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Arrivillaga MR, Gold M, Rivera EP, Juárez JG. Incorporating an intersectional gender approach to improve access to maternal and child health screening services. Int J Equity Health 2024; 23:32. [PMID: 38378594 PMCID: PMC10880357 DOI: 10.1186/s12939-024-02109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND In the Americas, the Pan American Health Organization (PAHO) has promoted initiatives that aim at the elimination of mother-to-child transmitted diseases for over two decades. Although Guatemala has assumed the commitment to improve access and coverage of reproductive and perinatal services, the goals have not yet been reached. Often, the implementation of these efforts is hampered by complexities rooted in social, cultural, and environmental intersections. The objective of this work is to share our experience applying gender intersectionality as a methodological and analytical tool in a participatory research project that aims to improve access to maternal and child health screening services. The study shows the novel strategy that incorporates intersectionality contributing to evidence on how it can be applied to strengthen public health efforts around the implementation of the EMTCT Plus (Elimination of mother-to-child transmission of HIV, Syphilis, Hepatitis B, and Chagas disease) framework, in the mostly rural municipality of Comapa, in Guatemala. METHODS We applied a participatory methodology, integrating theoretical and methodological frameworks to have an intersectional understanding of health services delivered by both, midwives, and the public health institution, for the prevention, diagnosis, treatment, and follow-up of HIV, Syphilis, Hepatitis B, and Chagas. The data was collected by conducting interviews, focus groups, workshops, and reviewing laboratory databases, guided by five strategies from a cultural appropriateness framework. RESULTS The intersectional analysis shed light on the synergies and gaps of the current efforts and protocols implemented by both the midwives and the Ministry of Health. The services offered for the four diseases were often delivered independently from each other, and a comprehensive educational and communication material strategy was absent. However, our findings will be used to inform consistent, locally relevant, and culturally appropriate educational content for the local population, also following the national policy guidelines. CONCLUSIONS Using intersectionality as a method and as an analytical tool allowed us to understand the (1) interrelation of diverse social, cultural, and environmental determinants which influence the delivery of health services, as well as (2) the dynamics between the traditional and institutional health systems. (3) Community engagement and the participation of different stakeholders in a consultative process have been fundamental for the conceptual and methodological tenets of this research. (4) Finally, giving a more prominent role to midwives can strengthen sustainability and cultural appropriateness, which is complementary to the delivery of institutional health services.
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Affiliation(s)
- Margarita Rivera Arrivillaga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala.
| | - Marina Gold
- Fundación Mundo Sano, Recaredo, 3. Puerta Garaje, 28002, Madrid, Spain.
| | - Elizabeth Pellecer Rivera
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
- Environmental Sciences, University of Maine, Orono, ME, 04469-5755, USA
| | - Jose Guillermo Juárez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
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Rapp E, Gold M. Knowledge Production on Congenital Chagas Disease across Time, Borders and Disciplines: A Comprehensive Scoping Review. Trop Med Infect Dis 2023; 8:422. [PMID: 37755884 PMCID: PMC10536740 DOI: 10.3390/tropicalmed8090422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/23/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
Congenital transmission is a key route of Trypanosoma cruzi infection in Latin America and globally, contributing significantly to the burden of Chagas disease. The interruption of transmission from mother to child has recently become a focus issue. However, the research landscape on congenital Chagas disease remains largely unexplored. The purpose of this scoping review is to assess the production of knowledge on congenital Chagas disease (CCD), aiming to identify research trends and potential gaps. Our initial hypothesis was that the CCD literature overly represents the medical sciences and that there is a need for socio-cultural research on the subject. We conducted a systematic search of publications focusing on congenital Chagas disease in six languages (English, Spanish, Portuguese, French, German and Italian). This comprehensive literature search identified 876 studies that met the inclusion criteria, out of a total of 8893 sources. The relevant literature was analyzed by language, year of publication, discipline, source type and research location. The main outcome of this study has been to prove our hypothesis that there is a scarcity of knowledge produced within the non-biomedical sciences on CCD. This underscores the need for further exploration into the social and structural issues surrounding this disease. Visually clear data concerning congenital Chagas disease produced by this study can contribute to hone in future research efforts and support funding applications. Additionally, this article provides a reference list that other researchers can consult for their own studies.
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Affiliation(s)
- Elise Rapp
- HESAV School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, CH-2800 Delémont, Switzerland;
- Institute of Humanities in Medecine, Faculty of Biology and Medecine, University of Lausanne (UNIL), CH-1015 Lausanne, Switzerland
| | - Marina Gold
- Fundación Mundo Sano, Buenos Aires C1061ABC, Argentina
- Institut für Sozialanthropologie und Empirische Kulturwissenschaft (ISEK), University of Zürich, CH-8005 Zurich, Switzerland
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Ince I, Prins K, Willmann S, Sutter G, Hanze E, Sadre-Marandi F, Stass H, Garmann D. Population Pharmacokinetics of Nifurtimox in Adult and Pediatric Patients with Chagas' Disease. J Clin Pharmacol 2022; 62:1273-1284. [PMID: 35460577 DOI: 10.1002/jcph.2064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/17/2022] [Indexed: 11/11/2022]
Abstract
Nifurtimox (LAMPIT®) has been used for decades for the treatment of Chagas' Disease, a chronic and potentially life-threatening disease caused by the parasite Trypanonosma Cruzi. The pharmacokinetics (PK) information on nifurtimox in humans derived from controlled clinical studies is very limited. The objective was to investigate and compare the Population PK (PopPK) of nifurtimox in adult and pediatric patients with Chagas' disease to confirm the clinical dosing regimen in children, which was based on allometric approaches using the concept that a dose equivalent exposure would reach equivalent antiparasitic efficacy as in adults. The resulting adult model adequately described the PK in adults. Significant predictors of the availability in PK were food intake, tablet formulation (fast vs. slow dissolution tablet), study, and body weight (WT). As the resulting adult model could not adequately predict the sparse sampled pediatric patient data, these data were analyzed separately to derive exposure estimates for comparison with adult exposure. In the PopPK model for pediatric patients, significant covariates were WT and age. As compared to adults, children older than 2 years were estimated to have 50.6 % higher apparent clearance (CL/F). No hints of dose-nonlinearity were observed in a dose range of 30 to 240 mg single dose in adults and 15 to 300 mg 3 times daily (8 to 20 mg/kg) in children. Altogether, this study retroactively showed that the current mg/kg dosing regimen in children reached similar exposure as in adults receiving an 8 mg/kg total daily dose. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ibrahim Ince
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | | | - Stefan Willmann
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | - Gabriele Sutter
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | - Eva Hanze
- qPharmetra, LLC, Nijmegen, The Netherlands
| | | | - Heino Stass
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - Dirk Garmann
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
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The Importance of Screening for Chagas Disease Against the Backdrop of Changing Epidemiology in the USA. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:185-193. [PMID: 36105114 PMCID: PMC9463514 DOI: 10.1007/s40475-022-00264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review This review seeks to identify factors contributing to the changing epidemiology of Chagas disease in the United States of America (US). By showcasing screening programs for Chagas disease that currently exist in endemic and non-endemic settings, we make recommendations for expanding access to Chagas disease diagnosis and care in the US. Recent Findings Several factors including but not limited to increasing migration, climate change, rapid population growth, growing urbanization, changing transportation patterns, and rising poverty are thought to contribute to changes in the epidemiology of Chagas disease in the US. Outlined are some examples of successful screening programs for Chagas disease in other countries as well as in some areas of the US, notably those which focus on screening high-risk populations and are linked to affordable and effective treatment options. Summary Given concerns that Chagas disease prevalence and even risk of transmission may be increasing in the US, there is a need for improving detection and treatment of the disease. There are many successful screening programs in place that can be replicated and/or expanded upon in the US. Specifically, we propose integrating Chagas disease into relevant clinical guidelines, particularly in cardiology and obstetrics/gynecology, and using advocacy as a tool to raise awareness of Chagas disease.
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Gold M. Health, Migration, and NTDs: An Anthropological View. Med Anthropol 2021; 40:491-496. [PMID: 34314263 DOI: 10.1080/01459740.2021.1953494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stass H, Just S, Weimann B, Ince I, Willmann S, Feleder E, Freitas C, Yerino G, Münster U. Clinical investigation of the biopharmaceutical characteristics of nifurtimox tablets - Implications for quality control and application. Eur J Pharm Sci 2021; 166:105940. [PMID: 34265407 DOI: 10.1016/j.ejps.2021.105940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
Nifurtimox is approved in Chagas disease and has been used in endemic countries since the 1960s. Nifurtimox, available as a 120 mg tablet, is administered with food typically three times daily, and dose is adjusted for age and bodyweight. Accurately or reproducibly fragmenting the 120 mg tablet for dose adjustment in young children and those with low bodyweight is problematic. Based on the existing tablet formulation, new nifurtimox 30 mg and 120 mg tablets have been developed in a format that can be divided accurately into 15 mg and 60 mg fragments. In adults with chronic Chagas disease, we investigated whether nifurtimox bioavailability is affected by tablet dissolution rate, and whether different diets affect nifurtimox bioavailability. In an open-label, three-period cross-over study (n=36; ClinicalTrials.gov, NCT03350295), patients randomly received three 30 mg tablet formulations (slow, medium, or fast dissolution; a 4 × 30 mg dose of one formulation per period). In an open-label, four-period cross-over study (n=24; ClinicalTrials.gov, NCT03334838) patients randomly fasted or received one of three meal types (high-fat/high-calorie, low-fat, dairy-based) before ingesting nifurtimox (a 4 × 30 mg dose per period). Acceptance criteria for no difference between groups were 90% confidence intervals (CIs) of exposure ratios in the range 0.8-1.25. Nifurtimox bioavailability was unaffected by tablet dissolution kinetics. Ratios of area under the curve at final assessment (AUC(0-tlast) [90% CI]) were: fast/medium dissolution, 1.061 (0.990-1.137); slow/medium dissolution, 0.964 (0.900-1.033); fast/slow dissolution, 1.100 (1.027-1.179). Compared with a fasting state, nifurtimox bioavailability increased by 73% after a high-fat/high-calorie meal (AUC(0-tlast) ratio [90% CI], 1.732 [1.581-1.898]); smaller increases were seen with the other meal types (low-fat: 1.602 [1.462-1.755]; dairy-based: 1.340 [1.222-1.468]). Although type of diet can affect bioavailability, taking nifurtimox with food is most important.
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Affiliation(s)
- Heino Stass
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany.
| | - Sarah Just
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| | - Boris Weimann
- Chrestos Concept GmbH & Co. KG, 45131 Essen, Germany
| | | | - Stefan Willmann
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| | | | - Cecilia Freitas
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| | | | - Uwe Münster
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
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Stass H, Feleder E, Garcia-Bournissen F, Nagelschmitz J, Weimann B, Yerino G, Altcheh J. Biopharmaceutical Characteristics of Nifurtimox Tablets for Age- and Body Weight-Adjusted Dosing in Patients With Chagas Disease. Clin Pharmacol Drug Dev 2020; 10:542-555. [PMID: 33029953 PMCID: PMC8246722 DOI: 10.1002/cpdd.871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
Treatment of Chagas disease with nifurtimox requires age‐ and body weight‐adjusted dosing, resulting in complex dosing instructions. Appropriate formulations are needed for precise and compliant dosing, especially in pediatric patients. We characterized the biopharmaceutical features of a standard nifurtimox 120‐mg tablet and a 30‐mg tablet developed to improve dose accuracy. Two open‐label, randomized crossover studies were conducted in adult outpatients with Chagas disease. One study investigated whether 4 × 30‐mg tablets and 1 × 120‐mg tablet were bioequivalent and whether tablets can be administered as an aqueous slurry without affecting bioavailability. The second study investigated the effect of a high‐calorie/high‐fat diet versus fasting on the absorption of nifurtimox after a single 4 × 30‐mg dose. Interventions were equivalent if the 90% confidence interval (CI) of their least‐squares (LS) mean ratios for both AUC0‐tlast and Cmax were in the range of 80%‐125%. The 4 × 30‐mg and 1 × 120‐mg tablet doses were bioequivalent (AUC0‐tlast: LS mean ratio, 104.7%; 90%CI, 99.1%‐110.7%; Cmax: LS mean ratio, 101.7%; 90%CI, 89.4%‐115.6%; n = 24). Exposure when giving the 4 × 30‐mg dose as a slurry or as tablets was comparable, with an AUC0‐tlast ratio of 93.2% (84.2%‐103.1%; n = 12) and a slightly decreased Cmax ratio for the slurry of 76.5% (68.8%‐85.1%). Food improved the bioavailability of nifurtimox substantially (AUC0‐tlast ratiofed/fasted, 172%; 90%CI, 154%‐192%; Cmax ratiofed/fasted, 168%; 90%CI, 150%‐187%). The data indicate that the 30‐ and 120‐mg tablets are suitable for dosing adult and pediatric patients accurately; nifurtimox should be administered under fed conditions.
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Affiliation(s)
| | | | - Facundo Garcia-Bournissen
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,CONICET-GCBA, Hospital de Niños Ricardo Gutiérrez and Instituto Multidisciplinario de Investigación en Patologías Pediátricas, Buenos Aires, Argentina
| | | | | | | | - Jaime Altcheh
- CONICET-GCBA, Hospital de Niños Ricardo Gutiérrez and Instituto Multidisciplinario de Investigación en Patologías Pediátricas, Buenos Aires, Argentina
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Santana KH, Oliveira LGR, Barros de Castro D, Pereira M. Epidemiology of Chagas disease in pregnant women and congenital transmission of
Trypanosoma cruzi
in the Americas: systematic review and meta‐analysis. Trop Med Int Health 2020; 25:752-763. [DOI: 10.1111/tmi.13398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kaio Henrique Santana
- Center of Biological and Health Sciences Universidade Federal do Oeste da Bahia Barreiras Brazil
| | | | | | - Marcos Pereira
- Collective Health Institute Universidade Federal da Bahia Salvador Brazil
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Echeverría LE, Marcus R, Novick G, Sosa-Estani S, Ralston K, Zaidel EJ, Forsyth C, RIbeiro ALP, Mendoza I, Falconi ML, Mitelman J, Morillo CA, Pereiro AC, Pinazo MJ, Salvatella R, Martinez F, Perel P, Liprandi ÁS, Piñeiro DJ, Molina GR. WHF IASC Roadmap on Chagas Disease. Glob Heart 2020; 15:26. [PMID: 32489799 PMCID: PMC7218776 DOI: 10.5334/gh.484] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Chagas Disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, with some of the most serious manifestations affecting the cardiovascular system. It is a chronic, stigmatizing condition, closely associated with poverty and affecting close to 6 million people globally. Although historically the disease was limited to endemic areas of Latin America recent years have seen an increasing global spread. In addition to the morbidity and mortality associated with the disease, the social and economic burdens on individuals and society are substantial. Often called the 'silent killer', Chagas disease is characterized by a long, asymptomatic phase in affected individuals. Approximately 30% then go on develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances and severe heart failure. Methods In a collaboration of the World Hearth Federation (WHF) and the Inter-American Society of Cardiology (IASC) a writing group consisting of 20 diverse experts on Chagas disease (CD) was convened. The group provided up to date expert knowledge based on their area of expertise. An extensive review of the literature describing obstacles to diagnosis and treatment of CD along with proposed solutions was conducted. A survey was sent to all WHF Members and, using snowball sampling to widen the consultation, to a variety of health care professionals working in the CD global health community. The results were analyzed, open comments were reviewed and consolidated, and the findings were incorporated into this document, thus ensuring a consensus representation. Results The WHF IASC Roadmap on Chagas Disease offers a comprehensive summary of current knowledge on prevention, diagnosis and management of the disease. In providing an analysis of 'roadblocks' in access to comprehensive care for Chagas disease patients, the document serves as a framework from which strategies for implementation such as national plans can be formulated. Several dimensions are considered in the analysis: healthcare system capabilities, governance, financing, community awareness and advocacy. Conclusion The WHF IASC Roadmap proposes strategies and evidence-based solutions for healthcare professionals, health authorities and governments to help overcome the barriers to comprehensive care for Chagas disease patients. This roadmap describes an ideal patient care pathway, and explores the roadblocks along the way, offering potential solutions based on available research and examples in practice. It represents a call to action to decision-makers and health care professionals to step up efforts to eradicate Chagas disease.
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Affiliation(s)
| | - Rachel Marcus
- LASOCHA, Washington DC, US
- Medstar Union Memorial Hospital, Baltimore, MD, US
| | - Gabriel Novick
- Swiss Medical Group, Buenos Aires, AR
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, US
| | - Sergio Sosa-Estani
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, BR
| | | | - Ezequiel Jose Zaidel
- Sanatorio Güemes, Buenos Aires, AR
- Pharmacology Department, School of Medicine, University of Buenos Aires, Buenos Aires, AR
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, BR
| | - Antonio Luiz P. RIbeiro
- Internal Medicine Department, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, BR
- Hospital das Clínicas, UFMG, Belo Horizonte, BR
| | | | - Mariano Luis Falconi
- Cardiology Division, Italian Hospital of Buenos Aires, Buenos Aires, AR
- University Institute of the Italian Hospital of Buenos Aires, Buenos Aires, AR
| | - Jorge Mitelman
- Faculty of Medicine, University of Buenos Aires, Buenos Aires, AR
- School of Medicine, Barcélo University, Buenos Aires, AR
| | - Carlos A. Morillo
- Department of Cardiac Sciences, Cumming School of Medicine Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, CA
- Southeastern Alberta Region, Alberta Health Services, Foothills Medical Centre, CA
| | | | | | | | - Felipe Martinez
- National University of Cordoba, Cordoba, AR
- DAMIC Institute/Rusculleda Foundation, Cordoba, AR
| | - Pablo Perel
- World Heart Federation, Geneva, CH
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, GB
| | - Álvaro Sosa Liprandi
- Sanatorio Güemes, Buenos Aires, AR
- Medical School of Cardiology, University of Buenos Aires, Buenos Aires, AR
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Peterson JK, Yoshioka K, Hashimoto K, Caranci A, Gottdenker N, Monroy C, Saldaña A, Rodriguez S, Dorn P, Zúniga C. Chagas Disease Epidemiology in Central America: an Update. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Pérez-Ayala A, Fradejas I, Rebollo L, Lora-Pablos D, Lizasoain M, Herrero-Martínez JM. Usefulness of the ARCHITECT Chagas ® assay as a single test for the diagnosis of chronic Chagas disease. Trop Med Int Health 2019; 23:634-640. [PMID: 29683542 DOI: 10.1111/tmi.13063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Imported Chagas disease (CD) is an emerging health problem in Europe due to immigration from endemic countries. Although WHO currently recommends two different serological methods to establish diagnosis, new tools like the ARCHITECT Chagas assay have potential for use as a single diagnostic test. Our objective was to determine an optimal signal-to-cut-off (S/CO) value for the ARCHITECT Chagas assay to diagnose CD with a single test. METHODS A retrospective study conducted at the 12 de Octubre University Hospital (Madrid, Spain). All patients with requests for Chagas screening between January 2014 and August 2017 were consecutively included. All samples were routinely tested with the ARCHITECT assay. Negative samples (S/CO < 0.8) required no further testing. Immunochromatographic testing (ICT) and/or indirect immunofluorescence (IFI) was used to confirm samples with S/CO ≥ 0.8. Receiver operator characteristic (ROC) curve analysis determined the ARCHITECT S/CO value that yielded 100% specificity and positive predictive value. SPSS software, version 22.0 was used for data analysis. RESULTS A total of 4153 samples were analysed; 361 (8.69%) gave a reactive ARCHITECT Chagas result. 261/361 (72.3%) were women; median age was 38 years old (2-79). 92.8% were Bolivian. A total of 307 (85.0%) were confirmed as cases of Chagas; 52 (14.4%) were not infected; two (0.6%) were not evaluable. Seroprevalence was 7.39%. An S/CO ≥ 3.80 yielded 100% specificity (95% confidence interval [CI], 0.93-1.00) and 100% positive predictive value (95% CI, 0.99-1.00). CONCLUSIONS Using S/CO ≥ 3.80, the ARCHITECT Chagas could be used as a single test for diagnosis of chronic CD in Bolivian immigrants. Patients with S/CO between 0.80 and 3.80 would require additional testing.
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Affiliation(s)
- Ana Pérez-Ayala
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Isabel Fradejas
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lourdes Rebollo
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Lora-Pablos
- Clinical Research Department, Hospital 12 Octubre Research Institute, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Manuel Lizasoain
- Internal Medicine and Infectious Diseases Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Juarez JG, Pennington PM, Bryan JP, Klein RE, Beard CB, Berganza E, Rizzo N, Cordon-Rosales C. A decade of vector control activities: Progress and limitations of Chagas disease prevention in a region of Guatemala with persistent Triatoma dimidiata infestation. PLoS Negl Trop Dis 2018; 12:e0006896. [PMID: 30399143 PMCID: PMC6239342 DOI: 10.1371/journal.pntd.0006896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 11/16/2018] [Accepted: 10/03/2018] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Chagas disease, a neglected tropical disease that affects millions of Latin Americans, has been effectively controlled in Guatemala after multiple rounds of indoor residual insecticide spraying (IRS). However, a few foci remain with persistent Triatoma dimidiata infestation. One such area is the municipality of Comapa, Department of Jutiapa, in the southeastern region of Guatemala, where control interventions appear less effective. We carried out three cross sectional entomological and serological surveys in Comapa to evaluate a decade of vector control activities. Baseline serological (1999) and entomological (2001-2) surveys were followed by three rounds of insecticide applications (2003-2005) and intermittent focal spraying of infested houses, until approximately 2012. Household inspections to determine entomological indices and construction materials were conducted in 2001, 2007 and 2011. Seroprevalence surveys were conducted in school-age children in 1999, 2007 and 2015, and in women of child bearing age (15-44 years) only in 2015. After multiple rounds of indoor residual sprayings (IRS), the infestation index decreased significantly from 39% (2001-2) to 27% (2011). Household construction materials alone predicted <10% of infested houses. Chagas seroprevalence in Comapa declined in school-aged children by 10-fold, from 10% (1999) to 1% (2015). However, seroprevalence in women of child bearing age remains >10%. CONCLUSION After a decade of vector control activities in Comapa, there is evidence of significantly reduced transmission. However, the continued risk for vector-borne and congenital transmission pose a threat to the 2022 Chagas disease elimination goal. Systematic integrated vector control and improved Chagas disease screening and treatment programs for congenital and vector-borne disease are needed to reach the elimination goal in regions with persistent vector infestation.
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Affiliation(s)
- Jose G. Juarez
- Center of Health Studies, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala
| | - Pamela M. Pennington
- Center of Biotechnology, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala
| | - Joe P. Bryan
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City, Guatemala
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert E. Klein
- Visiting Investigator, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala
| | - Charles B. Beard
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Elsa Berganza
- Area de Salud de Jutiapa, Ministerio de Salud Pública y Asistencia Social de Guatemala, Guatemala
| | - Nidia Rizzo
- Center of Health Studies, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala
| | - Celia Cordon-Rosales
- Center of Health Studies, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala
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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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