[Investigation of vectors and reservoirs in an acute Chagas outbreak due to possible oral transmission in Aguachica, Cesar, Colombia]

Trypanosoma cruzi in domestic and wild mammals in the northeast region of Colombia

Trypanosoma cruzi hosts can serve as a source of infection for animals, vectors, and humans, contributing to the establishment of Chagas disease (CD) in a given area. Traditionally, the Department of Córdoba has not been considered a transmission area for CD; however, the report of several acute cases of Chagas disease highlights the importance of studying the dynamics of disease transmission in this region. This study aimed to detect T. cruzi in domestic and wild mammals in the department of Córdoba. In 2017, a cross-sectional descriptive study was conducted in six villages in two municipalities in the department of Córdoba. Blood samples from dogs living in the zones were collected in EDTA vacutainer tubes for domestic mammals. Wild mammals were collected using Sherman and Tomahawk traps and mist nets in crops and peridomiciles. T. cruzi DNA was detected using the kinetoplast DNA (kDNA) variable region and the tandem repeat satellite region of T. cruzi as molecular targets. We sampled 168 dogs and 146 wild mammals. The detected prevalence of T. cruzi was 6.37%; the TcI lineage was found in D. marsupialis, H. anomalus, and one canine. A specimen of D. marsupialis with TcI and TcII lineages was also identified. T. cruzi DNA was detected in domestic and wild animals in the study area, indicating the circulation of the parasite in peridomestic environments. D. marsupialis may represent an important host in maintaining this region's wild and domestic cycle.

Multilocus genetic analysis of Trypanosoma cruzi supports non-domestic intrusion into domestic transmission in an endemic region of Colombia

Trypanosoma cruzi, the causative agent of Chagas disease, is primarily transmitted to humans by hematophagous bugs of the Triatominae subfamily. In the Colombian Caribbean region, particularly on Margarita Island, T. cruzi transmission is highly endemic and associated with vectors such as Triatoma maculata and Rhodnius pallescens. Additionally, T. cruzi-infected Didelphis marsupialis are commonly found in close proximity to human dwellings. Given the complex transmission dynamics involving various domestic and non-domestic hosts, this study aimed to analyze 145 T. cruzi clones from twelve strains isolated from T. maculata, R. pallescens, and D. marsupialis using spliced leader intergenic region (SL-IR) sequences and nine polymorphic microsatellite loci. The results indicate the presence of a single polymorphic T. cruzi population, suggesting sustained local transmission dynamics between triatomines adapted to A. butyracea forests and peridomestic areas inhabited by synanthropic mammal reservoir such as D. marsupialis. Notably, this population appears to lack substructure, highlighting the importance of adopting an alternative eco-health approach to complement traditional chemical vector control methods for more effective and sustainable interruption of transmission.

Sugar feeding in triatomines: a new perspective for controlling the transmission of Chagas disease

Introduction: Triatomines are vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. Currently, there is no vaccine against this disease. Thus, control of the insect vector population is the main strategy available to reduce the number of cases. Triatomines are considered obligate hematophagous, but different alternative feeding behaviors were described, such as haemolymphagy or plant feeding. Methods: To determine the preference for sugar feeding in nymphs and adults of Rhodnius prolixus, the insects were exposed a piece of cotton containing bromophenol blue plus sucrose. In addition, we offered several sugars for different species of triatomines, and tested sugar meals as a route of delivery of insecticides in first-instar nymphs of R. prolixus. The effect of sugar feeding on the physiology of these different species of triatomines was recorded. Results: First instar nymphs ingested sucrose more strongly than other stages, and showed high mortality rates. In different species of triatomines, sucrose induced an ingestion, but engorgement varied according to the species. R. prolixus nymphs showed an indiscriminate intake of various sugars, with very different physiological effects. Furthermore, ingesting different combinations of insecticides + sugar significantly reduced insect survival. Discussion: In summary, we described for the first-time sugar feeding as a widespread behavior in several species of triatomines, and the possibility of the use of toxic sugar baits for the control of these vectors. The knowledge of feeding behavior in these insects can be fundamental for the development of new strategies to control Chagas disease.

Addressing Chagas disease from a One Health perspective: risk factors, lessons learned and prevention of oral transmission outbreaks in Colombia

Background

Chagas disease (CD) is transmitted by vectors but can also be transmitted orally through contaminated food, drinks, or meat. The One Health perspective aims to understand the complex interaction between human, animal, and environmental health in controlling disease. This study analyzed risk factors and drew lessons from past outbreaks of orally transmitted CD to develop effective preventive strategies.

Methods

A simultaneous mixed methods study was conducted. The study consisted of two phases: an ecological epidemiological analysis at the municipal level using secondary data spanning from 1992 to 2023, and semistructured interviews with health providers and policymakers at the national level in Colombia. The results from both phases were triangulated to gain a comprehensive understanding of the topic.

Results

A total of 64 outbreaks, infecting 302 individuals, were reported. Most of these outbreaks (89.2%) were classified as family-related, and they occurred most frequently during the months of April to June (46.6%). It is worth noting that a significant number of these outbreaks took place in municipalities that lacked vector control plans. Risk factors for oral transmission included the location of food preparation, poor housing quality, food preparation water source, the presence of vectors/marsupials, forest type, and climatic variables. Interviews conducted emphasized the importance of implementing outbreak plans and providing staff training to effectively address the issue.

Conclusion

A One Health approach strengthening prevention, surveillance, case management and cross-sectoral collaboration is needed to control outbreaks and reduce transmission in Colombia. Preparedness plans and education of health professionals are also important. This study identified modifiable risk factors to guide public health interventions.

Oral Chagas Disease in Colombia-Confirmed and Suspected Routes of Transmission

Chagas disease (CD) remains endemic throughout many regions of Colombia despite implementing decades of vector control strategies in several departments. Some regions have had a significant decrease in vectorial transmission, but the oral ingestion of Trypanosoma cruzi through consumption of contaminated food and drink products is increasingly described. This form of transmission has important public health relevance in Colombia due to an increase in reported acute CD cases and clinical manifestations that often lead to significant morbidity and mortality. Oral CD in Colombia has been associated with the consumption of contaminated fruit juices, such as palm wine, sugar cane, or tangerine juice and water for consumption, or contaminated surfaces where food has been prepared. Another interesting route of oral transmission includes ingestion of unbeknownst infected armadillos' blood, which is related to a traditional medicine practice in Colombia. Some earlier reports have also implemented consumption of infected bush meat as a source, but this is still being debated. Within the Amazon Basin, oral transmission is now considered the principal cause of acute CD in these regions. Furthermore, new cases of acute CD are now being seen in departments where CD has not been documented, and triatomine vectors are not naturally found, thus raising suspicion for oral transmission. The oral CD could also be considered a food-borne zoonosis, and odoriferous didelphid secretions have been implemented in contaminating the human dwelling environment, increasing the risk of consumption of infectious metacyclic trypomastigotes. In this article, we will discuss the complex transmission dynamics of oral CD in Colombia and further examine the unique clinical manifestations of this route of infection. New insights into the oral transmission of Trypanosoma cruzi are being discovered in Colombia, which can help bring increased awareness and a better understanding of this neglected tropical disease to reduce the burden of CD throughout Latin America.

Urban vectors of Chagas disease in the American continent: A systematic review of epidemiological surveys

BACKGROUND

Chagas is a complex and multidimensional socio-environmental health phenomenon, in which different components converge and interact. Historically, this disease was associated with insect vectors found in the rural environment. However, in the Americas, we are currently facing a new paradigm, in which different scenarios allow maintaining the vectorial transmission of the parasite through triatomine populations that either occasionally enter the dwellings or colonize urban environments.

METHODOLOGY/PRINCIPAL FINDINGS

Records of scientific reports available in the PubMed and LILACS search engines were retrieved, using three criteria according to the main triatomine genera of epidemiological importance and to the general scientific production on Chagas disease in urban contexts. Results showed that records on the occurrence of vectors in urban dwellings began to increase in the last three decades. Results also showed that the main species of triatomines collected inside dwellings (18 in total) belong mainly to the genera Triatoma and Panstrongylus, with most species (16/18, 88.8%) infected with the parasite, and that infestation of triatomine species occurs in all types of cities (small, medium and large, including megalopolises), from Argentina to the USA.

CONCLUSIONS/SIGNIFICANCE

Urban Chagas represents a new challenge that adds a different dimension to the problem of Chagas disease due to the particular characteristics of the lifestyle in urban agglomerates. The new scenario will require adaptations of the programs of control of vector to this shift from rural to urban settlements.

The potential risk of enzootic Trypanosoma cruzi transmission inside four training and re-training military battalions (BITER) in Colombia

BACKGROUND

Colombia's National Army is one of the largest military institutions in the country based on the number of serving members and its presence throughout the country. There have been reports of cases of acute or chronic cases of Chagas disease among active military personnel. These may be the result of military-associated activities performed in jungles and other endemic areas or the consequence of exposure to Trypanosoma cruzi inside military establishments/facilities located in endemic areas. The aim of the present study was to describe the circulation of T. cruzi inside facilities housing four training and re-training battalions [Battalions of Instruction, Training en Re-training (BITERs)] located in municipalities with historical reports of triatomine bugs and Chagas disease cases. An entomological and faunal survey of domestic and sylvatic environments was conducted inside each of these military facilities.

METHODS

Infection in working and stray dogs present in each BITER location was determined using serological and molecular tools, and T. cruzi in mammal and triatomine bug samples was determined by PCR assay. The PCR products of the vertebrate 12S rRNA gene were also obtained and subjected to Sanger sequencing to identify blood-feeding sources. Finally, we performed a geospatial analysis to evaluate the coexistence of infected triatomines and mammals with the military personal inside of each BITER installation.

RESULTS

In total, 86 specimens were collected: 82 Rhodnius pallescens, two Rhodnius prolixus, one Triatoma dimidiata and one Triatoma maculata. The overall T. cruzi infection rate for R. pallescens and R. prolixus was 56.1 and 100% respectively, while T. dimidiata and T. maculata were not infected. Eight feeding sources were found for the infected triatomines, with opossum and humans being the most frequent sources of feeding (85.7%). Infection was most common in the common opossum Didelphis marsupialis, with infection levels of 77.7%. Sylvatic TcI was the most frequent genotype, found in 80% of triatomines and 75% of D. marsupialis. Of the samples collected from dogs (n = 52), five (9.6%; 95% confidence interval: 3.20-21.03) were seropositive based on two independent tests. Four of these dogs were creole and one was a working dog. The spatial analysis revealed a sympatry between infected vectors and mammals with the military population.

CONCLUSIONS

We have shown a potential risk of spillover of sylvatic T. cruzi transmission to humans by oral and vectorial transmission in two BITER installations in Colombia. The results indicate that installations where 100,000 active military personnel carry out training activities should be prioritized for epidemiological surveillance of Chagas disease.

Case-fatality From Orally-transmitted Acute Chagas Disease: A Systematic Review and Meta-analysis

Orally-transmitted acute Chagas disease (CD) is emerging as an important public health problem. The prognosis of acute infection following oral transmission is unknown. The aim of this study was to analyze and summarize data on orally-transmitted acute CD. We searched for publications from 1968 to 31 January 2018. We included studies and unpublished data from government sources that reported patients with acute orally-transmitted CD. We identified 41 papers and we added 932 unpublished cases. In all, our study covered 2470 cases and occurrence of 97 deaths. Our meta-analysis estimated that the case-fatality rate was 1.0% (95% CI 0.0-4.0%). Lethality rates have declined over time (P = .02). In conclusion, orally-transmitted acute CD has considerable lethality in the first year after infection. The lethality in symptomatic cases is similar to that from other routes of infection. The lethality rate of orally-acquired disease has declined over the years.

Systematic review on the biology, ecology, genetic diversity and parasite transmission potential of Panstrongylus geniculatus (Latreille 1811) in Latin America

Panstrongylus geniculatus (Latreille, 1811) is the triatomine with the largest geographic distribution in Latin America. It has been reported in 18 countries from southern Mexico to northern Argentina, including the Caribbean islands. Although most reports indicate that P. geniculatus has wild habitats, this species has intrusive habits regarding human dwellings mainly located in intermediate deforested areas. It is attracted by artificial light from urban and rural buildings, raising the risk of transmission of Trypanosoma cruzi. Despite the wide body of published information on P. geniculatus, many knowledge gaps exist about its biology and epidemiological potential. For this reason, we analysed the literature for P. geniculatus in Scopus, PubMed, Scielo, Google Scholar and the BibTriv3.0 databases to update existing knowledge and provide better information on its geographic distribution, life cycle, genetic diversity, evidence of intrusion and domiciliation, vector-related circulating discrete taxonomic units, possible role in oral T. cruzi transmission, and the effect of climate change on its biology and epidemiology.

Understanding the oral transmission of Trypanosoma cruzi as a veterinary and medical foodborne zoonosis

Chagas disease is a neglected tropical disease transmitted by the protozoan Trypanosoma cruzi that lately has been highlighted because several outbreaks attributed to oral transmission of the parasite have occurred. These outbreaks are characterized by high mortality rates and massive infections that cannot be related to other types of transmission such as the vectorial route. Oral transmission of Chagas disease has been reported in Brazil, Colombia, Venezuela, Bolivia, Ecuador, Argentina and French Guiana, most of them are massive oral outbreaks caused by the ingestion of beverages and food contaminated with triatomine feces or parasites' reservoirs secretions and considered since 2012 as a foodborne disease. In this review, we present the current status and all available data regarding oral transmission of Chagas disease, highlighting its relevance as a veterinary and medical foodborne zoonosis.

Heterogeneity of Trypanosoma cruzi infection rates in vectors and animal reservoirs in Colombia: a systematic review and meta-analysis

Background

The heterogeneity of Trypanosoma cruzi infection rates among triatomines insects and animal reservoirs has been studied in independent studies, but little information has been systematised to allow pooled and comparative estimates. Unravelling the main patterns of this heterogeneity could contribute to a further understanding of T. cruzi transmission in Colombia.

Methods

A systematic search was conducted in PubMed, Medline, LILACS, Embase, Web of Knowledge, Google Scholar and secondary sources with no filters of language or time and until April 2018. Based on selection criteria, all relevant studies reporting T. cruzi infection rates in reservoirs or triatomines were chosen. For pooled analyses, a random effects model for binomial distribution was used. Heterogeneity among studies is reported as I². Subgroup analyses included: taxonomic classification, ecotope and diagnostic methods. Publication bias and sensitivity analyses were performed.

Results

Overall, 39 studies reporting infection rates in Colombia were found (22 for potential reservoirs and 28 for triatomine insects) for a total sample of 22,838 potential animals and 11,307 triatomines evaluated for T. cruzi infection. We have found evidence of 38/71 different animal species as potential T. cruzi reservoirs and 14/18 species as triatomine vectors for T. cruzi. Among animals, the species with the highest pooled prevalence were opossum (Didelphis marsupialis) with 48.0% (95% CI: 26–71%; I² = 88%, τ² = 0.07, P < 0.01) and domestic dog (Canis lupus familiaris) with 22.0% (95% CI: 4–48%; I² = 96%, τ² = 0.01, P < 0.01). Among triatomines, the highest prevalence was found for Triatoma maculata in the peridomestic ecotope (68.0%, 95% CI: 62–74%; I² = 0%, τ² = 0, P < 0.0001), followed by Rhodnius prolixus (62.0%, 95% CI: 38–84%; I² = 95%, τ² = 0.05, P < 0.01) and Rhodnius pallescens (54.0%, 95% CI: 37–71%; I² = 86%, τ² = 0.035, P < 0.01) in the sylvatic ecotope.

Conclusions

To our knowledge, this is the first systematic and quantitative analyses of triatomine insects and potential animal reservoirs for T. cruzi infection in Colombia. The results highlight a marked heterogeneity between species and provide initial estimates of infection rates heterogeneity.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3541-5) contains supplementary material, which is available to authorized users.

Occurrences of triatomines (Hemiptera: Reduviidae) and first reports of Panstrongylus geniculatus in urban environments in the city of Sao Paulo, Brazil

This note reports on occurrences of triatomine species in the city of Sao Paulo, Brazil, registered between 1988 and 2017. Records of triatomines captured in Sao Paulo are based on specimens received spontaneously from Health Surveillance Centers, Health Centers and Zoonosis Control Centers in the city as well as from citizens. Species were identified morphologically at the Public Health Entomology Laboratory, Faculty of Public Health, University of Sao Paulo, where the triatomines, which are vectors of Chagas disease, were tested for Trypanosoma cruzi infection. The first reported occurrence of triatomine bugs in urban Sao Paulo was in 1988. The specimen, which was captured in Jardim Sao Luiz district, was from the genus Panstrongylus and was registered as Panstrongylus sp. but was not sexed. Since this first recorded occurrence, the following species have been found in the city: Panstrongylus geniculatus (2 occurrences), P. megistus (15 occurrences), Triatoma infestans (1 occurrence) and T. sordida (3 occurrences). In this paper, the importance of reporting occurrences of triatomine bugs in the city of Sao Paulo, one of the largest metropolis in the world, is discussed with an emphasis on P. megistus. The occurrences discussed here indicate the importance of entomological surveillance for these vectors even in urban centers although the possibility of vector transmission of Chagas disease in these centers is very low.

Análise espaço-temporal da doença de Chagas e seus fatores de risco ambientais e demográficos no município de Barcarena, Pará, Brasil

RESUMO: Introdução: A doença de Chagas é uma parasitose considerada um grave problema de saúde pública. No município de Barcarena, Pará, de 2007 a 2014, ocorreu a maior prevalência dessa doença no Brasil. Objetivo: Analisar a distribuição dessa doença relacionada às variáveis epidemiológicas, ambientais e demográficas, na área e no período do estudo. Métodos: Foram utilizados dados epidemiológicos e demográficos da Secretaria Municipal de Saúde de Barcarena e imagens de satélites do Instituto Nacional de Pesquisas Espaciais. Os dados de desmatamento foram obtidos por classificação de imagens de satélites, utilizando rede neural artificial. As análises de significância estatística foram realizadas com o teste do χ2, e as de dependência espacial entre as variáveis, com as técnicas de Kernel e Moran. Resultados: A curva epidemiológica indicou um padrão sazonal da doença. O maior percentual dos casos foi em indivíduos do sexo masculino, pardos, adultos, analfabetos, da zona urbana e com provável contaminação oral. Foi confirmada dependência espacial dos casos da doença com os diferentes tipos de desmatamento identificados no município, bem como aglomerados de casos em áreas urbanas e rurais. Discussão: A distribuição da doença não ocorreu de forma homogênea, possivelmente pela dinâmica demográfica do município, com intensos fluxos migratórios que causam os desmatamentos. Conclusão: Foram observadas diferentes relações entre as variáveis estudadas e a ocorrência da doença no município. As tecnologias utilizadas foram satisfatórias para a construção dos cenários epidemiológicos da doença.

[Possible oral transmission of Chagas disease among hydrocarbons sector workers in Casanare, Colombia, 2014]

INTRODUCTION

Trypanosoma cruzi, the etiological agent for Chagas disease, can be transmitted by oral intake of contaminated food or drinks. During epidemiological week 14 of 2014, two cases of acute Chagas disease were notified among hydrocarbons sector workers in Paz de Ariporo, Casanare.

OBJECTIVE

To characterize the affected population, to establish control and prevention measures and to confirm the outbreak.

MATERIALS AND METHODS

We conducted an outbreak investigation that included the following components: a) Search for symptomatic people compatible with Chagas disease according to the case definition for their referral to medical services; b) entomological survey (192/197 houses); c) sanitary inspection and microbiological analysis of food samples; and d) study of reservoirs. Data management and analysis were done with Epi-Info 7.1.5 using descriptive statistics. We also calculated intradomicile and peridomicile triatomine infestation indexes.

RESULTS

We detected 552 exposed people; 40 had the disease (7.2%), of whom seven were women (17,5%) and 33, men (82.5%), i.e., a male-female ratio of 5:1. The mean age was 39.1 ± 10.8 years; the attack rate was 7.2% and lethality, 5% (2/40). Symptoms included fever (100% of cases), headache (80%), myalgia and arthralgia (65%), facial edema (55%), and abdominal pain (37.5%). The mean incubation time was 17 days (range: 3-21). Rhodnius prolixus domiciliary infestation index was 3.3 % and 2.2% in the peridomicile. In the five restaurants inspected sanitary conditions were deficient and food samples were microbiologically non-conforming. We found a dog and two opossums positive for IgG antibodies by ELISA.

CONCLUSIONS

Environmental, sanitary and epidemiological conditions at the place confirmed an outbreak of Chagas diseases related to occupational exposure, possibly by oral transmission, which may be the largest to date in Colombia.

Triatoma dimidiata in Colombia. Distribution, ecology and its epidemiological importance

Triatoma dimidiata es un importante vector de la enfermedad de Chagas en Centro América y países del norte de Suramérica. En Colombia tiene una amplia dispersión con reportes de presencia en 14 departamentos de las regiones Andina, Caribe, Llanos Orientales y Alto Magdalena, áreas en las cuales ocupa diferentes ecotopos naturales y artificiales. La especie está clasificada como secundaria para la transmisión de Trypanosoma cruzi sin embargo su presencia en el ambiente silvestre, peridoméstico e intradoméstico en la región Andina, y su capacidad de movilizarse entre estos escenarios lo facultan para escapar del control basado en aspersión con piretroides resaltando su importancia en el mantenimiento de la transmisión del parásito a través de la potencial re-infestación de las viviendas. La comprensión de las conexiones establecidas por T. dimidiata, entre los escenarios, y el trabajo con la comunidad en actividades de empoderamiento permitirá contribuir en el desarrollo de sistemas de control efectivos y perdurables en el tiempo. El propósito de esta revisión es describir la distribución, factores de riesgo, ecología, características entomológicas y escenarios de las poblaciones de T. dimidiata en Colombia, así como proponer alternativas de intervención acorde a las exigencias particulares que esta especie demanda.

[Risk of transmission of Chagas disease by intrusion of triatomines and wild mammals in Bucaramanga, Santander, Colombia]

INTRODUCTION

Notice of triatomines in dwellings of some neighborhoods in Bucaramanga motivated the realization of this study.Objetive: To evaluate the intrusion of triatomines and mammals, as well as some risk factors in urban dwellings.

MATERIALS AND METHODS

Triatomines were collected in a neighborhood in Bucaramanga, Santander, on a monthly basis during one year with participation of the community. Collection included manual search in lamp posts, use of light traps, animal bait, and chemical attractants in nearby forests. Reservoirs were collected with bait traps. Insects and mammals were identified and examined in order to determine their natural infection. Risk factors in homes were assessed by means of a social-environmental survey.

RESULTS

Eleven adult specimens of Pastrongylus geniculatus, as well as 63 of Rhodnius pallescens were collected in the forest, recreational peridomiciliary areas, and houses. Even two females and 21 nymphs of R. pallescens were found in bedrooms. Two specimens of Didelphis marsupialis were captured in neighboring forests. Out of the eleven P. geniculatus captured, nine were examined. Of these, five were positive for Trypanosoma cruzi. It was not possible to establish a significant risk factor;however, the dwellings with report of triatomines were located nearer to the adjacent forest.

CONCLUSIONS

The finding of intrusive triatominae species and mammals with T. cruzi in intradomiciliary and peridomiciliary areas and periurban forests prove the potential risk to acquire infection from these populations that dwell in urban housing adjacent to these ecotopes where the sylvan cycle is kept.

[Diversity of Triatominae (Hemiptera: Reduviidae) in Santander, Colombia: Epidemiological implications]

INTRODUCTION

Domestic and wild triatomines in the department of Santander have an epidemiological impact, as recently they have been linked to outbreaks of acute Chagas disease. The analysis of their diversity and temporal variation contributes to the understanding of their biology and ecology in one of the most endemic areas of the country.

OBJECTIVES

To analyze triatominae diversity in two regions of Santander.

MATERIALS AND METHODS

We analyzed the triatomine records for Santander contained in the CINTROP-UIS entomology lab database. We grouped the information for two regions: the Middle Magdalena area and the Andean region, and for each one we designed species accumulation and range-abundance curves, we calculated diversity and equality indices, and we analyzed colonization and temporal variation or persistence of the community.

RESULTS

Ninety five percent of triatomines came from the Andean area and 4.57% from Magdalena Medio, with nine and ten species each. The dominant species in the Andean area were Rhodnius prolixus and Triatoma dimidiata while in Magdalena Medio they were Rhodnius pallescens and Panstrongylus geniculatus. We found a greater diversity and richness in Middle Magdalena compared to the Andean area. The temporal variation showed persistence of communities over time.

CONCLUSIONS

Results revealed differences in the diversity of the two regions and the potential of wild species to occupy artificial ecotopes. Triatomines intrusion and the recent involvement of wild species in the transmission of Trypanosoma cruzi emphasize the need to further investigate the ecology of these vectors in order to guide population control strategies.

Untangling the transmission dynamics of primary and secondary vectors of Trypanosoma cruzi in Colombia: parasite infection, feeding sources and discrete typing units

BACKGROUND

Trypanosoma cruzi is the causative agent of Chagas disease. Due to its genetic diversity has been classified into six Discrete Typing Units (DTUs) in association with transmission cycles. In Colombia, natural T. cruzi infection has been detected in 15 triatomine species. There is scarce information regarding the infection rates, DTUs and feeding preferences of secondary vectors. Therefore, the aim of this study was to determine T. cruzi infection rates, parasite DTU, ecotopes, insect stages, geographical location and bug feeding preferences across six different triatomine species.

METHODS

A total of 245 insects were collected in seven departments of Colombia. We conducted molecular detection and genotyping of T. cruzi with subsequent identification of food sources. The frequency of infection, DTUs, TcI genotypes and feeding sources were plotted across the six species studied. A logistic regression model risk was estimated with insects positive for T. cruzi according to demographic and eco-epidemiological characteristics.

RESULTS

We collected 85 specimens of Panstrongylus geniculatus, 77 Rhodnius prolixus, 37 R. pallescens, 34 Triatoma maculata, 8 R. pictipes and 4 T. dimidiata. The overall T. cruzi infection rate was 61.2% and presented statistical associations with the departments Meta (OR: 2.65; 95% CI: 1.69-4.17) and Guajira (OR: 2.13; 95% CI: 1.16-3.94); peridomestic ecotope (OR: 2.52: 95% CI: 1.62-3.93); the vector species P. geniculatus (OR: 2.40; 95% CI: 1.51-3.82) and T. maculata (OR: 2.09; 95% CI: 1.02-4.29); females (OR: 2.05; 95% CI: 1.39-3.04) and feeding on opossum (OR: 3.15; 95% CI: 1.85-11.69) and human blood (OR: 1.55; 95% CI: 1.07-2.24). Regarding the DTUs, we observed TcI (67.3%), TcII (6.7%), TcIII (8.7%), TcIV (4.0%) and TcV (6.0%). Across the samples typed as TcI, we detected TcIDom (19%) and sylvatic TcI (75%). The frequencies of feeding sources were 59.4% (human blood); 11.2% (hen); 9.6% (bat); 5.6% (opossum); 5.1% (mouse); 4.1% (dog); 3.0% (rodent); 1.0% (armadillo); and 1.0% (cow).

CONCLUSIONS

New scenarios of T. cruzi transmission caused by secondary and sylvatic vectors are considered. The findings of sylvatic DTUs from bugs collected in domestic and peridomestic ecotopes confirms the emerging transmission scenarios in Colombia.

Molecular Diagnosis of Chagas Disease in Colombia: Parasitic Loads and Discrete Typing Units in Patients from Acute and Chronic Phases

BACKGROUND

The diagnosis of Chagas disease is complex due to the dynamics of parasitemia in the clinical phases of the disease. The molecular tests have been considered promissory because they detect the parasite in all clinical phases. Trypanosoma cruzi presents significant genetic variability and is classified into six Discrete Typing Units TcI-TcVI (DTUs) with the emergence of foreseen genotypes within TcI as TcIDom and TcI Sylvatic. The objective of this study was to determine the operating characteristics of molecular tests (conventional and Real Time PCR) for the detection of T. cruzi DNA, parasitic loads and DTUs in a large cohort of Colombian patients from acute and chronic phases.

METHODOLOGY/PRINCIPAL FINDINGS

Samples were obtained from 708 patients in all clinical phases. Standard diagnosis (direct and serological tests) and molecular tests (conventional PCR and quantitative PCR) targeting the nuclear satellite DNA region. The genotyping was performed by PCR using the intergenic region of the mini-exon gene, the 24Sa, 18S and A10 regions. The operating capabilities showed that performance of qPCR was higher compared to cPCR. Likewise, the performance of qPCR was significantly higher in acute phase compared with chronic phase. The median parasitic loads detected were 4.69 and 1.33 parasite equivalents/mL for acute and chronic phases. The main DTU identified was TcI (74.2%). TcIDom genotype was significantly more frequent in chronic phase compared to acute phase (82.1% vs 16.6%). The median parasitic load for TcIDom was significantly higher compared with TcI Sylvatic in chronic phase (2.58 vs.0.75 parasite equivalents/ml).

CONCLUSIONS/SIGNIFICANCE

The molecular tests are a precise tool to complement the standard diagnosis of Chagas disease, specifically in acute phase showing high discriminative power. However, it is necessary to improve the sensitivity of molecular tests in chronic phase. The frequency and parasitemia of TcIDom genotype in chronic patients highlight its possible relationship to the chronicity of the disease.

Experimental Infection of Rhodnius prolixus (Hemiptera, Triatominae) with Mycobacterium leprae Indicates Potential for Leprosy Transmission

Leprosy is a chronic dermato-neurological disease caused by infection with Mycobacterium leprae. In 2013 almost 200,000 new cases of leprosy were detected around the world. Since the first symptoms take from years to decades to appear, the total number of asymptomatic patients is impossible to predict. Although leprosy is one of the oldest records of human disease, the mechanisms involved with its transmission and epidemiology are still not completely understood. In the present work, we experimentally investigated the hypothesis that the mosquitoes Aedes aegypti and Culex quinquefasciatus and the hemiptera Rhodnius prolixus act as leprosy vectors. By means of real-time PCR quantification of M. leprae 16SrRNA, we found that M. leprae remained viable inside the digestive tract of Rhodnius prolixus for 20 days after oral infection. In contrast, in the gut of both mosquito species tested, we were not able to detect M. leprae RNA after a similar period of time. Inside the kissing bug Rhodnius prolixus digestive tract, M. leprae was initially restricted to the anterior midgut, but gradually moved towards the hindgut, in a time course reminiscent of the life cycle of Trypanosoma cruzi, a well-known pathogen transmitted by this insect. The maintenance of M. leprae infectivity inside the digestive tract of this kissing bug is further supported by successful mice footpad inoculation with feces collected 20 days after infection. We conclude that Rhodnius prolixus defecate infective M. leprae, justifying the evaluation of the presence of M. leprae among sylvatic and domestic kissing bugs in countries endemic for leprosy.

Host cell invasion and oral infection by Trypanosoma cruzi strains of genetic groups TcI and TcIV from chagasic patients

BACKGROUND

Outbreaks of acute Chagas disease by oral infection have been reported frequently over the last ten years, with higher incidence in northern South America, where Trypanosoma cruzi lineage TcI predominates, being responsible for the major cause of resurgent human disease, and a small percentage is identified as TcIV. Mechanisms of oral infection and host-cell invasion by these parasites are poorly understood. To address that question, we analyzed T. cruzi strains isolated from chagasic patients in Venezuela, Guatemala and Brazil.

METHODS

Trypanosoma cruzi metacyclic trypomastigotes were orally inoculated into mice. The mouse stomach collected four days later, as well as the stomach and the heart collected 30 days post-infection, were processed for histological analysis. Assays to mimic parasite migration through the gastric mucus layer were performed by counting the parasites that traversed gastric mucin-coated transwell filters. For cell invasion assays, human epithelial HeLa cells were incubated with metacyclic forms and the number of internalized parasites was counted.

RESULTS

All TcI and TcIV T. cruzi strains were poorly infective by the oral route. Parasites were either undetectable or were detected in small numbers in the mouse stomach four days post oral administration. Replicating parasites were found in the stomach and/or in the heart 30 days post-infection. As compared to TcI lineage, the migration capacity of TcIV parasites through the gastric mucin-coated filter was higher but lower than that exhibited by TcVI metacyclic forms previously shown to be highly infective by the oral route. Expression of pepsin-resistant gp90, the surface molecule that downregulates cell invasion, was higher in TcI than in TcIV parasites and, accordingly, the invasion capacity of TcIV metacyclic forms was higher. Gp90 molecules spontaneously released by TcI metacyclic forms inhibited the parasite entry into host cells. TcI parasites exhibited low intracellular replication rate.

CONCLUSIONS

Our findings indicate that the poor capacity of TcI lineage, and to a lesser degree of TcIV parasites, in invading gastric epithelium after oral infection of mice may be associated with the inefficiency of metacyclic forms, in particular of TcI parasites, to migrate through the gastric mucus layer, to invade target epithelial cells and to replicate intracellularly.

Everybody loves sugar: first report of plant feeding in triatomines

BACKGROUND

Triatomines, which are the vectors of Trypanosoma cruzi, have been considered to be exclusive blood feeders for more than 100 years, since the discovery of Chagas disease.

METHODS

We offered artificial sugar meals to the laboratory model-insect Rhodnius prolixus, which is considered a strict haematophagous insect. We registered feeding by adding colorant to sugar meals. To assess putative phytophagy, fruits of the tomato Solanum lycopersicum were offered to R. prolixus and the presence of tomato DNA was assessed in the insects using PCR. We also assessed longevity, blood feeding and urine production of fruit-exposed triatomines and control insects.

RESULTS

All instars of R. prolixus ingested sugar from artificial sugar meals in laboratory conditions. First instar R. prolixus ingested plant tissue from S. lycopersicum fruits, and this increased the amount of blood ingested and urine excreted. Decreased mortality was also observed after blood feeding. Exposure to S. lycopersicum increased longevity and reduced weight loss caused by desiccation.

CONCLUSIONS

We describe here the first report of sugar feeding and phytophagy in a species that was considered to be a strict blood-feeder for over a century. We suggest that local plants might be not merely shelters for insects and vertebrate hosts as previously described, but may have a nutritional role for the maintenance of the triatomine vectors. The description of sugar and plant meals in triatomines opens new perspectives for the study and control of Chagas Disease.

On palms, bugs, and Chagas disease in the Americas

Palms are ubiquitous across Neotropical landscapes, from pristine forests or savannahs to large cities. Although palms provide useful ecosystem services, they also offer suitable habitat for triatomines and for Trypanosoma cruzi mammalian hosts. Wild triatomines often invade houses by flying from nearby palms, potentially leading to new cases of human Chagas disease. Understanding and predicting triatomine-palm associations and palm infestation probabilities is important for enhancing Chagas disease prevention in areas where palm-associated vectors transmit T. cruzi. We present a comprehensive overview of palm infestation by triatomines in the Americas, combining a thorough reanalysis of our published and unpublished records with an in-depth review of the literature. We use site-occupancy modeling (SOM) to examine infestation in 3590 palms sampled with non-destructive methods, and standard statistics to describe and compare infestation in 2940 palms sampled by felling-and-dissection. Thirty-eight palm species (18 genera) have been reported to be infested by ∼39 triatomine species (10 genera) from the USA to Argentina. Overall infestation varied from 49.1-55.3% (SOM) to 62.6-66.1% (dissection), with important heterogeneities among sub-regions and particularly among palm species. Large palms with complex crowns (e.g., Attalea butyracea, Acrocomia aculeata) and some medium-crowned palms (e.g., Copernicia, Butia) are often infested; in slender, small-crowned palms (e.g., Euterpe) triatomines associate with vertebrate nests. Palm infestation tends to be higher in rural settings, but urban palms can also be infested. Most Rhodnius species are probably true palm specialists, whereas Psammolestes, Eratyrus, Cavernicola, Panstrongylus, Triatoma, Alberprosenia, and some Bolboderini seem to use palms opportunistically. Palms provide extensive habitat for enzootic T. cruzi cycles and a critical link between wild cycles and transmission to humans. Unless effective means to reduce contact between people and palm-living triatomines are devised, palms will contribute to maintaining long-term and widespread, albeit possibly low-intensity, transmission of human Chagas disease.

Eco-epidemiological study of an endemic Chagas disease region in northern Colombia reveals the importance of Triatoma maculata (Hemiptera: Reduviidae), dogs and Didelphis marsupialis in Trypanosoma cruzi maintenance

BACKGROUND

In Colombia, Rhodnius prolixus and Triatoma dimidiata are the main domestic triatomine species known to transmit T. cruzi. However, there are multiple reports of T. cruzi transmission involving secondary vectors. In this work, we carried out an eco-epidemiological study on Margarita Island, located in the Caribbean region of Colombia, where Chagas disease is associated with non-domiciliated vectors.

METHODS

To understand the transmission dynamics of Trypanosoma cruzi in this area, we designed a comprehensive, multi-faceted study including the following: (i) entomological evaluation through a community-based insect-surveillance campaign, blood meal source determination and T. cruzi infection rate estimation in triatomine insects; (ii) serological determination of T. cruzi prevalence in children under 15 years old, as well as in domestic dogs and synanthropic mammals; (iii) evaluation of T. cruzi transmission capacity in dogs and Didelphis marsupialis, and (iv) genetic characterization of T. cruzi isolates targeting spliced-leader intergene region (SL-IR) genotypes.

RESULTS

Out of the 124 triatomines collected, 94% were Triatoma maculata, and 71.6% of them were infected with T. cruzi. Blood-meal source analysis showed that T. maculata feeds on multiple hosts, including humans and domestic dogs. Serological analysis indicated 2 of 803 children were infected, representing a prevalence of 0.25%. The prevalence in domestic dogs was 71.6% (171/224). Domestic dogs might not be competent reservoir hosts, as inferred from negative T. cruzi xenodiagnosis and haemoculture tests. However, 61.5% (8/13) of D. marsupialis, the most abundant synanthropic mammal captured, were T. cruzi-positive on xenodiagnosis and haemocultures.

CONCLUSIONS

This study reveals the role of peridomestic T. maculata and dogs in T. cruzi persistence in this region and presents evidence that D. marsupialis are a reservoir mediating peridomestic-zoonotic cycles. This picture reflects the complexity of the transmission dynamics of T. cruzi in an endemic area with non-domiciliated vectors where active human infection exists. There is an ongoing need to control peridomestic T. maculata populations and to implement continuous reservoir surveillance strategies with community participation.

Between a bug and a hard place: Trypanosoma cruzi genetic diversity and the clinical outcomes of Chagas disease

Over the last 30 years, concomitant with successful transnational disease control programs across Latin America, Chagas disease has expanded from a neglected, endemic parasitic infection of the rural poor to an urbanized chronic disease, and now a potentially emergent global health problem. Trypanosoma cruzi infection has a highly variable clinical course, ranging from complete absence of symptoms to severe and often fatal cardiovascular and/or gastrointestinal manifestations. To date, few correlates of clinical disease progression have been identified. Elucidating a putative role for T. cruzi strain diversity in Chagas disease pathogenesis is complicated by the scarcity of parasites in clinical specimens and the limitations of our contemporary genotyping techniques. This article systematically reviews the historical literature, given our current understanding of parasite genetic diversity, to evaluate the evidence for any association between T. cruzi genotype and chronic clinical outcome, risk of congenital transmission or reactivation and orally transmitted outbreaks.

Effect of the physiognomy of Attalea butyracea (Arecoideae) on population density and age distribution of Rhodnius prolixus (Triatominae)

BACKGROUND

Rhodnius prolixus Stål, 1859 is one of the main vectors of Trypanosoma (Schyzotrypanum) cruzi Chagas, 1909. In its natural forest environment, this triatomine is mainly found in palm tree crowns, where it easily establishes and develops dense populations. The aim of this study was to evaluate the effect of the physiognomy and reproductive status of Attalea butyracea on the population relative density and age structure of R. prolixus and to determine the vector's population stratification according to the vertical and horizontal profile of an A. butyracea forest.

METHODS

Using live bait traps, 150 individuals of A. butyracea with different physiognomy and 40 individuals with similar physiognomy (crown size, number of leaves, palm tree height, diameter at breast height, reproductive status) were sampled for triatomines in Yopal, Casanare-Colombia. Temperature and relative humidity were measured in the crown of the palm tree. Entomological indices and natural infection rates were also determined.

RESULTS

The relative population density of R. prolixus on natural A. butyracea groves is associated with the palm's height, number of leaves and crown volume. The young immature stages were present mostly at the crown's base and the advanced immature stages and adults were present mostly at the crown of the palm tree. This distribution correlates with the temperature stability and relative humidity in the base and the fluctuation of both environmental variables in the palm's crown. A higher density of R. prolixus was found as the palm tree height increased and as the distance of the palm with respect to the forest border decreased, especially towards anthropically intervened areas. A density index of 12.6 individuals per palm tree with an infestation index of 88.9% and a colonization index of 98.7% was observed. 85.2% was the infection index with T. cruzi.

CONCLUSION

The physiognomy of palm trees affects the relative population density and the distribution of developmental stages of R. prolixus. Therefore, they constitute a risk factor for the potential migration of infected insects from wild environments towards residential environments and the subsequent epidemiological risk of transmission of T. cruzi to people.