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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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Clark EH, Bern C. Chagas disease in the immunocompromised host. Curr Opin Infect Dis 2024:00001432-990000000-00157. [PMID: 38963802 DOI: 10.1097/qco.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
PURPOSE OF REVIEW To highlight recent advances in our understanding of Trypanosoma cruzi infection in immunocompromised individuals, a condition that is increasingly recognized as populations shift and use of immunosuppressive medications becomes more commonplace. RECENT FINDINGS Chagas disease screening programs should include people at risk for both Chagas disease and immunocompromise, e.g. people who have resided for ≥6 months in endemic Latin America who have an immunocompromising condition such as HIV or who are planned to start an immunosuppressive medication regimen. The goal of identifying such individuals is to allow management strategies that will reduce their risk of T. cruzi reactivation disease. For people with HIV-T. cruzi coinfection, strict adherence to antiretroviral therapy is important and antitrypanosomal treatment is urgent in the setting of symptomatic reactivation. People at risk for T. cruzi reactivation due to immunosuppression caused by advanced hematologic conditions or postsolid organ transplantation should be monitored via T. cruzi qPCR and treated with preemptive antitrypanosomal therapy if rising parasite load on serial specimens indicates reactivation. Reduction of the immunosuppressive regimen, if possible, is important. SUMMARY Chronic Chagas disease can lead to severe disease in immunocompromised individuals, particularly those with advanced HIV (CD4+ < 200 cells/mm3) or peri-transplantation.
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Affiliation(s)
- Eva H Clark
- Departments of Medicine, Section of Infectious Diseases, and Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, Clifornia, USA
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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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4
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Carvalho NB, de Freitas VLT, Seguro FS, Bezerra RC, Fatobene G, Nakanishi ÉYS, Visnadi H, Martinez G, Batista MV, Rocha V, Dulley FL, Costa SF, Shikanai-Yasuda MA. Multiple myeloma and Chagas disease: qPCR as a marker for preemptive antiparasitic therapy: a case reports series and review. Rev Inst Med Trop Sao Paulo 2024; 66:e10. [PMID: 38324876 PMCID: PMC10846554 DOI: 10.1590/s1678-9946202466010] [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: 10/03/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024] Open
Abstract
Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9-2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR.
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Affiliation(s)
- Noemia Barbosa Carvalho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Moléstias Infecciosas e Parasitarias, São Paulo, São Paulo, Brazil
| | - Vera Lúcia Teixeira de Freitas
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitarias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
| | - Fernanda Salles Seguro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Hematologia, Transfusão e Terapia Celular, São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratorio de Investigação Médica em Patogenese e Terapia Celular Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Rita Cristina Bezerra
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Parasitologia (LIM-46), São Paulo, São Paulo, Brazil
| | - Giancarlo Fatobene
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Hematologia, Transfusão e Terapia Celular, São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratorio de Investigação Médica em Patogenese e Terapia Celular Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Érika Yoshie Shimoda Nakanishi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
| | - Helena Visnadi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Hematologia, Transfusão e Terapia Celular, São Paulo, São Paulo, São Paulo, Brazil
| | - Gracia Martinez
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Hematologia, Transfusão e Terapia Celular, São Paulo, São Paulo, São Paulo, Brazil
| | - Marjorie Vieira Batista
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Moléstias Infecciosas e Parasitarias, São Paulo, São Paulo, Brazil
- AC Camargo Cancer Center, Departamento de Infectologia, São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Hematologia, Transfusão e Terapia Celular, São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratorio de Investigação Médica em Patogenese e Terapia Celular Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Frederico Luis Dulley
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Hematologia, Transfusão e Terapia Celular, São Paulo, São Paulo, São Paulo, Brazil
| | - Sílvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitarias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Protozoologia (LIM-49), São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Aparecida Shikanai-Yasuda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitarias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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5
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Freitas VLTD, Novaes CTG, Sartori AMC, Carvalho NB, Silva SCVD, Nakanishi ÉS, Salvador F, Castro CND, Bezerra RC, Westphalen EVN, Oliveira CMRD, Busser FD, Ho YL, Buccheri R, Bonilla C, Shikanai-Yasuda MA. Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi/HIV coinfection. PLoS Negl Trop Dis 2024; 18:e0011961. [PMID: 38408095 PMCID: PMC10896531 DOI: 10.1371/journal.pntd.0011961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Trypanosoma cruzi and HIV coinfection can evolve with depression of cellular immunity and increased parasitemia. We applied quantitative PCR (qPCR) as a marker for preemptive antiparasitic treatment to avoid fatal Chagas disease reactivation and analyzed the outcome of treated cases. METHODOLOGY This mixed cross-sectional and longitudinal study included 171 Chagas disease patients, 60 coinfected with HIV. Of these 60 patients, ten showed Chagas disease reactivation, confirmed by parasites identified in the blood, cerebrospinal fluid, or tissues, 12 exhibited high parasitemia without reactivation, and 38 had low parasitemia and no reactivation. RESULTS We showed, for the first time, the success of the timely introduction of benznidazole in the non-reactivated group with high levels of parasitemia detected by qPCR and the absence of parasites in reactivated cases with at least 58 days of benznidazole. All HIV+ patients with or without reactivation had a 4.0-5.1 higher chance of having parasitemia than HIV seronegative cases. A positive correlation was found between parasites and viral loads. Remarkably, treated T. cruzi/HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. Additionally, untreated patients showed ~13.6 times higher Odds Ratio of having positive parasitemia in the follow-up period compared with treated patients. Treated and untreated patients showed no differences regarding the evolution of Chagas disease. The main factors associated with all-cause mortality were higher parasitemia, lower CD4 counts/μL, higher viral load, and absence of antiretroviral therapy. CONCLUSION We recommend qPCR prospective monitoring of T. cruzi parasitemia in HIV+ coinfected patients and point out the value of pre-emptive therapy for those with high parasitemia. In parallel, early antiretroviral therapy introduction is advisable, aiming at viral load control, immune response restoration, and increasing survival. We also suggest an early antiparasitic treatment for all coinfected patients, followed by effectiveness analysis alongside antiretroviral therapy.
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Affiliation(s)
- Vera Lúcia Teixeira de Freitas
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Imunologia (LIM 48), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Christina Terra Gallafrio Novaes
- Divisao de Molestias Infecciosas e Parasitarias, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Divisao de Molestias Infecciosas e Parasitarias, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Noemia Barbosa Carvalho
- Divisao de Molestias Infecciosas e Parasitarias, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Sheila Cristina Vicente da Silva
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Imunologia (LIM 48), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Érika Shimoda Nakanishi
- Laboratorio de Investigacao Medica em Imunologia (LIM 48), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fernando Salvador
- 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
| | - Cleudson Nery de Castro
- Centre for Tropical Medicine, School of Medicine, University of Brasilia, Brasília, Distrito Federal, Brazil
| | - Rita Cristina Bezerra
- Laboratorio de Investigacao Medica em Parasitologia (LIM 46), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Caroline Medeji Ramos de Oliveira
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Imunologia (LIM 48), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Felipe Delatorre Busser
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Imunologia (LIM 48), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Divisao de Molestias Infecciosas e Parasitarias, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Renata Buccheri
- Instituto de Infectologia Emilio Ribas, São Paulo, Brasil
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Carolina Bonilla
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Maria Aparecida Shikanai-Yasuda
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Imunologia (LIM 48), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, 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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7
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Bocchi EA, Veiga Guimarães G, Espinoza Romero C, Sato PK, de Freitas VLT, Yamashiro Kanashiro EH, Furuchó CR, Das Dores Cruz F, Shimoda Nakanishi É, Busser FD, Bezerra RC, Westphalen EVN, Cisotto Rocha M, Shikanai Yasuda MA. Assessment of biomarkers and clinical parameters as predictors of survival in patients with chagasic heart failure. PLoS Negl Trop Dis 2023; 17:e0011847. [PMID: 38109427 PMCID: PMC10760923 DOI: 10.1371/journal.pntd.0011847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/02/2024] [Accepted: 12/06/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Chagas disease, endemic in Latin America and spreading globally due to emigration, has a significant health burden, particularly in relation to chagasic heart failure (HF). Chagasic cardiomyopathy (CCM) is characterized by chronic inflammatory myocardial disease. This study aimed to identify inflammatory parameters and biomarkers that could aid in the management of patients with chagasic HF. METHODS AND FINDINGS A cohort study was conducted at a tertiary cardiology single-center over a mean follow-up period of 2.4 years. The study included patients with HF secondary to CCM enrolled between October 2013 and July 2017. Various clinical parameters, echocardiography findings, parasitemia status, brain natriuretic peptide (BNP) and troponin T (TnT) levels, and inflammatory biomarkers (IL-6, IL-10, IL-12p70, IL-17A, adiponectin, and IFN-γ) were assessed. The study encompassed a cohort of 103 patients, with a median age of 53 years and 70% being male. The left ventricular ejection fraction (LVEF) was 28%, with 40% of patients classified as NYHA II functional class. The median BNP level was 291 pg/ml. The observed mortality rate during the study period was 38.8%. Predictors of lower survival were identified as elevated levels of BNP, TnT, reduced LVEF, and increased adiponectin (thresholds: BNP > 309 pg/ml, TnT > 27.5 ng/ml, LVEF < 25.5%, adiponectin > 38 μg/mL). Notably, there was no evidence indicating a relationship between parasitemia and the inflammatory parameters with lower survival in these patients, including INF-γ, IL-6, IL-10, IL12-(p70), and IL17a. CONCLUSION Despite the presence of a chronic inflammatory process, the evaluated inflammatory biomarkers in this cohort were not predictive of survival in patients with chagasic HF with reduced ejection fraction (HFrEF). However, reduced LVEF, elevated BNP, adiponectin levels, and troponin T were identified as predictors of lower survival in these patients.
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Affiliation(s)
- Edimar Alcides Bocchi
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Veiga Guimarães
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cristhian Espinoza Romero
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Keiko Sato
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Vera Lúcia Teixeira de Freitas
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Edite Hatsumi Yamashiro Kanashiro
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Célia Regina Furuchó
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fatima Das Dores Cruz
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Felipe Delatorre Busser
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rita Cristina Bezerra
- Laboratory of Medical Investigation in Parasitology (LIM-46), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Mussya Cisotto Rocha
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Maria Aparecida Shikanai Yasuda
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
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8
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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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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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10
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Hasslocher-Moreno AM, de Sousa AS, Xavier SS, Mendes FDSNS, Nunes EP, Grinsztejn BGJ, Mediano MFF. Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center. Rev Soc Bras Med Trop 2022; 55:e02402022. [PMID: 36287507 PMCID: PMC9592103 DOI: 10.1590/0037-8682-0240-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. METHODS This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. RESULTS Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. CONCLUSIONS Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients.
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Affiliation(s)
| | - Andréa Silvestre de Sousa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil., Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil
| | - Sergio Salles Xavier
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | - Estevão Portela Nunes
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
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11
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Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy. Trop Med Infect Dis 2022; 7:tropicalmed7100268. [PMID: 36288009 PMCID: PMC9609300 DOI: 10.3390/tropicalmed7100268] [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: 08/10/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Aplastic anemia is a rare and life-threatening condition, seldomly witnessed concomitantly with Chagas disease. We aim to discuss the management of these patients under risk of chronic Chagas disease reactivation (CDR), a severe condition with a high morbimortality that occurs in chronic Chagas disease patients under immunosuppression. Case reports: Trypanosoma cruzi (T. cruzi) parasitemia was monitored in three patients for 4−58 months by conventional PCR (cPCR), quantitative PCR (qPCR), microhematocrit/buffy coat, blood culture, and/or xenodiagnosis. One patient received antiparasitic treatment (benznidazole) and the other received allopurinol. Although parasitemia was controlled during and after benznidazole treatment at 300 mg/d for 51 days, in one patient, hematologic parameters worsened continuously before, during, and after treatment. Allopurinol led only to the temporary suppression of T. cruzi parasitemia in the second patient, but after danazol and hematological improvement, parasitemia became undetectable until the end of monitoring. Discussion and Conclusion: Unexpected undetectable or low parasitemia by cPCR/qPCR was reported. We show that the monitoring of parasitemia by qPCR and the use of preemptive therapy when the parasitemia was positive proved to be beneficial to our patients. As a result of the toxicity of more effective antiparasitics, shorter regimens of benznidazole or less toxic drugs in preemptive therapy are options that deserve future studies.
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12
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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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Enriquez GF, Bua J, Orozco MM, Macchiaverna NP, Otegui JAA, Argibay HD, Fernández MDP, Gürtler RE, Cardinal MV. Over-dispersed Trypanosoma cruzi parasite load in sylvatic and domestic mammals and humans from northeastern Argentina. Parasit Vectors 2022; 15:37. [PMID: 35073983 PMCID: PMC8785451 DOI: 10.1186/s13071-022-05152-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The distribution of parasite load across hosts may modify the transmission dynamics of infectious diseases. Chagas disease is caused by a multi-host protozoan, Trypanosoma cruzi, but the association between host parasitemia and infectiousness to the vector has not been studied in sylvatic mammalian hosts. We quantified T. cruzi parasite load in sylvatic mammals, modeled the association of the parasite load with infectiousness to the vector and compared these results with previous ones for local domestic hosts. METHODS The bloodstream parasite load in each of 28 naturally infected sylvatic mammals from six species captured in northern Argentina was assessed by quantitative PCR, and its association with infectiousness to the triatomine Triatoma infestans was evaluated, as determined by natural or artificial xenodiagnosis. These results were compared with our previous results for 88 humans, 70 dogs and 13 cats, and the degree of parasite over-dispersion was quantified and non-linear models fitted to data on host infectiousness and bloodstream parasite load. RESULTS The parasite loads of Didelphis albiventris (white-eared opossum) and Dasypus novemcinctus (nine-banded armadillo) were directly and significantly associated with infectiousness of the host and were up to 190-fold higher than those in domestic hosts. Parasite load was aggregated across host species, as measured by the negative binomial parameter, k, and found to be substantially higher in white-eared opossums, cats, dogs and nine-banded armadillos (range: k = 0.3-0.5) than in humans (k = 5.1). The distribution of bloodstream parasite load closely followed the "80-20 rule" in every host species examined. However, the 20% of human hosts, domestic mammals or sylvatic mammals exhibiting the highest parasite load accounted for 49, 25 and 33% of the infected triatomines, respectively. CONCLUSIONS Our results support the use of bloodstream parasite load as a proxy of reservoir host competence and individual transmissibility. The over-dispersed distribution of T. cruzi bloodstream load implies the existence of a fraction of highly infectious hosts that could be targeted to improve vector-borne transmission control efforts toward interruption transmission. Combined strategies that decrease the parasitemia and/or host-vector contact with these hosts would disproportionally contribute to T. cruzi transmission control.
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Affiliation(s)
- Gustavo Fabián Enriquez
- Laboratorio de Eco-Epidemiología, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina.
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Jacqueline Bua
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén, Administración Nacional de Laboratorios e Institutos de Salud Dr. C.G. Malbrán, Buenos Aires, Argentina
| | - María Marcela Orozco
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natalia Paula Macchiaverna
- Laboratorio de Eco-Epidemiología, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Julián Antonio Alvarado Otegui
- Laboratorio de Eco-Epidemiología, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Hernán Darío Argibay
- Laboratorio de Patologia e Biologia Molecular, Instituto Gonçalo Moniz/Fiocruz Bahia, Salvador, Brazil
| | | | - Ricardo Esteban Gürtler
- Laboratorio de Eco-Epidemiología, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marta Victoria Cardinal
- Laboratorio de Eco-Epidemiología, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
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14
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Sánchez AG, Baenas DF, Bonisconti F, Salinas MJH, Alvarellos A, Saurit V, Caeiro F, Salomone O, Caeiro JP, Carballo V, Medeot M, Albertini R, Alvarellos T. Reactivation of Chagas Disease in Patients With Rheumatic Autoimmune Diseases Diagnosed by Molecular Quantification Techniques. J Clin Rheumatol 2021; 27:S533-S536. [PMID: 31295157 DOI: 10.1097/rhu.0000000000001108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Clark EH, Bern C. Chagas Disease in People with HIV: A Narrative Review. Trop Med Infect Dis 2021; 6:tropicalmed6040198. [PMID: 34842854 PMCID: PMC8628961 DOI: 10.3390/tropicalmed6040198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 01/18/2023] Open
Abstract
Many questions remain unanswered regarding the epidemiology, pathophysiology, diagnosis, treatment, and monitoring of Trypanosoma cruzi infection in people with HIV (PWH). The reported prevalence of T. cruzi infection in PWH living in endemic countries ranges from 1-28% and is likely similar in at-risk US populations. While classic cardiac and gastrointestinal presentations of chronic Chagas disease occur in PWH, PWH are additionally at risk for a severe and often fatal form of T. cruzi-mediated disease called reactivation disease. T. cruzi reactivation typically occurs in PWH with low CD4 counts and poor virologic control. National HIV guidelines in several endemic South American countries recommend that all PWH be screened for T. cruzi infection at the time of HIV diagnosis; however, this recommendation is not widely implemented. The early detection of T. cruzi infection in PWH is critical as the sequelae of Chagas disease, including T. cruzi reactivation, may be preventable through the restoration of robust cellular immunity via the initiation of antiretroviral therapy and the appropriate use of antitrypanosomal therapy.
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Affiliation(s)
- Eva H. Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Caryn Bern
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA 94158, USA;
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16
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Shikanai-Yasuda MA, Mediano MFF, Novaes CTG, de Sousa AS, Sartori AMC, Santana RC, Correia D, de Castro CN, Severo MMDS, Hasslocher-Moreno AM, Fernandez ML, Salvador F, Pinazo MJ, Bolella VR, Furtado PC, Corti M, Neves Pinto AY, Fica A, Molina I, Gascon J, Viñas PA, Cortez-Escalante J, Ramos AN, de Almeida EA. Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the "Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions". PLoS Negl Trop Dis 2021; 15:e0009809. [PMID: 34591866 PMCID: PMC8483313 DOI: 10.1371/journal.pntd.0009809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. METHODS This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. RESULTS Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. CONCLUSION This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
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Affiliation(s)
- Maria Aparecida Shikanai-Yasuda
- Departament of Infectious and Parasitic, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- * E-mail: ,
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | - Ana Marli Christovam Sartori
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Carvalho Santana
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Dalmo Correia
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | - Marisa Liliana Fernandez
- Hospital de Infecciosas, Buenos Aires, Argentina
- National Institute of Parasitology, Departament of Clinics, Pathology and Treatment, Health Ministry, Buenos Aires, Argentina
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Valdes Roberto Bolella
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Pedro Carvalho Furtado
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Marcelo Corti
- Hospital de Infecciosas, Buenos Aires, Argentina
- Departamento de Medicina, Asignatura Enfermedades Infecciosas, Facultad de Medicina, Universidad Buenos Aires, Buenos Aires, Argentina
| | - Ana Yecê Neves Pinto
- Evandro Chagas Institute, Health Surveillance Secretary, Health Ministry, Belém, Brazil
| | - Alberto Fica
- Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- ISGlobal, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - Pedro Albajar Viñas
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- Department of Control of Neglected Tropical Diseases, World Health Organization, WHO, Geneva, Switzerland
| | - Juan Cortez-Escalante
- Pan American Health Organization (PAHO), World Health Organization (WHO), Brasília, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Eros Antonio de Almeida
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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17
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Reimer-McAtee MJ, Mejia C, Clark T, Terle J, Pajuelo MJ, Cabeza J, Lora MH, Valencia E, Castro R, Lozano D, Bern C, Torrico F, Gilman RH. HIV and Chagas Disease: An Evaluation of the Use of Real-Time Quantitative Polymerase Chain Reaction to Measure Levels of Trypanosoma cruzi Parasitemia in HIV Patients in Cochabamba, Bolivia. Am J Trop Med Hyg 2021; 105:643-650. [PMID: 34398818 PMCID: PMC8592353 DOI: 10.4269/ajtmh.20-1141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/11/2021] [Indexed: 11/07/2022] Open
Abstract
This cross-sectional study evaluated epidemiologic characteristics of persons living with HIV (PWH) coinfected with Trypanosoma cruzi in Cochabamba, Bolivia, and estimated T. cruzi parasitemia by real-time quantitative polymerase chain reaction (qPCR) in patients with and without evidence of reactivation by direct microscopy. Thirty-two of the 116 HIV patients evaluated had positive serology for T. cruzi indicative of chronic Chagas disease (27.6%). Sixteen of the 32 (50%) patients with positive serology were positive by quantitative polymerase chain reaction (qPCR), and four of the 32 (12.5%) were positive by direct microscopy. The median parasite load by qPCR in those with CD4+ < 200 was 168 parasites/mL (73-9951) compared with 28.5 parasites/mL (15-1,528) in those with CD4+ ≥ 200 (P = 0.89). There was a significant inverse relationship between the degree of parasitemia estimated by qPCR from blood clot and CD4+ count on the logarithmic scale (rsBC= -0.70, P = 0.007). The correlation between T. cruzi estimated by qPCR+ blood clot and HIV viral load was statistically significant with rsBC = 0.61, P = 0.047. Given the significant mortality of PWH and Chagas reactivation and that 57% of our patients with CD4+ counts < 200 cells/mm3 showed evidence of reactivation, we propose that screening for chronic Chagas disease be considered in PWH in regions endemic for Chagas disease and in the immigrant populations in nonendemic regions. Additionally, our study showed that PWH with advancing immunosuppression have higher levels of estimated parasitemia measured by qPCR and suggests a role for active surveillance for Chagas reactivation with consideration of treatment with antitrypanosomal therapy until immune reconstitution can be achieved.
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Affiliation(s)
- Melissa J. Reimer-McAtee
- Division of Infectious Diseases, University of Texas Health Science Center, McGovern School of Medicine, Houston, Texas
| | - Carolina Mejia
- Colectivo de Estudios Aplicados y Desarrollo Salud y Medio Ambiente, Cochabamba, Bolivia
| | - Taryn Clark
- Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Medical Center, Brooklyn, New York; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jules Terle
- Department of Emergency Medicine, Louisiana State University, New Orleans, Louisiana
| | - Monica J. Pajuelo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Laboratory of Infectious Diseases, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeanne Cabeza
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Edward Valencia
- Laboratory of Infectious Diseases, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Castro
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Daniel Lozano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Caryn Bern
- University of California in San Francisco, San Francisco, California
| | - Faustino Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Robert H. Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Bowman NM, Balasubramanian S, Gilman RH, Parobek C, Calderon M, Waltmann A, Messenger LA, Sanchez L, Bern C, Juliano JJ. Deep sequencing to detect diversity of Trypanosoma cruzi infection in patients co-infected with HIV and Chagas disease. J Infect Dis 2021; 225:243-247. [PMID: 34240175 DOI: 10.1093/infdis/jiab350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, can reactivate and cause severe acute disease in immunocompromised patients such as those infected with HIV. We conducted amplicon deep sequencing of a 327-base pair fragment of the tcscd5 gene using an Ion Torrent PGM directly from clinical samples from HIV patients with high parasitemia. We describe the within host diversity, both characterizing the discrete typing unit (DTUs) of the infections and confirming the presence of multi-strain infections, directly from clinical samples. This method can rapidly provide information on the genetic diversity of T. cruzi infection, which can have direct impacts on clinical disease.
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Affiliation(s)
- Natalie M Bowman
- University of North Carolina at Chapel Hill School of Medicine, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC, United States
| | - Sujata Balasubramanian
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Christian Parobek
- University of North Carolina at Chapel Hill School of Medicine, NC, United States
| | | | - Andreea Waltmann
- University of North Carolina at Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, NC, United States
| | - Louisa A Messenger
- London School of Hygiene and Tropical Medicine, Department of Disease Control, Keppel Street, London, United Kingdom
| | - Leny Sanchez
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Caryn Bern
- University of California-San Francisco School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Jonathan J Juliano
- University of North Carolina at Chapel Hill School of Medicine, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC, United States
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19
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Benvenuti LA, Freitas VLT, Roggério A, Nishiya AS, Mangini S, Strabelli TMV. Usefulness of PCR for Trypanosoma cruzi DNA in blood and endomyocardial biopsies for detection of Chagas disease reactivation after heart transplantation: A comparative study. Transpl Infect Dis 2021; 23:e13567. [PMID: 33448054 DOI: 10.1111/tid.13567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/16/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chagas disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease with proliferation and dissemination of Trypanosoma cruzi parasites. Serial blood PCR testing is consensually recommended for CDR monitoring, but there is uncertainty about the incremental value in performing the molecular tests in endomyocardial biopsies (EMB). METHODS We compared qualitative and quantitative results of PCR for T cruzi DNA in 62 pairs of blood and EMB collected with a maximum time interval of 7 days, from 34 heart-transplanted, chagasic patients. RESULTS Blood PCR resulted positive in 39/62 (62.9%) samples, with PL ranging from 0.14 to 1610.73 (median: 3.31). PCR resulted positive in 8/60 (13.3%) EMB, with PL ranging from 2.82 to 1670.55 (median: 65.63). All blood samples which tested negative presented a paired EMB which also tested negative. However, 31/39 (79.5%) blood samples which tested positive presented a paired EMB which tested negative. There was poor agreement between blood and EMB PCR (kappa = 0.153). CDR affecting the myocardium (myo-CDR) was diagnosed in three occasions. PCR resulted positive in both blood and EMB at the time of myo-CDR, with PL ranging from 0.61 to 1610.73 in blood and 13.8 to 1670.55 in EMB. CONCLUSIONS Negative PCR for T cruzi in blood rules out myo-CDR, with no value of testing EMB. Positive PCR in blood with high PL is diagnostic for myo-CDR. If PCR in blood results positive with low PL, testing EMB is useful: negative PCR turns unlikely, and positive PCR reinforces greatly the possibility of myo-CDR.
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Affiliation(s)
- Luiz A Benvenuti
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera L T Freitas
- Department of Infectious and Parasitic Disease, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra Roggério
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna S Nishiya
- Fundação Pró-Sangue/Hemocentro de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sandrigo Mangini
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tânia M V Strabelli
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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20
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Chalela CM, Peña AM, Roa AM, Reyes DL, Rueda JP, Salazar LA, Rosales M, Gomez ED, Bernal EA, Melo CLS. Reactivation of Chagas disease after autologous hematopoietic stem cell transplantation. Rev Soc Bras Med Trop 2020; 54:e20200143. [PMID: 33338116 PMCID: PMC7747816 DOI: 10.1590/0037-8682-0143-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi. Reactivation of CD occurs via drug-induced immunosuppression before and during transplantation. Here, we report the case of a 62-year-old man diagnosed with classic Hodgkin lymphoma who received highly aggressive conditioning chemotherapy before undergoing stem cell transplantation (SCT). The patient tested positive for CD in pre-transplantation evaluation. The patient exhibited persistent fever and elevated C-reactive protein levels before and after SCT, and was treated with antibiotics. Micro-Strout test showed evidence of trypomastigotes and he was treated with benznidazole until tested negative. Post-transplantation seropositive patients should be screened for possible reactivation.
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Affiliation(s)
- Claudia Marcela Chalela
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia
| | - Angela Maria Peña
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia.,Clínica FOSCAL, Hematopoietic and Stem Cell Transplantation Unit, Floridablanca, Santander, Colombia
| | - Angela Maria Roa
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia
| | - David L Reyes
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia
| | - Jennifer Paola Rueda
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia
| | - Luis Antonio Salazar
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia.,Clínica FOSCAL, Hematopoietic and Stem Cell Transplantation Unit, Floridablanca, Santander, Colombia
| | - Manuel Rosales
- Clínica FOSCAL, Hematopoietic and Stem Cell Transplantation Unit, Floridablanca, Santander, Colombia
| | - Edgar David Gomez
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia.,Clínica FOSCAL, Department of Internal Medicine, Floridablanca, Santander, Colombia
| | - Edgar Augusto Bernal
- Clínica FOSCAL, Department of Infectious Diseases, Floridablanca, Santander, Colombia
| | - Claudia Lucia Sossa Melo
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Santander, Colombia.,Clínica FOSCAL, Hematopoietic and Stem Cell Transplantation Unit, Floridablanca, Santander, Colombia
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21
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Gomes Dos Santos A, Watanabe EH, Ferreira DT, Oliveira J, Nakanishi ÉS, Oliveira CS, Bocchi E, Novaes CTG, Cruz F, Carvalho NB, Sato PK, Yamashiro-Kanashiro EH, Pontillo A, de Freitas VLT, Onuchic LF, Shikanai-Yasuda MA. A Specific IL6 Polymorphic Genotype Modulates the Risk of Trypanosoma cruzi Parasitemia While IL18, IL17A, and IL1B Variant Profiles and HIV Infection Protect Against Cardiomyopathy in Chagas Disease. Front Immunol 2020; 11:521409. [PMID: 33193300 PMCID: PMC7642879 DOI: 10.3389/fimmu.2020.521409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 09/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chagas disease caused by Trypanosoma cruzi (T. cruzi) affects approximately six million individuals worldwide. Clinical manifestations are expected to occur due to the parasite persistence and host immune response. Herein we investigated potential associations between IL1B, IL6, IL17A, or IL18 polymorphism profiles and cardiomyopathy or T. cruzi parasitemia, as well as the impact of HIV infection on cardiopathy. Methods Two hundred twenty-six patients and 90 control individuals were analyzed. IL1B rs1143627 T>C, IL6 rs1800795 C>G, IL17A rs2275913 G>A, IL18 rs187238 C>G, and IL18 rs1946518 C>A SNVs were analyzed by real-time PCR and T. cruzi parasitemia by PCR. Results Our data revealed association between a cytokine gene polymorphism and parasitemia never previously reported. The IL6 rs1800795 CG genotype lowered the risk of positive parasitemia (OR = 0.45, 95% CI 0.24–0.86, P = 0.015). Original findings included associations between IL17A rs2275913 AA and IL18 s1946518 AA genotypes with decreased risk of developing cardiomyopathy (OR = 0.27, 95% CI 0.07–0.97, P = 0.044; and OR = 0.35, 95% CI 0.14–0.87, P = 0.023, respectively). IL18 rs1946518 AA and IL1B rs1143627 TC were associated with reduced risk for cardiomyopathy severity, including NYHA (New York Heart Association) class ≥ 2 (OR = 0.21, 95% CI 0.06–0.68, P = 0.009; and OR = 0.48, 95% CI 0.24–0.95, P = 0.036, respectively) and LVEF (left ventricular ejection fraction) <45% for IL18 rs1946518 AA (OR = 0.22, 95% CI 0.05–0.89, P = 0.034). A novel, unexpected protective effect of HIV infection against development/progression of cardiomyopathy was identified, based on a lower risk of developing cardiopathy (OR = 0.48, 95% CI 0.23–0.96, P = 0.039), NYHA class ≥ 2 (OR = 0.15, 95% CI 0.06–0.39, P < 0.001), and LVEF < 45% (OR = 0.03, 95% CI 0.00–0.25, P = 0.001). Digestive involvement was negatively associated with NYHA ≥ 2 and LVEF < 45% (OR = 0.20, 95% CI 0.09–0.47, P < 0.001; and OR = 0.24, 95% CI 0.09–0.62, P = 0.004, respectively). Conclusions Our data support a protective role of IL17A AA, IL18 AA, and IL1B TC genotypes against development/progression of cardiomyopathy and a modulatory effect of the IL6 CG genotype on the risk of parasitemia in Chagas disease. Notably, HIV infection was shown to protect against development/progression of cardiopathy, potentially associated with a synergistic effect of HIV and highly active antiretroviral therapy (HAART), attenuating a Th1-mediated response in the myocardium. This proposed hypothesis requires confirmation, however, in larger and more comprehensive future studies.
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Affiliation(s)
- Alexandra Gomes Dos Santos
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Elieser Hitoshi Watanabe
- Department of Medicine, Divisions of Molecular Medicine and Nephrology, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Daiane Tomomi Ferreira
- Laboratory of Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Jamille Oliveira
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Érika Shimoda Nakanishi
- Laboratory of Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Claudia Silva Oliveira
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Edimar Bocchi
- Heart Institute, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | | | - Fatima Cruz
- Heart Institute, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Noemia Barbosa Carvalho
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Paula Keiko Sato
- Laboratory of Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Edite Hatsumi Yamashiro-Kanashiro
- Laboratory of Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil.,Instituto de Medicina Tropical, University of São Paulo, São Paulo, Brazil
| | - Alessandra Pontillo
- Departament of Immunology, Instituto de Ciências Biomédicas (ICB), University of São Paulo, São Paulo, Brazil
| | - Vera Lucia Teixeira de Freitas
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil.,Laboratory of Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Luiz Fernando Onuchic
- Department of Medicine, Divisions of Molecular Medicine and Nephrology, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Maria Aparecida Shikanai-Yasuda
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil.,Laboratory of Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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22
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Chagas disease: Historic perspective. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165689. [DOI: 10.1016/j.bbadis.2020.165689] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/02/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022]
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23
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Multani A, Meer A, Smith DS, Kheraj MN, Plowey ED, Blackburn BG. Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene. Emerg Infect Dis 2019; 25:1370-1372. [PMID: 31211674 PMCID: PMC6590746 DOI: 10.3201/eid2507.180285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of chagasic encephalitis diagnosed by 28S rRNA sequencing. The diagnosis of chagasic encephalitis is challenging, given the broad differential diagnosis for central nervous system lesions in immunocompromised patients and low sensitivity of traditional diagnostics. Sequencing should be part of the diagnostic armamentarium for potential chagasic encephalitis.
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24
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Michel-Todó L, Reche PA, Bigey P, Pinazo MJ, Gascón J, Alonso-Padilla J. In silico Design of an Epitope-Based Vaccine Ensemble for Chagas Disease. Front Immunol 2019; 10:2698. [PMID: 31824493 PMCID: PMC6882931 DOI: 10.3389/fimmu.2019.02698] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023] Open
Abstract
Trypanosoma cruzi infection causes Chagas disease, which affects 7 million people worldwide. Two drugs are available to treat it: benznidazole and nifurtimox. Although both are efficacious against the acute stage of the disease, this is usually asymptomatic and goes undiagnosed and untreated. Diagnosis is achieved at the chronic stage, when life-threatening heart and/or gut tissue disruptions occur in ~30% of those chronically infected. By then, the drugs' efficacy is reduced, but not their associated high toxicity. Given current deficiencies in diagnosis and treatment, a vaccine to prevent infection and/or the development of symptoms would be a breakthrough in the management of the disease. Current vaccine candidates are mostly based on the delivery of single antigens or a few different antigens. Nevertheless, due to the high biological complexity of the parasite, targeting as many antigens as possible would be desirable. In this regard, an epitope-based vaccine design could be a well-suited approach. With this aim, we have gone through publicly available databases to identify T. cruzi epitopes from several antigens. By means of a computer-aided strategy, we have prioritized a set of epitopes based on sequence conservation criteria, projected population coverage of Latin American population, and biological features of their antigens of origin. Fruit of this analysis, we provide a selection of CD8+ T cell, CD4+ T cell, and B cell epitopes that have <70% identity to human or human microbiome protein sequences and represent the basis toward the development of an epitope-based vaccine against T. cruzi.
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Affiliation(s)
- Lucas Michel-Todó
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Antonio Reche
- Laboratory of Immunomedicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Pascal Bigey
- Université de Paris, UTCBS, CNRS, INSERM, Paris, France.,PSL University, ChimieParisTech, Paris, France
| | - Maria-Jesus Pinazo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Joaquim Gascón
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Martinez F, Perna E, Perrone SV, Liprandi AS. Chagas Disease and Heart Failure: An Expanding Issue Worldwide. Eur Cardiol 2019; 14:82-88. [PMID: 31360228 PMCID: PMC6659042 DOI: 10.15420/ecr.2018.30.2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.
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Affiliation(s)
- Felipe Martinez
- Cordoba National University, Instituto DAMIC Córdoba, Argentina.,Docencia, Asistencia Médica e Investigación Clínica (DAMIC) Medical Institute, Rusculleda Foundation for Research Córdoba Argentina
| | - Eduardo Perna
- Coronary Care Unit and Heart Failure Division, Juana Cabral Cardiovascular Institute Corrientes, Argentina
| | - Sergio V Perrone
- El Cruce Hospital Buenos Aires, Argentina.,Argentine Catholic University Buenos Aires, Argentina
| | - Alvaro Sosa Liprandi
- Cardiovascular Division, Sanatorio Güemes Hospital Buenos Aires, Argentina.,Postgraduate Medical School in Cardiology Universidad de Buenos Aires, Argentina
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Schuurs TA, Koelewijn R, Brienen EAT, Kortbeek T, Mank TG, Mulder B, Stelma FF, van Lieshout L, van Hellemond JJ. Harmonization of PCR-based detection of intestinal pathogens: experiences from the Dutch external quality assessment scheme on molecular diagnosis of protozoa in stool samples. Clin Chem Lab Med 2019; 56:1722-1727. [PMID: 29451859 DOI: 10.1515/cclm-2017-1057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/23/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Real-time PCR methods are increasingly used in routine patient care settings not only to determine the presence or absence of pathogens in patient materials, but also to obtain semiquantitative results to estimate the pathogen load. However, it is so far unknown how well these methods are harmonized among different laboratories.
Methods:
Sets of stool samples were distributed three to four times per year to ca. 25–40 participating laboratories within the European Union as part of an external quality assessment scheme (EQAS) for the detection of gastrointestinal protozoa. This paper presents the results obtained over a 3-year period for Entamoeba histolytica, Entamoeba dispar, Giardia lamblia, Cryptosporidium species and Dientamoeba fragilis.
Results:
Although both false-positive and false-negative results were reported, the overall sensitivity and specificity were high. The substantial differences in the quantitative output of the real-time PCR assays could be traced back to differences in DNA isolation procedures between different laboratories.
Conclusions:
Participation in an EQAS proved to be important as it provides information on how the real-time PCR methods used by the participant compares to the generally reported results and indicates how procedures could be improved. Semiquantitative results of real-time PCR methods are not exchangeable between laboratories as long as the diagnostic procedures are not harmonized. Intralaboratory comparison of semiquantitative real-time PCR results seems only possible by the use of calibration curves derived from well-validated standards in clinical material and not by spiking solutions with purified DNA.
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Affiliation(s)
- Theo A Schuurs
- Centre for Infectious Diseases Friesland, Izore, Leeuwarden, the Netherlands
| | - Rob Koelewijn
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Eric A T Brienen
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Titia Kortbeek
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Theo G Mank
- Regional Laboratory for Medical Microbiology and Public Health, Haarlem, the Netherlands
| | - Bert Mulder
- Department of Medical Microbiology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Foekje F Stelma
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Esper HR, Freitas VLTD, Assy JGPL, Shimoda EY, Berreta OCP, Lopes MH, França FOS. Fatal evolution of acute Chagas disease in a child from Northern Brazil: factors that determine poor prognosis. Rev Inst Med Trop Sao Paulo 2019; 61:e27. [PMID: 31066753 PMCID: PMC6502456 DOI: 10.1590/s1678-9946201961027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
Trypanosoma cruzi is the causative agent of Chagas disease. Nowadays, the transmission in Brazil occurs mainly by oral ingestion of contaminated food that has been associated with more severe clinical manifestations. We report a case of Acute Chagas disease caused by oral transmission in a child from Northern Brazil. In the hospital admission, physical examination showed tachycardia, hepatomegaly, bipalpebral edema and anasarca. Trypanosoma cruzi trypomastigotes were found in microscopy during blood cell count. Twenty-three days before hospitalization, the child had ingested the "bacaba palm fruit's wine". Even with the appropriate diagnosis and starting of treatment, she did not survive. Quantitative analysis of Trypanosoma cruzi DNA in a blood sample resulted in 54,053.42 parasite equivalents/mL and the DTU TcIV was identified. The outcome may have been determined by several factors, including the delay to seek a medical service beyond the high parasitemia, detected by qPCR. DTU TcIV could also have influenced the natural history of the disease.
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Affiliation(s)
- Helena Rangel Esper
- Hospital Municipal, Santarém, Pará, Brazil.,Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil
| | | | | | - Erika Yoshie Shimoda
- Universidade de São Paulo, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM 48), São Paulo, São Paulo, Brazil
| | - Olivia Campos Pinheiro Berreta
- Hospital Municipal, Santarém, Pará, Brazil.,Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil
| | - Marta Heloisa Lopes
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM 48), São Paulo, São Paulo, Brazil
| | - Francisco Oscar Siqueira França
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM 48), São Paulo, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW Advancements in highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) has led to increased survival, approaching that of the general population. These patients are at an increased risk for heart disease, specifically HIV-associated cardiomyopathy. RECENT FINDINGS Initially, HIV-associated cardiomyopathy was predominantly noted as systolic dysfunction, but diastolic dysfunction has become more common with increased use of HAART. The pathogenesis of HIV-associated cardiomyopathy involves direct viral infection, cytokine activity, focal myocarditis, HAART side effects, immune system dysregulation, and/or ischemia. If cardiomyopathy is diagnosed, an HIV patient should be started, or continued, on HAART and initiated on guideline-directed medical therapy (GDMT) per the ACC/AHA guidelines. The safety and efficacy of mechanical circulatory support and heart transplant in this population has been repeatedly demonstrated, but it remains less available compared with the general advanced heart failure population. SUMMARY The widespread use of HAART has led to prolonged survival in HIV patients to the point that cardiac disease has become the most common cause of death. Patients should be treated with HAART for HIV and GDMT for heart failure. Patients progressing to end-stage heart failure should be referred for advanced therapies to centers with experience treating HIV patients.
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Espinosa-Pereiro J, Sánchez-Montalvá A, Salvador F, Sao-Avilés A, Sulleiro E, Molina I. A retrospective study on the influence of siblings' relatedness in Bolivian patients with chronic Chagas disease. Parasit Vectors 2019; 12:260. [PMID: 31126327 PMCID: PMC6533702 DOI: 10.1186/s13071-019-3518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chagas disease is a protozoan infection caused by Trypanosoma cruzi. The disease has a chronic course in which 20-30% of the patients would develop progressive damage to the cardiovascular system and the gastrointestinal tube. We are still unable to predict who will develop end-organ damage but there are some acquired and genetic risk factors already known. RESULTS We reviewed data from 833 patients with serologically confirmed Chagas disease in this retrospective study. Patients were classified as siblings or non-siblings (controls) and the results of pre-treatment blood PCR assay, end-organ damage (cardiac and/or gastrointestinal), and the presence of delayed type hypersensitivity (DTH) skin involvement in patients treated with benznidazole were analyzed. Siblings were grouped by family and we randomly generated groups of 2 or 3 persons with the remaining controls. We classified the results of each variable as concordant or discordant and compared the concordance in these results among the sibling groups with that among control groups. We identified 71 groups of siblings and randomly generated 299 groups of non-related patients. Pre-treatment blood PCR concordance was significantly higher (19%) among siblings compared to controls (P = 0.02), probably due to a higher frequency in pre-treatment positive results. No other statistically significant differences were found. CONCLUSIONS A significant difference was found in the concordance of pre-treatment blood PCR for T. cruzi among siblings compared to non-related controls.
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Affiliation(s)
- Juan Espinosa-Pereiro
- Infectious Diseases Department, Vall d’Hebron University Hospital, Programa de Salut Internacional de l’Institut Català de la Salut (PROSICS), Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d’Hebron University Hospital, Programa de Salut Internacional de l’Institut Català de la Salut (PROSICS), Barcelona, Spain
- Vall d’Hebron Resarch Institute, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall d’Hebron University Hospital, Programa de Salut Internacional de l’Institut Català de la Salut (PROSICS), Barcelona, Spain
- Vall d’Hebron Resarch Institute, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Augusto Sao-Avilés
- Infectious Diseases Department, Vall d’Hebron University Hospital, Programa de Salut Internacional de l’Institut Català de la Salut (PROSICS), Barcelona, Spain
- Cardiac Imaging Unit, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Infectious Diseases Department, Vall d’Hebron University Hospital, Programa de Salut Internacional de l’Institut Català de la Salut (PROSICS), Barcelona, Spain
- Vall d’Hebron Resarch Institute, University Hospital Vall d’Hebron, Barcelona, Spain
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30
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Smith K, Marcos LA. Pathogenesis of Chagas Disease: an Emphasis for Transplant Patient Populations. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-0168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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31
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Egui A, Lasso P, Pérez-Antón E, Thomas MC, López MC. Dynamics of T Cells Repertoire During Trypanosoma cruzi Infection and its Post-Treatment Modulation. Curr Med Chem 2018; 26:6519-6543. [PMID: 30381063 DOI: 10.2174/0929867325666181101111819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 09/11/2018] [Accepted: 09/25/2018] [Indexed: 01/16/2023]
Abstract
Chagas disease courses with different clinical phases and has a variable clinical presentation and progression. The acute infection phase mostly exhibits a non-specific symptomatology. In the absence of treatment, the acute phase is followed by a chronic phase, which is initially asymptomatic. This chronic asymptomatic phase of the disease is characterized by a fragile balance between the host's immune response and the parasite replication. The loss of this balance is crucial for the progression of the sickness. The virulence and tropism of the T. cruzi infecting strain together to the inflammation processes in the cardiac tissue are the main factors for the establishment and severity of the cardiomyopathy. The efficacy of treatment in chronic Chagas disease patients is controversial. However, several studies carried out in chronic patients demonstrated that antiparasitic treatment reduces parasite load in the bloodstream and leads to an improvement in the immune response against the Trypanosoma cruzi parasite. The present review is mainly focused on the cellular patterns associated to the clinical status and the evolution of the disease in chronic patients, as well as the effectiveness of the treatment related to T. cruzi infection control. Therefore, an emphasis is placed on the dynamics of specific-antigens T cell subpopulations, their memory and activation phenotypes, their functionality and their contribution to pathogenesis or disease control, as well as their association with risk of congenital transmission of the parasite.
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Affiliation(s)
- Adriana Egui
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - Paola Lasso
- Grupo de Inmunobiologia y Biologia Celular, Pontificia Universidad Javeriana; Bogota, Colombia
| | - Elena Pérez-Antón
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - M Carmen Thomas
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - Manuel Carlos López
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
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33
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Schijman AG. Molecular diagnosis of Trypanosoma cruzi. Acta Trop 2018; 184:59-66. [PMID: 29476727 DOI: 10.1016/j.actatropica.2018.02.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 01/01/2023]
Abstract
Chagas disease, caused by the kinetoplastid protozoan Trypanosoma cruzi, affects millions of people, most of them neglected populations. The different phases of the disease, the transmission mode and the high genetic variability of the parasite determine that molecular detection methods display different degree of success. Molecular diagnostic tests may be employed during epidemiological surveys of transmission, for early diagnosis of congenital transmission and acute infections due to oral transmission, transfusion or transplantation routes, reactivation due to immunosuppression and monitoring of treatment response in chronically infected patients receiving trypanocidal chemotherapy. This manuscript summarizes the most widely used molecular tools to detect T. cruzi infection in different epidemiological and clinical scenarios.
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Affiliation(s)
- Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Hector Torres" (INGEBI-CONICET), Ciudad de Buenos Aires, Argentina.
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34
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de Pablos Torró LM, Retana Moreira L, Osuna A. Extracellular Vesicles in Chagas Disease: A New Passenger for an Old Disease. Front Microbiol 2018; 9:1190. [PMID: 29910793 PMCID: PMC5992290 DOI: 10.3389/fmicb.2018.01190] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/16/2018] [Indexed: 12/13/2022] Open
Abstract
Extracellular vesicles (EVs) are small lipid vesicles released by prokaryotic and eukaryotic cells containing nucleic acids, proteins, and small metabolites essential for cellular communication. Depending on the targeted cell, EVs can act either locally or in distant tissues in a paracrine or endocrine cell signaling manner. Released EVs from virus-infected cells, bacteria, fungi, or parasites have been demonstrated to perform a pivotal role in a myriad of biochemical changes occurring in the host and pathogen, including the modulation the immune system. In the past few years, the biology of Trypanosoma cruzi EVs, as well as their role in innate immunity evasion, has been started to be unveiled. This review article will present findings on and provide a coherent understanding of the currently known mechanisms of action of T. cruzi-EVs and hypothesize the implication of these parasite components during the acute and chronic phases of Chagas disease.
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Affiliation(s)
- Luis M de Pablos Torró
- Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Campus de Fuentenueva, Universidad de Granada, Granada, Spain
| | - Lissette Retana Moreira
- Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Campus de Fuentenueva, Universidad de Granada, Granada, Spain
| | - Antonio Osuna
- Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Campus de Fuentenueva, Universidad de Granada, Granada, Spain
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35
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Yefi-Quinteros E, Muñoz-San Martín C, Bacigalupo A, Correa JP, Cattan PE. Trypanosoma cruzi load in synanthropic rodents from rural areas in Chile. Parasit Vectors 2018. [PMID: 29530074 PMCID: PMC5848452 DOI: 10.1186/s13071-018-2771-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi is the agent of Chagas disease, a major public health problem in Latin America. Many wild and domestic animals are naturally infected with T. cruzi; rodents are one of the groups which have been consistently detected infected in different countries. The aim of this work was to characterize blood T. cruzi load in naturally infected rodents from a Chagas disease endemic region in Chile. METHODS Baited traps were set in domestic and peridomestic areas of rural dwellings. The rodents were anesthetized and blood sampled; DNA was extracted and the parasite load was quantified by T. cruzi satellite DNA real-time PCR assays. RESULTS Seventy-one rodents of four species, Rattus rattus, Mus musculus, Phyllotis darwini and Octodon degus, were captured; R. rattus was the most abundant species. Fifty-nine samples (83.1%) were T. cruzi-positive and the median value of the parasite load was 2.99 parasite equivalents (par-eq)/ml. The comparison of frequency of infection or parasite load by species showed no differences. However, one R. rattus presented very elevated parasitemia (1644 par-eq/ml). CONCLUSIONS The overall levels of parasitemia were similar to those found in humans in Chile. The high infection levels in exotic and endemic rodents very near to rural settlements increases their relevance as T. cruzi hosts.
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Affiliation(s)
- Esteban Yefi-Quinteros
- Laboratorio de Ecología, Departamento de Ciencias Biológicas Animales, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Catalina Muñoz-San Martín
- Laboratorio de Ecología, Departamento de Ciencias Biológicas Animales, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Antonella Bacigalupo
- Laboratorio de Ecología, Departamento de Ciencias Biológicas Animales, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Juana P Correa
- Laboratorio de Ecología Evolutiva, Departamento de Ciencias Ecológicas, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Pedro E Cattan
- Laboratorio de Ecología, Departamento de Ciencias Biológicas Animales, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile.
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Balderramo D, Bonisconti F, Alcaraz A, Giordano E, Sánchez A, Barrabino M, Caeiro JP, Alvarellos T, Maraschio M. Chagas disease and liver transplantation: Experience in Argentina using real-time quantitative PCR for early detection and treatment. Transpl Infect Dis 2017; 19. [PMID: 28941300 DOI: 10.1111/tid.12782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/11/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chagas disease (CD) is an endemic zoonosis that occurs in Latin America and is caused by the parasite Trypanosoma cruzi. Early detection of T. cruzi in liver transplant recipients at risk may avoid complications from CD. The aim of this study was to examine the pre-operative evaluation and follow-up of CD after liver transplantation (LT) of patients at risk of CD using real-time quantitative polymerase chain reaction (qPCR) for T. cruzi. METHODS Between January 2009 and June 2016, 13 (12.7%) of 102 LTs performed in recipients at risk for CD without specific postoperative prophylaxis were prospectively evaluated using qPCR for T. cruzi. Four seronegative patients received livers from seropositive donors (R-/D+) and 9 seropositive recipients received livers from seronegative donors (R+/D-). A cohort of 89 patients without risk for CD during the same time period was analyzed as controls. RESULTS A positive qPCR for T. cruzi prior to LT was found in 2/9 (22.2%) seropositive recipients, and both achieved early response after therapy. The cumulative incidence of positive parasitemia after LT was higher in R+/D- than R-/D+ (37.7% vs 0%, P = .17). R+/D- transplant patients with positive qPCR achieved therapeutic response without manifestations of acute CD. LT outcomes at 1 year were similar in patients at risk of CD and in controls not at risk for CD. CONCLUSION A small proportion of T. cruzi-seropositive candidates presented positive parasitemia before LT. After LT, qPCR allowed detection of parasitemia leading to use of preemptive therapy in all R+/D- with T. cruzi replication. No cases of T. cruzi parasitemia occurred in R-/D+.
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Affiliation(s)
- Domingo Balderramo
- Liver Transplant Unit, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Florencia Bonisconti
- Laboratory of Molecular Diagnostics, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Alvaro Alcaraz
- Liver Transplant Unit, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Enzo Giordano
- Liver Transplant Unit, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Ariel Sánchez
- Laboratory of Molecular Diagnostics, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Martín Barrabino
- Liver Transplant Unit, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Juan Pablo Caeiro
- Department of Infectious Diseases, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Teresita Alvarellos
- Laboratory of Molecular Diagnostics, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Martín Maraschio
- Liver Transplant Unit, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
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Tozetto-Mendoza TR, de Moraes Vasconcelos D, Ibrahim KY, Sartori AMC, Bezerra RC, de Freitas VLT, Shikanai-Yasuda MA. Role of T. cruzi exposure in the pattern of T cell cytokines among chronically infected HIV and Chagas disease patients. Clinics (Sao Paulo) 2017; 72:652-660. [PMID: 29236910 PMCID: PMC5706062 DOI: 10.6061/clinics/2017(11)02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The impact of Chagas disease (CD) in HIV-infected patients is relevant throughout the world. In fact, the characterization of the adaptive immune response in the context of co-infection is important for predicting the need for interventions in areas in which HIV and Chagas disease co-exist. METHODS We described and compared the frequency of cytokine-producing T cells stimulated with soluble antigen of Trypanosoma cruzi (T. cruzi) using a cytometric assay for the following groups: individuals with chronic Chagas disease (CHR, n=10), those with Chagas disease and HIV infection (CO, n=11), those with only HIV (HIV, n=14) and healthy individuals (C, n=15). RESULTS We found 1) a constitutively lower frequency of IL-2+ and IFN-γ+ T cells in the CHR group compared with the HIV, CO and healthy groups; 2) a suppressive activity of soluble T. cruzi antigen, which down-regulated IL-2+CD4+ and IFN-γ+CD4+ phenotypes, notably in the healthy group; 3) a down-regulation of inflammatory cytokines on CD8+ T cells in the indeterminate form of Chagas disease; and 4) a significant increase in IL-10+CD8+ cells distinguishing the indeterminate form from the cardiac/digestive form of Chagas disease, even in the presence of HIV infection. CONCLUSIONS Taken together, our data suggest the presence of an immunoregulatory response in chronic Chagas disease, which seems to be driven by T. cruzi antigens. Our findings provide new insights into immunotherapeutic strategies for people living with HIV/AIDS and Chagas disease.
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Affiliation(s)
- Tania Regina Tozetto-Mendoza
- Laboratorio de Imunologia (LIM 48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Virologia (LIM 52), Universidade de Sao Paulo, Instituto de Medicina Tropical, Sao Paulo, SP, BR
- #These authors contributed equally to this work
| | - Dewton de Moraes Vasconcelos
- Laboratorio Dermatologia e Imunodeficiencias (LIM-56), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- #These authors contributed equally to this work
| | - Karim Yaqub Ibrahim
- Divisao de Doencas Infecciosas e Parasitarias, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ana Marli Christovam Sartori
- Divisao de Doencas Infecciosas e Parasitarias, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rita C. Bezerra
- Laboratorio de Parasitologia (LIM 46), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vera Lúcia Teixeira de Freitas
- Laboratorio de Imunologia (LIM 48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Doencas Infecciosas e Parasitarias, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Aparecida Shikanai-Yasuda
- Laboratorio de Imunologia (LIM 48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Doencas Infecciosas e Parasitarias, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Benvenuti LA, Roggério A, Cavalcanti MM, Nishiya AS, Levi JE. An autopsy-based study of Trypanosoma cruzi persistence in organs of chronic chagasic patients and its relevance for transplantation. Transpl Infect Dis 2017; 19. [PMID: 28945308 DOI: 10.1111/tid.12783] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/21/2017] [Accepted: 07/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chagas' disease (CD) is caused by infection with the protozoan Trypanosoma cruzi. The disease can affect the heart and/or the gastrointestinal (GI) tract, but around 70% of infected individuals remain asymptomatic in the chronic form. Organ transplantation from T. cruzi-infected donors is often avoided because of the risk of disease transmission, previously reported after heart, kidney, or liver transplantation. METHODS We investigated by histology, immunohistochemistry, and polymerase chain reaction (PCR) the persistence of T. cruzi in samples of the heart, lung, liver, kidney, pancreas, adrenal gland, esophagus, and GI tract of 21 chronic chagasic patients. RESULTS Parasite persistence was detected in 12/21 (57.1%) heart samples, mainly by PCR-based assays. T. cruzi parasites were detected by histology and immunohistochemistry in smooth muscle cells of the central vein from 1/21 (4.8%) adrenal gland samples. No samples of the lung, liver, kidney, pancreas, esophagus, or GI tract were found to have parasites by histology, immunohistochemistry, or PCR. CONCLUSIONS We concluded that, aside from the heart, the other solid organs of T. cruzi-infected donors can be used for transplantation with a lot of caution. Such organs are not safe in the view of previous reports of CD transmission, but seem to present a low T. cruzi load compared to the heart.
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Affiliation(s)
- Luiz A Benvenuti
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alessandra Roggério
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marta M Cavalcanti
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anna S Nishiya
- Molecular Biology Department, Fundação Pró-Sangue/São Paulo Blood Center, São Paulo, SP, Brazil
| | - José E Levi
- Molecular Biology Department, Fundação Pró-Sangue/São Paulo Blood Center, São Paulo, SP, Brazil
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The challenging diagnosis of Chagas disease reactivation in endomyocardial biopsies from heart-transplanted patients. J Heart Lung Transplant 2017; 36:1360-1361. [PMID: 28869079 DOI: 10.1016/j.healun.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 01/30/2023] Open
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Cura CI, Ramírez JC, Rodríguez M, Lopez-Albízu C, Irazu L, Scollo K, Sosa-Estani S. Comparative Study and Analytical Verification of PCR Methods for the Diagnosis of Congenital Chagas Disease. J Mol Diagn 2017; 19:673-681. [PMID: 28727985 DOI: 10.1016/j.jmoldx.2017.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022] Open
Abstract
Congenital infection is currently the first cause of new cases of Chagas disease in Argentina and nonendemic areas worldwide. Its diagnosis is of utmost importance to guarantee curative treatment. To improve such diagnosis, a transfer process of PCR tests to the national laboratory network has been initiated. We performed a comparative study of four PCR assays [two end-point PCR and two duplex real-time quantitative PCR (qPCR) procedures] to detect Trypanosoma cruzi DNA in blood samples. Because satellite DNA and kinetoplastid DNA qPCR methods showed the best performance and the use of two different molecular targets for confirmatory purposes has been recommended, these methods were selected to perform the transfer process and, in consequence, subjected to an analytical verification protocol based on international guidelines. The anticipated reportable range was verified between 0.25 and 105 parasite equivalents per milliliter of blood (par. eq./mL) for both qPCR methods, and the limit of detection was estimated to be 0.87 (95% CI, 0.62-1.24) and 0.43 (95% CI, 0.32-0.59) par. eq./mL for satellite DNA and kinetoplastid DNA qPCR methods, respectively. In addition, both qPCR methods showed trueness and verified precision in the highest and the lowest concentrations tested. This work provides critical knowledge of the technology transfer process planned to cover laboratories of the regional network with known installed facilities.
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Affiliation(s)
- Carolina I Cura
- National Institute of Parasitology "Dr. Mario Fatala Chaben", Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
| | - Juan C Ramírez
- Institute of Investigation in Genetic Engineering and Molecular Biology "Dr. Héctor N. Torres", Buenos Aires, Argentina
| | - Marcelo Rodríguez
- National Institute of Infectious Diseases, National Laboratories and Health Institutes Administration "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Constanza Lopez-Albízu
- National Institute of Parasitology "Dr. Mario Fatala Chaben", Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Lucía Irazu
- National Institute of Infectious Diseases, National Laboratories and Health Institutes Administration "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Karenina Scollo
- National Institute of Parasitology "Dr. Mario Fatala Chaben", Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- National Institute of Parasitology "Dr. Mario Fatala Chaben", Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Shikanai Yasuda MA, Sátolo CG, Carvalho NB, Atala MM, Ferrufino RQ, Leite RM, Furucho CR, Luna E, Silva RA, Hage M, de Oliveira CMR, Busser FD, de Freitas VLT, Wanderley DMV, Martinelli L, Almeida SR, Viñas PA, Carneiro N. Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo. PLoS Negl Trop Dis 2017; 11:e0005466. [PMID: 28333923 PMCID: PMC5380346 DOI: 10.1371/journal.pntd.0005466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 04/04/2017] [Accepted: 03/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Methods In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. Results The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. Conclusion An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system. Chagas disease affects approximately 6 million Latin American people. It is considered a neglected tropical disease since it mainly affects vulnerable, poverty-stricken people. Public health policies and investments in research on new treatment and control instruments have not been prioritized. In fact, disease urbanization occurred in Latin America in the 80s, and an estimated 15 million people moved from disease-endemic areas to nonendemic areas. Estimations have indicated that 2.9% of immigrants were infected by T. cruzi in 15 European countries, and more than 300,000 infected immigrants resided in the USA. In São Paulo, the estimated number of Bolivian immigrants exceeds 300,000. This study revealed the presence of mild clinical manifestations in predominantly young infected individuals, including reproductive-age women. For the first time, the feasibility of managing chronic Chagas disease at primary healthcare level centers with a biomedical and psychosocial interdisciplinary approach has been reported in the National Public Health System of Brazil. Additionally, the utilized commercial tests did not confirm the previously expected performance for diagnosis of infection. Finally, the itinerant characteristics of the Bolivian immigrant population was reported as a main factor underlying the lack of adherence to antiparasitic treatment and a main challenge for complete clinical management.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Camila Gonçalves Sátolo
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Noemia Barbosa Carvalho
- Division of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Magda Maya Atala
- Hospital das Clínicas, Faculdade de Medicina Ribeirão Preto of the University of São Paulo, São Paulo, Brazil
| | - Rosario Quiroga Ferrufino
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Ruth Moreira Leite
- Centro de Vigilância Epidemiológica, Coordenadoria de Controle de Doenças da Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Célia Regina Furucho
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Expedito Luna
- Tropical Medicine Institute of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Rubens Antonio Silva
- Superintendência de Controle de Endemias, Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Marcia Hage
- Laboratory of Parasitology (LIM 46), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | | | - Felipe Delatorre Busser
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Vera Lucia Teixeira de Freitas
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | | | - Luzia Martinelli
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Sonia Regina Almeida
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Pedro Albajar Viñas
- Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| | - Nivaldo Carneiro
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Social Medicine, School of Medical Sciences of Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Stauffert D, Silveira MFD, Mesenburg MA, Manta AB, Dutra ADS, Bicca GLDO, Villela MM. Prevalence of Trypanosoma cruzi/HIV coinfection in southern Brazil. Braz J Infect Dis 2016; 21:180-184. [PMID: 27914221 PMCID: PMC9427564 DOI: 10.1016/j.bjid.2016.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 12/12/2022] Open
Abstract
Chagas disease reactivation has been a defining condition for acquired immune deficiency syndrome in Brazil for individuals coinfected with Trypanosoma cruzi and HIV since 2004. Although the first coinfection case was reported in the 1980s, its prevalence has not been firmly established. In order to know coinfection prevalence, a cross-sectional study of 200 HIV patients was performed between January and July 2013 in the city of Pelotas, in southern Rio Grande do Sul, an endemic area for Chagas disease. Ten subjects were found positive for T. cruzi infection by chemiluminescence microparticle immunoassay and indirect immunofluorescence. The survey showed 5% coinfection prevalence among HIV patients (95% CI: 2.0–8.0), which was 3.8 times as high as that estimated by the Ministry of Health of Brazil. Six individuals had a viral load higher than 100,000 copies per μL, a statistically significant difference for T. cruzi presence. These findings highlight the importance of screening HIV patients from Chagas disease endemic areas.
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Affiliation(s)
- Dulce Stauffert
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Saúde Materno-Infantil, Pelotas, RS, Brazil; Universidade Federal de Pelotas, Instituto de Biologia, Programa de Pós-graduação em Parasitologia, Pelotas, RS, Brazil
| | - Mariangela Freitas da Silveira
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Saúde Materno-Infantil, Pelotas, RS, Brazil; Universidade Federal de Pelotas, Programa Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Marília Arndt Mesenburg
- Universidade Federal de Pelotas, Programa Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Adriane Brod Manta
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Saúde Materno-Infantil, Pelotas, RS, Brazil
| | - Alessandra da Silva Dutra
- Universidade Federal de Pelotas, Instituto de Biologia, Programa de Pós-graduação em Parasitologia, Pelotas, RS, Brazil
| | | | - Marcos Marreiro Villela
- Universidade Federal de Pelotas, Instituto de Biologia, Programa de Pós-graduação em Parasitologia, Pelotas, RS, Brazil.
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Dias JCP, Ramos Jr. AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, Torres RM, Melo JRDC, Almeida EAD, Oliveira Jr. WD, Silveira AC, Rezende JMD, Pinto FS, Ferreira AW, Rassi A, Fragata Filho AA, Sousa ASD, Correia D, Jansen AM, Andrade GMQ, Britto CFDPDC, Pinto AYDN, Rassi Jr. A, Campos DE, Abad-Franch F, Santos SE, Chiari E, Hasslocher-Moreno AM, Moreira EF, Marques DSDO, Silva EL, Marin-Neto JA, Galvão LMDC, Xavier SS, Valente SADS, Carvalho NB, Cardoso AV, Silva RAE, Costa VMD, Vivaldini SM, Oliveira SM, Valente VDC, Lima MM, Alves RV. 2 nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop 2016; 49Suppl 1:3-60. [DOI: 10.1590/0037-8682-0505-2016] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
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Klahr JI, Uribe AM, Roa N, González JM. Inmunidad celular en la patogénesis de la cardiopatía chagásica crónica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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45
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Enriquez GF, Garbossa G, Macchiaverna NP, Argibay HD, Bua J, Gürtler RE, Cardinal MV. Is the infectiousness of dogs naturally infected with Trypanosoma cruzi associated with poly-parasitism? Vet Parasitol 2016; 223:186-94. [PMID: 27198799 DOI: 10.1016/j.vetpar.2016.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 12/11/2022]
Abstract
Interactions among different species of parasites co-infecting the same host could be synergistic or antagonistic. These interactions may modify both the frequency of infected hosts and their infectiousness, and therefore impact on transmission dynamics. This study determined the infectiousness of Trypanosoma cruzi-seropositive dogs (using xenodiagnosis) and their parasite load (quantified by qPCR), and tested the association between both variables and the presence of concomitant endoparasites. A cross-sectional serosurvey conducted in eight rural villages from Pampa del Indio and neighboring municipalities (northeastern Argentina) detected 32 T. cruzi-seropositive dogs out of 217 individuals examined for infection. Both the infectiousness to the vector Triatoma infestans and parasite load of T. cruzi-seropositive dogs examined were heterogeneous. A statistically significant, nine-fold higher mean infectiousness was registered in T. cruzi-seropositive dogs co-infected with Ancylostoma caninum and a trematode than in T. cruzi-seropositive dogs without these infections. The median parasite load of T. cruzi was also significantly higher in dogs co-infected with these helminths. An opposite trend was observed in T. cruzi-seropositive dogs that were serologically positive to Toxoplasma gondii or Neospora caninum relative to dogs seronegative for these parasites. Using multiple logistic regression analysis with random effects, we found a positive and significant association between the infectiousness of T. cruzi-seropositive dogs and co-infections with A. caninum and a trematode. Our results suggest that co-infections may be a modifier of host infectiousness in dogs naturally infected with T. cruzi.
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Affiliation(s)
- G F Enriquez
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - G Garbossa
- Laboratory of Clinical and Environmental Parasitology, Faculty of Exact and Natural Sciences, University of Buenos Aires, (IQUIBICEN-CONICET-UBA), Public Health Research Institute, Argentina
| | - N P Macchiaverna
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - H D Argibay
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - J Bua
- National Institute of Parasitology Dr. M. Fatala Chaben, National Administration of Laboratories and Institutes of Health Dr. C.G. Malbrán, Buenos Aires, Argentina
| | - R E Gürtler
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - M V Cardinal
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina.
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46
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Hing S, Currie A, Broomfield S, Keatley S, Jones K, Thompson RCA, Narayan E, Godfrey SS. Host stress physiology and Trypanosoma haemoparasite infection influence innate immunity in the woylie (Bettongia penicillata). Comp Immunol Microbiol Infect Dis 2016; 46:32-9. [PMID: 27260808 DOI: 10.1016/j.cimid.2016.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
Abstract
Understanding immune function is critical to conserving wildlife in view of infectious disease threats, particularly in threatened species vulnerable to stress, immunocompromise and infection. However, few studies examine stress, immune function and infection in wildlife. We used a flow cytometry protocol developed for human infants to assess phagocytosis, a key component of innate immunity, in a critically endangered marsupial, the woylie (Bettongia penicillata). The effects of stress physiology and Trypanosoma infection on phagocytosis were investigated. Blood and faecal samples were collected from woylies in a captive facility over three months. Trypanosoma status was determined using PCR. Faecal cortisol metabolites (FCM) were quantified by enzyme-immunoassay. Mean phagocytosis measured was >90%. An interaction between sex and FCM influenced the percentage of phagocytosing leukocytes, possibly reflecting the influence of sex hormones and glucocorticoids. An interaction between Trypanosoma status and FCM influenced phagocytosis index, suggesting that stress physiology and infection status influence innate immunity.
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Affiliation(s)
- Stephanie Hing
- Murdoch University, School of Veterinary and Life Sciences, 90 South Street, Murdoch, Western Australia 6150, Australia.
| | - Andrew Currie
- Murdoch University, School of Veterinary and Life Sciences, 90 South Street, Murdoch, Western Australia 6150, Australia
| | - Steven Broomfield
- Health Innovation Research Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
| | - Sarah Keatley
- Murdoch University, School of Veterinary and Life Sciences, 90 South Street, Murdoch, Western Australia 6150, Australia
| | - Krista Jones
- Murdoch University, School of Veterinary and Life Sciences, 90 South Street, Murdoch, Western Australia 6150, Australia
| | - R C Andrew Thompson
- Murdoch University, School of Veterinary and Life Sciences, 90 South Street, Murdoch, Western Australia 6150, Australia
| | - Edward Narayan
- Charles Sturt University, School of Animal and Veterinary Science, Boorooma Street, Wagga Wagga, NSW 2678, Australia
| | - Stephanie S Godfrey
- Murdoch University, School of Veterinary and Life Sciences, 90 South Street, Murdoch, Western Australia 6150, Australia
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Use of a Chagas Urine Nanoparticle Test (Chunap) to Correlate with Parasitemia Levels in T. cruzi/HIV Co-infected Patients. PLoS Negl Trop Dis 2016; 10:e0004407. [PMID: 26919324 PMCID: PMC4768913 DOI: 10.1371/journal.pntd.0004407] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early diagnosis of reactivated Chagas disease in HIV patients could be lifesaving. In Latin America, the diagnosis is made by microscopical detection of the T. cruzi parasite in the blood; a diagnostic test that lacks sensitivity. This study evaluates if levels of T. cruzi antigens in urine, determined by Chunap (Chagas urine nanoparticle test), are correlated with parasitemia levels in T. cruzi/HIV co-infected patients. METHODOLOGY/PRINCIPAL FINDINGS T. cruzi antigens in urine of HIV patients (N = 55: 31 T. cruzi infected and 24 T. cruzi serology negative) were concentrated using hydrogel particles and quantified by Western Blot and a calibration curve. Reactivation of Chagas disease was defined by the observation of parasites in blood by microscopy. Parasitemia levels in patients with serology positive for Chagas disease were classified as follows: High parasitemia or reactivation of Chagas disease (detectable parasitemia by microscopy), moderate parasitemia (undetectable by microscopy but detectable by qPCR), and negative parasitemia (undetectable by microscopy and qPCR). The percentage of positive results detected by Chunap was: 100% (7/7) in cases of reactivation, 91.7% (11/12) in cases of moderate parasitemia, and 41.7% (5/12) in cases of negative parasitemia. Chunap specificity was found to be 91.7%. Linear regression analysis demonstrated a direct relationship between parasitemia levels and urine T. cruzi antigen concentrations (p<0.001). A cut-off of > 105 pg was chosen to determine patients with reactivation of Chagas disease (7/7). Antigenuria levels were 36.08 times (95% CI: 7.28 to 64.88) higher in patients with CD4+ lymphocyte counts below 200/mL (p = 0.016). No significant differences were found in HIV loads and CD8+ lymphocyte counts. CONCLUSION Chunap shows potential for early detection of Chagas reactivation. With appropriate adaptation, this diagnostic test can be used to monitor Chagas disease status in T. cruzi/HIV co-infected patients.
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48
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Bern C. Reply to Henao-Martínez, et al. Clin Infect Dis 2016; 62:408. [PMID: 26420799 DOI: 10.1093/cid/civ864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco
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49
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Navarrete-Dechent C, Majerson D, Torres M, Armijo D, Patel M, Menter A, de la Cruz C. Use of tumor necrosis factor alpha (TNF α) antagonists in a patient with psoriasis and Chagas disease. An Bras Dermatol 2016; 90:171-4. [PMID: 26312707 PMCID: PMC4540541 DOI: 10.1590/abd1806-4841.20153538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/28/2014] [Indexed: 11/18/2022] Open
Abstract
There are several studies on the benefits of using TNFα antagonists in the
treatment of psoriasis, but few studies addressing the interaction of these drugs
with chronic infections. We report the case of a 52-year-old patient diagnosed with
psoriasis refractory to traditional systemic agents, who was treated with biologic
therapies. After one year of treatment with biologic agents, the patient was
diagnosed with Chagas Disease.
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Affiliation(s)
| | | | - Marisa Torres
- Pontificia Universidad Católica de Chile, Santiago, CL
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do Brasil PEAA, Castro R, de Castro L. Commercial enzyme-linked immunosorbent assay versuspolymerase chain reaction for the diagnosis of chronic Chagas disease: a systematic review and meta-analysis. Mem Inst Oswaldo Cruz 2016; 111:1-19. [PMID: 26814640 PMCID: PMC4727431 DOI: 10.1590/0074-02760150296] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022] Open
Abstract
Chronic Chagas disease diagnosis relies on laboratory tests due to its clinical characteristics. The aim of this research was to review commercial enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) diagnostic test performance. Performance of commercial ELISA or PCR for the diagnosis of chronic Chagas disease were systematically searched in PubMed, Scopus, Embase, ISI Web, and LILACS through the bibliography from 1980-2014 and by contact with the manufacturers. The risk of bias was assessed with QUADAS-2. Heterogeneity was estimated with the I2 statistic. Accuracies provided by the manufacturers usually overestimate the accuracy provided by academia. The risk of bias is high in most tests and in most QUADAS dimensions. Heterogeneity is high in either sensitivity, specificity, or both. The evidence regarding commercial ELISA and ELISA-rec sensitivity and specificity indicates that there is overestimation. The current recommendation to use two simultaneous serological tests can be supported by the risk of bias analysis and the amount of heterogeneity but not by the observed accuracies. The usefulness of PCR tests are debatable and health care providers should not order them on a routine basis. PCR may be used in selected cases due to its potential to detect seronegative subjects.
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Affiliation(s)
| | - Rodolfo Castro
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro
Chagas, Laboratório de Pesquisa Clínica em DST e AIDS
- Universidade Federal do Estado do Rio de Janeiro, Instituto de Saúde
Coletiva, Rio de Janeiro, RJ, Brasil
| | - Liane de Castro
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro
Chagas, Laboratório de Farmacogenética, Rio de Janeiro, RJ, Brasil
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