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Choudhury SD. Nano-Medicines a Hope for Chagas Disease! Front Mol Biosci 2021; 8:655435. [PMID: 34141721 PMCID: PMC8204082 DOI: 10.3389/fmolb.2021.655435] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Chagas disease, is a vector-mediated tropical disease whose causative agent is a parasitic protozoan named Trypanosoma cruzi. It is a very severe health issue in South America and Mexico infecting millions of people every year. Protozoan T. cruzi gets transmitted to human through Triatominae, a subfamily of the Reduviidae, and do not have any effective treatment or preventative available. The lack of economic gains from this tropical parasitic infection, has always been the reason behind its negligence by researchers and drug manufacturers for many decades. Hence there is an enormous requirement for more efficient and novel strategies to reduce the fatality associated with these diseases. Even, available diagnosis protocols are outdated and inefficient and there is an urgent need for rapid high throughput diagnostics as well as management protocol. The current advancement of nanotechnology in the field of healthcare has generated hope for better management of many tropical diseases including Chagas disease. Nanoparticulate systems for drug delivery like poloxamer coated nanosuspension of benzimidazole have shown promising results in reducing toxicity, elevating efficacy and bioavailability of the active compound against the pathogen, by prolonging release, thereby increasing the therapeutic index. Moreover, nanoparticle-based drug delivery has shown promising results in inducing the host’s immune response against the pathogen with very few side effects. Besides, advances in diagnostic assays, such as nanosensors, aided in the accurate detection of the parasite. In this review, we provide an insight into the life cycle stages of the pathogen in both vertebrate host and the insect vector, along with an overview of the current therapy for Chagas disease and its limitations; nano carrier-based delivery systems for antichagasic agents, we also address the advancement of nano vaccines and nano-diagnostic techniques, for treatment of Chagas disease, majorly focusing on the novel perspectives in combating the disease.
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Sguassero Y, Cuesta CB, Roberts KN, Hicks E, Comandé D, Ciapponi A, Sosa-Estani S. Course of Chronic Trypanosoma cruzi Infection after Treatment Based on Parasitological and Serological Tests: A Systematic Review of Follow-Up Studies. PLoS One 2015; 10:e0139363. [PMID: 26436678 PMCID: PMC4593559 DOI: 10.1371/journal.pone.0139363] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/11/2015] [Indexed: 12/24/2022] Open
Abstract
Background Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi). It is endemic in Latin American countries outside the Caribbean. The current criterion for cure in the chronic phase of the disease is the negativization of at least two serological tests such as enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence assay (IIF) and indirect hemagglutination assay (IHA). The serological evolution of treated subjects with chronic T. cruzi infection is variable. Treatment failure is indicated by a positive parasitological and/or molecular test (persistence of parasitemia). Objectives To summarize the pattern of response to treatment of parasitological, molecular and serological tests performed during the follow-up of subjects with chronic T. cruzi infection. Methods Electronic searches in relevant databases and screening of citations of potentially eligible articles were accomplished. Organizations focusing on neglected infectious diseases were asked for help in identifying relevant studies. Included studies were randomized controlled trials (RCTs), quasi-RCTs, and cohort studies involving adults and children with chronic infection who received trypanocidal treatment (benznidazole or nifurtimox) and were followed over time. The assessment of risk of bias was performed separately for each study design. The Cochrane Collaboration’s tool and the guidelines developed by Hayden et al. were used. Two reviewers extracted all data independently. A third review author was consulted in case of discordant opinion. Additional analyses were defined in ad-hoc basis. Scatter plots for percentage of positive parasitological and molecular tests and for negative serological tests were developed by using the lowess curve technique. Heterogeneity was measured by I2. The protocol was registered in PROSPERO, an international prospective register of systematic review protocols (Registration Number CRD42012002162). Results Out of 2,136 citations screened, 54 studies (six RCTs and 48 cohort studies) were included. The smoothed curves for positive xenodiagnosis and positive polymerase chain reaction (PCR) were characterized by a sharp decrease at twelve month posttreatment. Afterwards, they reached 10–20% and 40% for xenodiagnosis and PCR, respectively. The smoothed curves for negative conventional serological tests increased up to 10% after 48 months of treatment. In the long-term, the rate of negativization was between 20% and 45%. The main sources of bias identified across cohort studies were the lack of control for confounding and attrition bias. In general, RCTs were judged as low risk of bias in all domains. The level of heterogeneity across included studies was moderate to high. Additional analysis were incomplete because of the limited availability of data. In this regard, the country of origin of study participants might affect the results of parasitological and molecular tests, while the level of risk of bias might affect serological outcomes. Subgroup analysis suggested that seronegativization occurs earlier in children compared to adults. Conclusions We acknowledge that there is a dynamic pattern of response based on parasitological, molecular and serological tests in subjects chronically infected with T. cruzi after treatment. Our findings suggest a trypanocidal effect in the long-term follow-up. Further research is needed to explore potential sources of heterogeneity and to conduct reliable subgroup analysis.
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Affiliation(s)
- Yanina Sguassero
- Centro Rosarino de Estudios Perinatales (CREP), Cochrane Centre CREP, Rosario, Santa Fe, Argentina
- Instituto Nacional de Parasitología (INP), “Dr Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Malbrán, Buenos Aires, Argentina
| | - Cristina B. Cuesta
- Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Karen N. Roberts
- Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Elizabeth Hicks
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS), Cochrane Centre IECS, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Cochrane Centre IECS, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología (INP), “Dr Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Malbrán, Buenos Aires, Argentina
- * E-mail:
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Mejía-Jaramillo AM, Agudelo-Uribe LA, Dib JC, Ortiz S, Solari A, Triana-Chávez O. Genotyping of Trypanosoma cruzi in a hyper-endemic area of Colombia reveals an overlap among domestic and sylvatic cycles of Chagas disease. Parasit Vectors 2014; 7:108. [PMID: 24656115 PMCID: PMC3994407 DOI: 10.1186/1756-3305-7-108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background Chagas disease is a neglected illness caused by the Trypanosoma cruzi parasite, which widely affects American communities. This study attempted to identify T. cruzi genotypes circulating in four indigenous communities of the Sierra Nevada of Santa Marta, Colombia, to investigate parasite transmission dynamics in these communities. In addition, some epidemiological variables to determine the risk factors for infection with this parasite, such as the prevalence of T. cruzi infection, the triatomine species, and the domestic and sylvatic mammals that act as vectors and reservoirs of the parasite in the domestic, peridomestic and sylvatic cycles, were examined. Methods We developed a prospective study to identify the main risk factors associated with T. cruzi infection in the region. The T. cruzi prevalence was determined by ELISA, IFA and PCR. Triatomines species and both domestic and sylvatic mammals from all communities were captured and sampled. To analyze parasite transmission dynamics in these four communities, eight DNA parasite probes were generated from insect and reservoir samples, and a DNA blot analysis were carried out. Results Serological studies revealed 37% prevalence in the four communities, and Kasakumake was the most endemic region, containing approximately 70% seropositives. Moreover, the molecular diagnosis showed a high correlation between the serological data and the T. cruzi circulating in the patients’ blood. A total of 464 triatomine insects were collected in domestic, peridomestic and sylvatic environments, and these insects belonged to five different species; Rhodnius prolixus and Triatoma dimidiata were the two more important species transmitting the parasite. After studying the eco-epidemiological factors in these four communities, the most important risk factors for infection with the parasite were determined. These risk factors are a high infection rate of people and domestic animals, the construction materials of the houses, the presence of infected triatomines inside the human dwellings, the proximity between houses and a sylvatic environment with several triatomine species and wild animals. Finally, the molecular characterization of T. cruzi showed the presence of three haplotypes and complex T. cruzi mixed infections in all reservoirs. Conclusions Active transmission of T. cruzi is present in four indigenous communities of the Sierra Nevada de Santa Marta with overlap between the domestic and the sylvatic transmission cycles of Chagas disease.
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Affiliation(s)
| | | | | | | | | | - Omar Triana-Chávez
- Grupo BCEI, Universidad de Antioquia UdeA, Calle 70 No, 52-21 Medellin, Colombia.
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Brenière SF, Salas R, Buitrago R, Brémond P, Sosa V, Bosseno MF, Waleckx E, Depickère S, Barnabé C. Wild populations of Triatoma infestans are highly connected to intra-peridomestic conspecific populations in the Bolivian Andes. PLoS One 2013; 8:e80786. [PMID: 24278320 PMCID: PMC3835561 DOI: 10.1371/journal.pone.0080786] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022] Open
Abstract
Triatoma infestans, the major vector of Chagas disease south of the Amazon in South America, has a large distribution of wild populations, contrary to what has previously been stated. These populations have been suspected of being the source of reinfestation of human habitats and could impede the full success of vector control campaigns. This study examined gene flow between intra-peridomestic populations and wild populations collected in the surround areas in three Andean localities in Bolivia. The populations were defined according to temporal, ecological, and spatial criteria. After DNA extraction from the legs of each insect, the samples were analyzed using seven microsatellite markers. First, the analysis of molecular variance (AMOVA) detected an absence of differentiation between wild and intra-peridomestic populations, although strong structuring was observed between the populations within each environment. Then for some populations, the Bayesian method of assignment to inferred populations showed very similar assignment patterns of the members of wild or intra-peridomestic populations in each locality. Finally, the detection of the first-generation migrants within the different populations provided evidence of insect displacement from the wild to the intra-peridomestic environment. This result indicates that, after control campaigns in the Andes, controlling this new paradigm of vector transmission risk stemming from the invasion of human habitats by wild populations of T. infestans requires long-term maintenance of public monitoring to keep the risk at a minimal level. Since wild populations of T. infestans have also been detected elsewhere in Argentina, Paraguay, and Chile, there is an urgent need to take these populations into account in future monitoring of Chagas disease transmission.
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Affiliation(s)
- Simone Frédérique Brenière
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto Nacional de Laboratorios de Salud (INLASA), Laboratorio de Entomología Médica, La Paz, Bolivia
- * E-mail:
| | - Renata Salas
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto Nacional de Laboratorios de Salud (INLASA), Laboratorio de Entomología Médica, La Paz, Bolivia
| | - Rosio Buitrago
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto Nacional de Laboratorios de Salud (INLASA), Laboratorio de Entomología Médica, La Paz, Bolivia
| | - Philippe Brémond
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
| | - Victor Sosa
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto de Investigaciones Biomédicas y de Interacción Social (IIBISMED), Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Marie-France Bosseno
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto Nacional de Laboratorios de Salud (INLASA), Laboratorio de Entomología Médica, La Paz, Bolivia
| | - Etienne Waleckx
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Laboratorio de Parasitología, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Mérida, Yucatán, México
| | - Stéphanie Depickère
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto Nacional de Laboratorios de Salud (INLASA), Laboratorio de Entomología Médica, La Paz, Bolivia
| | - Christian Barnabé
- Health Department, MIVEGEC (Université de Montpellier 1 et 2, CNRS 5290, IRD 224), Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle, Institut de recherche pour le développement (IRD), Montpellier, France
- Instituto Nacional de Laboratorios de Salud (INLASA), Laboratorio de Entomología Médica, La Paz, Bolivia
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Buttenheim AM, Paz-Soldan V, Barbu C, Skovira C, Quintanilla Calderón J, Mollesaca Riveros LM, Cornejo JO, Small DS, Bicchieri C, Naquira C, Levy MZ. Is participation contagious? Evidence from a household vector control campaign in urban Peru. J Epidemiol Community Health 2013; 68:103-9. [PMID: 24062411 DOI: 10.1136/jech-2013-202661] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES High rates of household participation are critical to the success of door-to-door vector control campaigns. We used the Health Belief Model to assess determinants of participation, including neighbour participation as a cue to action, in a Chagas disease vector control campaign in Peru. METHODS We evaluated clustering of participation among neighbours; estimated participation as a function of household infestation status, neighbourhood type and number of participating neighbours; and described the reported reasons for refusal to participate in a district of 2911 households. RESULTS We observed significant clustering of participation along city blocks (p<0.0001). Participation was significantly higher for households in new versus established neighbourhoods, for infested households, and for households with more participating neighbours. The effect of neighbour participation was greater in new neighbourhoods. CONCLUSIONS Results support a 'contagion' model of participation, highlighting the possibility that one or two participating households can tip a block towards full participation. Future campaigns can leverage these findings by making participation more visible, by addressing stigma associated with spraying, and by employing group incentives to spray.
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Affiliation(s)
- Alison M Buttenheim
- University of Pennsylvania School of Nursing, Family and Community Health, , Philadelphia, Pennsylvania, USA
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Hunter GC, Borrini-Mayorí K, Ancca Juárez J, Castillo Neyra R, Verastegui MR, Malaga Chavez FS, Cornejo del Carpio JG, Córdova Benzaquen E, Náquira C, Gilman RH, Bern C, Levy MZ. A field trial of alternative targeted screening strategies for Chagas disease in Arequipa, Peru. PLoS Negl Trop Dis 2012; 6:e1468. [PMID: 22253939 PMCID: PMC3254655 DOI: 10.1371/journal.pntd.0001468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 11/23/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chagas disease is endemic in the rural areas of southern Peru and a growing urban problem in the regional capital of Arequipa, population ∼860,000. It is unclear how to implement cost-effective screening programs across a large urban and periurban environment. METHODS We compared four alternative screening strategies in 18 periurban communities, testing individuals in houses with 1) infected vectors; 2) high vector densities; 3) low vector densities; and 4) no vectors. Vector data were obtained from routine Ministry of Health insecticide application campaigns. We performed ring case detection (radius of 15 m) around seropositive individuals, and collected data on costs of implementation for each strategy. RESULTS Infection was detected in 21 of 923 (2.28%) participants. Cases had lived more time on average in rural places than non-cases (7.20 years versus 3.31 years, respectively). Significant risk factors on univariate logistic regression for infection were age (OR 1.02; p = 0.041), time lived in a rural location (OR 1.04; p = 0.022), and time lived in an infested area (OR 1.04; p = 0.008). No multivariate model with these variables fit the data better than a simple model including only the time lived in an area with triatomine bugs. There was no significant difference in prevalence across the screening strategies; however a self-assessment of disease risk may have biased participation, inflating prevalence among residents of houses where no infestation was detected. Testing houses with infected-vectors was least expensive. Ring case detection yielded four secondary cases in only one community, possibly due to vector-borne transmission in this community, apparently absent in the others. CONCLUSIONS Targeted screening for urban Chagas disease is promising in areas with ongoing vector-borne transmission; however, these pockets of epidemic transmission remain difficult to detect a priori. The flexibility to adapt to the epidemiology that emerges during screening is key to an efficient case detection intervention. In heterogeneous urban environments, self-assessments of risk and simple residence history questionnaires may be useful to identify those at highest risk for Chagas disease to guide diagnostic efforts.
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Affiliation(s)
- Gabrielle C. Hunter
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katty Borrini-Mayorí
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jenny Ancca Juárez
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Castillo Neyra
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Eleazar Córdova Benzaquen
- Departamento de Microbiología y Patología, Facultad de Medicina, Universidad Nacional de San Agustín, Arequipa, Peru
| | - César Náquira
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caryn Bern
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael Z. Levy
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
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Yun O, Lima MA, Ellman T, Chambi W, Castillo S, Flevaud L, Roddy P, Parreño F, Albajar Viñas P, Palma PP. Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières. PLoS Negl Trop Dis 2009; 3:e488. [PMID: 19582142 PMCID: PMC2700957 DOI: 10.1371/journal.pntd.0000488] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 06/17/2009] [Indexed: 12/04/2022] Open
Abstract
Background Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. Methodology From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999–2002); Olopa, Guatemala (2003–2006); Entre Ríos, Bolivia (2002–2006); and Sucre, Bolivia (2005–2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. Results Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. Conclusions These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed. Chagas disease was discovered 100 years ago by the Brazilian physician Carlos Chagas. Predominantly affecting poor populations throughout Latin America, recognition and treatment of this parasitic disease are often neglected. Since 1999, the international medical humanitarian aid organization Médecins Sans Frontières (Doctors Without Borders) has offered diagnostic and therapeutic care for Chagas disease, and here we describe four of our programs in Honduras, Guatemala, and Bolivia, 1999–2008. The earliest programs focused on treating young children and in subsequent programs expanded up to 18 years of age. We identified six program components essential for project viability: information, education, and communication; vector control; health staff training; screening and diagnosis; treatment and compliance; and logistics. The number of children and adolescents screened for Chagas disease ranged from over 7,500 to nearly 25,000 in each program. Early analysis of cure rates ranged widely: from 87% and 58%, respectively, in Honduras and Guatemala, to 0%–5% in Bolivia. No deaths occurred in any of the programs, though drug-related side effects were observed in a quarter to half of all patients. Through our findings and experience, we discuss the feasibility, safety, and effectiveness of treatment programs for Chagas disease in resource-limited settings.
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Affiliation(s)
- Oliver Yun
- Médecins Sans Frontières/Doctors Without Borders, New York, New York, United States of America
| | - M. Angeles Lima
- Médecins Sans Frontières, Operational Center Barcelona-Athens (OCBA), Barcelona, Spain
- * E-mail:
| | - Tom Ellman
- Médecins Sans Frontières/Médicos Sin Fronteras, La Paz, Bolivia
| | - Wilma Chambi
- Médecins Sans Frontières/Médicos Sin Fronteras, La Paz, Bolivia
| | - Sandra Castillo
- Médecins Sans Frontières/Médicos Sin Fronteras, La Paz, Bolivia
| | - Laurence Flevaud
- Médecins Sans Frontières, Operational Center Barcelona-Athens (OCBA), Barcelona, Spain
| | - Paul Roddy
- Médecins Sans Frontières, Operational Center Barcelona-Athens (OCBA), Barcelona, Spain
| | - Fernando Parreño
- Médecins Sans Frontières, Operational Center Barcelona-Athens (OCBA), Barcelona, Spain
| | - Pedro Albajar Viñas
- Laboratory of Parasitological Diseases, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Pedro Pablo Palma
- Médecins Sans Frontières, Operational Center Barcelona-Athens (OCBA), Barcelona, Spain
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