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Silva RA, Estevão VAO, Villela EFDM. Circulation of Trypanosoma cruzi in triatomines and Didelphis sp. in urban areas: Transmission risk assessment in the Metropolitan Region. Vet Parasitol Reg Stud Reports 2024; 52:101059. [PMID: 38880572 DOI: 10.1016/j.vprsr.2024.101059] [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: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
The presence of Trypanosoma cruzi vectors in urban areas has been frequent, with colonization of homes and associated with reservoir animals that increase risk to humans, with simultaneous circulation of vectors and T. cruzi. The study aimed to describe the circulation of triatomines and T. cruzi in the Metropolitan Region of São Paulo, as well as evaluate risk situations. For analysis purposes, the triatomine notification information from January 2016 to July 2023 was used. While for Didelphis sp. collection with the aid of traps, notification information used was from 2019 to 2023. Information about triatomines came from spontaneous demand by the population and notification services were carried out by state field teams following defined protocols. 202 notifications were received with the capture of 448 triatomines. The positivity for T. cruzi observed was 60.5%. Regarding Didelphis sp., 416 animals were collected, 5.3% of which were positive for T. cruzi. There was overlapping areas of presence of infected triatomines and Didelphis sp., whose Discrete Typing Unit (DTU) was T. cruzi I. This work indicates the presence of infected vectors in urban areas, and the presence of a wild cycle of T. cruzi in didelphiids, reaffirming the need for and importance of vector surveillance work, through actions that can prevent the transmission of Chagas disease.
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Affiliation(s)
- Rubens Antonio Silva
- São Paulo State Department of Health, Disease Control Coordination, Pasteur Institute, Afonso Pessini 86, Mogi Guaçu, Brazil.
| | - Vera Aparecida Oliveira Estevão
- São Paulo State Department of Health, Disease Control Coordination, Vector Control, Avenue Dr Arnaldo 351, São Paulo, Brazil
| | - Edlaine Faria de Moura Villela
- São Paulo State Department of Health, Disease Control Coordination, Postgraduate Program in Sciences, Avenue Dr Arnaldo 351, São Paulo, Brazil
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2
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Granada D, Silveira C, Inoue SRV, Matsue RY, Martin D. [The covid-19 pandemic and international mobility in Brazil: challenges for the health and social protection of international migrants in times of uncertainty]. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2023; 30:e2023033. [PMID: 37585977 PMCID: PMC10481635 DOI: 10.1590/s0104-59702023000100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/12/2022] [Indexed: 08/18/2023]
Abstract
The relationship between health and migration was severely affected during the covid-19 pandemic. This article discusses the literature on health and migration, including the deteriorating levels of social and economic vulnerability of international migrants to Brazil in 2020 and 2021. The analysis was based on a review of articles published in the national and international press addressing the impacts of covid-19 on contemporary processes of human mobility and its consequences for stigmatized populations. The results point to the possibility of understanding the pandemic as a key moment for rethinking nationality and borders.
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Affiliation(s)
- Daniel Granada
- Professor, Departamento de Ciências Naturais e Sociais/Universidade Federal de Santa Catarina. Curitibanos - SC - Brasil
| | - Cássio Silveira
- Professor, Faculdade de Ciências Médicas da Santa Casa de São Paulo/Universidade Federal de São Paulo. São Paulo - SP - Brasil
| | - Silvia Regina Viodres Inoue
- Pesquisadora independente, Grupo de Pesquisa "Processos Migratórios Internacionais e Saúde Coletiva". São Paulo - SP - Brasil
| | - Regina Yoshie Matsue
- Professora, Escola Paulista de Medicina/Universidade Federal de São Paulo.São Paulo - SP - Brasil
| | - Denise Martin
- Professora, Escola Paulista de Medicina/Universidade Federal de São Paulo. São Paulo - SP - Brasil
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3
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Kmetiuk LB, Gonçalves G, Chechia Do Couto A, Biondo AW, Figueiredo FB. Serosurvey of Trypanosoma cruzi in persons experiencing homelessness and shelter workers of Brazil. Front Public Health 2023; 11:1125028. [PMID: 36935667 PMCID: PMC10022815 DOI: 10.3389/fpubh.2023.1125028] [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: 12/15/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Although Chagas disease, caused by Trypanosoma cruzi, has been associated with social vulnerability worldwide, producing disability and mortality, no study to date has assessed this protozoal infection in persons experiencing homelessness. Accordingly, the present study aimed to assess anti-T. cruzi antibodies by Wiener Chagatest ELISA recombinant v.3.0 in serum samples of persons experiencing homelessness and related shelter workers in São Paulo, a city with reported vectors but no recent autochthonous case report. Overall, seropositivity to T. cruzi resulted in three of 203 (1.5%) persons experiencing homelessness and two of 87 (2.3%) shelter workers, with similar seroprevalence likely associated with their past social vulnerability. Although the seropositivity in persons experiencing homelessness and shelter workers was within 0 to 25.1% seroprevalence for chronic Chagas disease in the general Brazilian population, the disease has almost decreased 2-fold from the 1980s to 2000s, and such a wide range may not reflect the local disease status. In addition, the authors hypothesized that the similar seroprevalence and exposure between homeless persons and shelter workers herein may be more associated with shared past and present low-income social vulnerability than migratory movements, which may also include infection by sharing injecting drugs, vertical transmission, or blood transfusion. Thus, future studies are needed to confirm the active transmission of Chagas disease in São Paulo city. Moreover, Chagas disease should be considered as differential diagnosis in homeless persons and shelter workers, even in major disease-free Brazilian or other worldwide cities, mostly due to early exposure and vulnerable living conditions.
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Affiliation(s)
- Louise Bach Kmetiuk
- Laboratory of Cell Biology, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Paraná, Brazil
| | - Gustavo Gonçalves
- Laboratory of Cell Biology, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Paraná, Brazil
| | - Anahi Chechia Do Couto
- Department of Veterinary Medicine, Federal University of Paraná State, Curitiba, Paraná, Brazil
| | - Alexander Welker Biondo
- Department of Veterinary Medicine, Federal University of Paraná State, Curitiba, Paraná, Brazil
| | - Fabiano Borges Figueiredo
- Laboratory of Cell Biology, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Paraná, Brazil
- *Correspondence: Fabiano Borges Figueiredo
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4
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Arifin MA, Su Peng C, Baharudin UM, Baharudin MH, Rahim MAA, Rahim SSSA, Atil A, Madrim MF, Ahmad ZNBS, Mokti K, Ramdzan AR, Jeffree MS, Hassan MR. A Systematic Review of Tropical Disease Prevalence among Migrants. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: Few studies have assessed the burden of tropical diseases among migrants into non-endemic countries.
AIM: This study aimed to systematically review the existing data of the prevalence of tropical diseases globally, including neglected tropical diseases globally.
MATERIALS AND METHODS: The authors conducted a systematic review reporting prevalence (including seroprevalence) of tropical diseases following the PRISMA guidelines and based on the database from PUBMED, WoS, and PROQUEST. All the identified records were screened according to the inclusion and exclusion criteria. The selected articles’ quality was appraised using the mixed methods appraisal tool to ensure its quality.
RESULTS: Overall, 19 studies conducted in 13 countries published between the year 2017–2020 were included in the study. Based on the thematic analysis, two themes (type of organism) and 11 sub-themes (disease) were used. The prevalence of tropical diseases among migrants ranged from 0.2 to 31% for malaria; 3–20% for Chagas Disease; 3.2–3.5% for Giardiasis; 31.7–57.4% for Toxoplasmosis; 0.1–51%, for Schistosomiasis; 0.1–15.8%, for Strongyloidiasis; 0.3–3.8% for Trichuriasis; 0.2–0.9% for Ascariasis; 6.4–9.7% for Toxocariasis; 0.3% for Loiasis; and 0.5% for Filariasis. All migrants warrant thorough screening and testing, based on the country of origin of their last visit. Routine screening and follow-up may reduce the re-emergence of tropical disease in non-endemic countries.
CONCLUSION: Multiple approaches in managing social and health issues among migrants are vital to secure healthy labor forces for the country’s economy and development. Public health sectors should implement strategic promotive, preventive, and curative programs targeted to this group.
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Shikanai Yasuda MA. Emerging and reemerging forms of Trypanosoma cruzi transmission. Mem Inst Oswaldo Cruz 2022; 117:e210033. [PMID: 35584508 PMCID: PMC9113729 DOI: 10.1590/0074-02760210033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/13/2023] Open
Abstract
This review aims to update and discuss the main challenges in controlling emergent and reemergent forms of Trypanosoma cruzi transmission through organ transplantation, blood products and vertical transmission in endemic and non-endemic areas as well as emergent forms of transmission in endemic countries through contaminated food, currently representing the major cause of acute illness in several countries. As a neglected tropical disease potentially controllable with a major impact on morbimortality and socioeconomic aspects, Chagas disease (CD) was approved at the WHO global plan to interrupt four transmission routes by 2030 (vector/blood transfusion/organ transplant/congenital). Implementation of universal or target screening for CD are highly recommended in blood banks of non-endemic regions; in organ transplants donors in endemic/non-endemic areas as well as in women at risk from endemic areas (reproductive age women/pregnant women-respective babies). Moreover, main challenges for surveillance are the application of molecular methods for identification of infected babies, donor transmitted infection and of live parasites in the food. In addition, the systematic recording of acute/non-acute cases and transmission sources is crucial to establish databases for control and surveillance purposes. Remarkably, antiparasitic treatment of infected reproductive age women and infected babies is essential for the elimination of congenital CD by 2030.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Ptarasitárias, São Paulo, SP, Brasil,Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Laboratório de Imunologia, São Paulo, SP, Brasil,WHO Technical Group IVb on Prevention and Control of Transmission and Case Management of Trypanosoma cruzi Infections, WHO, Geneva, Switzerland,+ Corresponding author:
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6
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Carneiro Junior N, Aith F, Silva RAD, Wanderley DMV, Luna EJ, Shikanai-Yasuda MA. Access and right to health for Bolivian migrants in a Brazilian metropolis. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210761en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract This paper analyzes the health care accessibility conditions afforded to Bolivian immigrants in the Brazilian health system and their perception of the right to health. This was a cross-sectional, quantitative and qualitative study carried out from 2013 to 2015. Data were collected by a questionnaire with closed questions answered by 633 Bolivian individuals; questions regarding access to health were answered by 472 immigrants over 18 years old. Semi-structured interviews conducted with 55 subjects (Bolivians, health professionals, representatives of Health Departments, Consulate of Bolivia, Public Defender’s Office, Federal Public Prosecutor’s Office and Non-Governmental Organizations) underwent content analysis. Most Bolivian immigrants know the Brazilian National Health System (SUS) and often use Primary Health Care; however, they described structural and systemic barriers to health accessibility, such as lack of documentation, working conditions, medium and high complexity procedures, language barriers, among others. The National Health Card (CNS) is an important gateway to access health care, playing a role of social integration. Interviewees recognize health as a social right, pointing it out as a human and solidary value. Ensuring this recognition, when not based on the consolidation of social policies aimed at strengthening universal social protection, is threatened.
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Affiliation(s)
- Nivaldo Carneiro Junior
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil; Centro Universitário FMABC, Brasil
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Carneiro Junior N, Aith F, Silva RAD, Wanderley DMV, Luna EJ, Shikanai-Yasuda MA. Acesso e direito à saúde para migrantes bolivianos em uma metrópole brasileira. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210761pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Este artigo analisa as condições de acesso do imigrante boliviano ao sistema de saúde brasileiro e a percepção do direito à saúde. É um estudo transversal de metodologia quantitativa e qualitativa, realizado de 2013 a 2015. Foi elaborado um questionário com perguntas fechadas respondidas por 633 bolivianos, e em relação ao acesso à saúde por 472 indivíduos bolivianos maiores de 18 anos. A abordagem qualitativa foi feita por meio da análise de conteúdo de entrevistas semiestruturadas com 55 sujeitos (bolivianos, profissionais de saúde, representantes de Secretarias de Saúde, Consulado da Bolívia, Defensoria Pública da União, Ministério Público Federal e Organizações Não Governamentais). Os bolivianos conhecem o Sistema Único de Saúde (SUS) e utilizam com frequência a Atenção Primária à Saúde (APS). Todavia, barreiras de acesso são descritas, como falta de documentação, condições de trabalho, procedimentos de média e/ou alta complexidades, dificuldades para entenderem o que é dito assim como para serem compreendidos, entre outras. Sobressai-se a obtenção do Cartão Nacional de Saúde (CNS) como porta de entrada para o acesso à saúde, desempenhando papel de integração social. O reconhecimento da Saúde como direito social destaca-se entre os entrevistados, apontado como valor humano e solidário. A garantia desse reconhecimento fica ameaçada quando não se apoia na consolidação de políticas sociais que visem o fortalecimento da proteção social universal.
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Affiliation(s)
- Nivaldo Carneiro Junior
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil; Centro Universitário FMABC, Brasil
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8
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Torrecilhas AC, Soares RP, Schenkman S, Fernández-Prada C, Olivier M. Extracellular Vesicles in Trypanosomatids: Host Cell Communication. Front Cell Infect Microbiol 2020; 10:602502. [PMID: 33381465 PMCID: PMC7767885 DOI: 10.3389/fcimb.2020.602502] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Trypanosoma cruzi, Trypanosoma brucei and Leishmania (Trypanosomatidae: Kinetoplastida) are parasitic protozoan causing Chagas disease, African Trypanosomiasis and Leishmaniases worldwide. They are vector borne diseases transmitted by triatomine bugs, Tsetse fly, and sand flies, respectively. Those diseases cause enormous economic losses and morbidity affecting not only rural and poverty areas but are also spreading to urban areas. During the parasite-host interaction, those organisms release extracellular vesicles (EVs) that are crucial for the immunomodulatory events triggered by the parasites. EVs are involved in cell-cell communication and can act as important pro-inflammatory mediators. Therefore, interface between EVs and host immune responses are crucial for the immunopathological events that those diseases exhibit. Additionally, EVs from these organisms have a role in the invertebrate hosts digestive tracts prior to parasite transmission. This review summarizes the available data on how EVs from those medically important trypanosomatids affect their interaction with vertebrate and invertebrate hosts.
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Affiliation(s)
- Ana Claudia Torrecilhas
- Departamento de Ciências Farmacêuticas, Federal University of Sao Paulo (UNIFESP), Diadema, Brazil
| | | | - Sergio Schenkman
- Departamento de Microbiologia, Imunologia e Parasitologia, UNIFESP, São Paulo, Brazil
| | | | - Martin Olivier
- The Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada
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9
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Silva RAD, Wanderley DMV, Forsyth C, Leite RM, Luna EJDA, Carneiro Júnior N, Shikanai-Yasuda MA. Awareness of Chagas disease and socioeconomic characteristics of Bolivian immigrants living in Sao Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e39. [PMID: 32578725 PMCID: PMC7304264 DOI: 10.1590/s1678-9946202062039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/18/2020] [Indexed: 11/29/2022] Open
Abstract
In this study which is part of a research project on Chagas disease (CD) among Bolivian immigrants in Sao Paulo, we describe socioeconomic characteristics, knowledge of CD and implications for acess to health care. We applied a structured questionnaire to a sample of 472 Bolivian adults (> 18 years) living in Sao Paulo and enrolled at the Barra Funda School Health Center. Participants’ median age was 28.5 years, 75.0% were from the Bolivian department of La Paz, and >90% worked in the garment industry. Respondents had lived in Sao Paulo for a median of 5.8 years. Only 169 (35.8%) were familiar with CD, while roughly half (50.4%) had lived in natural materials houses in Bolivia, 225 (47.7%) indicated familiarity with the vector, 23.9% had seen the vector in their homes in Bolivia, and 6.4% reported having been bitten by a triatomine bug. Factors associated with awareness of CD were analyzed by chi square tests, and those with p values <0.25 were included in a multivariable logistic regression model. In the multivariable logistic regression analysis, having a relative with CD (OR=4.3, 95% CI=1.5-12.0), having lived in a house with mud or wood walls (OR=0.4, 95% CI=0.2-0.8), and having heard of the triatomine bug, or vinchuca, (OR=10.0, 95% CI=5.1-19.5) were significantly associated with awareness of CD. This study shows a low familiarity with CD among Bolivian migrants living in Sao Paulo, Brazil. Raising awareness of the disease through specific communication strategies should be an essential component of public health programs to reduce the burden of CD in this and other vulnerable populations.
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Affiliation(s)
- Rubens Antonio da Silva
- Secretaria de Estado da Saúde de São Paulo, Superintendência de Controle de Endemias, São Paulo, Brazil
| | | | - Colin Forsyth
- Drugs for Neglected Diseases iniciative (DNDi), Geneva, Switzerland
| | - Ruth Moreira Leite
- Secretaria de Estado da Saúde de São Paulo, Centro de Vigilância Epidemiológica, São Paulo, São Paulo, Brazil
| | | | | | - Maria Aparecida Shikanai-Yasuda
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
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10
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Chagas Disease and Healthcare Rights in the Bolivian Immigrant Community of São Paulo, Brazil. Trop Med Infect Dis 2020; 5:tropicalmed5020062. [PMID: 32316420 PMCID: PMC7345312 DOI: 10.3390/tropicalmed5020062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Chagas disease (CD) poses a major public health challenge for the Americas and non endemic regions around the world. This study discusses the legal framework surrounding access to healthcare for CD for Bolivian migrants living in São Paulo, Brazil. While recent guidelines stipulating care for CD exist, there is a lack of legal provisions to ensure they are regularly implemented. Bolivian migrants in SP have specific needs, including language differences and a high level of mobility. Interviews were conducted with ten participants representing public health institutions or organizations working with the Bolivian migrant community. Additionally, a review was conducted of legal, official, and health policy documents pertaining to rights of Bolivian migrants in SP. Although the right to healthcare is constitutionally guaranteed for all, in practice, immigrants, especially those without documentation, encounter barriers to initiating treatment for CD. Providing the primary health care system (SUS) card would not only improve access to healthcare for Bolivian migrants, but also provide a potential pathway toward regularization of status. The approval of clinical protocols and therapeutic guidelines for CD (2018) represents an opportunity to improve care for all Brazilians with CD. Programs with multidisciplinary teams should be developed taking into account the specific social and cultural needs of this population.
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11
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Groom ZC, Zochios V, Protopapas AD. Translating Chagasic dilating cardiomyopathy to surgical therapies: An under published global challenge. SAGE Open Med 2020; 7:2050312119895927. [PMID: 31897298 PMCID: PMC6920581 DOI: 10.1177/2050312119895927] [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: 08/05/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022] Open
Abstract
Chagas disease is a neglected parasitic anthropozoonosis of the Americas linked to social deprivation with no hope of eradication in the future. Having been the most common non-ischemic cause of dilating cardiomyopathy in Latin America, it now spreads beyond the geographical boundaries of its vector via imported and autochthonous transmission. We review the evidence on surgery in Chagasic heart failure and offer a brief narrative on the main aspects of translational management. There is very limited literature on surgery for Chagasic heart failure, especially assist devices and transplantation. This may be attributed to the often unsurmountable economic burden of this single-system parasymphatholytic heart failure to young sufferers who commonly have very limited access to the aforementioned procedures. Chagasic heart failure offers a so far neglected translational model of parasymphatholytic non-ischemic cardiac failure.
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Affiliation(s)
- Zoe C Groom
- Costello Medical Consulting Limited, Cambridge, UK
| | - Vasileios Zochios
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, West Midlands Deanery, Birmingham, UK.,Department of Anaesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK
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12
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Azevedo PHR, Xavier MAP, Silva GND, Costa PAD, Carneiro CM, Brasileiro Filho G. Anti-serum validation for use in immunohistochemistry for Trypanosoma cruzi detection. Rev Soc Bras Med Trop 2018; 51:467-474. [DOI: 10.1590/0037-8682-0011-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/04/2018] [Indexed: 11/21/2022] Open
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13
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Villena FE, Gomez-Puerta LA, Jhonston EJ, Del Alcazar OM, Maguiña JL, Albujar C, Laguna-Torres VA, Recuenco SE, Ballard SB, Ampuero JS. First Report of Trypanosoma cruzi Infection in Salivary Gland of Bats from the Peruvian Amazon. Am J Trop Med Hyg 2018; 99:723-728. [PMID: 30014825 PMCID: PMC6169177 DOI: 10.4269/ajtmh.17-0816] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In the Americas, 8 million people are infected with Chagas disease, and an additional 90 million people are at risk for infection. Little is known about the role bats play in the sylvatic transmission cycle of Trypanosoma cruzi, the parasite causing Chagas disease. Here, we captured bats in the villages of Palmiche, Pachacutec, Nuevo San Martin, and Mayuriaga located in the Datem del Marañon Province in Loreto, Peru. Venous blood samples were collected by cardiac puncture or from the upper extremities, and trypanosomatids were identified by microscopy and molecularly. We collected blood samples from 121 bats on filter paper for molecular studies and 111 slides for microscopic examination of thin and thick blood smears from 16 different bat species. The prevalence of trypanosomatids in all bats species was 34.7% (42/121) and the prevalence of T. cruzi was 4.1% (5/121). In hematophagous bat species, the prevalence of trypanosomatids and T. cruzi was 36.9% (27/73) and 2.7% (2/73), respectively. In non-hematophagous bats, the prevalences of trypanosomatids and T. cruzi were 31.2% (15/48) and 6.2% (3/48), respectively. Also, we confirm the presence of T. cruzi in salivary glands of hematophagous bats Diaemus youngi. These results suggest a sylvatic cycle of trypanosomatid transmission in which bats may harbor infectious T. cruzi parasites that could be transmitted to humans via hematophagous bat bites or salivary contamination by non-hematophagous bats of vegetables consumed by humans.
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Affiliation(s)
- Fredy E Villena
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Luis A Gomez-Puerta
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.,U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Erik J Jhonston
- Facultad de Medicina de la Universidad Nacional de la Amazonia Peruana, Loreto, Peru
| | - O Melisa Del Alcazar
- Departamento de Mastozoología, Museo de Historia Natural, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Jorge L Maguiña
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | | | - V Alberto Laguna-Torres
- Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sergio E Recuenco
- Departamento de Medicina Preventiva y Salud Pública, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Julia S Ampuero
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
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Shikanai Yasuda MA, Sátolo CG, Carvalho NB, Atala MM, Ferrufino RQ, Leite RM, Furucho CR, Luna E, Silva RA, Hage M, de Oliveira CMR, Busser FD, de Freitas VLT, Wanderley DMV, Martinelli L, Almeida SR, Viñas PA, Carneiro N. Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo. PLoS Negl Trop Dis 2017; 11:e0005466. [PMID: 28333923 PMCID: PMC5380346 DOI: 10.1371/journal.pntd.0005466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 04/04/2017] [Accepted: 03/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Methods In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. Results The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. Conclusion An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system. Chagas disease affects approximately 6 million Latin American people. It is considered a neglected tropical disease since it mainly affects vulnerable, poverty-stricken people. Public health policies and investments in research on new treatment and control instruments have not been prioritized. In fact, disease urbanization occurred in Latin America in the 80s, and an estimated 15 million people moved from disease-endemic areas to nonendemic areas. Estimations have indicated that 2.9% of immigrants were infected by T. cruzi in 15 European countries, and more than 300,000 infected immigrants resided in the USA. In São Paulo, the estimated number of Bolivian immigrants exceeds 300,000. This study revealed the presence of mild clinical manifestations in predominantly young infected individuals, including reproductive-age women. For the first time, the feasibility of managing chronic Chagas disease at primary healthcare level centers with a biomedical and psychosocial interdisciplinary approach has been reported in the National Public Health System of Brazil. Additionally, the utilized commercial tests did not confirm the previously expected performance for diagnosis of infection. Finally, the itinerant characteristics of the Bolivian immigrant population was reported as a main factor underlying the lack of adherence to antiparasitic treatment and a main challenge for complete clinical management.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Camila Gonçalves Sátolo
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Noemia Barbosa Carvalho
- Division of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Magda Maya Atala
- Hospital das Clínicas, Faculdade de Medicina Ribeirão Preto of the University of São Paulo, São Paulo, Brazil
| | - Rosario Quiroga Ferrufino
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Ruth Moreira Leite
- Centro de Vigilância Epidemiológica, Coordenadoria de Controle de Doenças da Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Célia Regina Furucho
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Expedito Luna
- Tropical Medicine Institute of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Rubens Antonio Silva
- Superintendência de Controle de Endemias, Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Marcia Hage
- Laboratory of Parasitology (LIM 46), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | | | - Felipe Delatorre Busser
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Vera Lucia Teixeira de Freitas
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | | | - Luzia Martinelli
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Sonia Regina Almeida
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Pedro Albajar Viñas
- Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| | - Nivaldo Carneiro
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Social Medicine, School of Medical Sciences of Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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