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Silvestrini MMA, Alessio GD, Frias BED, Sales Júnior PA, Araújo MSS, Silvestrini CMA, Brito Alvim de Melo GE, Martins-Filho OA, Teixeira-Carvalho A, Martins HR. New insights into Trypanosoma cruzi genetic diversity, and its influence on parasite biology and clinical outcomes. Front Immunol 2024; 15:1342431. [PMID: 38655255 PMCID: PMC11035809 DOI: 10.3389/fimmu.2024.1342431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, remains a serious public health problem worldwide. The parasite was subdivided into six distinct genetic groups, called "discrete typing units" (DTUs), from TcI to TcVI. Several studies have indicated that the heterogeneity of T. cruzi species directly affects the diversity of clinical manifestations of Chagas disease, control, diagnosis performance, and susceptibility to treatment. Thus, this review aims to describe how T. cruzi genetic diversity influences the biology of the parasite and/or clinical parameters in humans. Regarding the geographic dispersion of T. cruzi, evident differences were observed in the distribution of DTUs in distinct areas. For example, TcII is the main DTU detected in Brazilian patients from the central and southeastern regions, where there are also registers of TcVI as a secondary T. cruzi DTU. An important aspect observed in previous studies is that the genetic variability of T. cruzi can impact parasite infectivity, reproduction, and differentiation in the vectors. It has been proposed that T. cruzi DTU influences the host immune response and affects disease progression. Genetic aspects of the parasite play an important role in determining which host tissues will be infected, thus heavily influencing Chagas disease's pathogenesis. Several teams have investigated the correlation between T. cruzi DTU and the reactivation of Chagas disease. In agreement with these data, it is reasonable to suppose that the immunological condition of the patient, whether or not associated with the reactivation of the T. cruzi infection and the parasite strain, may have an important role in the pathogenesis of Chagas disease. In this context, understanding the genetics of T. cruzi and its biological and clinical implications will provide new knowledge that may contribute to additional strategies in the diagnosis and clinical outcome follow-up of patients with Chagas disease, in addition to the reactivation of immunocompromised patients infected with T. cruzi.
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Affiliation(s)
| | - Glaucia Diniz Alessio
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Estefânia Diniz Frias
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Policarpo Ademar Sales Júnior
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Márcio Sobreira Silva Araújo
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Olindo Assis Martins-Filho
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Andréa Teixeira-Carvalho
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Helen Rodrigues Martins
- Department of Pharmacy, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
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Rios LE, Lokugamage N, Garg NJ. Effects of Acute and Chronic Trypanosoma cruzi Infection on Pregnancy Outcomes in Mice: Parasite Transmission, Mortality, Delayed Growth, and Organ Damage in Pups. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:313-331. [PMID: 36565805 PMCID: PMC10013038 DOI: 10.1016/j.ajpath.2022.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/20/2022] [Accepted: 11/30/2022] [Indexed: 12/22/2022]
Abstract
Chagas disease is caused by Trypanosoma cruzi. This study aimed to determine the effects of T. cruzi infection on fertility rate and health of the newborn pups in pregnant mice. Female mice were challenged with T. cruzi and mated at 21 days (acute parasitemic phase) or 90 days (chronic parasite persistence phase) after infection. Pups were examined for growth up to 20 days after birth; and parasite burden in brain, heart, skeletal muscle, and intestine was measured by real-time quantitative PCR. The inflammatory infiltrate, necrosis, and fibrosis in pups' heart and brain tissues were evaluated by histology. T. cruzi infection in dams delayed the onset of pregnancy, decreased the fertility rate, and led to vertical transmission of parasite to the pups. Furthermore, infected dams delivered pups that exhibited decreased survival rate, decreased birth weight, and decreased growth rate. Significantly increased inflammation, necrosis, and fibrosis of cardiac and brain tissues were noted in pups born to infected dams. Initial challenge with higher parasite dose had more detrimental effects on fertility rate and pups' health in both acutely and chronically infected dams. In conclusion, mice offer a promising model to evaluate the efficacy of new vaccines and therapeutic drugs in controlling the acute and chronic maternal T. cruzi infection and congenital transmission to newborns, and in improving the fertility rate and pups' health outcomes.
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Affiliation(s)
- Lizette E Rios
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas; Department of Biochemistry, Cellular and Molecular Biology, University of Texas Medical Branch, Galveston, Texas
| | - Nandadeva Lokugamage
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas
| | - Nisha J Garg
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas; Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas.
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Faral-Tello P, Greif G, Romero S, Cabrera A, Oviedo C, González T, Libisch G, Arévalo AP, Varela B, Verdes JM, Crispo M, Basmadjián Y, Robello C. Trypanosoma cruzi Isolates Naturally Adapted to Congenital Transmission Display a Unique Strategy of Transplacental Passage. Microbiol Spectr 2023; 11:e0250422. [PMID: 36786574 PMCID: PMC10100920 DOI: 10.1128/spectrum.02504-22] [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: 07/13/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023] Open
Abstract
Chagas disease is mainly transmitted by vertical transmission (VT) in nonendemic areas and in endemic areas where vector control programs have been successful. For the present study, we isolated natural Trypanosoma cruzi strains vertically transmitted through three generations and proceeded to study their molecular mechanism of VT using mice. No parasitemia was detected in immunocompetent mice, but the parasites were able to induce an immune response and colonize different organs. VT experiments revealed that infection with different strains did not affect mating, pregnancy, or resorption, but despite low parasitemia, VT strains reached the placenta and resulted in higher vertical transmission rates than strains of either moderate or high virulence. While the virulent strain modulated more than 2,500 placental genes, VT strains modulated 150, and only 29 genes are shared between them. VT strains downregulated genes associated with cell division and replication and upregulated immunomodulatory genes, leading to anti-inflammatory responses and tolerance. The virulent strain stimulated a strong proinflammatory immune response, and this molecular footprint correlated with histopathological analyses. We describe a unique placental response regarding the passage of T. cruzi VT isolates across the maternal-fetal interphase, challenging the current knowledge derived mainly from studies of laboratory-adapted or highly virulent strains. IMPORTANCE The main findings of this study are that we determined that there are Trypanosoma cruzi strains adapted to transplacental transmission and completely different from the commonly used laboratory reference strains. This implies a specific strategy for the vertical transmission of Chagas disease. It is impressive that the strains specialized for vertical transmission modify the gene expression of the placenta in a totally different way than the reference strains. In addition, we describe isolates of T. cruzi that cannot be transmitted transplacentally. Taken together, these results open up new insights into the molecular mechanisms of this insect vector-independent transmission form.
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Affiliation(s)
- Paula Faral-Tello
- Laboratorio de Interacciones Hospedero Patógeno/UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Gonzalo Greif
- Laboratorio de Interacciones Hospedero Patógeno/UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Selva Romero
- Departamento de Parasitología y Micología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Andrés Cabrera
- Laboratorio de Interacciones Hospedero Patógeno/UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
- Departamento de Parasitología y Micología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Unidad de Microbiología, Instituto de Patobiología, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Cristina Oviedo
- Departamento de Parasitología y Micología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Telma González
- Departamento de Parasitología y Micología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Gabriela Libisch
- Laboratorio de Interacciones Hospedero Patógeno/UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Ana Paula Arévalo
- Laboratory Animal Biotechnology Unit, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Belén Varela
- Unidad de Patología, Departamento de Patobiología, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - José Manuel Verdes
- Unidad de Patología, Departamento de Patobiología, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Martina Crispo
- Laboratory Animal Biotechnology Unit, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Yester Basmadjián
- Departamento de Parasitología y Micología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Carlos Robello
- Laboratorio de Interacciones Hospedero Patógeno/UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
- Departamento de Bioquímica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Torhorst CW, White ZS, Bhosale CR, Beatty NL, Wisely SM. Identification of the parasite, Trypanosoma cruzi, in multiple tissues of epidemiological significance in the Virginia opossum (Didelphis virginiana): Implications for environmental and vertical transmission routes. PLoS Negl Trop Dis 2022; 16:e0010974. [PMID: 36534706 PMCID: PMC9810149 DOI: 10.1371/journal.pntd.0010974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/03/2023] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Trypanosoma cruzi, a parasitic protozoan, is endemic to the Americas and the causative agent of Chagas disease in humans. In South America, opossums facilitate transmission via infected anal gland secretions in addition to transmission via triatomine vectors. In North America, the Virginia opossum is a reservoir host for the parasite with transmission routes that are not clearly defined. The unique biology of this marsupial provides the opportunity to investigate vertical transmission in this wildlife species in situ. Our objectives were to investigate alternative routes of transmission that may facilitate spillover into other species and to determine if vertical transmission was evident. METHODOLOGY/PRINCIPAL FINDINGS Virginia opossums were sampled at 10 trapping locations over a 10-month period in a 5-county region of north central Florida. Peripheral blood, fecal swabs, and anal gland secretions were collected from each adult individual, and peripheral blood was collected from joey opossums. Total DNA was extracted from each collected sample type, and T. cruzi infected individuals and the infecting Discrete Typing Unit (DTU) were identified using real time PCR methods. Adult Virginia opossums (n = 112) were infected with T. cruzi (51.8%, 95% CI [42.6-60.8%]) throughout the sampled period and at each location. T. cruzi DNA was found in each of the three biological sample types. Vertical transmission of T. cruzi was inferred in one litter of mother-dependent (n = 20, 5.0%, 95% CI [0.9-23.6%]) joey opossums where 2 joeys from this same litter were rtPCR positive for T. cruzi. CONCLUSIONS/SIGNIFICANCE We inferred vertical transmission from mother to neonate which may serve to amplify the prevalence of T. cruzi in adult Virginia opossums. T. cruzi DNA was detected in the anal gland secretions of Virginia opossums. Infected anal gland secretions suggest a possible environmental route of transmission for T. cruzi via the deposition of contaminated feces and spraint at wildlife latrines. Only DTU1 was identified in the sampled population which is consistent with human autochthonous cases in the United States.
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Affiliation(s)
- Carson W. Torhorst
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, Florida, United States of America
| | - Zoe S. White
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, Florida, United States of America
| | - Chanakya R. Bhosale
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, Florida, United States of America
| | - Norman L. Beatty
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Division of Infectious Diseases and Global Medicine, Department of Medicine in the College of Medicine, Gainesville, Florida, United States of America
| | - Samantha M. Wisely
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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Kamaruzaman INA, Ting HW, Mokhtar MAM, Yuan YK, Shah AWG, Hamid FFA, Zalati CWSCW, Shaharulnizim N, Reduan MFH, Abu-Bakar L. First case report on molecular detection of Trypanosoma lewisi in an urban rat in Kelantan, Malaysia: An accidental finding. J Adv Vet Anim Res 2021; 8:435-439. [PMID: 34722741 PMCID: PMC8520150 DOI: 10.5455/javar.2021.h531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This case report highlights the first detection of Trypanosoma lewisi, a blood protozoan parasite found in an urban rat in Kota Bharu, Kelantan. Materials and Methods: Rat trapping was carried out within the Kota Bharu vicinity near a local wet market. A total of 38 rats were captured and subjected to peripheral blood smearing using Giemsa stain. Positive rats were sent for histopathological analysis for the evaluation of the organ samples. Results: The presence of trypanosomes was found in one sample from a blood smear. This was connected to a histological lesion on kidney tissues, which revealed a high concentration of trypanosomes. Additionally, the positive sample was confirmed as T. lewisi based on molecular diagnosis via polymerase chain reaction and subsequent sequencing and phylogenetic analysis. Conclusions: This finding serves as a baseline for further surveillance on T. lewisi population among urban rats in Kelantan and possible zoonotic transmission to humans.
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Affiliation(s)
- Intan Noor Aina Kamaruzaman
- Department of Paraclinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Hong Wei Ting
- Department of Clinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Muhammad Aiman Mohd Mokhtar
- Department of Clinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Yong Kai Yuan
- Department of Clinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Azim Wafiy Gulam Shah
- Department of Clinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Fathin Faahimaah Abdul Hamid
- Department of Paraclinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Che Wan Salma Che Wan Zalati
- Department of Paraclinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Nurshahirah Shaharulnizim
- Department of Clinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Mohd Farhan Hanif Reduan
- Department of Clinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Luqman Abu-Bakar
- Department of Paraclinical Studies, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
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Carlier Y, Truyens C, Muraille E. Is Antibody-Dependent Enhancement of Trypanosoma cruzi Infection Contributing to Congenital/Neonatal Chagas Disease? Front Immunol 2021; 12:723516. [PMID: 34566981 PMCID: PMC8461104 DOI: 10.3389/fimmu.2021.723516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
The newborns of women infected with the parasite Trypanosoma cruzi (the agent of Chagas disease) can be infected either before birth (congenitally), or after birth (as e.g., by vector route). Congenital Chagas disease can induce high levels of neonatal morbidity and mortality. Parasite-infected pregnant women transmit antibodies to their fetus. Antibodies, by opsonizing parasites, can promote phagocytosis and killing of T. cruzi by cells expressing FcγR, on the mandatory condition that such cells are sufficiently activated in an inflammatory context. Antibody-dependent enhancement (ADE) is a mechanism well described in viral infections, by which antibodies enhance entry of infectious agents into host cells by exploiting the phagocytic FcγR pathway. Previously reported Chagas disease studies highlighted a severe reduction of the maternal-fetal/neonatal inflammatory context in parasite-transmitting pregnant women and their congenitally infected newborns. Otherwise, experimental observations brought to light ADE of T. cruzi infection (involving FcγR) in mouse pups displaying maternally transferred antibodies, out of an inflammatory context. Herein, based on such data, we discuss the previously unconsidered possibility of a role of ADE in the trans-placental parasite transmission, and/or the development of severe and mortal clinical forms of congenital/neonatal Chagas disease in newborns of T. cruzi-infected mothers.
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Affiliation(s)
- Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.,Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Eric Muraille
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Silberstein E, Kim KS, Acosta D, Debrabant A. Human Placental Trophoblasts Are Resistant to Trypanosoma cruzi Infection in a 3D-Culture Model of the Maternal-Fetal Interface. Front Microbiol 2021; 12:626370. [PMID: 33746919 PMCID: PMC7969514 DOI: 10.3389/fmicb.2021.626370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Trypanosoma cruzi (T. cruzi), the etiological agent of Chagas Disease (CD), is transmitted to humans by infected kissing bugs, blood transfusion, organ transplantation, and from mother-to-child. Congenital transmission is now considered an important route of CD spread in non-endemic countries where no routine testing of pregnant women for the disease is implemented. The main cellular mechanisms that lead to fetal infection by T. cruzi, despite the presence of a placental barrier, remain unclear. Mother-to-child transmission most likely occurs when bloodstream trypomastigotes reach the placental intervillous space and interact with the large cellular surface provided by the syncytioptrophoblasts. These highly specialized cells not only function as a physical obstacle between mother and fetus, but also modulate immune responses against pathogen infections. To overcome the limitations associated with the use of human fetal tissues, we employed a three-dimensional (3D) cell culture model to recreate the human placenta environment. In this system, the trophoblast-derived JEG-3 cell line is co-cultured with human brain microvascular endothelial cells attached to microcarrier beads in a rotating bioreactor. Here, we report that 3D culture of JEG-3/HBMEC spheroids promote JEG-3 cells differentiation revealed by the formation of syncytia and production of β human chorionic gonadotropin and human placental lactogen (hPL). Under these growth conditions, we demonstrate that 3D-grown JEG-3 cells have reduced susceptibility to T. cruzi infection compared to JEG-3 cells grown in conventional tissue culture flasks. We also show that 3D-cultured JEG-3 cells release paracrine factors in the supernatant that prevent T. cruzi infection of non-trophoblastic cell lines. Our in vitro model of T. cruzi vertical transmission may help better understand the molecular processes by which parasites bypass the human placental barrier and could be exploited to evaluate therapeutics to reduce congenital CD.
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Affiliation(s)
- Erica Silberstein
- Laboratory of Emerging Pathogens, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Kwang Sik Kim
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Acosta
- Laboratory of Emerging Pathogens, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Alain Debrabant
- Laboratory of Emerging Pathogens, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
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Marcus R, Henao-Martínez AF, Nolan M, Livingston E, Klotz SA, Gilman RH, Miranda-Schaeubinger M, Meymandi S. Recognition and screening for Chagas disease in the USA. Ther Adv Infect Dis 2021; 8:20499361211046086. [PMID: 34589212 PMCID: PMC8474340 DOI: 10.1177/20499361211046086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022] Open
Abstract
Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a public health concern, mainly among countries in South and Central America. However, despite the large number of immigrants from endemic countries living in the USA, awareness of CD is poor in the medical community, and therefore it is significantly underdiagnosed. To avoid the catastrophic cardiac complications of CD and to prevent maternal-fetal transmission, widespread educational programs highlighting the need for diagnosis are urgently needed.
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Affiliation(s)
- Rachel Marcus
- LASOCHA, MedStar Union Memorial Hospital,
Baltimore, MD 21218-2829, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa Nolan
- Arnold School of Public Health, University of
South Carolina, Columbia, SC, USA
| | - Elizabeth Livingston
- Department of Obstetrics and Gynecology, Duke
University Medical Center, Durham, NC, USA
| | - Stephen A. Klotz
- Division of Infectious Diseases, University of
Arizona, Tucson, AZ, USA
| | - Robert H. Gilman
- Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheba Meymandi
- Division of Cardiology, David Geffen School of
Medicine at UCLA, Los Angeles, CA, USA
- Center of Excellence for Chagas Disease, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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10
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Simón M, Gil-Gallardo LJ, Asunción Iborra M, Carrilero B, López MC, Romay-Barja M, Murcia L, Carmen Thomas M, Benito A, Segovia M. An observational longitudinal study to evaluate tools and strategies available for the diagnosis of Congenital Chagas Disease in a non-endemic country. Acta Trop 2019; 199:105127. [PMID: 31394076 DOI: 10.1016/j.actatropica.2019.105127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Congenital Chagas Disease (CCD) has become a global health problem. Early diagnosis and treatment is essential for the cure of the disease. Our aim was to evaluate techniques and samples used for the diagnosis of CCD in order to improve diagnostic strategies. METHODS A total of 181 children born in Spain from Latin American Chagas-infected mothers were consecutively enrolled and studied by microhematocrit, PCR and serology tests at 0-2, 6 and 9-12 months of age and followed up when it was required. Samples of cord blood and peripheral blood were collected for T. cruzi detection by PCR. Parasite culture was performed in patients with a positive PCR. RESULTS Of 181 children, 7 children (3.9%) were lost to follow-up. A total of 174 children completed follow-up, 12 were diagnosed with CCD (6.9%) and 162 (93.1%) as uninfected children (negative serology tests at the end of the follow-up). Traditional parasitological diagnosis by microhematocrit had a poor performance (sensitivity was 10%), while PCR in peripheral blood showed high sensitivity (90.9%) and specificity (100%), allowing the early diagnosis of 9 infected children during the first 6-months-old. In the other 3 congenital cases, diagnosis was only possible at 12 months by serological and molecular techniques. However, PCR in cord blood showed low sensitivity (33.3%) and less specificity (96.4%) for the diagnosis. CONCLUSION PCR in peripheral blood has proven to be the most adequate strategy for the diagnosis of CCD, allowing an early and reliable diagnosis.
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11
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Herrera C, Truyens C, Dumonteil E, Alger J, Sosa-Estani S, Cafferata ML, Gibbons L, Ciganda A, Matute ML, Zuniga C, Carlier Y, Buekens P. Phylogenetic Analysis of Trypanosoma cruzi from Pregnant Women and Newborns from Argentina, Honduras, and Mexico Suggests an Association of Parasite Haplotypes with Congenital Transmission of the Parasite. J Mol Diagn 2019; 21:1095-1105. [PMID: 31450011 DOI: 10.1016/j.jmoldx.2019.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/26/2019] [Accepted: 07/25/2019] [Indexed: 12/20/2022] Open
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, exhibits a high genetic variability and has been classified into six discrete typing units (DTUs) named TcI through TcVI. This genetic diversity is believed to be associated with clinical characteristics and outcomes, but evidence supporting such associations has been limited. Herein, we performed a phylogenetic analysis of T. cruzi sequences of the mini-exon intergenic region obtained from a large cohort of pregnant women and newborns from Argentina, Honduras, and Mexico, to assess parasite genetic diversity and possible associations with congenital transmission. Analysis of 105 samples (including five paired samples) from maternal and umbilical cord blood indicated that T. cruzi DTU distribution was similar among pregnant women and newborns from these three countries, with a high frequency of TcII-TcV-TcVI DTUs, including mixed infections with TcI. However, phylogenetic analysis revealed that although the same parasite haplotypes circulated in these three countries, they were present at different frequencies, leading to significant geographic differences. Of importance, a strong association was observed between parasite haplotypes and congenital infection of newborns. Thus, the identification of parasite haplotypes in pregnant women, but not of parasite DTUs, may help predict congenital transmission of T. cruzi.
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Affiliation(s)
- Claudia Herrera
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | | | - Eric Dumonteil
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autonoma de Yucatan, Merida, Mexico
| | - Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, Honduras; Hospital Escuela Universitario, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras
| | - Sergio Sosa-Estani
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben,", Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Administracion Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbran" (ANLIS), Buenos Aires, Argentina
| | - Maria L Cafferata
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Unidad de Investigacion Clinica y Epidemiologica Montevideo, Montevideo, Uruguay
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Alvaro Ciganda
- Unidad de Investigacion Clinica y Epidemiologica Montevideo, Montevideo, Uruguay
| | - Maria L Matute
- Laboratorio Nacional de Vigilancia de la Salud, Secretaria de Salud de Honduras, Tegucigalpa, Honduras
| | - Concepcion Zuniga
- Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, Honduras; Hospital Escuela Universitario, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras
| | - Yves Carlier
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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12
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Bustos PL, Milduberger N, Volta BJ, Perrone AE, Laucella SA, Bua J. Trypanosoma cruzi Infection at the Maternal-Fetal Interface: Implications of Parasite Load in the Congenital Transmission and Challenges in the Diagnosis of Infected Newborns. Front Microbiol 2019; 10:1250. [PMID: 31231337 PMCID: PMC6568191 DOI: 10.3389/fmicb.2019.01250] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022] Open
Abstract
Trypanosoma cruzi is the protozoan unicellular parasite that causes Chagas disease. It can be transmitted from infected mothers to their babies via the connatal route, thus being able to perpetuate even in the absence of Triatomine insect vectors. Chagas disease was originally endemic in Central and South America, but migration of infected women of childbearing age has spread the T. cruzi congenital infection to non-endemic areas like North America, Europe, Japan, and Australia. Currently, 7 million people are affected by this infection worldwide. This review focuses on the relevance of the T. cruzi parasite levels in different aspects of the congenital T. cruzi infection such as the mother-to-child transmission rate, the maternal and fetal immune response, and its impact on the diagnosis of infected newborns. Improvements in detection of this parasite, with tools that can be easily adapted to be used in remote rural areas, will make the early diagnosis of infected children possible, allowing a prompt trypanocidal treatment and avoiding the current loss of opportunities for the diagnosis of 100% of T. cruzi congenitally infected infants.
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Affiliation(s)
- Patricia L Bustos
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Natalia Milduberger
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina.,Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana, Buenos Aires, Argentina
| | - Bibiana J Volta
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Alina E Perrone
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Susana A Laucella
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina.,Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana, Buenos Aires, Argentina
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13
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Medina L, Castillo C, Liempi A, Herbach M, Cabrera G, Valenzuela L, Galanti N, de Los Angeles Curto M, Schijman AG, Kemmerling U. Differential infectivity of two Trypanosoma cruzi strains in placental cells and tissue. Acta Trop 2018; 186:35-40. [PMID: 30018029 DOI: 10.1016/j.actatropica.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022]
Abstract
Congenital Chagas disease, caused by Trypanosoma cruzi (T. cruzi), has become epidemiologically relevant. The probability of congenital transmission depends on the maternal and developing fetal/newborn immune responses, placental factors and importantly, the virulence of the parasite. It has been proposed, that different genotypes of T. cruzi and their associated pathogenicity, virulence and tissue tropism may play an important role in congenital infection. Since there is no laboratory or animal model that recapitulates the complexities of vertical transmission in humans, here we studied parasite infectivity in human placental explants (HPE) as well as in the human trophoblast-derived cell line BeWo of the Y(DTU II) and the VD (TcVI) T. cruzi strains; the latter was isolated from a human case of congenital infection. Our results show that the VD strain is more infective and pathogenic than the Y strain, as demonstrated by qPCR and cell counting as well as by histopathological analysis. The present study constitutes the first approach to study the relationship between parasite two parasite strains from different genotypes and the infection efficiency in human placenta.
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Affiliation(s)
- Lisvaneth Medina
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Christian Castillo
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Ana Liempi
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Mathias Herbach
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Gonzalo Cabrera
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Lucía Valenzuela
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Norbel Galanti
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - María de Los Angeles Curto
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor Torres", Buenos Aires, Argentina
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor Torres", Buenos Aires, Argentina
| | - Ulrike Kemmerling
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile.
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14
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Torres-Vargas J, Jiménez-Coello M, Guzmán-Marín E, Acosta-Viana KY, Yadon ZE, Gutiérrez-Blanco E, Guillermo-Cordero JL, Garg NJ, Ortega-Pacheco A. Quantitative and histological assessment of maternal-fetal transmission of Trypanosoma cruzi in guinea pigs: An experimental model of congenital Chagas disease. PLoS Negl Trop Dis 2018; 12:e0006222. [PMID: 29364882 PMCID: PMC5798842 DOI: 10.1371/journal.pntd.0006222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/05/2018] [Accepted: 01/09/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We evaluated the effect of Trypanosoma cruzi infection on fertility, gestation outcome, and maternal-fetal transmission in guinea pigs (Cavia porcellus). METHODS Animals were infected with T. cruzi H4 strain (TcI lineage) before gestation (IBG) or during gestation (IDG). Tissue and sera samples of dams and fetuses were obtained near parturition. RESULTS All IBG and IDG dams were seropositive by two tests, and exhibited blood parasite load of 1.62±2.2 and 50.1±62 parasites/μl, respectively, by quantitative PCR. Histological evaluation showed muscle fiber degeneration and cellular necrosis in all infected dams. Parasite nests were not detected in infected dams by histology. However, qPCR analysis detected parasites-eq/g heart tissue of 153±104.7 and 169.3±129.4 in IBG and IDG dams, respectively. All fetuses of infected dams were positive for anti-parasite IgG antibodies and tissue parasites by qPCR, but presented a low level of tissue inflammatory infiltrate. Fetuses of IDG (vs. IBG) dams exhibited higher degree of muscle fiber degeneration and cellular necrosis in the heart and skeletal tissues. The placental tissue exhibited no inflammatory lesions and amastigote nests, yet parasites-eq/g of 381.2±34.3 and 79.2±84.9 were detected in IDG and IBG placentas, respectively. Fetal development was compromised, and evidenced by a decline in weight, crow-rump length, and abdominal width in both groups. CONCLUSIONS T. cruzi TcI has a high capacity of congenital transmission even when it was inoculated at a very low dose before or during gestation. Tissue lesions, parasite load, and fetal under development provide evidence for high virulence of the parasite during pregnancy. Despite finding of high parasite burden by qPCR, placentas were protected from cellular damage. Our studies offer an experimental model to study the efficacy of vaccines and drugs against congenital transmission of T. cruzi. These results also call for T. cruzi screening in pregnant women and adequate follow up of the newborns in endemic areas.
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Affiliation(s)
- Jatziri Torres-Vargas
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Matilde Jiménez-Coello
- C.A. Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Eugenia Guzmán-Marín
- C.A. Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Karla Y. Acosta-Viana
- C.A. Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Zaida E. Yadon
- Health Surveillance, Disease Prevention and Control, Pan American Health Organization, Duque de Caxias, Rio de Janeiro, Brazil
| | - Eduardo Gutiérrez-Blanco
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - José Leonardo Guillermo-Cordero
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Nisha J. Garg
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail: (NJG); (AOP)
| | - Antonio Ortega-Pacheco
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
- * E-mail: (NJG); (AOP)
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15
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Flores-Ferrer A, Marcou O, Waleckx E, Dumonteil E, Gourbière S. Evolutionary ecology of Chagas disease; what do we know and what do we need? Evol Appl 2017; 11:470-487. [PMID: 29636800 PMCID: PMC5891055 DOI: 10.1111/eva.12582] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/19/2017] [Indexed: 01/02/2023] Open
Abstract
The aetiological agent of Chagas disease, Trypanosoma cruzi, is a key human pathogen afflicting most populations of Latin America. This vectorborne parasite is transmitted by haematophageous triatomines, whose control by large‐scale insecticide spraying has been the main strategy to limit the impact of the disease for over 25 years. While those international initiatives have been successful in highly endemic areas, this systematic approach is now challenged by the emergence of insecticide resistance and by its low efficacy in controlling species that are only partially adapted to human habitat. In this contribution, we review evidences that Chagas disease control shall now be entering a second stage that will rely on a better understanding of triatomines adaptive potential, which requires promoting microevolutionary studies and –omic approaches. Concomitantly, we show that our knowledge of the determinants of the evolution of T. cruzi high diversity and low virulence remains too limiting to design evolution‐proof strategies, while such attributes may be part of the future of Chagas disease control after the 2020 WHO's target of regional elimination of intradomiciliary transmission has been reached. We should then aim at developing a theory of T. cruzi virulence evolution that we anticipate to provide an interesting enrichment of the general theory according to the specificities of transmission of this very generalist stercorarian trypanosome. We stress that many ecological data required to better understand selective pressures acting on vector and parasite populations are already available as they have been meticulously accumulated in the last century of field research. Although more specific information will surely be needed, an effective research strategy would be to integrate data into the conceptual and theoretical framework of evolutionary ecology and life‐history evolution that provide the quantitative backgrounds necessary to understand and possibly anticipate adaptive responses to public health interventions.
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Affiliation(s)
- Alheli Flores-Ferrer
- UMR 228, ESPACE-DEV-IMAGES, 'Institut de Modélisation et d'Analyses en Géo-Environnement et Santé'Université de Perpignan Via Domitia Perpignan France.,UMR 5096 'Laboratoire Génome et Développement des Plantes' Université de Perpignan Via Domitia Perpignan France
| | - Olivier Marcou
- UMR 228, ESPACE-DEV-IMAGES, 'Institut de Modélisation et d'Analyses en Géo-Environnement et Santé'Université de Perpignan Via Domitia Perpignan France
| | - Etienne Waleckx
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi" Universidad Autónoma de Yucatán Mérida Mexico
| | - Eric Dumonteil
- Department of Tropical Medicine School of Public Health and Tropical Medicine Tulane University New Orleans LA USA
| | - Sébastien Gourbière
- UMR 228, ESPACE-DEV-IMAGES, 'Institut de Modélisation et d'Analyses en Géo-Environnement et Santé'Université de Perpignan Via Domitia Perpignan France.,UMR 5096 'Laboratoire Génome et Développement des Plantes' Université de Perpignan Via Domitia Perpignan France
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16
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Buekens P, Cafferata ML, Alger J, Althabe F, Belizán JM, Bustamante N, Carlier Y, Ciganda A, Del Cid JH, Dumonteil E, Gamboa-León R, García JA, Gibbons L, Graiff O, Maldonado JG, Herrera C, Howard E, Lara LS, López B, Matute ML, Ramírez-Sierra MJ, Robles MC, Sosa-Estani S, Truyens C, Valladares C, Wesson DM, Zúniga C, For The Congenital Chagas Working Group. Congenital Transmission of Trypanosoma cruzi in Argentina, Honduras, and Mexico: An Observational Prospective Study. Am J Trop Med Hyg 2017; 98:478-485. [PMID: 29210352 DOI: 10.4269/ajtmh.17-0516] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Compared with South America, there is a lack of epidemiologic studies about the risk of congenital transmission of Trypanosoma cruzi in Central America and Mexico. It has been suggested that T. cruzi genotypes might differ by region and that congenital transmission might vary according to the parasite's genotype. Our objective was to compare T. cruzi congenital transmission rates in three countries. We performed an observational prospective study in 2011-2014 enrolling women at delivery in one hospital in Argentina, two hospitals in Honduras, and two hospitals in Mexico. Congenital T. cruzi infection was defined as the presence of one or more of the following criteria: presence of parasites in cord blood (direct parasitological microscopic examination) with positive polymerase chain reaction (PCR) in cord blood, presence of parasites in infant's blood at 4-8 weeks (direct parasitological microscopic examination), and persistence of T. cruzi-specific antibodies at 10 months, as measured by at least two tests. Among 28,145 enrolled women, 347 had at least one antibody rapid test positive in cord blood and a positive enzyme-linked immunosorbent assay in maternal blood. PCR in maternal blood was positive in 73.2% of the cases, and genotyping identified a majority of non-TcI in the three countries. We found no (0.0%; 95% confidence interval [CI]: 0.0, 2.0) confirmed congenital case in Honduras. Congenital transmission was 6.6% (95% CI: 3.1, 12.2) in Argentina and 6.3% (95% CI: 0.8, 20.8) in Mexico. Trypanosoma cruzi non-TcI predominated and risks of congenital transmission were similar in Argentina and Mexico.
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Affiliation(s)
- Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - María Luisa Cafferata
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | - Jackeline Alger
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Fernando Althabe
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - José M Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Yves Carlier
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Alvaro Ciganda
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | | | - Eric Dumonteil
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Jorge A García
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Olga Graiff
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Jesús Gurubel Maldonado
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, México
| | - Claudia Herrera
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Elizabeth Howard
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Laura Susana Lara
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | | | - María Luisa Matute
- Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - María Jesús Ramírez-Sierra
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, México
| | - María Cecilia Robles
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben," CONICET, ANLIS, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Carine Truyens
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Valladares
- Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Dawn M Wesson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Concepción Zúniga
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
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17
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Dumonteil E, Herrera C. Ten years of Chagas disease research: Looking back to achievements, looking ahead to challenges. PLoS Negl Trop Dis 2017; 11:e0005422. [PMID: 28426735 PMCID: PMC5398480 DOI: 10.1371/journal.pntd.0005422] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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18
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Juiz NA, Solana ME, Acevedo GR, Benatar AF, Ramirez JC, da Costa PA, Macedo AM, Longhi SA, Schijman AG. Different genotypes of Trypanosoma cruzi produce distinctive placental environment genetic response in chronic experimental infection. PLoS Negl Trop Dis 2017; 11:e0005436. [PMID: 28273076 PMCID: PMC5358786 DOI: 10.1371/journal.pntd.0005436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/20/2017] [Accepted: 02/24/2017] [Indexed: 12/15/2022] Open
Abstract
Congenital infection of Trypanosoma cruzi allows transmission of this parasite through generations. Despite the problematic that this entails, little is known about the placenta environment genetic response produced against infection. We performed functional genomics by microarray analysis in C57Bl/6J mice comparing placentas from uninfected animals and from animals infected with two different T. cruzi strains: K98, a clone of the non-lethal myotropic CA-I strain (TcI), and VD (TcVI), isolated from a human case of congenital infection. Analysis of networks by GeneMANIA of differentially expressed genes showed that “Secretory Granule” was a pathway down-regulated in both infected groups, whereas “Innate Immune Response” and “Response to Interferon-gamma” were pathways up-regulated in VD infection but not in K98. Applying another approach, the GSEA algorithm that detects small changes in predetermined gene sets, we found that metabolic processes, transcription and macromolecular transport were down-regulated in infected placentas environment and some pathways related to cascade signaling had opposite regulation: over-represented in VD and down-regulated in K98 group. We also have found a stronger tropism to the placental organ by VD strain, by detection of parasite DNA and RNA, suggesting living parasites. Our study is the first one to describe in a murine model the genetic response of placental environment to T. cruzi infection and suggests the development of a strong immune response, parasite genotype-dependent, to the detriment of cellular metabolism, which may contribute to control infection preventing the risk of congenital transmission. Congenital transmission of Trypanosoma cruzi, the causative agent of Chagas disease, remains a problem of global public health impact in endemic areas where vectorial and transfusional transmission have been controlled and in non-endemic countries due to migration movements. Little is known about how the parasite´s presence and genetic variability affect placental capacity to protect the fetus. This study explores, for the first time, the effects of placental environment infection by analyzing parasite persistence and gene expression using functional genomics and biological network analyses in mice infected by two strains of T. cruzi, with differential capacity of congenital transmission. The infection with the strain with a stronger placental tropism was associated to a higher degree of up-regulation in genes related to innate immunity and response to interferon-gamma. Our findings suggest that the placental environment exerts a strong immune response in detriment of cellular metabolism modulated by the parasite strain. These findings constitute a significant contribution to better understand the mechanisms causing congenital infection of T. cruzi.
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Affiliation(s)
- Natalia Anahí Juiz
- Grupo de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular ‘‘Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - María Elisa Solana
- Departamento de Microbiología, Parasitología e Inmunología, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Gonzalo Raúl Acevedo
- Grupo de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular ‘‘Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Alejandro Francisco Benatar
- Grupo de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular ‘‘Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Juan Carlos Ramirez
- Grupo de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular ‘‘Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Priscilla Almeida da Costa
- Departamento de Bioquímica e Inmunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andrea Mara Macedo
- Departamento de Bioquímica e Inmunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvia Andrea Longhi
- Grupo de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular ‘‘Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Alejandro G. Schijman
- Grupo de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular ‘‘Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
- * E-mail:
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Prevalence of anti-Trypanosoma cruzi antibodies in women of childbearing age in Socotá, Boyacá, 2014. BIOMEDICA 2016; 36:90-6. [PMID: 27622629 DOI: 10.7705/biomedica.v36i3.2923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/18/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chagas' disease is a parasitic disease caused by the protozoan Trypanosoma cruzi. This condition presents epidemiological risk factors associated with socioeconomic conditions and is currently considered an important public health problem. Its presence has been reported in endemic regions at elevations of up to 2,000 meters above sea level. OBJECTIVE To determine the prevalence of anti-T. cruzi antibodies and the possible risk factors associated with this condition in women of childbearing age from the town of Socotá, Boyacá. MATERIALS AND METHODS An observational, descriptive cross-sectional study was conducted in a population of women of childbearing age from Socotá, Boyacá. The samples were analyzed by Chagas ELISA IgG and IgM test and indirect hemagglutination test. A univariate analysis and statistical association of variables were performed. RESULTS A confirmed prevalence of 2/138 (1.4%) was found in this town. Having pets or a history of contact with vectors were possible associated risk factors although without statistical significance. CONCLUSIONS From the results obtained in the present study, it is suggested that more active research be carried out for cases of Chagas' disease in non-endemic areas in Colombia that present risk factors for acquiring the disease, even when the environmental conditions and elevation differ from those described in the literature.
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Shiadeh MN, Niyyati M, Fallahi S, Rostami A. Human parasitic protozoan infection to infertility: a systematic review. Parasitol Res 2015; 115:469-77. [PMID: 26573517 DOI: 10.1007/s00436-015-4827-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/10/2015] [Indexed: 12/17/2022]
Abstract
Protozoan parasitic diseases are endemic in many countries worldwide, especially in developing countries, where infertility is a major burden. It has been reported that such infections may cause infertility through impairment in male and female reproductive systems. We searched Medline, PubMed, and Scopus databases and Google scholar to identify the potentially relevant studies on protozoan parasitic infections and their implications in human and animal model infertility. Literature described that some of the protozoan parasites such as Trichomonas vaginalis may cause deformities of the genital tract, cervical neoplasia, and tubal and atypical pelvic inflammations in women and also non-gonoccocal urethritis, asthenozoospermia, and teratozoospermia in men. Toxopalasma gondii could cause endometritis, impaired folliculogenesis, ovarian and uterine atrophy, adrenal hypertrophy, vasculitis, and cessation of estrus cycling in female and also decrease in semen quality, concentration, and motility in male. Trypanosoma cruzi inhibits cell division in embryos and impairs normal implantation and development of placenta. Decrease in gestation rate, infection of hormone-producing glands, parasite invasion of the placenta, and overproduction of inflammatory cytokines in the oviducts and uterine horns are other possible mechanisms induced by Trypanosoma cruzi to infertility. Plasmodium spp. and Trypanosoma brucei spp. cause damage in pituitary gland, hormonal disorders, and decreased semen quality. Entamoeba histolytica infection leads to pelvic pain, salpingitis, tubo-ovarian abscess, and genital ulcers. Cutaneous and visceral leishmaniasis can induce genital lesion, testicular amyloidosis, inflammation of epididymis, prostatitis, and sperm abnormality in human and animals. In addition, some epidemiological studies have reported that rates of protozoan infections in infertile patients are higher than healthy controls. The current review indicates that protozoan parasitic infections may be an important cause of infertility. Given the widespread prevalence of parasitic protozoa diseases worldwide, we suggest further studies to better understanding of relationship between such infections and infertility.
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Affiliation(s)
| | - Maryam Niyyati
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirzad Fallahi
- Department of Parasitology and Mycology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.,Razi Herbal Medicines Research Center, Lorestan University of Medical Science, Khorramabad, Iran
| | - Ali Rostami
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Carlier Y, Truyens C. Congenital Chagas disease as an ecological model of interactions between Trypanosoma cruzi parasites, pregnant women, placenta and fetuses. Acta Trop 2015; 151:103-15. [PMID: 26293886 DOI: 10.1016/j.actatropica.2015.07.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
The aim of this paper is to discuss the main ecological interactions between the parasite Trypanosoma cruzi and its hosts, the mother and the fetus, leading to the transmission and development of congenital Chagas disease. One or several infecting strains of T. cruzi (with specific features) interact with: (i) the immune system of a pregnant woman whom responses depend on genetic and environmental factors, (ii) the placenta harboring its own defenses, and, finally, (iii) the fetal immune system displaying responses also susceptible to be modulated by maternal and environmental factors, as well as his own genetic background which is different from her mother. The severity of congenital Chagas disease depends on the magnitude of such final responses. The paper is mainly based on human data, but integrates also complementary observations obtained in experimental infections. It also focuses on important gaps in our knowledge of this congenital infection, such as the role of parasite diversity vs host genetic factors, as well as that of the maternal and placental microbiomes and the microbiome acquisition by infant in the control of infection. Investigations on these topics are needed in order to improve the programs aiming to diagnose, manage and control congenital Chagas disease.
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Affiliation(s)
- Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), CP 616, Route de Lennik 808, 1070 Bruxelles, Belgium; Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, Suite 2210, 1440 Canal Street, New Orleans, LA 70112-2797, USA.
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), CP 616, Route de Lennik 808, 1070 Bruxelles, Belgium.
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Gamboa-León R, Ramirez-Gonzalez C, Pacheco-Tucuch FS, O'Shea M, Rosecrans K, Pippitt J, Dumonteil E, Buekens P. Seroprevalence of Trypanosoma cruzi among mothers and children in rural Mayan communities and associated reproductive outcomes. Am J Trop Med Hyg 2014; 91:348-53. [PMID: 24935948 DOI: 10.4269/ajtmh.13-0527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our objective was to determine the seroprevalence of Trypanosoma cruzi infection among mothers and children in two rural Mayan communities in Yucatan, Mexico and examine sociodemographic characteristics and adverse reproductive outcomes associated with maternal infection. We performed household surveys in the communities of Sudzal and Teya. Mothers were interviewed, and blood samples were obtained to perform rapid tests and enzyme-linked immunosorbent assays (ELISAs). We surveyed 390 mothers and 685 children. The overall seroprevalence was 2.3% among mothers and 0.4% among children. In Sudzal, we found a seroprevalence of 4.4% among mothers and 0.7% in children. In Teya, we found a seroprevalence of 0.9% among mothers and 0.3% among children. Compared with uninfected mothers, seropositive mothers reported more stillbirths (relative risk = 4.7; 95% confidence interval = 2.1-10.4). T. cruzi infection is present in these communities, and infected children indicate active transmission. Seropositivity in mothers is associated with a history of adverse reproductive outcomes.
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Affiliation(s)
- Rubi Gamboa-León
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Claudia Ramirez-Gonzalez
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Freddy S Pacheco-Tucuch
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Matthew O'Shea
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Kathryn Rosecrans
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Julia Pippitt
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Eric Dumonteil
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Pierre Buekens
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Chagas' disease: pregnancy and congenital transmission. BIOMED RESEARCH INTERNATIONAL 2014; 2014:401864. [PMID: 24949443 PMCID: PMC4052072 DOI: 10.1155/2014/401864] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/11/2014] [Accepted: 04/24/2014] [Indexed: 01/15/2023]
Abstract
Chagas disease is a chronic infection that kills approximately 12,000 people a year. Mass migration of chronically infected and asymptomatic persons has caused globalization of Chagas disease and has made nonvectorial infection, including vertical and blood-borne transmission, more of a threat to human communities than vectorial infection. To control transmission, it is essential to test all pregnant women living in endemic countries and all pregnant women having migrated from, or having lived in, endemic countries. All children born to seropositive mothers should be tested not only within the first month of life but also at ~6 months and ~12 months of age. The diagnosis is made by identification of the parasite in blood before the age of 6 months and by identification of the parasite in blood and/or positive serology after 10 months of age. Follow up for a year is essential as a significant proportion of cases are initially negative and are only detected at a later stage. If the condition is diagnosed and treated early, the clinical response is excellent and the majority of cases are cured.
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