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de Almeida EA, Mendes FDSNS, Ramos AN, de Sousa AS, Pavan TBS, Mediano MFF, Ostermayer AL, Hasslocher-Moreno AM, Britto CFDPDC, Novaes CG, Correia D, Santos FLN, da Silva GMS, Fernandez ML, Lima MM, de Carvalho NB, Moreira ODC, Albajar-Viñas P, Leite RM, Palmeira SL, da Costa VM, Yasuda MAS. Guidelines for Trypanosoma cruzi-HIV Co-infection and other Immunosuppressive Conditions: Diagnosis, Treatment, Monitoring, and Implementation from the International Network of Care and Studies - 2023. Rev Soc Bras Med Trop 2023; 56:0549. [PMID: 38088667 PMCID: PMC10706049 DOI: 10.1590/0037-8682-0549-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Eros Antonio de Almeida
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Grupo de Estudos em doença de Chagas, Campinas, SP, Brasil
| | | | - Alberto Novaes Ramos
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil
| | - Andréa Silvestre de Sousa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Tycha Bianca Sabaini Pavan
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Bahia, BA, Brasil
| | | | | | | | | | - Christina Gallafrio Novaes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, Brasil
| | - Dalmo Correia
- Universidade Federal de Sergipe, São Cristóvão, SE, Brasil
| | - Fred Luciano Neves Santos
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Bahia, BA, Brasil
| | | | - Marisa Liliana Fernandez
- Hospital de Infecciosas FJ Muñiz, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Administración Nacional de Laboratorios e Institutos de Salud, Buenos Aires, Argentina
| | - Mayara Maia Lima
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Noêmia Barbosa de Carvalho
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, Brasil
| | - Otacílio da Cruz Moreira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Virologia e Parasitologia Molecular, Rio de Janeiro, RJ, Brasil
| | - Pedro Albajar-Viñas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Ruth Moreira Leite
- Centro de Vigilância Epidemiológica Professor Alexandre Vranjac. Secretaria de Estado da Saúde do estado de São Paulo, São Paulo, SP, Brasil
| | - Swamy Lima Palmeira
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Hasslocher-Moreno AM, de Sousa AS, Xavier SS, Mendes FDSNS, Nunes EP, Grinsztejn BGJ, Mediano MFF. Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center. Rev Soc Bras Med Trop 2022; 55:e02402022. [PMID: 36287507 PMCID: PMC9592103 DOI: 10.1590/0037-8682-0240-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. METHODS This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. RESULTS Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. CONCLUSIONS Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients.
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Affiliation(s)
| | - Andréa Silvestre de Sousa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil., Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil
| | - Sergio Salles Xavier
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | - Estevão Portela Nunes
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
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Martins-Melo FR, Castro MC, Werneck GL, Heukelbach J. Deaths related to Chagas disease and HIV/AIDS coinfection in Brazil: a nationwide population-based analysis. Trans R Soc Trop Med Hyg 2021; 116:579-588. [PMID: 34891173 DOI: 10.1093/trstmh/trab183] [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: 09/09/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Trypanosoma cruzi/HIV coinfection has been described as a relevant clinical event and an emerging public health problem. Here, we describe the epidemiological patterns of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil from 2000 to 2019. METHODS We performed a nationwide population-based study using mortality data obtained from the Brazilian Mortality Information System. We included all deaths recorded in Brazil from 2000 to 2019 in which Chagas disease and HIV/AIDS were mentioned on the same death certificate, either as underlying or as associated causes of death. RESULTS Chagas disease and HIV/AIDS were mentioned on 196/22 663 092 death certificates. HIV/AIDS was the underlying cause in 58.2% (114/196) of deaths and Chagas disease in 33.2% (65/196). The average annual mortality rate was 0.05 deaths/1 000 000 inhabitants (95% CI 0.03 to 0.09). The highest death rates were found among males, those aged 60-69 y, Afro-Brazilians, those with 1-3 y of schooling/study and residents in Chagas disease-endemic regions/states. Respiratory, infectious/parasitic and cardiovascular diseases/disorders were the associated causes of death most commonly mentioned. CONCLUSIONS Mortality due to Chagas disease and HIV/AIDS coinfection may be largely underestimated in Brazil. Our data further reinforce the importance of screening for T. cruzi infection in HIV-infected patients from Chagas disease-endemic areas. Appropriate clinical management should be ensured for Chagas disease and HIV coinfected patients.
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Affiliation(s)
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston 02115, Massachusetts, USA
| | - Guilherme Loureiro Werneck
- Institute of Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro 21941-598, Rio de Janeiro, Brazil.,Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Rio de Janeiro, Brazil
| | - Jorg Heukelbach
- Postgraduate Program in Public Health, School of Medicine, Federal University of Ceará, Fortaleza 60430-140, Brazil
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Mateus J, Nocua P, Lasso P, López MC, Thomas MC, Egui A, Cuervo C, González JM, Puerta CJ, Cuéllar A. CD8 + T Cell Response Quality Is Related to Parasite Control in an Animal Model of Single and Mixed Chronic Trypanosoma cruzi Infections. Front Cell Infect Microbiol 2021; 11:723121. [PMID: 34712620 PMCID: PMC8546172 DOI: 10.3389/fcimb.2021.723121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022] Open
Abstract
Chagas disease (ChD) is a chronic infection caused by Trypanosoma cruzi. This highly diverse intracellular parasite is classified into seven genotypes or discrete typing units (DTUs) and they overlap in geographic ranges, vectors, and clinical characteristics. Although studies have suggested that ChD progression is due to a decline in the immune response quality, a direct relationship between T cell responses and disease outcome is still unclear. To investigate the relationship between parasite control and immune T cell responses, we used two distinct infection approaches in an animal model to explore the histological and parasitological outcomes and dissect the T cell responses in T. cruzi-infected mice. First, we performed single infection experiments with DA (TcI) or Y (TcII) T. cruzi strains to compare the infection outcomes and evaluate its relationship with the T cell response. Second, because infections with diverse T. cruzi genotypes can occur in naturally infected individuals, mice were infected with the Y or DA strain and subsequently reinfected with the Y strain. We found different infection outcomes in the two infection approaches used. The single chronic infection showed differences in the inflammatory infiltrate level, while mixed chronic infection by different T. cruzi DTUs showed dissimilarities in the parasite loads. Chronically infected mice with a low inflammatory infiltrate (DA-infected mice) or low parasitemia and parasitism (Y/Y-infected mice) showed increases in early-differentiated CD8+ T cells, a multifunctional T cell response and lower expression of inhibitory receptors on CD8+ T cells. In contrast, infected mice with a high inflammatory infiltrate (Y-infected mice) or high parasitemia and parasitism (DA/Y-infected mice) showed a CD8+ T cell response distinguished by an increase in late-differentiated cells, a monofunctional response, and enhanced expression of inhibitory receptors. Overall, our results demonstrated that the infection outcomes caused by single or mixed T. cruzi infection with different genotypes induce a differential immune CD8+ T cell response quality. These findings suggest that the CD8+ T cell response might dictate differences in the infection outcomes at the chronic T. cruzi stage. This study shows that the T cell response quality is related to parasite control during chronic T. cruzi infection.
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Affiliation(s)
- Jose Mateus
- Grupo de Enfermedades Infecciosas, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Paola Nocua
- Grupo de Enfermedades Infecciosas, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Paola Lasso
- Grupo de Inmunobiología y Biología Celular, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Manuel Carlos López
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - M Carmen Thomas
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - Adriana Egui
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - Claudia Cuervo
- Grupo de Enfermedades Infecciosas, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - John Mario González
- Grupo de Ciencias Básicas Médicas, Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Concepción J Puerta
- Grupo de Enfermedades Infecciosas, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adriana Cuéllar
- Grupo de Ciencias de Laboratorio Clínico, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
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Shikanai-Yasuda MA, Mediano MFF, Novaes CTG, de Sousa AS, Sartori AMC, Santana RC, Correia D, de Castro CN, Severo MMDS, Hasslocher-Moreno AM, Fernandez ML, Salvador F, Pinazo MJ, Bolella VR, Furtado PC, Corti M, Neves Pinto AY, Fica A, Molina I, Gascon J, Viñas PA, Cortez-Escalante J, Ramos AN, de Almeida EA. Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the "Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions". PLoS Negl Trop Dis 2021; 15:e0009809. [PMID: 34591866 PMCID: PMC8483313 DOI: 10.1371/journal.pntd.0009809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. METHODS This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. RESULTS Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. CONCLUSION This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
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Affiliation(s)
- Maria Aparecida Shikanai-Yasuda
- Departament of Infectious and Parasitic, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- * E-mail: ,
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | - Ana Marli Christovam Sartori
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Carvalho Santana
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Dalmo Correia
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | - Marisa Liliana Fernandez
- Hospital de Infecciosas, Buenos Aires, Argentina
- National Institute of Parasitology, Departament of Clinics, Pathology and Treatment, Health Ministry, Buenos Aires, Argentina
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Valdes Roberto Bolella
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Pedro Carvalho Furtado
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Marcelo Corti
- Hospital de Infecciosas, Buenos Aires, Argentina
- Departamento de Medicina, Asignatura Enfermedades Infecciosas, Facultad de Medicina, Universidad Buenos Aires, Buenos Aires, Argentina
| | - Ana Yecê Neves Pinto
- Evandro Chagas Institute, Health Surveillance Secretary, Health Ministry, Belém, Brazil
| | - Alberto Fica
- Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- ISGlobal, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - Pedro Albajar Viñas
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- Department of Control of Neglected Tropical Diseases, World Health Organization, WHO, Geneva, Switzerland
| | - Juan Cortez-Escalante
- Pan American Health Organization (PAHO), World Health Organization (WHO), Brasília, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Eros Antonio de Almeida
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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Ramos-Rincon JM, Llenas-García J, Pinargote-Celorio H, Sánchez-García V, Wikman-Jorgensen P, Navarro M, Gil-Anguita C, Ramos-Sesma V, Torrus-Tendero D. Chagas Disease-Related Mortality in Spain, 1997 to 2018. Microorganisms 2021; 9:microorganisms9091991. [PMID: 34576886 PMCID: PMC8469044 DOI: 10.3390/microorganisms9091991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background. Chagas disease (CD) is associated with excess mortality in infected people in endemic countries, but little information is available in non-endemic countries. The aim of the study was to analyze mortality in patients admitted to the hospital with CD in Spain. Methods. A retrospective, observational study using the Spanish National Hospital Discharge Database. We used the CD diagnostic codes of the 9th and 10th International Classification of Diseases to retrieve CD cases from the national public registry from 1997 to 2018. Results. Of the 5022 hospital admissions in people with CD, there were 56 deaths (case fatality rate (CFR) 1.1%, 95% confidence interval (CI) 0.8%, 1.4%), 20 (35.7%) of which were considered directly related to CD. The median age was higher in those who died (54.5 vs. 38 years; p < 0.001). The CFR increased with age, peaking in the 70–79-year (7.9%, odds ratio (OR) 6.27, 95% CI 1.27, 30.90) and 80–89-year (16.7%, OR 14.7, 95% CI 2.70, 79.90) age groups. Men comprised a higher proportion of those who died compared to survivors (50% vs. 22.6%; p < 0.001). Non-survivors were more likely to have neoplasms (19.6% vs. 3.4%; p < 0.001), heart failure (17.9% vs. 7.2%; p = 0.002), diabetes (12.5% vs. 3.7%; p = 0.001), chronic kidney failure (8.9% vs. 1.6%; p < 0.001), and HIV (8.9% vs. 0.8%; p < 0.001). In the multivariable analysis, the variables associated with mortality were age (adjusted OR (aOR) 1.05; 95% CI: 1.03, 1.07), male sex (aOR 1.79, 95% CI 1.03, 3.14), cancer (aOR: 4.84, 95% CI 2.13, 11.22), and HIV infection (aOR 14.10 95% CI 4.88, 40.73). Conclusions. The case fatality rate of CD hospitalization was about 1%. The mortality risk increased with age, male sex, cancer, and HIV infection.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Internal Medicine Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
- Clinical Medicine Department, Miguel Hernández University of Elche, 03550 Alicante, Spain
- Correspondence:
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 03314 Alicante, Spain;
| | - Hector Pinargote-Celorio
- Internal Medicine Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
| | - Veronica Sánchez-García
- Dermatology Service, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
| | - Philip Wikman-Jorgensen
- Internal Medicine Department, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), University Hospital of Sant Joan, 03550 Alicante, Spain;
| | - Miriam Navarro
- Epidemiology Unit, Public Health Center of Elche, 03302 Alicante, Spain;
- Department of Public Health, Science History and Gynecology, Miguel Hernández University of Elche, 03550 Alicante, Spain
| | - Concepción Gil-Anguita
- Internal Medicine Department, Hospital Marina Baixa—Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 03570 Alicante, Spain;
| | | | - Diego Torrus-Tendero
- Infectious Diseases Unit, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
- Parasitology Area, Miguel Hernández University of Elche, 03550 Alicante, Spain
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8
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Olivera MJ, Porras-Villamil JF, Villar JC, Herrera EV, Buitrago G. Chagas disease-related mortality in Colombia from 1979 to 2018: temporal and spatial trends. Rev Soc Bras Med Trop 2021; 54:e07682020. [PMID: 33656153 PMCID: PMC8008899 DOI: 10.1590/0037-8682-0768-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTIOn: Studies on Chagas disease-related mortality assist in decision-making in health policies. We analyzed the epidemiological characteristics, temporal trends, and regional differences in Chagas disease-related mortality in Colombia from 1979 to 2018. METHODS: A time-series study was conducted using death records and population data from the National Administrative Department of Statistics, using categorizations from the International Classification of Disease (ICD)-9 and ICD-10 systems. All deaths with Chagas disease as an underlying or associated cause of death were included. Crude and age-sex standardized mortality rates per 100,000 inhabitants and the annual percent change (APC) were calculated. RESULTS: Of the 7,287,461 deaths recorded in Colombia during 1979-2018, 3,276 (0.04%) deaths were related to Chagas disease-2,827 (86.3%) as an underlying cause and 449 (13.7%) as an associated cause. The average annual age-sex standardized mortality rate was 0.211 (95% confidence interval [CI]: 0.170-0.252) deaths/100,000 inhabitants, with a significant upward trend (APC = 6.60%; 95% CI: 5.9-7.3). The highest Chagas disease-related death rates were in males (0.284 deaths/100,000 inhabitants), those ≥65 years old (1.296 deaths/100,000 inhabitants), and residents of the Orinoco region (1.809 deaths/100,000 inhabitants). There was a significant increase in mortality in the Orinoco (APC = 8.28%; 95% CI: 6.4-10.2), Caribbean (APC = 5.06%; 95% CI: 3.6-6.5), and Andean (APC = 4.63%; 95% CI: 3.9-5.3) regions. CONCLUSIONS: Chagas disease remains a major public health issue in Colombia with high mortality rates in older age groups, a wide geographic distribution, regional differences, and the potential to increase.
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Affiliation(s)
| | | | - Juan Carlos Villar
- Fundación Cardioinfantil - Instituto de Cardiología, Departamento de Investigaciones, Bogotá D.C., Colombia
| | - Eliana Váquiro Herrera
- Fundación Cardioinfantil - Instituto de Cardiología, Departamento de Investigaciones, Bogotá D.C., Colombia
| | - Giancarlo Buitrago
- Universidad Nacional de Colombia, Facultad de Medicina, Instituto de Investigaciones Clínicas, Bogotá D.C., Colombia.,Hospital Universitario Nacional de Colombia, Bogotá D.C., Colombia
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9
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Zika Virus Infection and Differential Diagnosis in a Cohort of HIV-Infected Patients. J Acquir Immune Defic Syndr 2019; 79:237-243. [PMID: 29912006 DOI: 10.1097/qai.0000000000001777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Zika virus (ZIKV) emergence in South America revealed the lack of knowledge regarding clinical manifestations in HIV-infected individuals. OBJECTIVES We described the clinical characteristics, laboratory manifestations, differential diagnosis, and outcome of ZIKV infection in a large, single-center cohort of HIV-infected patients. METHODS HIV-infected patients aged 18 years and older with clinical suspected arboviral disease from an ongoing cohort were followed from February 2015 through December 2015. Acute serum samples were tested for ZIKV, dengue virus (DENV), and chikungunya virus by real-time reverse transcriptase polymerase chain reaction, anti-DENV immunoglobulin (Ig)M/IgG, and syphilis assays; convalescent samples were tested for anti-DENV IgM/IgG; and urine samples were tested for ZIKV by real-time reverse transcriptase polymerase chain reaction. ZIKV disease was defined according to the Pan American Health Organization (PAHO) guidelines. RESULTS Of 101 patients, ZIKV was confirmed in 43 cases and suspected in 34, and another diagnosis was assumed for 24 patients (dengue, secondary/latent syphilis, respiratory infections, human parvovirus B19, adverse drug reaction, musculoskeletal disorders, and acute gastroenteritis). ZIKV-confirmed and ZIKV-suspected patients reported similar signs and symptoms. Pruritic rash was the most common symptom, followed by myalgia, nonpurulent conjunctivitis, arthralgia, prostration, and headache. In the short-term follow-up [median 67.5 days (interquartile range: 32-104.5)], CD4 cell count (Z = -0.831, P = 0.406) and HIV viral load (Z = -0.447, P = 0.655) did not change significantly after ZIKV infection. There were no hospitalizations, complications, or deaths. CONCLUSIONS Among HIV-infected patients with suspected arboviral disease, 42.6% were ZIKV-infected. CD4 cell counts and HIV viral load were not different after ZIKV infection. Differential diagnosis with other diseases and adverse drug reaction should be evaluated.
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10
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Haematological alterations in non-human hosts infected with Trypanosoma cruzi: a systematic review. Parasitology 2018; 146:142-160. [PMID: 30070181 DOI: 10.1017/s0031182018001294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
American trypanosomiasis is a neglected tropical disease whose spectrum has not been quite understood, including the impact of Trypanosoma cruzi infection on the haematological parameters of different vertebrate hosts. Thus, this study was designed to compare the pattern of haematological changes induced by T. cruzi infection in order to identify possible species-specific differences among taxons. We also aimed at evaluating the use of this parameter as a tool for diagnosis during the acute phase, when symptoms are usually masked. For this purpose, we performed a systematic search on PubMed and Scopus databases to retrieve original studies published until August 2016. Thirty-one studies were selected using Prisma strategy, which were then submitted to data extraction and methodological bias analysis. Half of the studies showed that the number of erythrogram decreased in infected animals, indicating anaemia. In 68.2% of the studies, the total amount of leukogram values increased, suggesting infection. The main methodological limitations were insufficient information for T. cruzi strains identification, inoculation routes and parasitological characterization. Most of the mammalian species analysed showed the same pattern of haematological changes following T. cruzi infection, indicating that haematological parameters might direct the diagnosis of Chagas disease in the initial phase.
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11
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Oda JY, Belém MO, Carlos TM, Gouveia R, Luchetti BFC, Moreira NM, Massocatto CL, Araújo SM, Sant Ana DMG, Buttow NC, Pinge-Filho P, Araújo EJA. Myenteric neuroprotective role of aspirin in acute and chronic experimental infections with Trypanosoma cruzi. Neurogastroenterol Motil 2017; 29:1-13. [PMID: 28524628 DOI: 10.1111/nmo.13102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Experimental and clinical studies have shown that myenteric neuron cell death during infection with Trypanosoma cruzi mainly occurs in the esophagus and colon, resulting in megaesophagus and megacolon, respectively. Evidence suggests that the cyclooxygenase enzyme (COX) is involved in the T. cruzi invasion process. The use of low-dose aspirin (ASA), a COX-1/COX-2 inhibitor, has been shown to reduce infection with T. cruzi. Therefore, in this study, we evaluated the effects of treatment with low-dose ASA on myenteric colonic neurons during murine infection with T. cruzi. METHODS Swiss mice were assigned into groups treated with either phosphate-buffered saline or low doses of ASA during the acute phase (20 mg/kg ASA) and chronic phase (50 mg/kg ASA) of infection with the Y strain of T. cruzi. Seventy-five days after infection, colon samples were collected to quantify inflammatory foci in histological sections and also general (myosin-V+ ), nitrergic, and VIPergic myenteric neurons in whole mounts. Gastrointestinal transit time was also measured. KEY RESULTS Aspirin treatment during the acute phase of infection reduced parasitemia (P<.05). Aspirin treatment during the acute or chronic phase of the infection reduced the intensity of inflammatory foci in the colon, protected myenteric neurons from cell death and plastic changes, and recovered the gastrointestinal transit of mice infected with T. cruzi (P<.05). CONCLUSION & INFERENCES Early and delayed treatment with low-dose ASA can reduce the morphofunctional damage of colonic myenteric neurons caused by murine T. cruzi infection.
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Affiliation(s)
- J Y Oda
- Department of Medicine, Federal University of Mato Grosso do Sul, Três Lagoas, Mato Grosso do Sul, Brazil.,Department of Pathological Science, State University of Londrina, Londrina, Paraná, Brazil
| | - M O Belém
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - T M Carlos
- Department of Histology, State University of Londrina, Londrina, Paraná, Brazil
| | - R Gouveia
- Department of Histology, State University of Londrina, Londrina, Paraná, Brazil
| | - B F C Luchetti
- Department of Pathological Science, State University of Londrina, Londrina, Paraná, Brazil
| | - N M Moreira
- Center for Education, Letters and Health, State University of Western Paraná, Foz do Iguaçu, Paraná, Brazil
| | - C L Massocatto
- Department of Morphological Science, State University of Maringá, Maringá, Paraná, Brazil
| | - S M Araújo
- Department of Basic Health Science, State University of Maringá, Maringá, Paraná, Brazil
| | - D M G Sant Ana
- Department of Morphological Science, State University of Maringá, Maringá, Paraná, Brazil
| | - N C Buttow
- Department of Morphological Science, State University of Maringá, Maringá, Paraná, Brazil
| | - P Pinge-Filho
- Department of Pathological Science, State University of Londrina, Londrina, Paraná, Brazil
| | - E J A Araújo
- Department of Histology, State University of Londrina, Londrina, Paraná, Brazil
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12
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Stauffert D, da Silveira MF, Mesenburg MA, Gaspar T, Manta AB, Bicca GLDO, Villela MM. Serological diagnosis of Chagas disease in HIV-infected patients. Rev Soc Bras Med Trop 2016; 48:331-3. [PMID: 26108013 DOI: 10.1590/0037-8682-0268-2014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/28/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study assessed the rate of request for the serological diagnosis of Chagas disease among human immunodeficiency virus (HIV)-infected patients treated at the Specialized Care Service of Pelotas, Rio Grande do Sul, Brazil. METHODS This cross-sectional study used secondary data obtained from the medical records of 252 patients aged between 18 and 75 years. RESULTS The serological diagnosis of Chagas disease was requested only in 3.2% of cases. CONCLUSIONS The results demonstrate poor adherence to protocols on the part of healthcare professionals, indicating the need to reevaluate the procedures applied to HIV-infected patients from endemic regions for both diseases.
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Affiliation(s)
- Dulce Stauffert
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Mariângela Freitas da Silveira
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marilia Arndt Mesenburg
- Programa de Pós Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Thiago Gaspar
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Adriane Brod Manta
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Marcos Marreiro Villela
- Programa de Pós Graduação em Parasitologia, Instituto de Biologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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13
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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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14
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Vazquez BP, Vazquez TP, Miguel CB, Rodrigues WF, Mendes MT, de Oliveira CJF, Chica JEL. Inflammatory responses and intestinal injury development during acute Trypanosoma cruzi infection are associated with the parasite load. Parasit Vectors 2015; 8:206. [PMID: 25889515 PMCID: PMC4399205 DOI: 10.1186/s13071-015-0811-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/17/2015] [Indexed: 12/12/2022] Open
Abstract
Background Chagas disease is caused by the protozoan Trypanosoma cruzi and is characterized by cardiac, gastrointestinal, and nervous system disorders. Although much about the pathophysiological process of Chagas disease is already known, the influence of the parasite burden on the inflammatory process and disease progression remains uncertain. Methods We used an acute experimental disease model to evaluate the effect of T. cruzi on intestinal lesions and assessed correlations between parasite load and inflammation and intestinal injury at 7 and 14 days post-infection. Low (3 × 102), medium (3 × 103), and high (3 × 104) parasite loads were generated by infecting C57BL/6 mice with “Y”-strain trypomastigotes. Statistical analysis was performed using analysis of variance with Tukey’s multiple comparison post-test, Kruskal–Wallis test with Dunn’s multiple comparison, χ2 test and Spearman correlation. Results High parasite load-bearing mice more rapidly and strongly developed parasitemia. Increased colon width, inflammatory infiltration, myositis, periganglionitis, ganglionitis, pro-inflammatory cytokines (e.g., TNF-α, INF-γ, IL-2, IL-17, IL-6), and intestinal amastigote nests were more pronounced in high parasite load-bearing animals. These results were remarkable because a positive correlation was observed between parasite load, inflammatory infiltrate, amastigote nests, and investigated cytokines. Conclusions These experimental data support the idea that the parasite load considerably influences the T. cruzi-induced intestinal inflammatory response and contributes to the development of the digestive form of the disease.
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Affiliation(s)
- Bruna Perez Vazquez
- Disciplina de Biologia Celular/Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, 38061-500, Minas Gerais, Brazil.
| | - Thaís Perez Vazquez
- Disciplina de Biologia Celular/Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, 38061-500, Minas Gerais, Brazil.
| | - Camila Botelho Miguel
- Curso de Pós-graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 38025-180, Minas Gerais, Brazil. .,Disciplina de Biologia Celular/Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, 38061-500, Minas Gerais, Brazil.
| | - Wellington Francisco Rodrigues
- Curso de Pós-graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 38025-180, Minas Gerais, Brazil. .,Disciplina de Biologia Celular/Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, 38061-500, Minas Gerais, Brazil.
| | - Maria Tays Mendes
- Curso de Pós-Graduação em Medicina Tropical e Infectologia, Universidade Federal do Triângulo Mineiro, Uberaba, 38015-050, Minas Gerais, Brasil.
| | - Carlo José Freire de Oliveira
- Curso de Pós-Graduação em Medicina Tropical e Infectologia, Universidade Federal do Triângulo Mineiro, Uberaba, 38015-050, Minas Gerais, Brasil.
| | - Javier Emílio Lazo Chica
- Curso de Pós-graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 38025-180, Minas Gerais, Brazil. .,Disciplina de Biologia Celular/Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, 38061-500, Minas Gerais, Brazil.
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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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16
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Martins-Melo FR, Ramos AN, Alencar CH, Heukelbach J. Prevalence of Chagas disease in Brazil: a systematic review and meta-analysis. Acta Trop 2014; 130:167-74. [PMID: 24139912 DOI: 10.1016/j.actatropica.2013.10.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/30/2013] [Accepted: 10/01/2013] [Indexed: 12/14/2022]
Abstract
Chagas disease is a major public health problem in Brazil and Latin America. During the last years, it has become an emerging problem in North America and Europe due to increasing international migration. Here we describe the prevalence of Chagas disease in Brazil through a systematic review. We searched national and international electronic databases, grey literature and reference lists of selected articles for population-based studies on Chagas disease prevalence in Brazil, performed from 1980 until September 2012. Forty-two articles with relevant prevalence data were identified from a total of 4985 references. Prevalence ranged from 0% to 25.1%. Most surveys were performed in the Northeast region, especially in the state of Piauí. We observed a high degree of heterogeneity in most pooled estimates (I(2)>75%; p<0.001). The pooled estimate of Chagas disease prevalence across studies for the entire period was 4.2% (95% CI: 3.1-5.7), ranging from 4.4% (95% CI: 2.3-8.3) in the 1980s to 2.4% (95% CI: 1.5-3.8) after 2000. Females (4.2%; 95% CI: 2.6-6.8), >60 year-olds (17.7%; 95% CI: 11.4-26.5), Northeast (5.0%; 95% CI: 3.1-8.1) and Southeast (5.0%; CI: 2.4-9.9) regions and mixed (urban/rural) areas (6.4%; 95% CI: 4.2-9.4) had the highest pooled prevalence. About 4.6 million (95% CI: 2.9-7.2 million) of people are estimated to be infected with Trypanosoma cruzi. The small number of studies and small-scale samples of the general population in some areas limit interpretation, and findings of this review do not necessarily reflect the situation of the entire country. Systematic population-based studies at regional and national level are recommended to provide more accurate estimates and better define the epidemiology and risk areas of Chagas disease in Brazil.
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Affiliation(s)
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, Brazil
| | - Carlos Henrique Alencar
- Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, Brazil
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, Brazil; Anton Breinl Centre for Public Health and Tropical Medicine, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD 4811, Australia.
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17
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Management of Trypanosoma cruzi coinfection in HIV-positive individuals outside endemic areas. Curr Opin Infect Dis 2014; 27:9-15. [DOI: 10.1097/qco.0000000000000023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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