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Schijman AG, Alonso-Padilla J, Britto C, Herrera Bernal CP. Retrospect, advances and challenges in Chagas disease diagnosis: a comprehensive review. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100821. [PMID: 39006126 PMCID: PMC11246061 DOI: 10.1016/j.lana.2024.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
Chagas disease, caused by Trypanosoma cruzi, affects millions worldwide. The 2030 WHO roadmap aims to eliminate it as a public health concern, emphasising the need for timely diagnosis to enhance treatment access. Current diagnostic algorithms, which rely on multiple tests, have prolonged turnaround times. This proves particularly problematic in resource-limited settings. Addressing this issue necessitates the validation and adoption of innovative tools. We explore recent developments in Chagas disease diagnosis, reviewing historical context and advancements. Despite progress, challenges persist. This article contributes to the understanding of current and future directions in this neglected healthcare area. Parasitological methods are simple but exhibit low sensitivity and require supplementary tests. Molecular methods, with automation potential, allow quantification and higher throughput. Serological tools show good performance but struggle with parasite antigenic diversity. Prioritising point-of-care tests is crucial for widespread accessibility and could offer a strategy to control disease impact. Ultimately, balancing achievements and ongoing obstacles is essential for comprehensive progress.
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Affiliation(s)
- Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI- CONICET, Vuelta de Obligado 2490, Buenos Aires, 1428 ADN, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, Carrer Rosselló 149, 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Constança Britto
- Fundação Oswaldo Cruz, Fiocruz, Instituto Oswaldo Cruz, Laboratory of Molecular Biology and Endemic Diseases, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21045-900, Brazil
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2
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Sabino EC, Nunes MCP, Blum J, Molina I, Ribeiro ALP. Cardiac involvement in Chagas disease and African trypanosomiasis. Nat Rev Cardiol 2024:10.1038/s41569-024-01057-3. [PMID: 39009679 DOI: 10.1038/s41569-024-01057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/17/2024]
Abstract
Trypanosomiases are diseases caused by various species of protozoan parasite in the genus Trypanosoma, each presenting with distinct clinical manifestations and prognoses. Infections can affect multiple organs, with Trypanosoma cruzi predominantly affecting the heart and digestive system, leading to American trypanosomiasis or Chagas disease, and Trypanosoma brucei primarily causing a disease of the central nervous system known as human African trypanosomiasis or sleeping sickness. In this Review, we discuss the effects of these infections on the heart, with particular emphasis on Chagas disease, which continues to be a leading cause of cardiomyopathy in Latin America. The epidemiology of Chagas disease has changed substantially since 1990 owing to the emigration of over 30 million Latin American citizens, primarily to Europe and the USA. This movement of people has led to the global dissemination of individuals infected with T. cruzi. Therefore, cardiologists worldwide must familiarize themselves with Chagas disease and the severe, chronic manifestation - Chagas cardiomyopathy - because of the expanded prevalence of this disease beyond traditional endemic regions.
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Affiliation(s)
- Ester Cerdeira Sabino
- Department of Pathology, Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Maria Carmo P Nunes
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Luiz P Ribeiro
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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3
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Clark EH, Messenger LA, Whitman JD, Bern C. Chagas disease in immunocompromised patients. Clin Microbiol Rev 2024; 37:e0009923. [PMID: 38546225 PMCID: PMC11237761 DOI: 10.1128/cmr.00099-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYAs Chagas disease remains prevalent in the Americas, it is important that healthcare professionals and researchers are aware of the screening, diagnosis, monitoring, and treatment recommendations for the populations of patients they care for and study. Management of Trypanosoma cruzi infection in immunocompromised hosts is challenging, particularly because, regardless of antitrypanosomal treatment status, immunocompromised patients with Chagas disease are at risk for T. cruzi reactivation, which can be lethal. Evidence-based practices to prevent and manage T. cruzi reactivation vary depending on the type of immunocompromise. Here, we review available data describing Chagas disease epidemiology, testing, and management practices for various populations of immunocompromised individuals, including people with HIV and patients undergoing solid organ and hematopoietic stem cell transplantation.
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Affiliation(s)
- Eva H Clark
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Louisa A Messenger
- Department of Environmental and Occupational Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
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Silvestrini MMA, Alessio GD, Frias BED, Sales Júnior PA, Araújo MSS, Silvestrini CMA, Brito Alvim de Melo GE, Martins-Filho OA, Teixeira-Carvalho A, Martins HR. New insights into Trypanosoma cruzi genetic diversity, and its influence on parasite biology and clinical outcomes. Front Immunol 2024; 15:1342431. [PMID: 38655255 PMCID: PMC11035809 DOI: 10.3389/fimmu.2024.1342431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, remains a serious public health problem worldwide. The parasite was subdivided into six distinct genetic groups, called "discrete typing units" (DTUs), from TcI to TcVI. Several studies have indicated that the heterogeneity of T. cruzi species directly affects the diversity of clinical manifestations of Chagas disease, control, diagnosis performance, and susceptibility to treatment. Thus, this review aims to describe how T. cruzi genetic diversity influences the biology of the parasite and/or clinical parameters in humans. Regarding the geographic dispersion of T. cruzi, evident differences were observed in the distribution of DTUs in distinct areas. For example, TcII is the main DTU detected in Brazilian patients from the central and southeastern regions, where there are also registers of TcVI as a secondary T. cruzi DTU. An important aspect observed in previous studies is that the genetic variability of T. cruzi can impact parasite infectivity, reproduction, and differentiation in the vectors. It has been proposed that T. cruzi DTU influences the host immune response and affects disease progression. Genetic aspects of the parasite play an important role in determining which host tissues will be infected, thus heavily influencing Chagas disease's pathogenesis. Several teams have investigated the correlation between T. cruzi DTU and the reactivation of Chagas disease. In agreement with these data, it is reasonable to suppose that the immunological condition of the patient, whether or not associated with the reactivation of the T. cruzi infection and the parasite strain, may have an important role in the pathogenesis of Chagas disease. In this context, understanding the genetics of T. cruzi and its biological and clinical implications will provide new knowledge that may contribute to additional strategies in the diagnosis and clinical outcome follow-up of patients with Chagas disease, in addition to the reactivation of immunocompromised patients infected with T. cruzi.
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Affiliation(s)
| | - Glaucia Diniz Alessio
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Estefânia Diniz Frias
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Policarpo Ademar Sales Júnior
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Márcio Sobreira Silva Araújo
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Olindo Assis Martins-Filho
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Andréa Teixeira-Carvalho
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Helen Rodrigues Martins
- Department of Pharmacy, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
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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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de Oliveira RS, Moll-Bernardes R, de Brito AX, Pinheiro MVT, de Almeida SA, da Silva Gomes NL, de Oliveira Terzi FV, Moreira OC, Xavier SS, Rosado-de-Castro PH, de Sousa AS. Use of PET/CT to detect myocardial inflammation and the risk of malignant arrhythmia in chronic Chagas disease. J Nucl Cardiol 2023; 30:2702-2711. [PMID: 37605061 DOI: 10.1007/s12350-023-03350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Chagas heart disease (CHD) is characterized by progressive myocardial inflammation associated with myocardial fibrosis and segmental abnormalities that may lead to malignant ventricular arrhythmia and sudden cardiac death. This arrhythmia might be related to the persistence of parasitemia or inflammation in the myocardium in late-stage CHD. Positron emission tomography/computed tomography (PET/CT) has been used to detect myocardial inflammation in non-ischemic cardiomyopathies, such as sarcoidosis, and might be useful for risk prediction in patients with CHD. METHODS AND RESULTS Twenty-four outpatients with chronic CHD were enrolled in this prospective cross-sectional study between May 2019 and March 2022. The patients were divided into two groups: those with sustained ventricular tachycardia and/or aborted sudden cardiac death who required implantable cardioverter-defibrillators, and those with the same stages of CHD and no complex ventricular arrhythmia. Patients underwent 18F-fluorodeoxyglucose (18F-FDG) and 68Ga-DOTATOC PET/CT, and blood samples were collected for qualitative parasite assessment by polymerase chain reaction. Although similar proportions of patients with and without complex ventricular arrhythmia showed 18F-FDG and 68Ga-DOTATOC uptake, 68Ga-DOTATOC corrected SUVmax was higher in patients with complex arrhythmia (3.4 vs 1.7; P = .046), suggesting that inflammation could be associated with the presence of malignant arrhythmia in the late stages of CHD. We also detected Trypanosoma cruzi in both groups, with a nonsignificant trend of increased parasitemia in the group with malignant arrhythmia (66.7% vs 33.3%). CONCLUSION 18F-FDG and 68Ga-DOTATOC uptake on PET/CT may be useful for the detection of myocardial inflammation in patients with Chagas cardiomyopathy, and 68Ga-DOTATOC uptake may be associated with the presence of malignant arrhythmia, with potential therapeutic implications.
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Affiliation(s)
- Renée Sarmento de Oliveira
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Internal Medicine Department, Rio de Janeiro Federal State University, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | - Sergio Salles Xavier
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Pascual-Vázquez G, Alonso-Sardón M, Rodríguez-Alonso B, Pardo-Lledías J, Romero Alegría A, Fernández-Soto P, Muñoz Bellido JL, Muro A, Belhassen-García M. Molecular diagnosis of Chagas disease: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12:95. [PMID: 37845734 PMCID: PMC10577976 DOI: 10.1186/s40249-023-01143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/20/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The complexity of the Chagas disease and its phases is impossible to have a unique test for both phases and a lot of different epidemiological scenarios. Currently, serology is the reference standard technique; occasionally, results are inconclusive, and a different diagnostic technique is needed. Some guidelines recommend molecular testing. A systematic review and meta-analysis of available molecular tools/techniques for the diagnosis of Chagas disease was performed to measure their heterogeneity and efficacy in detecting Trypanosoma cruzi infection in blood samples. METHODS A systematic review was conducted up to July 27, 2022, including studies published in international databases. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA 2020 guidelines. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A random-effects model was used to calculate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Forest plots and a summary of the receiving operating characteristics (SROC) curves displayed the outcomes. Heterogeneity was determined by I2 and Tau2 statistics and P values. Funnel plots and Deek's test were used to assess publication bias. A quantitative meta-analysis of the different outcomes in the two different clinical phases was performed. RESULTS We identified 858 records and selected 32 papers. Studies pertained to endemic countries and nonendemic areas with adult and paediatric populations. The sample sizes ranged from 17 to 708 patients. There were no concerns regarding the risk of bias and applicability of all included studies. A positive and nonsignificant correlation coefficient (S = 0.020; P = 0.992) was obtained in the set of studies that evaluated diagnostic tests in the acute phase population (ACD). A positive and significant correlation coefficient (S = 0.597; P < 0.000) was obtained in the case of studies performed in the chronic phase population (CCD). This resulted in high heterogeneity between studies, with the master mix origin and guanidine addition representing significant sources. INTERPRETATION/CONCLUSIONS AND RELEVANCE The results described in this meta-analysis (qualitative and quantitative analyses) do not allow the selection of the optimal protocol of molecular method for the study of Trypanosoma cruzi infection in any of its phases, among other reasons due to the complexity of this infection. Continuous analysis and optimization of the different molecular techniques is crucial to implement this efficient diagnosis in endemic areas.
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Affiliation(s)
- Guillermo Pascual-Vázquez
- Infectious and Tropical Diseases Group (E-INTRO), Biomedical Research Institute of Salamanca (IBSAL), Tropical Diseases Research Center of the University of Salamanca (CIETUS), Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Montserrat Alonso-Sardón
- Area of Preventive Medicine, Epidemiology and Public Health, Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, E-INTRO, IBSAL, CIETUS, University of Salamanca, Salamanca, Spain
| | - Beatriz Rodríguez-Alonso
- Internal Medicine Service, University Health Care Complex of Salamanca (CAUSA), E-INTRO, IBSAL, CIETUS, Salamanca, Spain
| | - Javier Pardo-Lledías
- Internal Medicine Department, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL (Valdecilla Research Institute), Santander, Spain
| | | | - Pedro Fernández-Soto
- Infectious and Tropical Diseases Group (E-INTRO), IBSAL. CIETUS. Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Juan Luis Muñoz Bellido
- Microbiology and Parasitology Service, CAUSA, IBSAL, CIETUS, CSIC, Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Antonio Muro
- Infectious and Tropical Diseases Group (E-INTRO), IBSAL. CIETUS. Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Moncef Belhassen-García
- Internal Medicine Service. Infectious Diseases Section, CAUSA, IBSAL, CIETUS, University of Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain.
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8
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Avalos-Borges EE, Jiménez-Coello M, Chan-Pérez JI, Cigarroa-Toledo N, Garg NJ, Guillermo-Cordero L, Segura-Correa JC, Ortega-Pacheco A. Congenital Transmission of Trypanosoma cruzi in Naturally Infected Dogs. Vector Borne Zoonotic Dis 2023; 23:465-474. [PMID: 37339451 PMCID: PMC10625467 DOI: 10.1089/vbz.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Background: Congenital transmission (CT) of Trypanosoma cruzi in dogs has not been clearly demonstrated, even though dogs are important reservoirs of this agent. Materials and Methods: Seventeen late pregnant dogs seropositive for T. cruzi were selected, and a total of 84 fetuses were obtained. Blood and heart tissues from the fetuses and dams, and placental tissue from dam were collected. All tissues were analyzed by quantitative polymerase chain reaction (qPCR) for T. cruzi DNA (TcDNA) and inflammatory infiltrate and pathology by histological examination. CT was determined when physical, histological, or molecular evidence of T. cruzi was detected in blood or tissues of the fetuses. Results: A general transmission frequency of 59% was found, and 0.20 ± 0.24 of fetuses per litter were infected. Dams that were qPCR positive for TcDNA in cardiac tissue or blood displayed a transmission frequency of 100% and 67%, respectively. The highest parasite burden was noted in dams that were positive for TcDNA in both blood (82E-01 ± 1.54E-01) and cardiac (5.28E+03 ± 8.85E+03) tissues. In fetuses, higher parasitic burden in blood and cardiac tissue was found in those carried by dams that were seropositive and qPCR positive for TcDNA in cardiac tissue and blood. No amastigote nests were recorded in the cardiac tissue of fetuses in the histopathological studies, but typical lesions of T. cruzi infection were identified in all fetuses where CT occurred. Conclusions: CT of T. cruzi occurred at a high frequency in naturally infected pregnant dogs from the endemic areas.
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Affiliation(s)
- Eduardo E. Avalos-Borges
- Doctorado Institucional en Ciencias Agropecuarias, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Matilde Jiménez-Coello
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Jose I. Chan-Pérez
- Centro de Investigaciones Regionales “Dr Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Nohemi Cigarroa-Toledo
- Centro de Investigaciones Regionales “Dr Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Nisha J. Garg
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Leonardo Guillermo-Cordero
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Jose C. Segura-Correa
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Antonio Ortega-Pacheco
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Mexico
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Gabaldón-Figueira JC, Skjefte M, Longhi S, Escabia E, García LJ, Ros-Lucas A, Martínez-Peinado N, Muñoz-Calderón A, Gascón J, Schijman AG, Alonso-Padilla J. Practical diagnostic algorithms for Chagas disease: a focus on low resource settings. Expert Rev Anti Infect Ther 2023; 21:1287-1299. [PMID: 37933443 DOI: 10.1080/14787210.2023.2279110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Chagas disease, caused by parasite Trypanosoma cruzi, is the most important neglected tropical disease in the Americas. Two drugs are available for treatment, but access to them is challenging, in part due to complex diagnostic algorithms. These are stage-dependent, involve multiple tests, and are ill-adapted to the reality of vast areas where the disease is endemic. Molecular and serologic tools are used to detect acute and chronic infections, with the performance of the latter showing geographic differences. Breakthroughs in the development of new diagnostic tools include the validation of a loop-mediated isothermal amplification assay for acute infections (T. cruzi-LAMP), and the regional validation of several rapid diagnostic tests (RDTs) for chronic infection, which simplify testing in resource-limited settings. The literature search was carried out in the MEDLINE database until 1 August 2023. AREAS COVERED This review outlines existing algorithms, and proposes new ones focused on point-of-care testing. EXPERT OPINION Integrating point-of-care testing into existing diagnostic algorithms in certain endemic areas will increase access to timely diagnosis and treatment. However, additional research is needed to validate the use of these techniques across a wider geography, and to better understand the cost-effectiveness of their large-scale implementation.
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Affiliation(s)
| | - Malia Skjefte
- Population Services International (PSI), Washington, MA, USA
| | - Silvia Longhi
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Elisa Escabia
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Lady Juliette García
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Albert Ros-Lucas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Nieves Martínez-Peinado
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Arturo Muñoz-Calderón
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Joaquim Gascón
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Héctor Torres", INGEBI-CONICET, Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
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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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11
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Altcheh J, Moscatelli G, Caruso M, Moroni S, Bisio M, Miranda MR, Monla C, Vaina M, Valdez M, Moran L, Ramirez T, Patiño OL, Riarte A, Gonzalez N, Fernandes J, Alves F, Ribeiro I, Garcia-Bournissen F. Population pharmacokinetics of benznidazole in neonates, infants and children using a new pediatric formulation. PLoS Negl Trop Dis 2023; 17:e0010850. [PMID: 37256863 DOI: 10.1371/journal.pntd.0010850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/23/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND There is a major need for information on pharmacokinetics (PK) of benznidazole (BNZ) in children with Chagas disease (CD). We conducted a multicentre population PK, safety and efficacy study in children, infants and neonates with CD treated with BNZ (formulated in 100 mg tablets or 12.5 mg dispersible tablets, developed by the pharmaceutical company LAFEPE, in a collaboration with DNDi). METHODS 81 children 0-12 years old were enrolled at 5 pediatric centers in Argentina. Diagnosis of T. cruzi infection was confirmed by direct microscopic examination, or at least two positive conventional serological tests. Subject enrolment was stratified by age: newborns to 2 years (minimum of 10 newborns) and >2-12 years. BNZ 7.5 mg/kg/d was administered in two daily doses for 60 days. Five blood samples per child were obtained at random times within pre-defined time windows at Day 0 at 2-5 h post-dose; during steady state, one sample at Day 7 and at Day 30; and two samples at 12-24 h after final BNZ dose at Day 60. The primary efficacy endpoint was parasitological clearance by qualitative PCR at the end of treatment. RESULTS Forty-one (51%) patients were under 2 years of age (including 14 newborns <1 month of age). Median age at enrolment was 22 months (mean: 43.2; interquartile range (IQR) 7-72 months). The median measured BNZ Cmax was 8.32 mg/L (IQR 5.95-11.8; range 1.79-19.38). Median observed BNZ Cmin (trough) concentration was 2 mg/L (IQR 1.25-3.77; range 0.14-7.08). Overall median simulated Css was 6.3 mg/L (IQR 4.7-8.5 mg/L). CL/F increased quickly during the first month of postnatal life and reached adult levels after approximately 10 years of age. Negative qPCR was observed at the end of treatment in all 76 patients who completed the treatment. Five patients discontinued treatment (3 due to AEs and 2 due to lack of compliance). CONCLUSION We observed lower BNZ plasma concentrations in infants and children than those previously reported in adults treated with comparable mg/kg doses. Despite these lower concentrations, pediatric treatment was well tolerated and universally effective, with a high response rate and infrequent, mild AEs. TRIAL REGISTRATION Registered in clinicaltrials.gov #NCT01549236.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Martin Caruso
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital de Niños Doctor Hector Quintana, Jujuy, Argentina
| | - Samanta Moroni
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Maria Rosa Miranda
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital de Niños Doctor Hector Quintana, Jujuy, Argentina
| | - Celia Monla
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital Público Materno Infantil, Salta, Argentina
| | - Maria Vaina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital Público Materno Infantil, Salta, Argentina
| | - Maria Valdez
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital Público Materno Infantil, Salta, Argentina
| | - Lucrecia Moran
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Centro de Chagas y Patología Regional, Santiago del Estero, Argentina
| | - Teresa Ramirez
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
| | - Oscar Ledesma Patiño
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Centro de Chagas y Patología Regional, Santiago del Estero, Argentina
| | - Adelina Riarte
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - Nicolas Gonzalez
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Jayme Fernandes
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Isabela Ribeiro
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Facundo Garcia-Bournissen
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Division of Paediatric Clinical Pharmacology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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Moreira OC, Fernandes AG, Gomes NLDS, Dos Santos CM, Jacomasso T, Costa ADT, Nascimento LDOR, Hasslocher-Moreno AM, do Brasil PEAA, Morello LG, Marchini FK, Krieger MA, Britto C. Validation of the NAT Chagas IVD Kit for the Detection and Quantification of Trypanosoma cruzi in Blood Samples of Patients with Chagas Disease. Life (Basel) 2023; 13:1236. [PMID: 37374019 DOI: 10.3390/life13061236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
In the absence of validated biomarkers to control the cure of Chagas disease, PCR-based diagnosis is being used as the main tool for an early indication of therapeutic failure. However, since it is considered a technique of complex reproducibility, mainly due to difficulties in establishing accurate controls to guarantee the quality of the reaction, the use of PCR for Chagas disease diagnosis is restricted to specialized centers. In an effort to disseminate the molecular diagnosis of Chagas disease and its applications, new diagnostic kits based on qPCR have been made available in the market in recent years. Here, we show the results of the validation of the NAT Chagas kit (Nucleic Acid Test for Chagas Disease) for the detection and quantification of T. cruzi in blood samples of patients suspected of Chagas disease infection. The kit, composed of a TaqMan duplex reaction targeting the T. cruzi satellite nuclear DNA and an exogenous internal amplification control, presented a reportable range from 104 to 0.5 parasite equivalents/mL and a limit of detection (LOD) of 0.16 parasite equivalents/mL of blood. In addition, the NAT Chagas kit detected T. cruzi belonging to all six discrete typing units (DTUs-TcI to TcVI), similarly to the in-house real-time PCR performed with commercial reagents, which has been selected as the best performance assay in the international consensus for the validation of qPCR for Chagas disease. In the clinical validation presented here, the kit showed 100% sensitivity and 100% specificity when compared to the consensus in-house real-time PCR assay. Thus, the NAT Chagas kit, which is produced entirely in Brazil under the international standards of good manufacturing practices (GMP), appears as an excellent alternative to enable the molecular diagnosis of Chagas disease in public and private diagnostic centers, as well as to facilitate the monitoring of patients under etiological treatment participating in clinical trials.
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Affiliation(s)
- Otacilio C Moreira
- Real Time PCR Platform RPT09A, Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Alice Gomes Fernandes
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Natalia Lins da Silva Gomes
- Real Time PCR Platform RPT09A, Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Carolina Messias Dos Santos
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Thiago Jacomasso
- Instituto de Biologia Molecular do Paraná, Curitiba 81350-010, Brazil
| | - Alexandre Dias Tavares Costa
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute/Fiocruz, Curitiba 81310-020, Brazil
| | | | - Alejandro Marcel Hasslocher-Moreno
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases/Fiocruz, Rio de Janeiro 21040-360, Brazil
| | | | - Luis Gustavo Morello
- Instituto de Biologia Molecular do Paraná, Curitiba 81350-010, Brazil
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute/Fiocruz, Curitiba 81310-020, Brazil
| | - Fabricio Klerynton Marchini
- Instituto de Biologia Molecular do Paraná, Curitiba 81350-010, Brazil
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute/Fiocruz, Curitiba 81310-020, Brazil
| | - Marco Aurelio Krieger
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute/Fiocruz, Curitiba 81310-020, Brazil
| | - Constança Britto
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro 21040-900, Brazil
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Kann S, Concha G, Weinreich F, Hahn A, Rückert C, Kalinowski J, Landt O, Frickmann H. Comparative Assessment of Two Commercial Real-Time PCR Assays for the Diagnosis of Trypanosoma cruzi DNA in Serum. Microorganisms 2023; 11:microorganisms11040901. [PMID: 37110326 PMCID: PMC10142699 DOI: 10.3390/microorganisms11040901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023] Open
Abstract
This study was performed to comparably assess two commercial real-time PCR assays for the identification of Trypanosoma cruzi DNA in serum. A total of 518 Colombian serum samples with high pre-test probability for infections with either T. cruzi or apathogenic Trypanosoma rangeli were assessed. The assessment comprised the NDO real-time PCR (TIB MOLBIOL, ref. no. 53-0755-96, referred to as the TibMolBiol assay in the following) with specificity for T. cruzi and the RealStar Chagas PCR Kit 1.0 (altona DIAGNOSTICS, order no. 611013, referred to as the RealStar assay in the following) targeting a kinetoplast sequence of both T. cruzi and T. rangeli without further discrimination. To discriminate between T. cruzi- and T. rangeli-specific real-time PCR amplicons, Sanger sequencing results were available for a minority of cases with discordant real-time PCR results, while the amplicons of the remaining discordant samples were subjected to nanopore sequencing. The study assessment indicated a proportion of 18.1% (n = 94) T. cruzi-positive samples next to 24 samples (4.6%) containing DNA of the phylogenetically related but apathogenic parasite T. rangeli. The observed diagnostic accuracy as expressed by sensitivity and specificity was 97.9% (92/94) and 99.3% (421/424) with the TibMolBiol assay and 96.8% (91/94) and 95.0% (403/424) with the RealStar assay, respectively. Reduced specificity resulted from cross-reaction with T. rangeli in all instances (3 cross-reactions with the TibMolBiol assay and 21 cross-reactions with the RealStar assay). DNA from the six discrete typing units (DTUs) of T. cruzi was successfully amplified by both real-time PCR assays. In summary, both assays showed a comparable diagnostic accuracy for the diagnosis of T. cruzi from human serum, with a slightly higher specificity seen for the TibMolBiol assay. The pronounced co-amplification of DNA from apathogenic T. rangeli according to the RealStar assay may be a disadvantage in areas of co-circulation with T. cruzi, while the test performance of the two compared assays will be quite similar in geographic settings where T. rangeli infections are unlikely.
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Affiliation(s)
- Simone Kann
- Medical Mission Institute, 97074 Würzburg, Germany
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 2000001, Colombia
| | - Felix Weinreich
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
| | - Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
| | - Christian Rückert
- CeBiTec Centrum for Biotechnology, Bielefeld University, 33615 Bielefeld, Germany
| | - Jörn Kalinowski
- CeBiTec Centrum for Biotechnology, Bielefeld University, 33615 Bielefeld, Germany
| | | | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
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14
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Ferreira JDJG, Costa SCB, Addas-Carvalho M, Pereira MB, França ADO, de Lima RG, Andrade PD, Wanderley JDS, Martins LC, de Almeida EA, Marcon GEB. Evaluation of Molecular Methods to Identify Chagas Disease and Leishmaniasis in Blood Donation Candidates in Two Brazilian Centers. Pathogens 2023; 12:pathogens12040508. [PMID: 37111394 PMCID: PMC10141534 DOI: 10.3390/pathogens12040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 04/29/2023] Open
Abstract
In Brazil, blood donation is regulated by the Brazilian Ministry of Health, and all States follow the same protocol for clinical and laboratory screening. Brazil is an endemic country for Chagas disease (CD), caused by Trypanosoma cruzi, and for leishmaniasis, caused by a species of Leishmania spp. Screening for leishmaniosis is not routinely performed by blood banks. Given the antigenic similarity between T. cruzi and Leishmania spp., cross-reactions in serological tests can occur, and inconclusive results for CD have been found. The objective of this study was to apply molecular techniques, e.g., nPCR, PCR, and qPCR, to clarify cases of blood donation candidates with non-negative serology for CD and to analyze the difference between the melting temperature during real-time PCR using SYBR Green. Thirty-seven cases that showed non-negative results for CD using chemiluminescent microparticle immunoassay (CMIA) tests from blood banks in Campo Grande, MS, and Campinas, SP, were analyzed. In the serum samples, 35 samples were evaluated by ELISA, and 24.3% (9/35) showed positive results for CD. nPCR was able to detect 12 positive results in 35 samples (34.28%). qPCR for T. cruzi was quantifiable in the samples that showed a value ≥0.002 par eq/mL (parasite equivalents per milliliter), and in 35 samples, 11 (31.42%) were positive. Of all evaluated samples using the described tests (CMIA, ELISA, nPCR, and qPCR), 18 (48.6%) were positive for CD. For MCA by qPCR, the melting temperature was 82.06 °C ± 0.46 for T. cruzi and 81.9 °C ± 0.24 for Leishmania infantum. The Mann-Whitney test showed a significant value of p < 0.0001. However, the differentiation between T. cruzi and L. infantum could not be considered due to temperature overlap. For leishmaniasis, of the 35 samples with non-negative serology for CD tested by the indirect fluorescent antibody test (IFAT), only one sample (2.85%) was positive (1:80). The PCR for Leishmania spp. was performed on 36 blood samples from donation candidates, and all were negative. qPCR for L. infantum showed 37 negative results for the 37 analyzed samples. The data presented here show the importance of performing two different tests in CD screening at blood banks. Molecular tests should be used for confirmation, thereby improving the blood donation system.
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Affiliation(s)
- Juliana de Jesus Guimarães Ferreira
- Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Sandra Cecília Botelho Costa
- Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Marcelo Addas-Carvalho
- Centro de Hematologia e Hemoterapia, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Mariane Barroso Pereira
- Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Adriana de Oliveira França
- Laboratório de Doenças Infecciosas e Parasitárias (LabDIP), Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Cidade Universitária s/n, Campo Grande 79090-900, MS, Brazil
| | - Rodrigo Gonçalves de Lima
- Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Paula Durante Andrade
- Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Jamiro da Silva Wanderley
- Grupo de Estudos em Doença de Chagas (GEDoCh), Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Luiz Cláudio Martins
- Grupo de Estudos em Doença de Chagas (GEDoCh), Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Eros Antonio de Almeida
- Grupo de Estudos em Doença de Chagas (GEDoCh), Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Gláucia Elisete Barbosa Marcon
- Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
- Fundação Oswaldo Cruz Mato Grosso do Sul (FIOCRUZ MS), Rua Gabriel Abrão, 92, Jardim das Nações, Campo Grande 79081-746, MS, Brazil
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de Azevedo SLC, Catanho M, Guimarães ACR, Galvão TC. Genomic surveillance: a potential shortcut for effective Chagas disease management. Mem Inst Oswaldo Cruz 2023; 117:e220164. [PMID: 36700581 PMCID: PMC9870261 DOI: 10.1590/0074-02760220164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/27/2023] Open
Abstract
Chagas disease is an enduring public health issue in many Latin American countries, receiving insufficient investment in research and development. Strategies for disease control and management currently lack efficient pharmaceuticals, commercial diagnostic kits with improved sensitivity, and vaccines. Genetic heterogeneity of Trypanosoma cruzi is a key aspect for novel drug design since pharmacological technologies rely on the degree of conservation of parasite target proteins. Therefore, there is a need to expand the knowledge regarding parasite genetics which, if fulfilled, could leverage Chagas disease research and development, and improve disease control strategies. The growing capacity of whole-genome sequencing technology and its adoption as disease surveillance routine may be key for solving this long-lasting problem.
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Affiliation(s)
- Sophia Lincoln Cardoso de Azevedo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil,Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - Marcos Catanho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Ana Carolina Ramos Guimarães
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil
| | - Teca Calcagno Galvão
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil,+ Corresponding author:
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16
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[Circulación de Leishmania infantum y Trypanosoma cruzi en perros domésticos de áreas urbanas de Sincelejo, región Caribe de Colombia]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:633-649. [PMID: 36511676 PMCID: PMC9814371 DOI: 10.7705/biomedica.6369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Indexed: 12/14/2022]
Abstract
Introducción. La enfermedad de Chagas y la leishmaniasis tradicionalmente se han considerado zoonosis endémicas de áreas rurales del país. Sin embargo, la aparición de casos de estas enfermedades en áreas urbanas sugiere nuevos ciclos de circulación de estos parásitos. Por esta razón, se ha propuesto a los perros como centinelas de estos agentes zoonóticos, dado su rol como huéspedes accidentales o reservorios. Objetivo. Evaluar la circulación silenciosa de Leishmania spp. y Trypanosoma cruzi en perros de zonas urbanas de la ciudad de Sincelejo, Sucre. Materiales y métodos. Se analizaron 100 muestras de sangre de perros para amplificar la región ITS1 de Leishmania spp. Las muestras positivas se utilizaron para amplificar la región conservada del minicírculo del ADN del cinetoplasto de Leishmania infantum y para el análisis de polimorfismos de longitud de fragmentos de restricción con la endonucleasa HaeIII. Por otra parte, se amplificó un fragmento del ADN satelital de T. cruzi. Además, se evaluó la presencia de infecciones por Ehrlichia canis y Anaplasma platys, como potencialmente modificadoras de las manifestaciones clínicas. Resultados. De los 100 perros estudiados, se detectó: Leishmania spp. en 32, T. cruzi en 12, ambos parásitos en 7 y L. infantum en 18. Se encontraron infecciones por anaplasmatáceos en 18, y coinfecciones por bacterias y parásitos en 8 de los perros. En general, 47 de los animales estaban infectados por, al menos, un agente etiológico. Conclusión. Se demuestra la circulación de L. infantum y T. cruzi en zonas urbanas de Sincelejo, así como coinfecciones de estos parásitos junto con parásitos de la familia Anaplasmataceae. El presente estudio demuestra la conveniencia del uso de perros en la vigilancia epidemiológica de estos agentes zoonóticos.
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17
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De Salazar PM, Sosa-Estani S, Salvador F, Sulleiro E, Sánchez-Montalvá A, Ribeiro I, Molina I, Buckee CO. Human Trypanosoma cruzi chronic infection leads to individual level steady-state parasitemia: Implications for drug-trial optimization in Chagas disease. PLoS Negl Trop Dis 2022; 16:e0010828. [PMID: 36409773 PMCID: PMC9721471 DOI: 10.1371/journal.pntd.0010828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/05/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022] Open
Abstract
Currently available drugs against Trypanosoma cruzi infection, which causes 12000 deaths annually, have limitations in their efficacy, safety and tolerability. The evaluation of therapeutic responses to available and new compounds is based on parasite detection in the bloodstream but remains challenging because a substantial proportion of infected individuals have undetectable parasitemia even when using diagnostic tools with the highest accuracy. We characterize parasite dynamics which might impact drug efficacy assessments in chronic Chagas by analyzing pre- and post-treatment quantitative-PCR data obtained from blood samples collected regularly over a year. We show that parasitemia remains at a steady-state independently of the diagnostic sensitivity. This steady-state can be probabilistically quantified and robustly predicted at an individual level. Furthermore, individuals can be assigned to categories with distinct parasitological status, allowing a more detailed evaluation of the efficacy outcomes and adjustment for potential biases. Our analysis improves understanding of parasite dynamics and provides a novel background for optimizing future drug efficacy trials in Chagas disease. Trial Registration: original trial registered with ClinicalTrials.gov, number NCT01489228.
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Affiliation(s)
- Pablo M. De Salazar
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sergio Sosa-Estani
- Drugs for Neglected Diseases Initiative. Rio de Janeiro, Brazil
- Epidemiology and Public Health Research Centre, CONICET, Buenos Aires, Argentina
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d’Hebron University Hospital, International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabela Ribeiro
- Drugs for Neglected Diseases Initiative, Geneve, Switzerland
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain
- Instituto René Rachou-FIOCRUZ Minas, Laboratório de Triatomíneos e Epidemiologia da Doença de Chagas, Belo Horizonte, Brazil
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Caroline O. Buckee
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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18
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Cavalcante EHM, de Oliveira HP. Magnetite‐doped electrospun fibers for
DNA
adsorption. J Appl Polym Sci 2022. [DOI: 10.1002/app.53198] [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]
Affiliation(s)
| | - Helinando Pequeno de Oliveira
- Institute of Materials Science Federal University of São Francisco Valley, Avenida Antônio Carlos Magalhães Juazeiro Brazil
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19
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Padilla AM, Wang W, Akama T, Carter DS, Easom E, Freund Y, Halladay JS, Liu Y, Hamer SA, Hodo CL, Wilkerson GK, Orr D, White B, George A, Shen H, Jin Y, Wang MZ, Tse S, Jacobs RT, Tarleton RL. Discovery of an orally active benzoxaborole prodrug effective in the treatment of Chagas disease in non-human primates. Nat Microbiol 2022; 7:1536-1546. [PMID: 36065062 PMCID: PMC9519446 DOI: 10.1038/s41564-022-01211-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/21/2022] [Indexed: 12/26/2022]
Abstract
Trypanosoma cruzi, the agent of Chagas disease, probably infects tens of millions of people, primarily in Latin America, causing morbidity and mortality. The options for treatment and prevention of Chagas disease are limited and underutilized. Here we describe the discovery of a series of benzoxaborole compounds with nanomolar activity against extra- and intracellular stages of T. cruzi. Leveraging both ongoing drug discovery efforts in related kinetoplastids, and the exceptional models for rapid drug screening and optimization in T. cruzi, we have identified the prodrug AN15368 that is activated by parasite carboxypeptidases to yield a compound that targets the messenger RNA processing pathway in T. cruzi. AN15368 was found to be active in vitro and in vivo against a range of genetically distinct T. cruzi lineages and was uniformly curative in non-human primates (NHPs) with long-term naturally acquired infections. Treatment in NHPs also revealed no detectable acute toxicity or long-term health or reproductive impact. Thus, AN15368 is an extensively validated and apparently safe, clinically ready candidate with promising potential for prevention and treatment of Chagas disease.
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Affiliation(s)
- Angel M Padilla
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA
| | - Wei Wang
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA
| | | | | | - Eric Easom
- Anacor Pharmaceuticals, Inc, Palo Alto, CA, USA
| | | | | | - Yang Liu
- Anacor Pharmaceuticals, Inc, Palo Alto, CA, USA
| | - Sarah A Hamer
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Carolyn L Hodo
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Gregory K Wilkerson
- Michale E. Keeling Center for Comparative Medicine and Research of The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Dylan Orr
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA
| | - Brooke White
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA
| | - Arlene George
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA
| | - Huifeng Shen
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA
| | - Yiru Jin
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, KS, USA
| | - Michael Zhuo Wang
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, KS, USA
| | - Susanna Tse
- Pharmacokinetics, Dynamics and Metabolism, Worldwide Research, Pfizer Inc., New York, NY, USA
| | | | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, USA.
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20
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Torrico F, Gascón J, Ortiz L, Pinto J, Rojas G, Palacios A, Barreira F, Blum B, Schijman AG, Vaillant M, Strub-Wourgaft N, Pinazo MJ, Bilbe G, Ribeiro I. A Phase 2, Randomized, Multicenter, Placebo-Controlled, Proof-of-Concept Trial of Oral Fexinidazole in Adults With Chronic Indeterminate Chagas Disease. Clin Infect Dis 2022; 76:e1186-e1194. [PMID: 35925555 PMCID: PMC9907522 DOI: 10.1093/cid/ciac579] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/28/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chagas disease (CD) has significant global health impact, but safe, effective treatments remain elusive. The nitroimidazole fexinidazole is a potential treatment. METHODS This double-blind, randomized, placebo-controlled, dose-finding, proof-of-concept study was conducted in Bolivia. Adults with serologically confirmed chronic indeterminate CD and positive PCR were randomly assigned to 1 of 6 fexinidazole regimens (1200 or 1800 mg/day for 2, 4, or 8 weeks) or placebo. Target recruitment was 20 patients/arm. The primary endpoint was sustained parasitological clearance by serial negative qPCR from end of treatment (EOT) until 6 months follow-up in the intention-to-treat (ITT) population. Follow-up was extended to 12 months. RESULTS Enrollment was interrupted after 4/47 patients presented with transient asymptomatic grade 3 and 4 neutropenia. Treatment of ongoing patients was stopped in all patients administered >2 weeks. A total of 40 patients received treatment with fexinidazole from 3 days to 8 weeks. Delayed-onset neutropenia (n = 8) and increased liver enzymes (n = 8) were found in fexinidazole patients vs none in the placebo arm. In the ITT analysis, sustained parasitological clearance from EOT to 12 months follow-up varied between 66.7% (1200 mg-2 week) and 100.0% (1800 mg-2 week). Rapid, sustained clearance of parasitemia was observed in all treated patients with available data, but not in any patients in the placebo group, at 12 months (P = .0056). Further exploratory exposure-response analysis suggested low dosages of fexinidazole may be safe and effective. CONCLUSIONS Further evaluation is needed to establish fexinidazole's minimum effective dosage and risk-benefit relationship. Results suggest potential for effective treatment regimens <10 days. CLINICAL TRIALS REGISTRATION NCT02498782.
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Affiliation(s)
- Faustino Torrico
- Universidad Mayor de San Simón and Fundación CEADES, Cochabamba, Bolivia
| | - Joaquim Gascón
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Barcelona, Spain
| | - Lourdes Ortiz
- Universidad Autónoma Juan Misael Saracho de Tarija, Bolivia and Fundación CEADES, Tarija, Bolivia
| | - Jimy Pinto
- Universidad Mayor de San Simón and Fundación CEADES, Cochabamba, Bolivia
| | - Gimena Rojas
- Universidad Mayor de San Simón and Fundación CEADES, Cochabamba, Bolivia
| | - Alejandro Palacios
- Universidad Autónoma Juan Misael Saracho de Tarija, Bolivia and Fundación CEADES, Tarija, Bolivia
| | | | - Bethania Blum
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres”—INGEBI-CONICET, Buenos Aires, Argentina
| | - Michel Vaillant
- Centre de Recherche Public de la Santé CRP-Santé, Strassen, Luxembourg
| | | | - Maria-Jesus Pinazo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Barcelona, Spain,Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Graeme Bilbe
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Isabela Ribeiro
- Correspondence: I. Ribeiro, Dynamic Portfolio Unit, Isabela Ribeiro, Viral Diseases Cluster, Drugs for Neglected Diseases initiative, 15 Chemin Camille Vidart 1202 Geneva, Switzerland ()
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21
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Abad-Franch F. Trypanosoma cruzi parasitemia in chronic Chagas disease: Insights from hierarchical modeling. PLoS Negl Trop Dis 2022; 16:e0010612. [PMID: 35925882 PMCID: PMC9352048 DOI: 10.1371/journal.pntd.0010612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fernando Abad-Franch
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- * E-mail:
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22
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Pinto L, Schijman AG, Alonso-Padilla J, Lozano D, Torrico MC, Gamba P, Torrez M, Lozada V, Cartagena K, Sanchez J, Torrico F, Gascon J. Molecular detection and parasite load of Trypanosoma cruzi in digestive tract tissue of Chagas disease patients affected by megacolon. Acta Trop 2022; 235:106632. [PMID: 35932843 DOI: 10.1016/j.actatropica.2022.106632] [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: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
Chagas disease, caused by the Trypanosoma cruzi parasite in the Americas affects ∼ 7 million people, 30% with cardiac tissue damage and 10-15% with digestive disorders. In this study, we have developed a protocol to detect the presence of the parasite and estimate its load in resected dysfunctional tissue segments of chronically infected patients with digestive megacolon. We have included samples from 43 individuals, 38/5 with positive/negative serology for Chagas disease and digestive syndromes.. Samples of 1.5 to 2.0 cm were taken from different points of the dysfunctional digestive tract in specialized centres in Cochabamba, Bolivia. T.cruzi cultures were performed by inoculation with NNN-LIT culture medium, and genomic material was obtained from the samples formultiplex qPCR with TaqMan probes targeting satellite nuclear DNA. Cultures failed to isolate T. cruzi but qPCR reached a sensitivity of 42.1% (16/38) with all three spots and in triplicate.. A new quantification methodology using synthetic satellite DNA as quantitation standard revealed parasite loads ranging from 2.2 × 102 to 1.0 × 106 satellite DNA copies/μl. Positive samples from the distal end showed a higher parasite load. The results of the present study strengthen and add further evidence to previous findings in an experimental mouse model of chronic T. cruzi infection, providing a valuable tool to improve scientific knowledge on the relevance of the digestive tract in parasite persistence, and underlines the need of a better understanding of host-pathogen interaction in digestive tissues, considering pathophysiology, disease immunology and response to treatment.
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Affiliation(s)
| | - Alejandro G Schijman
- Laboratory of Molecular Biology of Chagas Disease, Institute for Research in Genetic Engineering and Molecular Biology (INGEBI-CONICET), Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, 08036, Barcelona, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII)
| | - Daniel Lozano
- CEADES Foundation, Cochabamba, Bolivia.; Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Mary Cruz Torrico
- Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Pietro Gamba
- Pietro Gamba Foundation Anzaldo, Cochabamba, Bolivia
| | | | - Vania Lozada
- Institute of Gastroenterology Bolivian Japanese, Cochabamba, Bolivia
| | - Karina Cartagena
- Institute of Gastroenterology Bolivian Japanese, Cochabamba, Bolivia
| | - Jareth Sanchez
- Hospital "Dr. Manuel Ascencio Villarroel", Punata, Cochabamba, Bolivia
| | - Faustino Torrico
- CEADES Foundation, Cochabamba, Bolivia.; Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, 08036, Barcelona, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII)
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23
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REYES CAROLINA, GONZÁLEZ CHRISTIANR, ALVARADO SERGIO, FLORES LETICIA, MARTIN CATHERINE, OYARCE ALAN, AYLWIN MARÍAPAZ, CANALS MAURICIO, PARRA ALONSO, VALDERRAMA LARA. Chagas Disease in northern Chile: detection of Trypanosoma cruzi in children, dogs and triatomine bugs. Acta Trop 2022; 235:106631. [DOI: 10.1016/j.actatropica.2022.106631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
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Kann S, Zabala-Monterroza W, García C, Concha G, Landt O, Hahn A, Weinreich F, Frickmann H. Comparison of the Influence of Different Nucleic Acid Extraction Assays on the Sensitivity of Trypanosoma cruzi-Specific Real-Time PCR. Microorganisms 2022; 10:microorganisms10081554. [PMID: 36013972 PMCID: PMC9414588 DOI: 10.3390/microorganisms10081554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/27/2023] Open
Abstract
For the molecular diagnosis of Chagas disease by real-time PCR (polymerase chain reaction), optimization of diagnostic accuracy is desirable. The detection limit of real-time PCR assays for the diagnosis of Trypanosoma cruzi in human serum is affected by various influences including the choice of the nucleic acid extraction assay. In this study, three nucleic acid extraction assays were compared regarding their influence on the sensitivity of a T. cruzi-specific real-time PCR with 62 reference sera containing T. cruzi target DNA (deoxyribonucleotide acid). More than 95% of the positive sera were correctly identified after all three nucleic acid extraction strategies with a detection rate ranging from 96.8% (60/62) for the worst assay to 100% (62/62) for the best one. A matched pairs analysis for the comparison of the cycle threshold (Ct) values obtained with the 59 reference samples with positive real-time PCR results after all three nucleic acid extraction schemes indicated differences in a range of about 3 Ct steps. Summarized, all three compared nucleic acid extraction schemes were basically suitable for T. cruzi-specific PCR from serum with some minor differences. However, in the case of low quantities of circulating parasite DNA in the serum of a patient with Chagas disease, even minor effects can make a difference in the individual diagnosis.
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Affiliation(s)
- Simone Kann
- Medical Mission Institute, 97074 Würzburg, Germany
- Correspondence:
| | - Wendy Zabala-Monterroza
- Public Health Laboratory, Secretariat of Health, Department Cesar, Valledupar 20000001, Colombia; (W.Z.-M.); (C.G.)
| | - Cenia García
- Public Health Laboratory, Secretariat of Health, Department Cesar, Valledupar 20000001, Colombia; (W.Z.-M.); (C.G.)
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 2000001, Colombia;
| | | | - Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (H.F.)
| | - Felix Weinreich
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (H.F.)
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
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Finamore-Araujo P, Silva da Fonseca GL, Vieira CS, de Castro DP, Moreira OC. RNA as a feasible marker of Trypanosoma cruzi viability during the parasite interaction with the triatomine vector Rhodnius prolixus (Hemiptera, Triatominae). PLoS Negl Trop Dis 2022; 16:e0010535. [PMID: 35797352 PMCID: PMC9307183 DOI: 10.1371/journal.pntd.0010535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/22/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
A recurring question concerning Trypanosoma cruzi DNA detection/quantification is related to the fact that DNA amplification, by itself, does not differentiate between viable or dead parasites. On the other hand, RNA can be considered a potential molecular marker of pathogens viability. Herein, we developed a quantitative real-time PCR with reverse Transcription (RT-qPCR) to quantify viable T. cruzi in artificially infected Rhodnius prolixus whilst evaluating differences between DNA and mRNA quantification along the insect midgut during 5, 9, 15 and 29 days after feeding. The RT-qPCR presented an improved performance with linearities ranging from 107 to 102 parasites equivalents and 3 to 0.0032 intestine unit equivalents, and efficiencies of 100.3% and 102.8% for both T. cruzi and triatomine targets, respectively. Comparing both RT-qPCR and qPCR, we confirmed that RNA is faster degraded, no longer being detected at day 1 after parasite lysis, while DNA detection was stable, with no decrease in parasite load over the days, even after parasite lysis. We also observed statistical differences between the quantification of the parasite load by DNA and by RNA on day 15 after feeding of experimentally infected R. prolixus. When assessing different portions of the digestive tract, by RT-qPCR, we could detect a statistically significant reduction in the parasite amount in the anterior midgut. Oppositely, there was a statistically significant increase of the parasite load in the hindgut. In conclusion, for this study parasite’s viability in R. prolixus digestive tract were assessed targeting T. cruzi mRNA. In addition, differences between DNA and RNA detection observed herein, raise the possibility that RNA is a potential molecular viability marker, which could contribute to understanding the dynamics of the parasite infection in invertebrate hosts. In this study, we developed and standardized a Real-Time PCR with Reverse Transcription (RT-qPCR) to determine T. cruzi viability in R. prolixus samples. Moreover, we aimed to assess differences between the amplification signals of DNA and mRNA on a T. cruzi colonization kinetics in experimentally infected R. prolixus. Thus, it was possible to analyze the potential of parasite’s RNA as a molecular viability marker in parasite-vector interaction. This novel RT-qPCR methodology has potential application in viability assessment and raises the possibility for further monitoring of the parasite load in infected insects or studies related to vectorial capacity. Furthermore, the analysis of parasite viability by RT qPCR could be an especially effective tool for Chagas disease diagnostic purposes.
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Affiliation(s)
- Paula Finamore-Araujo
- Real Time PCR Platform RPT09A, Laboratory of Molecular Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Gabriel Lucio Silva da Fonseca
- Real Time PCR Platform RPT09A, Laboratory of Molecular Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cecília Stahl Vieira
- Laboratory of Biochemistry and Physiology of Insects, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Postgraduate Program in Science and Biotechnology, Biology Institute, Federal Fluminense University, Niterói, Brazil
| | - Daniele Pereira de Castro
- Laboratory of Biochemistry and Physiology of Insects, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Otacilio Cruz Moreira
- Real Time PCR Platform RPT09A, Laboratory of Molecular Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- * E-mail:
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Schijman AG, Alonso-Padilla J, Longhi SA, Picado A. Parasitological, serological and molecular diagnosis of acute and chronic Chagas disease: from field to laboratory. Mem Inst Oswaldo Cruz 2022; 117:e200444. [PMID: 35613155 PMCID: PMC9164950 DOI: 10.1590/0074-02760200444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
There is no consensus on the diagnostic algorithms for many scenarios of Trypanosoma cruzi infection, which hinders the establishment of governmental guidelines in endemic and non-endemic countries. In the acute phase, parasitological methods are currently employed, and standardised surrogate molecular tests are being introduced to provide higher sensitivity and less operator-dependence. In the chronic phase, IgG-based serological assays are currently used, but if a single assay does not reach the required accuracy, PAHO/WHO recommends at least two immunological tests with different technical principles. Specific algorithms are applied to diagnose congenital infection, screen blood and organ donors or conduct epidemiological surveys. Detecting Chagas disease reactivation in immunosuppressed individuals is an area of increasing interest. Due to its neglect, enhancing access to diagnosis of patients at risk of suffering T. cruzi infection should be a priority at national and regional levels.
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Affiliation(s)
- Alejandro Gabriel Schijman
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Hector Torres, CONICET, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Ciudad de Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | - Silvia Andrea Longhi
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Hector Torres, CONICET, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Ciudad de Buenos Aires, Argentina
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Chan-Pérez JI, Torres-Acosta JF, Ortega-Pacheco A, Hernández-Cortazar IB, Cigarroa-Toledo N, Jiménez-Coello M. Combined use of real-time PCR and serological techniques for improved surveillance of chronic and acute American trypanosomiasis in dogs and their owners from an endemic rural area of Neotropical Mexico. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100081. [PMID: 36589870 PMCID: PMC9795344 DOI: 10.1016/j.crpvbd.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 01/04/2023]
Abstract
In this study, the prevalence of T. cruzi infection was estimated in dogs and their owners from a rural community in Mexico using serological techniques for chronic infection cases, qPCR for acute phase cases, and a combination of both techniques to detect chronic and acute infections. Eighty-nine blood samples were collected from owners and their dogs for obtaining serum and parasite DNA. Prevalence was calculated using (i) positive cases detected in a serological test (ELISA and Western blot), (ii) positive cases detected in a qPCR test, and (iii) positive cases detected by both techniques. Sensitivity, specificity, and predictive values were determined individually for serology, qPCR and for both techniques used simultaneously. The prevalence observed varied: for serology, 25.8% of the dogs and 7.9% of the owners were seropositive, while for qPCR 29.2% of the dogs and 10.1% of the owners were identified as positive. Combination of serological and molecular techniques resulted in a prevalence of 38.2% for dogs and 12.4% for their owners. The sensitivity, specificity and predictive values calculated for both techniques improved when both techniques were used simultaneously (sensitivity of 92.4% and specificity of 100% for infected dogs and sensitivity of 93.4% and specificity of 100% for infected owners). Combined use of serological tests and qPCR allowed identifying a greater number of positive cases in dogs and their owners. This strategy may help implement adequate and timely epidemiological surveillance of American trypanosomiasis in order to prevent the appearance of new cases of Trypanosoma cruzi infections in endemic zones.
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Affiliation(s)
- José I. Chan-Pérez
- Centro de Investigaciones Regionales Dr Hideyo Noguchi, Universidad Autónoma de Yucatán, Avenida Itzáes, x Calle 59, Col. Centro, Mérida, Yucatán, Mexico
| | - Juan F.J. Torres-Acosta
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Km 15.5 Carretera Mérida-Xmatkuil, Mérida, Yucatán, Mexico
| | - Antonio Ortega-Pacheco
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Km 15.5 Carretera Mérida-Xmatkuil, Mérida, Yucatán, Mexico
| | - Ivonne B. Hernández-Cortazar
- Centro de Investigaciones Regionales Dr Hideyo Noguchi, Universidad Autónoma de Yucatán, Avenida Itzáes, x Calle 59, Col. Centro, Mérida, Yucatán, Mexico
| | - Nohemi Cigarroa-Toledo
- Centro de Investigaciones Regionales Dr Hideyo Noguchi, Universidad Autónoma de Yucatán, Avenida Itzáes, x Calle 59, Col. Centro, Mérida, Yucatán, Mexico
| | - Matilde Jiménez-Coello
- Centro de Investigaciones Regionales Dr Hideyo Noguchi, Universidad Autónoma de Yucatán, Avenida Itzáes, x Calle 59, Col. Centro, Mérida, Yucatán, Mexico
- Corresponding author.
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Bosch-Nicolau P, Espinosa-Pereiro J, Salvador F, Sánchez-Montalvá A, Molina I. Association Between Trypanosoma cruzi DNA in Peripheral Blood and Chronic Chagasic Cardiomyopathy: A Systematic Review. Front Cardiovasc Med 2022; 8:787214. [PMID: 35174221 PMCID: PMC8841718 DOI: 10.3389/fcvm.2021.787214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic chagasic cardiomyopathy (CCC) is the most important complication of patients with Chagas disease (CD). The role of persistent detection of DNA in peripheral blood and its association to CCC is unknown. We performed a systematic review up to July 2021, including studies that reported ratios of CCC and PCR positivity among non-treated adult patients. We identified 749 records and selected 12 for inclusion corresponding to 1,686 patients. Eight studies were performed in endemic countries and 4 in non-endemic countries. Only two studies showed an association between CCC and Trypanosoma cruzi parasitemia by means of PCR detection. Six studies reported greater positive PCR ratios among patients with CCC than in the patients with indeterminate chagas disease (ICD) with no statistical significance. A significant risk of bias has been detected among most of the studies. Therefore, while we performed a meta-analysis, wide inter-study heterogeneity impeded its interpretation.ConclusionsWith the available information, we could not establish a correlation between PCR-detectable parasitemia and CCC.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216072, identifier: CRD42020216072.
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Affiliation(s)
- Pau Bosch-Nicolau
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Israel Molina
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Elucidating the 3D Structure of a Surface Membrane Antigen from Trypanosoma cruzi as a Serodiagnostic Biomarker of Chagas Disease. Vaccines (Basel) 2022; 10:vaccines10010071. [PMID: 35062732 PMCID: PMC8781870 DOI: 10.3390/vaccines10010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Chagas disease (CD) is a vector-borne parasitosis, caused by the protozoan parasite Trypanosoma cruzi, that affects millions of people worldwide. Although endemic in South America, CD is emerging throughout the world due to climate change and increased immigratory flux of infected people to non-endemic regions. Containing of the diffusion of CD is challenged by the asymptomatic nature of the disease in early infection stages and by the lack of a rapid and effective diagnostic test. With the aim of designing new serodiagnostic molecules to be implemented in a microarray-based diagnostic set-up for early screening of CD, herein, we report the recombinant production of the extracellular domain of a surface membrane antigen from T. cruzi (TcSMP) and confirm its ability to detect plasma antibodies from infected patients. Moreover, we describe its high-resolution (1.62 Å) crystal structure, to which in silico epitope predictions were applied in order to locate the most immunoreactive regions of TcSMP in order to guide the design of epitopes that may be used as an alternative to the full-length antigen for CD diagnosis. Two putative, linear epitopes, belonging to the same immunogenic region, were synthesized as free peptides, and their immunological properties were tested in vitro. Although both peptides were shown to adopt a structural conformation that allowed their recognition by polyclonal antibodies raised against the recombinant protein, they were not serodiagnostic for T. cruzi infections. Nevertheless, they represent good starting points for further iterative structure-based (re)design cycles.
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Rahim S, Sharif MM, Amin MR, Rahman MT, Karim MM. Real Time PCR-based diagnosis of human visceral leishmaniasis using urine samples. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000834. [PMID: 36962767 PMCID: PMC10022223 DOI: 10.1371/journal.pgph.0000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022]
Abstract
Diagnosis of visceral leishmaniasis (VL) through the detection of its causative agents namely Leishmania donovani and L. infantum is traditionally based on immunochromatographic tests, microscopy of bone marrow, spleen aspirates, liver or lymph node and differential diagnosis. While the first process has low specificity, the later one carries the risk of fatal hemorrhage. Over the last decade, multiple Polymerase Chain Reaction (PCR) based diagnosis has been developed using blood and urine sample with a varying degree of sensitivity and specificity, an issue worth improving for precision diagnosis. Earlier, we reported a PCR-based diagnosis of L. donovani in peripheral blood using a novel set of PCR primers with absolute specificity. Using the same set of primers and PCR conditions, here we describe diagnosis of L. donovani from urine, for a non-invasive, rapid and safe diagnosis. Diagnosis of VL was carried out using urine samples collected from clinically diagnosed VL patients (n = 23) of Bangladesh in Real Time PCR. Test results were validated by comparing blood samples from the same set of patients. Sensitivity and specificity of this diagnosis was analyzed using retrospective bone marrow samples, collected earlier from confirmed VL patients (n = 19). The method showed 100% sensitivity in detecting L. donovani in urine and corresponding blood and retrospective bone marrow samples, as well as 100% specificity in control groups. A Real Time PCR-based molecular detection system using urine sample is hereafter presented what could be a, non-invasive approach for VL detection with precision and perfection.
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Affiliation(s)
- Samiur Rahim
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
| | | | - Md Robed Amin
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
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Abstract
The parasitic trypanosomatids cause lethal and debilitating diseases, the leishmaniases, Chagas disease, and the African trypanosomiases, with major impacts on human and animal health. Sustained research has borne fruit by assisting efforts to reduce the burden of disease and by improving our understanding of fundamental molecular and cell biology. But where has the research primarily been conducted, and which research areas have received the most attention? These questions are addressed below using publication and citation data from the past few decades.
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Affiliation(s)
- David Horn
- The Wellcome Trust Centre for Anti-Infectives Research, Division of Biological Chemistry & Drug Discovery, School of Life Sciences, University of Dundee, Dundee, United Kingdom
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32
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Rogers MJ, McManus DP, Muhi S, Gordon CA. Membrane Technology for Rapid Point-of-Care Diagnostics for Parasitic Neglected Tropical Diseases. Clin Microbiol Rev 2021; 34:e0032920. [PMID: 34378956 PMCID: PMC8404699 DOI: 10.1128/cmr.00329-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Parasitic neglected tropical diseases (NTDs) affect over one billion people worldwide, with individuals from communities in low-socioeconomic areas being most at risk and suffering the most. Disease management programs are hindered by the lack of infrastructure and resources for clinical sample collection, storage, and transport and a dearth of sensitive diagnostic methods that are inexpensive as well as accurate. Many diagnostic tests and tools have been developed for the parasitic NTDs, but the collection and storage of clinical samples for molecular and immunological diagnosis can be expensive due to storage, transport, and reagent costs, making these procedures untenable in most areas of endemicity. The application of membrane technology, which involves the use of specific membranes for either sample collection and storage or diagnostic procedures, can streamline this process, allowing for long-term sample storage at room temperature. Membrane technology can be used in serology-based diagnostic assays and for nucleic acid purification prior to molecular analysis. This facilitates the development of relatively simple and rapid procedures, although some of these methods, mainly due to costs, lack accessibility in low-socioeconomic regions of endemicity. New immunological procedures and nucleic acid storage, purification, and diagnostics protocols that are simple, rapid, accurate, and cost-effective must be developed as countries progress control efforts toward the elimination of the parasitic NTDs.
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Affiliation(s)
- Madeleine J. Rogers
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine A. Gordon
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Stevens L, Lima-Cordón RA, Helms Cahan S, Dorn PL, Monroy MC, Axen HJ, Nguyen A, Hernáiz-Hernánde Y, Rodas A, Justi SA. Catch me if you can: Under-detection of Trypanosoma cruzi (Kinetoplastea: Trypanosomatida) infections in Triatoma dimidiata s.l. (Hemiptera: Reduviidae) from Central America. Acta Trop 2021; 224:106130. [PMID: 34536368 DOI: 10.1016/j.actatropica.2021.106130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
Assays for parasite detection in insect vectors provide important information for disease control. American Trypanosomiasis (Chagas disease) is the most devastating vector-borne illness and the fourth most common in Central America behind HIV/AIDS and acute respiratory and diarrheal infections (Peterson et al., 2019). Under-detection of parasites is a general problem which may be influenced by parasite genetic variation; however, little is known about the genetic variation of the Chagas parasite, especially in this region. In this study we compared six assays for detecting the Chagas parasite, Trypanosoma cruzi: genomic reduced representation sequencing (here referred to as genotype-by-sequencing or GBS), two with conventional PCR (i.e., agarose gel detection), two with qPCR, and microscopy. Our results show that, compared to GBS genomic analysis, microscopy and PCR under-detected T. cruzi in vectors from Central America. Of 94 samples, 44% (50/94) were positive based on genomic analysis. The lowest detection, 9% (3/32) was in a subset assayed with microscopy. Four PCR assays, two with conventional PCR and two with qPCR showed intermediate levels of detection. Both qPCR tests and one conventional PCR test targeted the 195 bp repeat of satellite DNA while the fourth test targeted the 18S gene. Statistical analyses of the genomic and PCR results indicate that the PCR assays significantly under detect infections of Central American T. cruzi genotypes.
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Affiliation(s)
- Lori Stevens
- Department of Biology, University of Vermont, Burlington, VT, 05401, USA.
| | | | - Sara Helms Cahan
- Department of Biology, University of Vermont, Burlington, VT, 05401, USA
| | - Patricia L Dorn
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, LA, USA
| | - M Carlota Monroy
- The Applied Entomology and Parasitology Laboratory, Biology School, Pharmacy Faculty, San Carlos University of Guatemala, Guatemala
| | - Heather J Axen
- Department of Biology, University of Vermont, Burlington, VT, 05401, USA
| | - Andrew Nguyen
- Department of Biology, University of Vermont, Burlington, VT, 05401, USA
| | | | - Antonieta Rodas
- The Applied Entomology and Parasitology Laboratory, Biology School, Pharmacy Faculty, San Carlos University of Guatemala, Guatemala
| | - Silvia A Justi
- The Walter Reed Biosystematics Unit, Smithsonian Institution Museum Support Center, MD, USA; Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Busselman RE, Meyers AC, Zecca IB, Auckland LD, Castro AH, Dowd RE, Curtis-Robles R, Hodo CL, Saunders AB, Hamer SA. High incidence of Trypanosoma cruzi infections in dogs directly detected through longitudinal tracking at 10 multi-dog kennels, Texas, USA. PLoS Negl Trop Dis 2021; 15:e0009935. [PMID: 34758049 PMCID: PMC8631682 DOI: 10.1371/journal.pntd.0009935] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/30/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Canine Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is increasingly recognized as a health concern for dogs in the USA, and infected dogs may signal geographic regions of risk for human disease. Dogs living in multi-dog kennel environments (kennels with more than one dog) where triatomine vectors are endemic may be at high risk for infection. We monitored a cohort of 64 T. cruzi-infected and uninfected dogs across 10 kennels in Texas, USA, to characterize changes in infection status over one year. We used robust diagnostic criteria in which reactivity on multiple independent platforms was required to be considered positive. Among the 30 dogs enrolled as serologically- and/or PCR-positive, all but one dog showed sustained positive T. cruzi diagnostic results over time. Among the 34 dogs enrolled as serologically- and PCR-negative, 10 new T. cruzi infections were recorded over a 12-month period. The resulting incidence rate for dogs initially enrolled as T. cruzi-negative was 30.7 T. cruzi infections per 100 dogs per year. This study highlights the risk of T. cruzi infection to dogs in kennel environments. To protect both dog and human health, there is an urgent need to develop more integrated vector control methods as well as prophylactic and curative antiparasitic treatment options for T. cruzi infection in dogs.
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Affiliation(s)
- Rachel E. Busselman
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Alyssa C. Meyers
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Italo B. Zecca
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Lisa D. Auckland
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Andres H. Castro
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rebecca E. Dowd
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rachel Curtis-Robles
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Carolyn L. Hodo
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, United States of America
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
- * E-mail:
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de Oliveira MT, Schmidt A, da Silva MC, Donadi EA, da Silva JS, Marin-Neto JA. Parasitic Load Correlates With Left Ventricular Dysfunction in Patients With Chronic Chagas Cardiomyopathy. Front Cardiovasc Med 2021; 8:741347. [PMID: 34604362 PMCID: PMC8481622 DOI: 10.3389/fcvm.2021.741347] [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: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic Chagas disease (CChD), one of the infectious parasitic diseases with the greatest social and economic impact upon a large part of the American continent, has distinct clinical manifestations in humans (cardiac, digestive, or mixed clinical forms). The mechanisms underlying the development of the most common and ominous clinical form, the chronic Chagas cardiomyopathy (CCC) have not been completely elucidated, despite the fact that a high intensity of parasite persistence in the myocardium is deemed responsible for an untoward evolution of the disease. The present study aimed to assess the parasite load CCC and its relation to left ventricular ejection fraction (LVEF), a definite prognostic marker in patients with CCC. Methods: Patients with CCC were clinically evaluated using 12-lead-electrocardiogram, echocardiogram, chest X-ray. Peripheral blood sampling (5 ml of venous blood in guanidine/EDTA) was collected from each patient for subsequent DNA extraction and the quantification of the parasite load using real-time PCR. Results: One-hundred and eighty-one patients with CCC were evaluated. A total of 140 (77.3%) had preserved left ventricular ejection fraction (of ≥40%), and 41 individuals had LV dysfunction (LVEF of <40%). A wide variation in parasite load was observed with a, mean of 1.3460 ± 2.0593 (0.01 to 12.3830) par. Eq./mL. The mean ± SD of the parasite load was 0.6768 ± 0.9874 par. Eq./mL and 3.6312 ± 2.9414 par. Eq./mL in the patients with LVEF ≥ 40% and <40%, respectively. Conclusion: The blood parasite load is highly variable and seems to be directly related to the reduction of LVEF, an important prognostic factor in CCC patients.
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Affiliation(s)
- Maykon Tavares de Oliveira
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Cláudia da Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Eduardo Antônio Donadi
- Division of Clinical Immunology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Santana da Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Fiocruz-Bi-Institutional Translational Medicine Plataform, Ribeirão Preto, Brazil
| | - José Antônio Marin-Neto
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Holanda MT, Mediano MF, Hasslocher-Moreno AM, Gonzaga BM, Carvalho ACC, Ferreira RR, Garzoni LR, Pereira-Silva FS, Pimentel LO, Mendes MO, Azevedo MJ, Britto C, Moreira OC, Fernandes AG, Santos CM, Constermani J, Paravidino VB, Maciel ER, Carneiro FM, Xavier SS, Sperandio da Silva GM, Santos PF, Veloso HH, Brasil PE, de Sousa AS, Bonecini-de-Almeida MG, da Silva PS, Sangenis LHC, Saraiva RM, Araujo-Jorge TC. Effects of Selenium treatment on cardiac function in Chagas heart disease: Results from the STCC randomized Trial. EClinicalMedicine 2021; 40:101105. [PMID: 34485877 PMCID: PMC8406152 DOI: 10.1016/j.eclinm.2021.101105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chagas disease (caused by Trypanosoma cruzi infection) evolves to chronic chagasic cardiomyopathy (CCC) affecting 1.8 million people worldwide. This is the first randomized, placebo-controlled, double-blinded, clinical trial designed to estimate efficacy and safety of selenium (Se) treatment in CCC. METHODS 66 patients with CCC stages B1 (left ventricular ejection fraction [LVEF] > 45% and no heart failure; n = 54) or B2 (LVEF < 45% and no heart failure; n = 12) were randomly assigned to receive 100 mcg/day sodium selenite (Se, n = 32) or placebo (Pla, n = 34) for one year (study period: May 2014-September 2018). LVEF changes over time and adverse effects were investigated. Trial registration number: NCT00875173 (clinicaltrials.gov). FINDINGS No significant differences between the two groups were observed for the primary outcome: mean LVEF after 6 (β= +1.1 p = 0.51 for Se vs Pla) and 12 months (β= +2.1; p = 0.23). In a subgroup analysis, statistically significant longitudinal changes were observed for mean LVEF in the stage B2 subgroup (β= +10.1; p = 0.02 for Se [n = 4] vs Pla [n = 8]). Se treatment was safe for CCC patients, and the few adverse effects observed were similarly distributed across the two groups. INTERPRETATION Se treatment did not improve cardiac function (evaluated from LVEF) in CCC. However, in the subgroup of patients at B2 stage, a potential beneficial influence of Se was observed. Complementary studies are necessary to explore diverse Se dose and/or associations in different CCC stages (B2 and C), as well as in A and B1 stages with longer follow-up. FUNDING Brazilian Ministry of Health, Fiocruz, CNPq, FAPERJ.
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Affiliation(s)
- Marcelo T. Holanda
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Mauro F.F. Mediano
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Alejandro M. Hasslocher-Moreno
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Beatriz M.S. Gonzaga
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Anna Cristina C. Carvalho
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Roberto R. Ferreira
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Luciana R. Garzoni
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Fernanda S. Pereira-Silva
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Luis O. Pimentel
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Marcelo O. Mendes
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Marcos J. Azevedo
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
| | - Constança Britto
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute (LABIMDOE-IOC/Fiocruz), Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Leonidas Deane, Rio de Janeiro 21040-360, Brazil
| | - Otacilio C. Moreira
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute (LABIMDOE-IOC/Fiocruz), Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Leonidas Deane, Rio de Janeiro 21040-360, Brazil
| | - Alice G. Fernandes
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute (LABIMDOE-IOC/Fiocruz), Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Leonidas Deane, Rio de Janeiro 21040-360, Brazil
| | - Carolina M. Santos
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute (LABIMDOE-IOC/Fiocruz), Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Leonidas Deane, Rio de Janeiro 21040-360, Brazil
| | - Jéssica Constermani
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute (LABIMDOE-IOC/Fiocruz), Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Leonidas Deane, Rio de Janeiro 21040-360, Brazil
| | - Vitor B. Paravidino
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier, 524, Pavilhão João Lyra Filho, 7° andar / blocos D e E, Maracanã, Rio de Janeiro 20550-013, Brazil
- Department of Physical Education and Sports, Naval Academy, Avenida Almirante Silvio de Noronha, s/n, Castelo, Rio de Janeiro 20021-010, Brazil
| | - Erica R. Maciel
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Fernanda M. Carneiro
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Sérgio S. Xavier
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Gilberto M. Sperandio da Silva
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Priscila F. Santos
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Henrique H. Veloso
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Pedro E.A.A. Brasil
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Andrea S. de Sousa
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Maria G. Bonecini-de-Almeida
- Laboratory of Immunology and Immunogenetics, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Paula S. da Silva
- Nutrition Service, Evandro Chagas Hospital, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Luiz Henrique C. Sangenis
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Roberto M. Saraiva
- Laboratory of Clinical Research in Chagas Disease, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Tania C. Araujo-Jorge
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute (LITEB-IOC/Fiocruz), Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro 21040-360, Brazil
- Corresponding author at: Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fiocruz, Av. Brasil 4365, Pav. Cardoso Fontes, Manguinhos, Rio de Janeiro RJ 21040-900, Brasil.
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Warang A, Zhang M, Zhang S, Shen Z. A panel of real-time PCR assays for the detection of Bourbon virus, Heartland virus, West Nile virus, and Trypanosoma cruzi in major disease-transmitting vectors. J Vet Diagn Invest 2021; 33:1115-1122. [PMID: 34414840 DOI: 10.1177/10406387211039549] [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] [Indexed: 11/15/2022] Open
Abstract
Vector-borne pathogens, such as Bourbon virus (BRBV), Heartland virus (HRTV), West Nile virus (WNV), and Trypanosoma cruzi (TCZ) are a great threat to public health and animal health. We developed a panel of TaqMan real-time PCR assays for pathogen surveillance. PCR targets were selected based on nucleic acid sequences deposited in GenBank. Primers and probes were either designed de novo or selected from publications. The coverages and specificities of the primers and probes were extensively evaluated by performing BLAST searches. Synthetic DNA or RNA fragments (gBlocks) were used as PCR templates in initial assay development and PCR positive controls in subsequent assay validation. For operational efficiency, the same thermocycling profile was used in BRBV, HRTV, and WNV reverse-transcription quantitative PCR (RT-qPCR) assays, and a similar thermocycling profile without the initial reverse-transcription step was used in TCZ qPCR. The assays were optimized by titrating primer and probe concentrations. The analytical sensitivities were 100, 100, 10, and 10 copies of gBlock per reaction for BRBV (Cq = 36.0 ± 0.7), HRTV (Cq = 36.6 ± 0.9), WNV (Cq = 35.5 ± 0.4), and TCZ (Cq = 38.8 ± 0.3), respectively. PCR sensitivities for vector genomic DNA or RNA spiked with gBlock reached 100, 100, 10, and 10 copies per reaction for BRBV, HRTV, WNV, and TCZ, respectively. PCR specificity evaluated against a panel of non-target pathogens showed no significant cross-reactivity. Our BRBV, HRTV, WNV, and TCZ PCR panel could support epidemiologic studies and pathogen surveillance.
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Affiliation(s)
- Anushri Warang
- Veterinary Medical Diagnostic Laboratory and Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Michael Zhang
- Veterinary Medical Diagnostic Laboratory and Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Shuping Zhang
- Veterinary Medical Diagnostic Laboratory and Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Zhenyu Shen
- Veterinary Medical Diagnostic Laboratory and Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO, USA
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Levin LG, Kreimer PR, Jensen P. Chagas Disease across Contexts: Scientific Knowledge in a Globalized World. Med Anthropol 2021; 40:572-589. [PMID: 34237229 DOI: 10.1080/01459740.2021.1946805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Chagas is the most important endemic disease in Latin America. It was progressively constructed as a relevant public issue, starting as a medical problem, focusing later on housing conditions, poverty, or vector agents. In recent decades, research has mainly focused on the parasite's biological characterization. In the meanwhile, both Chagas disease and knowledge about it spread out geographically. We analyze the worldwide scientific production on Chagas, showing that countries' research strategies depend on two main factors: endemicity and research traditions. This approach complements previous studies, allowing us to better understand the construction of Chagas disease as a social and scientific problem.
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Affiliation(s)
- Luciano G Levin
- Universidad Nacional de Río Negro, CITECDE, Río Negro, Argentina Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | | | - Pablo Jensen
- CNRS, Laboratoire de Physique, Inst, Systèmes Complexes, Université de Lyon, ENS de Lyon, Lyon, France
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Benatar AF, Danesi E, Besuschio SA, Bortolotti S, Cafferata ML, Ramirez JC, Albizu CL, Scollo K, Baleani M, Lara L, Agolti G, Seu S, Adamo E, Lucero RH, Irazu L, Rodriguez M, Poeylaut-Palena A, Longhi SA, Esteva M, Althabe F, Rojkin F, Bua J, Sosa-Estani S, Schijman AG. Prospective multicenter evaluation of real time PCR Kit prototype for early diagnosis of congenital Chagas disease. EBioMedicine 2021; 69:103450. [PMID: 34186488 PMCID: PMC8243352 DOI: 10.1016/j.ebiom.2021.103450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Current algorithm for Congenital Chagas Disease (cCD) diagnosis is unsatisfactory due to low sensitivity of the parasitological methods. Moreover, loss to follow-up precludes final serodiagnosis after nine months of life in many cases. A duplex TaqMan qPCR kit for Trypanosoma cruzi DNA amplification was prospectively evaluated in umbilical cord (UCB) and peripheral venous blood (PVB) of infants born to CD mothers at endemic and non-endemic sites of Argentina. METHODS We enrolled and followed-up 370 infants; qPCR was compared to gold-standard cCD diagnosis following studies of diagnostic accuracy guidelines. FINDINGS Fourteen infants (3·78%) had cCD. The qPCR sensitivity and specificity were higher in PVB (72·73%, 99·15% respectively) than in UCB (66·67%, 96·3%). Positive and negative predictive values were 80 and 98·73% and 50 and 98·11% for PVB and UCB, respectively. The Areas under the Curve (AUC) of ROC analysis for qPCR and micromethod (MM) were 0·81 and 0·67 in UCB and 0·86 and 0·68 in PVB, respectively. Parasitic loads ranged from 37·5 to 23,709 parasite equivalents/mL. Discrete typing Unit Tc V was identified in five cCD patients and in six other cCD cases no distinction among Tc II, Tc V or Tc VI was achieved. INTERPRETATION This first prospective field study demonstrated that qPCR was more sensitive than MM for early cCD detection and more accurate in PVB than in UCB. Its use, as an auxiliary diagnostic tool to MM will provide more accurate records on cCD incidence. FUNDING FITS SALUD 001-CHAGAS (FONARSEC, MINCyT, Argentina) to the Public-Private Consortium (INGEBI-CONICET, INP-ANLIS MALBRAN and Wiener Laboratories); ERANET-LAC-HD 328 to AGS and PICT 2015-0074 (FONCYT, MinCyT) to AGS and FA.
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Affiliation(s)
- Alejandro Francisco Benatar
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Emmaría Danesi
- Centro Nacional de Diagnóstico e Investigación en Endemoepidemias (ANLIS Dr. C. G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina)
| | - Susana Alicia Besuschio
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Santiago Bortolotti
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - María Luisa Cafferata
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Carlos Ramirez
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Constanza Lopez Albizu
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Karenina Scollo
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - María Baleani
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - Laura Lara
- Instituto de Maternidad y Ginecología "Nuestra Señora de las Mercedes", San Miguel de Tucumán, Pcia. de Tucumán, Argentina
| | - Gustavo Agolti
- Hospital "Dr. Julio César Perrando", Resistencia, Pcia. de Chaco, Argentina
| | - Sandra Seu
- Hospital Regional "Dr. Ramón Carrillo", Santiago del Estero, Pcia. de Santiago del Estero, Argentina
| | - Elsa Adamo
- Centro Integral de Salud La Banda, La Banda, Pcia. de Santiago del Estero, Argentina
| | - Raúl Horacio Lucero
- Instituto de Medicina Regional, Universidad Nacional del Nordeste (IMR-UNNE) Resistencia, Provincia de Chaco, Argentina
| | - Lucía Irazu
- Departamento de Calidad. Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán)
| | - Marcelo Rodriguez
- Departamento de Calidad. Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán)
| | - Andrés Poeylaut-Palena
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - Silvia Andrea Longhi
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Esteva
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Althabe
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Federico Rojkin
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Congenital Chagas Disease Study Group
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
- Centro Nacional de Diagnóstico e Investigación en Endemoepidemias (ANLIS Dr. C. G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina)
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
- Instituto de Maternidad y Ginecología "Nuestra Señora de las Mercedes", San Miguel de Tucumán, Pcia. de Tucumán, Argentina
- Hospital "Dr. Julio César Perrando", Resistencia, Pcia. de Chaco, Argentina
- Hospital Regional "Dr. Ramón Carrillo", Santiago del Estero, Pcia. de Santiago del Estero, Argentina
- Centro Integral de Salud La Banda, La Banda, Pcia. de Santiago del Estero, Argentina
- Instituto de Medicina Regional, Universidad Nacional del Nordeste (IMR-UNNE) Resistencia, Provincia de Chaco, Argentina
- Departamento de Calidad. Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán)
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Callejas-Hernández F, Herreros-Cabello A, Del Moral-Salmoral J, Fresno M, Gironès N. The Complete Mitochondrial DNA of Trypanosoma cruzi: Maxicircles and Minicircles. Front Cell Infect Microbiol 2021; 11:672448. [PMID: 34268138 PMCID: PMC8277381 DOI: 10.3389/fcimb.2021.672448] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
The mitochondrial DNA of Trypanosomatids, known as the kinetoplast DNA or kDNA or mtDNA, consists of a few maxicircles and thousands of minicircles concatenated together into a huge complex network. These structures present species-specific sizes, from 20 to 40 Kb in maxicircles and from 0.5 to 10 Kb in minicircles. Maxicircles are equivalent to other eukaryotic mitochondrial DNAs, while minicircles contain coding guide RNAs involved in U-insertion/deletion editing processes exclusive of Trypanosomatids that produce the maturation of the maxicircle-encoded transcripts. The knowledge about this mitochondrial genome is especially relevant since the expression of nuclear and mitochondrial genes involved in oxidative phosphorylation must be coordinated. In Trypanosoma cruzi (T. cruzi), the mtDNA has a dual relevance; the production of energy, and its use as a phylogenetic marker due to its high conservation among strains. Therefore, this study aimed to assemble, annotate, and analyze the complete repertoire of maxicircle and minicircle sequences of different T. cruzi strains by using DNA sequencing. We assembled and annotated the complete maxicircle sequence of the Y and Bug2148 strains. For Bug2148, our results confirm that the maxicircle sequence is the longest assembled to date, and is composed of 21 genes, most of them conserved among Trypanosomatid species. In agreement with previous results, T. cruzi minicircles show a conserved structure around 1.4 Kb, with four highly conserved regions and other four hypervariable regions interspersed between them. However, our results suggest that the parasite minicircles display several sizes and numbers of conserved and hypervariable regions, contrary to those previous studies. Besides, this heterogeneity is also reflected in the three conserved sequence blocks of the conserved regions that play a key role in the minicircle replication. Our results using sequencing technologies of second and third-generation indicate that the different consensus sequences of the maxicircles and minicircles seem to be more complex than previously described indicating at least four different groups in T. cruzi minicircles.
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Affiliation(s)
- Francisco Callejas-Hernández
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alfonso Herreros-Cabello
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Del Moral-Salmoral
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel Fresno
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto Sanitario de Investigación de la Princesa, Group 12, Madrid, Spain
| | - Núria Gironès
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto Sanitario de Investigación de la Princesa, Group 12, Madrid, Spain
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Disagreement between PCR and serological diagnosis of Trypanosoma cruzi infection in blood donors from a Colombian endemic region. ACTA ACUST UNITED AC 2021; 41:47-59. [PMID: 34111340 PMCID: PMC8318390 DOI: 10.7705/biomedica.5441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Chagas' disease is the leading cause of infectious myocarditis worldwide. This infection caused by Trypanosoma cruzi is usually life-long and asymptomatic; however, the third part of infected people can develop severe or even fatal cardiomyopathy. As the parasitemia in the chronic phase is both low-grade and intermittent, T. cruzi infection is principally detected by serology, although this method has sensitivity and specificity limitations. Objective: To determine the level of agreement between serologic and molecular tests in 658 voluntary blood donors from six provinces in the Colombian department of Santander. Materials and methods: We evaluated an array of diagnostic technologies by cross-section sampling performing a serological double diagnostic test for T. cruzi antibody detection (Chagas III ELISA™, BiosChile Group, and ARCHITECT Chagas CMIA™, Abbott;, and DNA detection by polymerase chain reaction (PCR). We collected the demographic, clinical, and epidemiological information of participants. The sample size was calculated using Epidat™ and the statistical analysis was done with Stata 12.1™. Results: PCR was six times more sensitive in detecting T. cruzi infection than ELISA/CMIA with prevalence values of 1.8% (12/658) and 0.3% (2/658), respectively, and kappa=0.28 (95%CI: -0.03 - 0.59). In contrast, serology showed a sensitivity of 16.7% (95%CI: 2.09 -48.4) and a specificity of 100% (95%CI: 99.4 - 100). All seropositive samples were found to be positive by PCR. Conclusions: The implementation of PCR as a complementary method for screening donors could reduce the probability of false negative and the consequent risk of transfusional-transmission of Chagas' disease, especially in endemic regions.
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Muñoz-Calderón A, Díaz-Bello Z, Alarcón de Noya B, Noya-González OO, Schijman AG. Characterization and Follow-Up of Trypanosoma cruzi Natural Populations Refractory to Etiological Chemotherapy in Oral Chagas Disease Patients. Front Cell Infect Microbiol 2021; 11:665063. [PMID: 33996636 PMCID: PMC8121101 DOI: 10.3389/fcimb.2021.665063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to characterize the genetic constitution of natural T. cruzi populations involved in an Oral Chagas Disease (OCD) outbreak at a rural school of the community of Chichiriviche de la Costa, Venezuela, which affected patients did not respond to the etiological treatment. Peripheral blood samples and/or hemocultures were obtained from twenty-nine OCD patients at time of diagnosis or along nine years of Post-treatment (Tx) follow-up. The IgG serology, T. cruzi discrete typing units (DTU), satellite DNA-qPCR parasitic loads, and minicircle signatures were determined at Pre-Tx and after Tx. The serological titles and parasitic loads changed after treatment, with a significant decrease of IgG titers (Spearman’s r value= -0.961) and median parasite loads from 2.869 [IQR = 2.113 to 3.720] to 0.105 [IQR = -1.147 to 1.761] log10 par eq. /mL at Pre-Tx and Post-Tx, respectively, suggesting infection evolution from acute to chronic phase, without seroconversion or parasitological eradication, which was indicative of treatment failure. All patients were infected with T. cruzi DTU I populations. At Pre-Tx their median Jaccard genetic distances were 0.775 [IQR = 0.708 to 0.882], decreasing in genetic variability towards the end of follow-up (Mann-Whitney U test p= 0.0031). Interestingly, no Post-Tx minicircle signature was identical to its Pre-Tx counterpart population in a same patient, revealing selection of parasite subpopulations between the primary infection and Post-Tx. The parasitic populations isolated from hemocultures showed a lower number of bands in the minicircle signatures with respect to the signatures obtained directly from the patients’ blood samples, demonstrating a process of parasitic selection and reduction of the population variability that initially infected the patients. Decrease of parasitic loads after treatment as well as Pre- and Post-Tx intra-TcI diversity might be a consequence of both, natural evolution of the acute infection to the chronic phase and persistence of refractory populations due to Tx selection.
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Affiliation(s)
- Arturo Muñoz-Calderón
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Zoraida Díaz-Bello
- Instituto de Medicina Tropical "Dr Félix Pifano", Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Oscar O Noya-González
- Instituto de Medicina Tropical "Dr Félix Pifano", Universidad Central de Venezuela, Caracas, Venezuela
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Kamdem BP, Elizabeth FI. The Role of Nitro (NO 2-), Chloro (Cl), and Fluoro (F) Substitution in the Design of Antileishmanial and Antichagasic Compounds. Curr Drug Targets 2021; 22:379-398. [PMID: 33371845 DOI: 10.2174/1389450121666201228122239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
Neglected tropical diseases (NTDs) are responsible for over 500,000 deaths annually and are characterized by multiple disabilities. Leishmaniasis and Chagas diseases are among the most severe NTDs, and are caused by the Leishmania sp and Trypanosoma cruzi, respectively. Glucantime, pentamidine, and miltefosine are commonly used to treat leishmaniasis, whereas nifurtimox, benznidazole are current treatments for Chagas disease. However, these treatments are associated with drug resistance and severe side effects. Hence, the development of synthetic products, especially those containing N02, F, or Cl, are known to improve biological activity. The present work summarizes the information on the antileishmanial and antitrypanosomal activity of nitro-, chloro-, and fluorosynthetic derivatives. Scientific publications referring to halogenated derivatives in relation to antileishmanial and antitrypanosomal activities were hand-searched in databases such as SciFinder, Wiley, Science Direct, PubMed, ACS, Springer, Scielo, and so on. According to the literature information, more than 90 compounds were predicted as lead molecules with reference to their IC50/EC50 values in in vitro studies. It is worth mentioning that only active compounds with known cytotoxic effects against mammalian cells were considered in the present study. The observed activity was attributed to the presence of nitro-, fluoro-, and chloro-groups in the compound backbone. All in all, nitro and halogenated derivatives are active antileishmanial and antitrypanosomal compounds and can serve as the baseline for the development of new drugs against leishmaniasis and Chagas disease. However, efforts in in vitro and in vivo toxicity studies of the active synthetic compounds is still needed. Pharmacokinetic studies and the mechanism of action of the promising compounds need to be explored. The use of new catalysts and chemical transformation can afford unexplored halogenated compounds with improved antileishmanial and antitrypanosomal activity.
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Affiliation(s)
- Boniface P Kamdem
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Ferreira I Elizabeth
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Muñoz-Calderón A, Silva-Gomes NL, Apodaca S, Alarcón de Noya B, Díaz-Bello Z, Souza LRQ, Costa ADT, Britto C, Moreira OC, Schijman AG. Toward the Establishment of a Single Standard Curve for Quantification of Trypanosoma cruzi Natural Populations Using a Synthetic Satellite Unit DNA Sequence. J Mol Diagn 2021; 23:521-531. [PMID: 33549859 DOI: 10.1016/j.jmoldx.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
Accurate diagnostic tools and surrogate markers of parasitologic response to treatment are needed for managing Chagas disease. Quantitative real-time PCR (qPCR) is used for treatment monitoring, but variability in copy dosage and sequences of molecular target genes among different Trypanosoma cruzi strains limit the precision of quantitative measures. To improve qPCR quantification accuracy, we designed and evaluated a synthetic DNA molecule containing a satellite DNA (satDNA) repeat unit as standard for quantification of T. cruzi loads in clinical samples, independently of the parasite strain. Probit regression analysis established for Dm28c (TcI) and CL-Brener (TcVI) stocks similar 95% limit of detection values [0.903 (0.745 to 1.497) and 0.667 (CI, 0.113 to 3.927) copy numbers/μL, respectively] when synthetic DNA was the standard for quantification, allowing direct comparison of loads in samples infected with different discrete typing units. This standard curve was evaluated in 205 samples (38 acute oral and 19 chronic Chagas disease patients) from different geographical areas infected with various genotypes, including samples obtained during treatment follow-up; high agreement with parasitic load trends using standard curves based on DNA extracted from spiked blood with counted parasites was obtained. This qPCR-based quantification strategy will be a valuable tool in phase 3 clinical trials, to follow up patients under treatment or at risk of reactivation, and in experimental models using different parasite strains.
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Affiliation(s)
- Arturo Muñoz-Calderón
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular "Dr Héctor Torres" (INGEBI), Buenos Aires, Argentina
| | - Natalia Lins Silva-Gomes
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sofia Apodaca
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular "Dr Héctor Torres" (INGEBI), Buenos Aires, Argentina
| | - Belkisyolé Alarcón de Noya
- Sección de Inmunologia, Instituto de Medicina Tropical "Dr Félix Pifano," Universidad Central de Venezuela, Caracas, Venezuela
| | - Zoraida Díaz-Bello
- Sección de Inmunologia, Instituto de Medicina Tropical "Dr Félix Pifano," Universidad Central de Venezuela, Caracas, Venezuela
| | - Leticia Rocha Quintino Souza
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Alexandre Dias Tavares Costa
- Laboratório de Ciências e Tecnologias Aplicadas à Saúde (LaCTAS), Instituto Carlos Chagas (ICC), Fundação Oswaldo Cruz, Curitiba, Brazil
| | - Constança Britto
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Otacilio Cruz Moreira
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular "Dr Héctor Torres" (INGEBI), Buenos Aires, Argentina.
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Hochberg NS, Wheelock A, Hamer DH, Marcus R, Nolan MS, Meymandi S, Gilman RH. Chagas Disease in the United States: A Perspective on Diagnostic Testing Limitations and Next Steps. Am J Trop Med Hyg 2021; 104:800-804. [PMID: 33534741 DOI: 10.4269/ajtmh.19-0871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Chagas disease is a neglected tropical disease that affects an estimated 300,000 people in the United States. This perspective piece reviews diagnostic challenges and proposes next steps to address these shortfalls.
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Affiliation(s)
- Natasha S Hochberg
- 1Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,2Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.,3Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Alyse Wheelock
- 1Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,3Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Davidson H Hamer
- 1Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,3Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts.,4Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Rachel Marcus
- 5Latin American Society of Chagas (LASOCHA), Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Melissa S Nolan
- 6Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,7Department of Pediatrics, Section of Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sheba Meymandi
- 8Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Robert H Gilman
- 9Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Vallejo M, Reyes PP, Martinez Garcia M, Gonzalez Garay AG. Trypanocidal drugs for late-stage, symptomatic Chagas disease (Trypanosoma cruzi infection). Cochrane Database Syst Rev 2020; 12:CD004102. [PMID: 33305846 PMCID: PMC8103997 DOI: 10.1002/14651858.cd004102.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND People with Chagas disease may develop progressive and lethal heart conditions. Drugs to eliminate the parasite Trypanosoma cruzi (T cruzi) currently carry limited therapeutic value and are used in the early stages of the disease. Extending the use of these drugs to treat chronic chagasic cardiomyopathy (CCC) has also been proposed. OBJECTIVES To assess the benefits and harms of nitrofurans and trypanocidal drugs for treating late-stage, symptomatic Chagas disease and CCC in terms of blood parasite reduction or clearance, mortality, adverse effects, and quality of life. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS databases on 12 November 2019. We also searched two clinical trials registers, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), on 3 December 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) assessing trypanocidal drugs versus placebo or no treatment for late-stage, symptomatic Chagas disease and CCC. DATA COLLECTION AND ANALYSIS We conducted the reporting of the review according the standard Cochrane methods. Two review authors independently retrieved articles, performed data extraction, and assessed risk of bias. Any disagreements were resolved by a third review author. We contacted study authors for additional information. MAIN RESULTS We included two studies in this review update. One RCT randomly assigned 26 participants to benznidazole 5 mg/kg/day; 27 participants to nifurtimox 5 mg/kg/day; and 24 participants to placebo for 30 days. The second RCT, newly included in this update, randomised 1431 participants to benznidazole 300 mg/day for 40 to 80 days and 1423 participants to placebo. We also identified one ongoing study. Benznidazole compared to placebo At five-year follow-up, low quality of the evidence suggests that there may be a benefit of benznidazole when compared to placebo for clearance or reduction of antibody titres (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.14 to 1.37; 1 trial; 1896 participants). We are uncertain about the effects of benznidazole for the clearance of parasitaemia demonstrated by negative xenodiagnosis, blood culture, and/or molecular assays due to very limited evidence. Low quality of the evidence suggests that when compared to placebo, benznidazole may make little to no difference in the risk of heart failure (RR 0.89, 95% CI 0.69 to 1.14; 1 trial; 2854 participants) and ventricular tachycardia (RR 0.80, 95% CI 0.51 to 1.26; 1 trial; 2854 participants). We found moderate quality of the evidence that adverse events increase with benznidazole when compared to placebo (RR 2.52, 95% CI 2.09 to 3.03; 1 trial; 2854 participants). Adverse effects were observed in 23.9% of patients in the benznidazole group compared to 9.5% in the placebo group. The most frequent adverse effects were: cutaneous rash, gastrointestinal symptoms, and peripheral polyneuropathy. No data were available for the outcomes of pathological demonstration of tissue parasites and quality of life. Nifurtimox compared to placebo Data were only available for this comparison for the outcome clearance or reduction of antibody titres, and we are uncertain about the effect due to very limited evidence. Regarding adverse events, one RCT mentioned in a general manner that nifurtimox caused intense adverse events, without any quantification. AUTHORS' CONCLUSIONS There is insufficient evidence to support the efficacy of the trypanocidal drugs benznidazole and nifurtimox for late-stage, symptomatic Chagas disease and CCC.
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Affiliation(s)
- Maite Vallejo
- Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Seccion XVI, Tlalpan, Mexico
| | - Pedro Pa Reyes
- Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Seccion XVI, Tlalpan, Mexico
| | - Mireya Martinez Garcia
- Sociomedical Research Unit, Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City, Mexico
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Calderón JM, Erazo D, Kieran TJ, Gottdenker NL, León C, Cordovez J, Guhl F, Glenn TC, González C. How microclimatic variables and blood meal sources influence Rhodnius prolixus abundance and Trypanosoma cruzi infection in Attalea butyracea and Elaeis guineensis palms? Acta Trop 2020; 212:105674. [PMID: 32827453 DOI: 10.1016/j.actatropica.2020.105674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
Chagas disease is a zoonosis that affects several million people and is caused by the parasite Trypanosoma cruzi, which is mainly transmitted through the feces of triatomine bugs. Within triatomines, several Rhodnius species have been found inhabiting palms, and certain factors such as palm species and location have been related to the abundance and T. cruzi infection of those insects in palms. In this study, the main goal was to determine if R. prolixus abundances and infection rates in Attalea butyracea and Elaeis guineensis palms are related to ecological factors such as palm species, crown microclimate, and available blood meal sources. Triatomine sampling was performed in two municipalities of Casanare, Colombia, specifically in the intersection of riparian forests and oil palm plantations. For R. prolixus abundance per palm, the predictors showing more relationship were palm species and blood meal species identified in the palm, and for T. cruzi infection per triatomine, they were palm species and nymphal stage. Palm microclimate was very similar in both palm species and did not show a relationship with triatomine abundance. Comparing palm species, A. butyracea showed more blood meal species, including more refractory host species, than E. guineensis, but lower T. cruzi infection rate and parasitaemia. Interestingly, non-arboreal blood meal species were frequently found in the analyzed nymphs, indicating that the blood source for R. prolixus in palms corresponded to all the fauna located in the surrounded landscape and not only in the palm. These results could expose a new ecological scenario to interpret the T. cruzi transmission in sylvatic environments.
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Affiliation(s)
- Johan M Calderón
- Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá D.C. 111711, Colombia.
| | - Diana Erazo
- Grupo de Investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de Los Andes, Bogotá D.C. 111711, Colombia
| | - Troy J Kieran
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602, USA
| | - Nicole L Gottdenker
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
| | - Cielo León
- Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá D.C. 111711, Colombia
| | - Juan Cordovez
- Grupo de Investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de Los Andes, Bogotá D.C. 111711, Colombia
| | - Felipe Guhl
- Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá D.C. 111711, Colombia
| | - Travis C Glenn
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602, USA
| | - Camila González
- Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá D.C. 111711, Colombia
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Urquiza J, Cevallos C, Elizalde MM, Delpino MV, Quarleri J. Priming Astrocytes With HIV-Induced Reactive Oxygen Species Enhances Their Trypanosoma cruzi Infection. Front Microbiol 2020; 11:563320. [PMID: 33193149 PMCID: PMC7604310 DOI: 10.3389/fmicb.2020.563320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/22/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction: Trypanosoma cruzi is an intracellular protozoa and etiological agent that causes Chagas disease. Its presence among the immunocompromised HIV-infected individuals is relevant worldwide because of its impact on the central nervous system (CNS) causing severe meningoencephalitis. The HIV infection of astrocytes – the most abundant cells in the brain, where the parasite can also be hosted – being able to modify reactive oxygen species (ROS) could influence the parasite growth. In such interaction, extracellular vesicles (EVs) shed from trypomastigotes may alter the surrounding environment including its pro-oxidant status. Methods: We evaluated the interplay between both pathogens in human astrocytes and its consequences on the host cell pro-oxidant condition self-propitiated by the parasite – using its EVs – or by HIV infection. For this goal, we challenged cultured human primary astrocytes with both pathogens and the efficiency of infection and multiplication were measured by microscopy and flow cytometry and parasite DNA quantification. Mitochondrial and cellular ROS levels were measured by flow cytometry in the presence or not of scavengers with a concomitant evaluation of the cellular apoptosis level. Results: We observed that increased mitochondrial and cellular ROS production boosted significantly T. cruzi infection and multiplication in astrocytes. Such oxidative condition was promoted by free trypomastigotes-derived EVs as well as by HIV infection. Conclusions: The pathogenesis of the HIV-T. cruzi coinfection in astrocytes leads to an oxidative misbalance as a key mechanism, which exacerbates ROS generation and promotes positive feedback to parasite growth in the CNS.
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Affiliation(s)
- Javier Urquiza
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Cintia Cevallos
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - María Mercedes Elizalde
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - M Victoria Delpino
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Instituto de Inmunología, Genética y Metabolismo (INIGEM), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Ribeiro JLS, Soares JCAV, Portapilla GB, Providello MV, Lima CHS, Muri EMF, de Albuquerque S, Dias LRS. Trypanocidal activity of new 1,6-diphenyl-1H-pyrazolo[3,4-b]pyridine derivatives: Synthesis, in vitro and in vivo studies. Bioorg Med Chem 2020; 29:115855. [PMID: 33199200 DOI: 10.1016/j.bmc.2020.115855] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022]
Abstract
Despite the serious public health problems caused by Chagas disease in several countries, the available therapy remains with only two drugs that are poorly active during the chronic phase of the disease in addition to having severe side effects. In search of new trypanocidal agents, herein we describe the synthesis and biological evaluation of eleven new 1,6-diphenyl-1H-pyrazolo[3,4-b]pyridine compounds containing the carbohydrazide or the 2,3-dihydro-1,3,4-oxadiazole moieties. Two of them showed promising in vitro activity against amastigote forms of T. cruzi and were evaluated in vivo in male BALB/c mice infected with T. cruzi Y strain. Our results suggest that the substitution at the C-2 position of the phenyl group connected to the carbohydrazide or to the 2,3-dihydro-1,3,4-oxadiazole moieties plays an important role in the trypanocidal activity of this class of compounds. Moreover, the compound containing the 2,3-dihydro-1,3,4-oxadiazole moiety has demonstrated more favorable structural requirements for in vivo activity than its carbohydrazide analog.
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Affiliation(s)
- Joana L S Ribeiro
- Universidade Federal Fluminense, Faculdade de Farmácia, Laboratório de Química Medicinal, RJ, Brazil
| | - Júlio C A V Soares
- Universidade Federal Fluminense, Faculdade de Farmácia, Laboratório de Química Medicinal, RJ, Brazil
| | - Gisele B Portapilla
- Universidade de São Paulo, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, SP, Brazil
| | - Maiara V Providello
- Universidade de São Paulo, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, SP, Brazil
| | - Camilo H S Lima
- Universidade Federal do Rio de Janeiro, Instituto de Química, RJ, Brazil
| | - Estela M F Muri
- Universidade Federal Fluminense, Faculdade de Farmácia, Laboratório de Química Medicinal, RJ, Brazil
| | - Sérgio de Albuquerque
- Universidade de São Paulo, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, SP, Brazil.
| | - Luiza R S Dias
- Universidade Federal Fluminense, Faculdade de Farmácia, Laboratório de Química Medicinal, RJ, Brazil.
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Ospina-Villa JD, Cisneros-Sarabia A, Sánchez-Jiménez MM, Marchat LA. Current Advances in the Development of Diagnostic Tests based on Aptamers in Parasitology: A Systematic Review. Pharmaceutics 2020; 12:pharmaceutics12111046. [PMID: 33142793 PMCID: PMC7693570 DOI: 10.3390/pharmaceutics12111046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Aptamers are single-stranded DNA or RNA sequences of 20–80 nucleotides that interact with different targets such as: proteins, ions, viruses, or toxins, through non-covalent interactions and their unique three-dimensional conformation. They are obtained in vitro by the systematic evolution of ligands by exponential enrichment (SELEX). Because of their ability of target recognition with high specificity and affinity, aptamers are usually compared to antibodies. However, they present many advantages that make them promising molecules for the development of new methods for the diagnosis and treatment of human diseases. In medical parasitology, aptamers also represent an attractive alternative for the implementation of new parasite detection methods, easy to apply in endemic regions. The aim of this study was to describe the current advances in the development of diagnostic tests based on aptamers in parasitology. For this, articles were selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with specific inclusion and exclusion criteria. The 26 resulting articles deal with the use of aptamers for the detection of six important protozoa that affect human health. This systematic review clearly demonstrates the specificity, sensitivity and selectivity of aptamers and aptasensors, that certainly will soon become standard methods in medical parasitology.
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Affiliation(s)
- Juan David Ospina-Villa
- Instituto Colombiano de Medicina Tropical, Universidad CES, Sabaneta CP 055450, Antioquia, Colombia; (J.D.O.-V.); (M.M.S.-J.)
| | - Alondra Cisneros-Sarabia
- ENMH, Instituto Politécnico Nacional, Guillermo Massieu Helguera 239, Fracc. La Escalera, Ticomán, Del. Gustavo A. Madero, Mexico City CP 07320, Mexico;
| | - Miryan Margot Sánchez-Jiménez
- Instituto Colombiano de Medicina Tropical, Universidad CES, Sabaneta CP 055450, Antioquia, Colombia; (J.D.O.-V.); (M.M.S.-J.)
| | - Laurence A. Marchat
- ENMH, Instituto Politécnico Nacional, Guillermo Massieu Helguera 239, Fracc. La Escalera, Ticomán, Del. Gustavo A. Madero, Mexico City CP 07320, Mexico;
- Correspondence: ; Tel.: +52-55-5729-6300 (ext. 55543)
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