Plasmodium, and Toxoplasma, which are responsible for significant morbidity and mortality.
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Affiliation(s)
- Dawn M Walker
- Department of Microbial Infection and Immunity, Wexner Medical Center, The Ohio State University, Columbus, OH, 43210, USA
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