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de Almeida EA, Mendes FDSNS, Ramos AN, de Sousa AS, Pavan TBS, Mediano MFF, Ostermayer AL, Hasslocher-Moreno AM, Britto CFDPDC, Novaes CG, Correia D, Santos FLN, da Silva GMS, Fernandez ML, Lima MM, de Carvalho NB, Moreira ODC, Albajar-Viñas P, Leite RM, Palmeira SL, da Costa VM, Yasuda MAS. Guidelines for Trypanosoma cruzi-HIV Co-infection and other Immunosuppressive Conditions: Diagnosis, Treatment, Monitoring, and Implementation from the International Network of Care and Studies - 2023. Rev Soc Bras Med Trop 2023; 56:0549. [PMID: 38088667 PMCID: PMC10706049 DOI: 10.1590/0037-8682-0549-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Eros Antonio de Almeida
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Grupo de Estudos em doença de Chagas, Campinas, SP, Brasil
| | | | - Alberto Novaes Ramos
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil
| | - Andréa Silvestre de Sousa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Tycha Bianca Sabaini Pavan
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Bahia, BA, Brasil
| | | | | | | | | | - Christina Gallafrio Novaes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, Brasil
| | - Dalmo Correia
- Universidade Federal de Sergipe, São Cristóvão, SE, Brasil
| | - Fred Luciano Neves Santos
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Bahia, BA, Brasil
| | | | - Marisa Liliana Fernandez
- Hospital de Infecciosas FJ Muñiz, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Administración Nacional de Laboratorios e Institutos de Salud, Buenos Aires, Argentina
| | - Mayara Maia Lima
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Noêmia Barbosa de Carvalho
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, Brasil
| | - Otacílio da Cruz Moreira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Virologia e Parasitologia Molecular, Rio de Janeiro, RJ, Brasil
| | - Pedro Albajar-Viñas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Ruth Moreira Leite
- Centro de Vigilância Epidemiológica Professor Alexandre Vranjac. Secretaria de Estado da Saúde do estado de São Paulo, São Paulo, SP, Brasil
| | - Swamy Lima Palmeira
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
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Pascual-Vázquez G, Alonso-Sardón M, Rodríguez-Alonso B, Pardo-Lledías J, Romero Alegría A, Fernández-Soto P, Muñoz Bellido JL, Muro A, Belhassen-García M. Molecular diagnosis of Chagas disease: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12:95. [PMID: 37845734 PMCID: PMC10577976 DOI: 10.1186/s40249-023-01143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/20/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The complexity of the Chagas disease and its phases is impossible to have a unique test for both phases and a lot of different epidemiological scenarios. Currently, serology is the reference standard technique; occasionally, results are inconclusive, and a different diagnostic technique is needed. Some guidelines recommend molecular testing. A systematic review and meta-analysis of available molecular tools/techniques for the diagnosis of Chagas disease was performed to measure their heterogeneity and efficacy in detecting Trypanosoma cruzi infection in blood samples. METHODS A systematic review was conducted up to July 27, 2022, including studies published in international databases. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA 2020 guidelines. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A random-effects model was used to calculate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Forest plots and a summary of the receiving operating characteristics (SROC) curves displayed the outcomes. Heterogeneity was determined by I2 and Tau2 statistics and P values. Funnel plots and Deek's test were used to assess publication bias. A quantitative meta-analysis of the different outcomes in the two different clinical phases was performed. RESULTS We identified 858 records and selected 32 papers. Studies pertained to endemic countries and nonendemic areas with adult and paediatric populations. The sample sizes ranged from 17 to 708 patients. There were no concerns regarding the risk of bias and applicability of all included studies. A positive and nonsignificant correlation coefficient (S = 0.020; P = 0.992) was obtained in the set of studies that evaluated diagnostic tests in the acute phase population (ACD). A positive and significant correlation coefficient (S = 0.597; P < 0.000) was obtained in the case of studies performed in the chronic phase population (CCD). This resulted in high heterogeneity between studies, with the master mix origin and guanidine addition representing significant sources. INTERPRETATION/CONCLUSIONS AND RELEVANCE The results described in this meta-analysis (qualitative and quantitative analyses) do not allow the selection of the optimal protocol of molecular method for the study of Trypanosoma cruzi infection in any of its phases, among other reasons due to the complexity of this infection. Continuous analysis and optimization of the different molecular techniques is crucial to implement this efficient diagnosis in endemic areas.
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Affiliation(s)
- Guillermo Pascual-Vázquez
- Infectious and Tropical Diseases Group (E-INTRO), Biomedical Research Institute of Salamanca (IBSAL), Tropical Diseases Research Center of the University of Salamanca (CIETUS), Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Montserrat Alonso-Sardón
- Area of Preventive Medicine, Epidemiology and Public Health, Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, E-INTRO, IBSAL, CIETUS, University of Salamanca, Salamanca, Spain
| | - Beatriz Rodríguez-Alonso
- Internal Medicine Service, University Health Care Complex of Salamanca (CAUSA), E-INTRO, IBSAL, CIETUS, Salamanca, Spain
| | - Javier Pardo-Lledías
- Internal Medicine Department, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL (Valdecilla Research Institute), Santander, Spain
| | | | - Pedro Fernández-Soto
- Infectious and Tropical Diseases Group (E-INTRO), IBSAL. CIETUS. Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Juan Luis Muñoz Bellido
- Microbiology and Parasitology Service, CAUSA, IBSAL, CIETUS, CSIC, Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Antonio Muro
- Infectious and Tropical Diseases Group (E-INTRO), IBSAL. CIETUS. Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Moncef Belhassen-García
- Internal Medicine Service. Infectious Diseases Section, CAUSA, IBSAL, CIETUS, University of Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain.
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3
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Shikanai-Yasuda MA, Mediano MFF, Novaes CTG, de Sousa AS, Sartori AMC, Santana RC, Correia D, de Castro CN, Severo MMDS, Hasslocher-Moreno AM, Fernandez ML, Salvador F, Pinazo MJ, Bolella VR, Furtado PC, Corti M, Neves Pinto AY, Fica A, Molina I, Gascon J, Viñas PA, Cortez-Escalante J, Ramos AN, de Almeida EA. Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the "Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions". PLoS Negl Trop Dis 2021; 15:e0009809. [PMID: 34591866 PMCID: PMC8483313 DOI: 10.1371/journal.pntd.0009809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. METHODS This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. RESULTS Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. CONCLUSION This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
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Affiliation(s)
- Maria Aparecida Shikanai-Yasuda
- Departament of Infectious and Parasitic, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- * E-mail: ,
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | - Ana Marli Christovam Sartori
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Carvalho Santana
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Dalmo Correia
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | - Marisa Liliana Fernandez
- Hospital de Infecciosas, Buenos Aires, Argentina
- National Institute of Parasitology, Departament of Clinics, Pathology and Treatment, Health Ministry, Buenos Aires, Argentina
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Valdes Roberto Bolella
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Pedro Carvalho Furtado
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Marcelo Corti
- Hospital de Infecciosas, Buenos Aires, Argentina
- Departamento de Medicina, Asignatura Enfermedades Infecciosas, Facultad de Medicina, Universidad Buenos Aires, Buenos Aires, Argentina
| | - Ana Yecê Neves Pinto
- Evandro Chagas Institute, Health Surveillance Secretary, Health Ministry, Belém, Brazil
| | - Alberto Fica
- Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- ISGlobal, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - Pedro Albajar Viñas
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- Department of Control of Neglected Tropical Diseases, World Health Organization, WHO, Geneva, Switzerland
| | - Juan Cortez-Escalante
- Pan American Health Organization (PAHO), World Health Organization (WHO), Brasília, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Eros Antonio de Almeida
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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Nielebock MAP, de Freitas Campos Miranda L, Americano do Brasil PEA, de Jesus S Pereira TO, da Silva AF, Hasslocher-Moreno AM, Sangenis LHC, Saraiva RM. Blood culture positivity rate for Trypanosoma cruzi in patients with chronic Chagas disease differs among different clinical forms. Trans R Soc Trop Med Hyg 2021; 115:720-725. [PMID: 33150435 DOI: 10.1093/trstmh/traa121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this research was to compare the clinical and epidemiological characteristics of patients with chronic Chagas disease with and without positive blood cultures for Trypanosoma cruzi. METHODS This was a retrospective longitudinal study that included 139 patients with chronic Chagas disease who underwent blood culture for T. cruzi. Blood cultures were performed using Novy-MacNeal-Nicolle medium enriched with Schneider's medium. Multivariate Cox proportional hazards regression analysis adjusting for age and sex was performed to identify if positive blood culture for T. cruzi was associated with all-cause mortality. RESULTS The blood culture positivity rate was 30.9%. Most patients were born in the Northeast and Southeast regions of Brazil. Patients with positive blood cultures were older (52±13 vs 45±13 y; p=0.0009) and more frequently women (72.1% vs. 53.1%; p=0.03) than patients with negative blood cultures. The frequency of patients with cardiac or cardiodigestive forms was higher among patients with positive vs negative blood cultures (74.4% vs 54.1%; p=0.02). A total of 28 patients died during a mean follow-up time of 6.6±4.1 y. A positive blood culture was associated with all-cause mortality (hazard ratio 2.26 [95% confidence interval 1.02 to 5.01], p=0.045). CONCLUSIONS We found a higher proportion of patients with Chagas heart disease among patients with T. cruzi-positive blood cultures. A positive blood culture was associated with an increased risk of all-cause mortality. Therefore T. cruzi persistence may influence Chagas disease pathogenesis and prognosis.
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Affiliation(s)
- Marco Antonio Prates Nielebock
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil 4365, Rio de Janeiro, Brazil 21040-900
| | - Luciana de Freitas Campos Miranda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil 4365, Rio de Janeiro, Brazil 21040-900
| | | | | | - Aline Fagundes da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil 4365, Rio de Janeiro, Brazil 21040-900
| | | | - Luiz Henrique Conde Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil 4365, Rio de Janeiro, Brazil 21040-900
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil 4365, Rio de Janeiro, Brazil 21040-900
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A sensitive and reliable quantitative immunohistochemistry technique to evaluate the percentage of Trypanosoma cruzi-infected tissue area. Parasitol Int 2020; 80:102210. [PMID: 33148532 DOI: 10.1016/j.parint.2020.102210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022]
Abstract
Quantification of parasites in the context of Chagas disease is required to monitor the treatment with benznidazole, disease-associated cardiomyopathies and graft rejection after heart transplantation. As parasitological exams lack sensitivity, Real Time Polymerase Chain Reaction (rt-PCR) has emerged to evaluate the parasite load in blood samples and cardiac biopsies. However, despite its higher sensitivity, rt-PCR does not provide information on the location and distribution of amastigote nests within infected tissues, the characterization of inflammatory infiltrates or changes to tissue architecture. On the contrary, a sensitive immunohistochemistry technique (IHC) could fill these gaps. In the present study, a quantitative IHC exam was standardized and validated by testing adipose and cardiac tissues of experimentally infected mice containing variable parasite load levels of T. cruzi assessed by a sensitive Sybr Green rt-PCR with kDNA primers. Tissues were divided into four groups according to the parasite load: group A- 100 parasites/50 ng of DNA; group B -10 parasites; group C - around 1 parasite and group D - less than 1 parasite/50 ng/DNA. IHC was able to detect T. cruzi in the four groups, even in group D tissues containing fractions of a single parasite/50 ng of DNA sample according to rt-PCR. In conclusion, a highly sensitivity and reliable quantitative immunohistochemistry technique was developed and is proposed to estimate the percentage of T. cruzi-infected tissue area in chagasic patients presenting with cardiomyopathies, as a complementary test to rt-PCR.
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Hasslocher-Moreno AM, Salles Xavier S, Magalhães Saraiva R, Conde Sangenis LH, Teixeira de Holanda M, Horta Veloso H, Rodrigues da Costa A, de Souza Nogueira Sardinha Mendes F, Alvarenga Americano do Brasil PE, Sperandio da Silva GM, Felix Mediano MF, Silvestre de Sousa A. Progression Rate from the Indeterminate Form to the Cardiac Form in Patients with Chronic Chagas Disease: Twenty-Two-Year Follow-Up in a Brazilian Urban Cohort. Trop Med Infect Dis 2020; 5:tropicalmed5020076. [PMID: 32408570 PMCID: PMC7345528 DOI: 10.3390/tropicalmed5020076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022] Open
Abstract
Most patients with chronic Chagas disease (CD) present the indeterminate form and are at risk to develop the cardiac form. However, the actual rate of progression to the cardiac form is still unknown. Methods: In total, 550 patients with the indeterminate CD form were followed by means of annual electrocardiogram at our outpatient clinic. The studied endpoint was progression to cardiac form defined by the appearance of electrocardiographic changes typical of CD. The progression rate was calculated as the cumulative progression rate and the incidence progression rate per 100 patient years. Results: Thirty-seven patients progressed to the CD cardiac form within a mean of 73 ± 48 months of follow-up, which resulted in a 6.9% cumulative progression rate and incidence rate of 1.48 cases/100 patient years. Patients who progressed were older (mean age 47.8 ± 12.2 years), had a higher prevalence of associated heart diseases (p < 0.0001), positive xenodiagnosis (p = 0.007), and were born in the most endemic Brazilian states (p = 0.018). Previous co-morbidities remained the only variable associated with CD progression after multivariate Cox proportional hazards regression analysis (p = 0.002). Conclusion: The progression rate to chronic CD cardiac form is low and inferior to rates previously reported in other studies.
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Montenote MC, Wajsman VZ, Konno YT, Ferreira PC, Silva RMG, Therezo ALS, Silva LP, Martins LPA. Antioxidant effect of Morus nigra on Chagas disease progression. Rev Inst Med Trop Sao Paulo 2017; 59:e73. [PMID: 29116293 PMCID: PMC5679685 DOI: 10.1590/s1678-9946201759073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 11/21/2022] Open
Abstract
Considering the widespread popular use of Morus nigra and the amount of scientific information on its antioxidant and anti-inflammatory activity, the effectiveness of this phytotherapeutic compound in the parasitemia progression during the acute phase of Chagas disease and its role in the development of the inflammatory process as well as its effects on the oxidative damage in the chronic phase of infection were evaluated. Thus, 96 male Swiss mice were randomly divided into eight groups, four groups were uninfected controls, and four groups were intraperitoneally infected with 5.0 x 104 blood trypomastigotes forms of T. cruzi QM2 strain. Four batches composed of one uninfected and one infected group were respectively treated with 70% alcohol solution and 25 μL, 50 μL and 75 μL of the phytotherapeutic compound. Levels of antioxidant elements (TBARS, FRAP, GSH and Sulfhydryl groups) were measured in plasma samples. The phytotherapeutic compound's antioxidant activity was measured by polyphenol and total flavonoid quantification, DPPH, NO, and FRAP method. Our results showed that the vehicle influenced some of the results that may have physiological relevance in Chagas disease. However, an important action of M. nigra tincture was observed in the progression of Chagas disease, since our results demonstrated a reduction in parasitemia of treated groups when compared to controls, especially in the group receiving 25 µL. However, in the chronic phase, the 50-µL dosage presented a better activity on some antioxidant defenses and minimized the tissue inflammatory process. Results indicated an important action of M. nigra tincture on the Chagas disease progression.
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Affiliation(s)
| | - Vithor Zuccaro Wajsman
- Faculdade de Medicina de Marília, Departamento de Parasitologia,
Marília, São Paulo, Brazil
| | - Yoichi Takaki Konno
- Faculdade de Medicina de Marília, Departamento de Parasitologia,
Marília, São Paulo, Brazil
| | - Paulo César Ferreira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Laboratório
de Fitoterápicos e Produtos Naturais (FitoLab), Assis, São Paulo, Brazil
| | - Regildo Márcio Gonçalves Silva
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Laboratório
de Fitoterápicos e Produtos Naturais (FitoLab), Assis, São Paulo, Brazil
| | | | - Luciana Pereira Silva
- Fundação Educacional do Município de Assis, Departamento de
Imunologia, Assis, São Paulo, Brazil
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Freitas EC, Oliveira MDF, Vasconcelos ASODB, Silva JDD, Viana CEM, Gomes KCMS, Cavalcanti LPDG. Analysis of the seroprevalence of and factors associated with Chagas disease in an endemic area in Northeastern Brazil. Rev Soc Bras Med Trop 2017; 50:44-51. [PMID: 28327801 DOI: 10.1590/0037-8682-0242-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Chagas disease (CD) is currently considered a neglected disease; hence, identifying the factors associated with its high prevalence is essential. This study aimed to identify the seroprevalence of and the possible factors associated with CD in inhabitants of the City of Limoeiro do Norte, Northeastern Brazil. METHODS: Between April and November 2013, blood collection was conducted and a semi-structured questionnaire was administered. Blood samples that showed positive or possible serology for anti-Trypanosoma cruzi antibodies based on indirect immunofluorescence, hemagglutination indirect, and an enzyme-linked immunosorbent assay were analyzed. Associations between CD positivity and the study variables were analyzed using prevalence ratios (PR) with 95% confidence intervals (CI). RESULTS: A total of 812 individuals were analyzed, of which T. cruzi seropositivity was determined in 4.2% (34 individuals). Sociodemographic variables showing a significant association with T. cruzi positivity included age >50 years (PR = 27.6; 95% CI = 6.66-114.4), elementary level education (PR = 5.15; 95% CI = 1.83-14.47), and retirement (PR = 7.25; 95% CI = 3.72-14.14). Positivity for T. cruzi was 6.17 times higher in those who had a history of living in rammed earth houses compared with those who did not (95% CI = 2.19-17.37). There was no evidence of vertical transmission in the individuals studied. Among the individuals infected with T. cruzi, the majority reported having a comorbidity (p < 0.01). CONCLUSIONS: This study demonstrated the seroprevalence of CD and identified factors associated with a high prevalence of CD.
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Affiliation(s)
- Erlane Chaves Freitas
- Programa de Pós-Graduação em Patologia, Departamento de Patologia e Medicina Legal, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | - Maria de Fátima Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | | | - José Damião da Silva
- Programa de Pós-Graduação em Patologia, Departamento de Patologia e Medicina Legal, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | - Carlos Eduardo Menezes Viana
- Programa de Pós-Graduação em Patologia, Departamento de Patologia e Medicina Legal, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | | | - Luciano Pamplona de Góes Cavalcanti
- Programa de Pós-Graduação em Patologia, Departamento de Patologia e Medicina Legal, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil.,Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
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Dias JCP, Ramos Jr. AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, Torres RM, Melo JRDC, Almeida EAD, Oliveira Jr. WD, Silveira AC, Rezende JMD, Pinto FS, Ferreira AW, Rassi A, Fragata Filho AA, Sousa ASD, Correia D, Jansen AM, Andrade GMQ, Britto CFDPDC, Pinto AYDN, Rassi Jr. A, Campos DE, Abad-Franch F, Santos SE, Chiari E, Hasslocher-Moreno AM, Moreira EF, Marques DSDO, Silva EL, Marin-Neto JA, Galvão LMDC, Xavier SS, Valente SADS, Carvalho NB, Cardoso AV, Silva RAE, Costa VMD, Vivaldini SM, Oliveira SM, Valente VDC, Lima MM, Alves RV. 2 nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop 2016; 49Suppl 1:3-60. [DOI: 10.1590/0037-8682-0505-2016] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
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Bahia M, de Nazaré Leite Barros F, Magalhães-Matos PC, de Souza Gonçalves T, Chiesorin Neto L, Oliveira Faria DCL, Aparecida Romeiro S, Barros Monteiro FO, Góes-Cavalcante G, Scofield A. Trypanosoma cruziinfection in captive Neotropical primates in the Brazilian Amazon. Am J Primatol 2016; 79:1-6. [DOI: 10.1002/ajp.22590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Bahia
- Universidade Federal do Pará (UFPA), Instituto de Medicina Veterinária; Laboratório de Parasitologia Animal; Castanhal Pará Brazil
| | - Flávia de Nazaré Leite Barros
- Universidade Federal do Pará (UFPA), Instituto de Medicina Veterinária; Laboratório de Parasitologia Animal; Castanhal Pará Brazil
| | - Paulo Cesar Magalhães-Matos
- Universidade Federal do Pará (UFPA), Instituto de Medicina Veterinária; Laboratório de Parasitologia Animal; Castanhal Pará Brazil
| | - Thamirys de Souza Gonçalves
- Universidade Federal do Pará (UFPA), Instituto de Medicina Veterinária; Laboratório de Parasitologia Animal; Castanhal Pará Brazil
| | - Laerzio Chiesorin Neto
- Centro de Triagem de Animais Silvestres Municipal Refúgio da Vida Silvestre Sauim Castanheiras; Manaus Amazonas Brazil
| | | | - Sandra Aparecida Romeiro
- Instituto Brasileiro de Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA); Macapá Amapá Brazil
| | - Frederico Ozanan Barros Monteiro
- Instituto Brasileiro de Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA); Macapá Amapá Brazil
- Universidade Federal Rural da Amazônia (UFRA); Instituto de Saúde e Produção Animal; Belém Pará Brazil
| | - Gustavo Góes-Cavalcante
- Universidade Federal do Pará (UFPA), Instituto de Medicina Veterinária; Laboratório de Parasitologia Animal; Castanhal Pará Brazil
| | - Alessandra Scofield
- Universidade Federal do Pará (UFPA), Instituto de Medicina Veterinária; Laboratório de Parasitologia Animal; Castanhal Pará Brazil
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Pereira MB, Batista AM, Aguiar C, Marcon GEB, Martins LC, Guariento ME, Costa SCB, de Almeida EA. The detection of Trypanosoma cruzi by nested-PCR in elderly patients: relationship to the clinical and epidemiological profile. Pathog Glob Health 2016; 110:228-232. [PMID: 27666187 DOI: 10.1080/20477724.2016.1232850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Chagas disease, which is caused by Trypanosoma cruzi, is transmitted primarily by triatomine bugs, although the incidence of new cases has decreased as a result of vector control. In Brazil, most of those affected have the chronic form of the disease and are generally elderly individuals who require appropriate clinical follow-up. In this work, we undertook a descriptive study in which 85 patients were interviewed and blood samples were collected for molecular analyses based on the amplification of parasite satellite DNA. The cardiac form of the disease was the most prevalent among the patients and hypertension was the most frequent comorbidity; polypharmacy was detected in 34% of the cases. Serological tests were positive in 95% of cases while 36% were positive in nested-polymerase chain reaction. These findings indicate an increased use of medications and a larger number of age-related diseases in elderly patients with Chagas disease, even in patients with low parasitemia. We conclude that elderly patients with Chagas disease require special attention and that further studies should be done with elderly individuals who carry this disease.
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Affiliation(s)
- Mariane Barroso Pereira
- a Department of Internal Medicine, School of Medical Sciences , University of Campinas (UNICAMP) , Campinas , Brazil
| | | | - Camila Aguiar
- a Department of Internal Medicine, School of Medical Sciences , University of Campinas (UNICAMP) , Campinas , Brazil
| | | | - Luiz Cláudio Martins
- a Department of Internal Medicine, School of Medical Sciences , University of Campinas (UNICAMP) , Campinas , Brazil
| | - Maria Elena Guariento
- a Department of Internal Medicine, School of Medical Sciences , University of Campinas (UNICAMP) , Campinas , Brazil
| | - Sandra Cecília Botelho Costa
- a Department of Internal Medicine, School of Medical Sciences , University of Campinas (UNICAMP) , Campinas , Brazil
| | - Eros Antonio de Almeida
- a Department of Internal Medicine, School of Medical Sciences , University of Campinas (UNICAMP) , Campinas , Brazil
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Applicability of a novel immunoassay based on surface plasmon resonance for the diagnosis of Chagas disease. Clin Chim Acta 2015; 454:39-45. [PMID: 26731593 DOI: 10.1016/j.cca.2015.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND We defined the methodological criteria for the interpretation of the results provided by a novel immunoassay based on surface plasmon resonance (SPR) to detect antibodies anti-Trypanosoma cruzi in human sera (SPRCruzi). Then, we evaluated its applicability as a diagnostic tool for Chagas disease. METHODS To define the cut-off point and serum dilution factor, 57 samples were analyzed at SPRCruzi and the obtained values of SPR angle displacement (ΔθSPR) were submitted to statistical analysis. Adopting the indicated criteria, its performance was evaluated into a wide panel of samples, being 99 Chagas disease patients, 30 non-infected subjects and 42 with other parasitic/infectious diseases. In parallel, these samples were also analyzed by ELISA. RESULTS Our data demonstrated that 1:320 dilution and cut-off point at ∆θSPR=17.2 m° provided the best results. Global performance analysis demonstrated satisfactory sensitivity (100%), specificity (97.2%), positive predictive value (98%), negative predictive value (100%) and global accuracy (99.6%). ELISA and SPRCruzi showed almost perfect agreement, mainly between chagasic and non-infected individuals. However, the new immunoassay was better in discriminate Chagas disease from other diseases. CONCLUSION This work demonstrated the applicability of SPRCruzi as a feasible, real time, label free, sensible and specific methodology for the diagnosis of Chagas disease.
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Jansen AM, Xavier SC, Roque ALR. The multiple and complex and changeable scenarios of the Trypanosoma cruzi transmission cycle in the sylvatic environment. Acta Trop 2015. [PMID: 26200785 DOI: 10.1016/j.actatropica.2015.07.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, we report and discuss the results generated from over 20 years of studies of the Trypanosoma cruzi sylvatic transmission cycle. Our results have uncovered new aspects and reviewed old concepts on issues including reservoirs, true generalist species, association of mammalian species with distinct discrete typing units - DTUs, distribution of T. cruzi genotypes in the wild, mixed infections, and T. cruzi transmission ecology. Using parasitological and serological tests, we examined T. cruzi infection in 7,285 mammalian specimens from nine mammalian orders dispersed all over the Brazilian biomes. The obtained T. cruzi isolates were characterized by mini-exon gene sequence polymorphism and PCR RFLP to identify DTUs. Infection by T. cruzi was detected by serological methods in 20% of the examined animals and isolated from 41% of those infected, corresponding to 8% of all the examined mammals. Each mammal taxon responded uniquely to T. cruzi infection. Didelphis spp. are able to maintain high and long-lasting parasitemias (positive hemocultures) caused by TcI but maintain and rapidly control parasitemias caused by TcII to almost undetectable levels. In contrast, the tamarin species Leontopithecus rosalia and L. chrysomelas maintain long-lasting and high parasitemias caused by TcII similarly to Philander sp. The coati Nasua nasua maintains high parasitemias by both parental T. cruzi DTUs TcI or TcII and by TcII/TcIV (formerly Z3) at detectable levels. Wild and domestic canidae seem to display only a short period of reservoir competence. T. cruzi infection was demonstrated in the wild canid species Cerdocyon thous and Chrysocyon brachyurus, and positive hemoculture was obtained in one hyper carnivore species (Leopardus pardalis), demonstrating that T. cruzi transmission is deeply immersed in the trophic net. T. cruzi DTU distribution in nature did not exhibit any association with a particular biome or habitat. TcI predominates throughout (58% of the T. cruzi isolates); however, in spite of being significantly less frequent (17%), TcII is also widely distributed. Concomitant DTU infection occurred in 16% of infected mammals of all biomes and included arboreal and terrestrial species, as well as bats. TcI/TcII concomitant infection was the most common and widely dispersed, with mixed TcI/TcII infections especially common in coatis and in Didelphimorphia. The second most common pattern of concomitant infection was TcI/TcIV, observed in Chiroptera, Didelphimorphia and Primates. Taken together, our results demonstrate the complexity of T. cruzi reservoir system and its transmission strategies, indicating that there is considerably more to be learned regarding ecology of T. cruzi.
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Alessio GD, Côrtes DF, Machado de Assis GF, Júnior PAS, Ferro EAV, Antonelli LRDV, Teixeira-Carvalho A, Martins-Filho OA, de Lana M. Innovations in diagnosis and post-therapeutic monitoring of Chagas disease: Simultaneous flow cytometric detection of IgG1 antibodies anti-live amastigote, anti-live trypomastigote, and anti-fixed epimastigote forms of Trypanosoma cruzi. J Immunol Methods 2014; 413:32-44. [DOI: 10.1016/j.jim.2014.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/23/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022]
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16
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Santana RAG, Magalhães LKC, Magalhães LKC, Prestes SR, Maciel MG, da Silva GAV, Monteiro WM, de Brito FR, de Aguiar Raposo Câmara Coelho LI, Barbosa-Ferreira JM, Guerra JAO, Silveira H, das Graças Vale Barbosa M. Trypanosoma cruzi strain TcI is associated with chronic Chagas disease in the Brazilian Amazon. Parasit Vectors 2014; 7:267. [PMID: 24916362 PMCID: PMC4072607 DOI: 10.1186/1756-3305-7-267] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/31/2014] [Indexed: 12/19/2022] Open
Abstract
Background Chagas disease in the Amazon region is considered an emerging anthropozoonosis with a predominance of the discrete typing units (DTUs) TcI and TcIV. These DTUs are responsible for cases of acute disease associated with oral transmission. Chronic disease cases have been detected through serological surveys. However, the mode of transmission could not be determined, or any association of chronic disease with a specific T. cruzi DTU’s. The aim of this study was to characterize Trypanosoma cruzi in patients with chronic Chagas disease in the State of Amazonas, Brazil. Methods Blood culture and xenodiagnosis were performed in 36 patients with positive serology for Chagas disease who participated in a serological survey performed in urban and rural areas of Manaus, Amazonas. DNA samples were extracted from the feces of triatomines used for xenodiagnosis, and the nontranscribed spacer of the mini-exon gene and the mitochondrial gene cytochrome oxidase subunit II (COII) were amplified by PCR and sequenced. Results Blood culture and xenodiagnosis were negative in 100% of samples; however, molecular techniques revealed that in 13 out of 36 (36%) fecal samples from xenodiagnosis, T. cruzi was characterized as the DTU TcI, and different haplotypes were identified within the same DTU. Conclusion The DTU TcI, which is mainly associated with acute cases of Chagas disease in the Amazon region, is also responsible for chronic infection in patients from a region in the State of Amazonas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Henrique Silveira
- Institute of Hygiene and Tropical Medicine (Instituto de Higiene e Medicina Tropical), New University of Lisbon (Universidade Nova de Lisboa), Lisbon, Portugal.
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Tenório M, Oliveira e Sousa L, Alves-Martin M, Paixão M, Rodrigues M, Starke-Buzetti W, Araújo Junior J, Lucheis S. Molecular identification of trypanosomatids in wild animals. Vet Parasitol 2014; 203:203-6. [DOI: 10.1016/j.vetpar.2014.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 11/26/2022]
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Ferrer E, Lares M, Viettri M, Medina M. Comparación entre técnicas inmunológicas y moleculares para el diagnóstico de la enfermedad de Chagas. Enferm Infecc Microbiol Clin 2013; 31:277-82. [DOI: 10.1016/j.eimc.2012.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/23/2012] [Accepted: 09/02/2012] [Indexed: 11/30/2022]
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Almeida EAD, Ramos Júnior AN, Correia D, Shikanai-Yasuda MA. Co-infection Trypanosoma cruzi/HIV: systematic review (1980-2010). Rev Soc Bras Med Trop 2012; 44:762-70. [PMID: 22231251 DOI: 10.1590/s0037-86822011000600021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/08/2011] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study was to describe clinical and epidemiological aspects published in literature. METHODS It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. RESULTS There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. CONCLUSIONS Despite the relevance of this clinical event there are still gaps to be filled.
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Eloy LJ, Lucheis SB. Hemoculture and Polymerase Chain Reaction Using Primers TCZ1/TCZ2 for the Diagnosis of Canine and Feline Trypanosomiasis. ISRN VETERINARY SCIENCE 2012; 2012:419378. [PMID: 23738124 PMCID: PMC3658593 DOI: 10.5402/2012/419378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/10/2012] [Indexed: 11/23/2022]
Abstract
Introduction. American trypanosomiasis, also known as Chagas disease, is a zoonosis caused by Trypanosoma cruzi (T. cruzi). Dogs and cats participate actively in this parasite's transmission cycle. This study aimed at evaluating the occurrence of T. cruzi in dogs and cats from Botucatu, SP, Brazil, as well as at evaluating the technique of hemoculture in LIT (liver infusion tryptose) medium by polymerase chain reaction (PCR). Methods. Blood samples were collected from 50 dogs and 50 cats in Botucatu-SP, Brazil. For hemoculture, the samples were inoculated in LIT medium, and readings were performed for four months. Upon completion of such period, all the hemocultures were processed for parasitic DNA extraction. The PCR reactions were performed by using primers TCZ1/TCZ2. Results. Ten dogs and ten cats (20%) were positive to PCR, and four dogs and three cats (7%) were positive to hemoculture. Only in a one cat sample (1%) there was confirmation of positive hemoculture by PCR for T. cruzi. Conclusions. Results showed that PCR was a suitable tool for the confirmation of the parasite detection in hemoculture samples, and that dogs and cats from Botucatu, SP, Brazil, are maintaining the role of household reservoirs of T. cruzi, which reinforces the need for constant epidemiologic surveillance for this zoonosis.
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Affiliation(s)
- Luciano José Eloy
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (UNESP), 18618970 Botucatu, SP, Brazil
| | - Simone Baldini Lucheis
- Agência Paulista de Tecnologia dos Agronegócios (APTA) Pólo Centro Oeste, 17030-000 Bauru, SP, Brazil
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López-Céspedes Á, Villagrán E, Briceño Álvarez K, de Diego JA, Hernández-Montiel HL, Saldaña C, Sānchez-Moreno M, Marín C. Trypanosoma cruzi: seroprevalence detection in suburban population of Santiago de Querétaro (Mexico). ScientificWorldJournal 2012; 2012:914129. [PMID: 22645467 PMCID: PMC3354744 DOI: 10.1100/2012/914129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/13/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the potential of iron-oxide dismutase excreted (SODeCRU) by T. cruzi as the antigen fraction in the serodiagnosis of Chagas disease and compile new epidemiological data on the seroprevalence of this disease in the suburban population of the city of Santiago de Querétaro (Mexico). DESIGN AND METHODS 258 human sera were analyzed by the techniques of ELISA and Western blot and using the homogenate and the SODeCRU. RESULTS A total of 31 sera were positive against ELISA/SODeCRU (12.4%), while 30 sera proved positive by WB/SODeCRU (11.6%). The comparison between the technique of ELISA and WB showed a sensitivity of 93%, and a specificity of 99%. The positive predictive value was 93% and the negative predictive value was 99%, with a Kappa (κ) value of 1. CONCLUSIONS These preliminary data reveal the degree of infection of nonrural areas of Mexico and demonstrated that SODeCRU is an antigen useful to diagnose Chagas disease.
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Affiliation(s)
- Ángeles López-Céspedes
- Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada, Severo Ochoa s/n, 18071 Granada, Spain
| | - Elena Villagrán
- Departamento de Investigación Biomédica, Facultad de Medicina, UAQ, 76050 Santiago de Queretaro, QRO, Mexico
| | - Kervin Briceño Álvarez
- Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada, Severo Ochoa s/n, 18071 Granada, Spain
| | - José Antonio de Diego
- Unidad de Parasitología y Medicina Tropical, Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, UAM, 28049 Madrid, Spain
| | | | - Carlos Saldaña
- Departamento de Investigación Biomédica, Facultad de Medicina, UAQ, 76050 Santiago de Queretaro, QRO, Mexico
| | - Manuel Sānchez-Moreno
- Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada, Severo Ochoa s/n, 18071 Granada, Spain
| | - Clotilde Marín
- Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada, Severo Ochoa s/n, 18071 Granada, Spain
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Abstract
Chagas disease is now an active disease in the urban centers of countries of nonendemicity and endemicity because of congenital and blood and/or organ transplantation transmissions and the reactivation of the chronic disease in smaller scale than vectorial transmission, reported as controlled in countries of endemicity. Oral transmission of Chagas disease has emerged in unpredictable situations in the Amazon region and, more rarely, in areas of nonendemicity where the domiciliary triatomine cycle was under control because of exposition of the food to infected triatomine and contaminated secretions of reservoir hosts. Oral transmission of Chagas disease is considered when >1 acute case of febrile disease without other causes is linked to a suspected food and should be confirmed by the presence of the parasite after direct microscopic examination of the blood or other biological fluid sample from the patient.
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Aguiar C, Batista AM, Pavan TBS, Almeida EA, Guariento ME, Wanderley JS, Costa SCB. Serological profiles and evaluation of parasitaemia by PCR and blood culture in individuals chronically infected by Trypanosoma cruzi treated with benzonidazole. Trop Med Int Health 2011; 17:368-73. [PMID: 22212647 DOI: 10.1111/j.1365-3156.2011.02936.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the serological and parasitological status of patients with chronic Chagas disease (CD) after chemotherapy with benzonidazole. METHODS Retrospective study of patients treated with benzonidazole (5 mg/kg/day for 60 days) between 1980 and 2010. Twenty-nine patients who had CD confirmed by two reagent immunological tests and/or one positive xenodiagnosis before treatment were included. Conventional serology (ELISA and IIF) and parasitological tests (haemoculture and N-PCR) were performed. RESULTS At the time of treatment, the mean age of patients was 36 ± 7.24 years (20-39 years) and the time post-treatment varied from 1 to 29 years. After chemotherapy, all individuals had reagent ELISA and 93.1% had positive results for the IIF test. T. cruzi DNA was detected by N-PCR in 48.3%. Negative results were observed in 41.4% and inconclusive ones in 10.3%. Haemoculture was negative for all individuals. CONCLUSIONS Our results suggest that N-PCR may be useful in the early identification of therapeutic failure of CD. Although it is difficult to determine parasitological cure in negative N-PCR cases, we can infer that this condition represents a declination of parasitaemia as a favourable consequence of aetiological treatment.
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Affiliation(s)
- Camila Aguiar
- Universidade Estadual de Campinas - UNICAMP, São Paulo, Brazil
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Trindade MÂB, Carvalho NB, Belfort EC, Pagliari C, Gakiya E, Sakai-Valente NY, Benard G, Shikanai-Yasuda MA. A patient with erythema nodosus leprosum and Chagas cardiopathy: challenges in patient management and review of the literature. Am J Trop Med Hyg 2011; 84:973-7. [PMID: 21633036 DOI: 10.4269/ajtmh.2011.10-0547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.
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Affiliation(s)
- Maria Ângela B Trindade
- Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, SP, Brazil.
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Pinazo MJ, Miranda B, Rodríguez-Villar C, Altclas J, Serra MB, García-Otero EC, de Almeida EA, de la Mata García M, Gascon J, Rodríguez MG, Manito N, Camacho AM, Oppenheimer F, Puente SP, Riarte A, Coronas JS, Lletí MS, Sanz GF, Torrico F, Tendero DT, Ussetti P, Shikanai-Yasuda MA. Recommendations for management of Chagas disease in organ and hematopoietic tissue transplantation programs in nonendemic areas. Transplant Rev (Orlando) 2011; 25:91-101. [DOI: 10.1016/j.trre.2010.12.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 12/22/2022]
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Brutus L, Ernould JC, Postigo J, Romero M, Schneider D, Santalla JA. Influence of pregnancy on Trypanosoma cruzi parasitemia in chronically infected women in a rural Bolivian community. Am J Trop Med Hyg 2011; 84:808-12. [PMID: 21540394 DOI: 10.4269/ajtmh.2011.10-0577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
To determine the role of pregnancy on Trypanosoma cruzi parasitemia, a matched cohort study was carried out in a rural Bolivian community comparing parasite rates in gravidae, puerperae, and non-pregnant infected women. A selection of 67 chronically infected women, who delivered between March 2004 and May 2005, were initially evaluated during the third trimester of pregnancy and again after delivery. They were matched for age, parity, and location with 104 seropositive non-pregnant women, who likewise had submitted blood for microscopic examination for T. cruzi parasites in June 2005. Seroreactive pregnant women had a higher rate of T. cruzi parasitemia (14.9%) than matched non-pregnant infected women (2.9%; P = 0.004). After delivery, parasitemia significantly decreased during puerperium (1.5%) compared with the period of pregnancy (14.9%; P = 0.03). This study showed an increase of parasite loads in maternal peripheral blood, during the third trimester, and a significant decline after delivery.
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Affiliation(s)
- Laurent Brutus
- UMR216--Mother and Child Facing Tropical Diseases, Institut de Recherche pour le Développement/Université Paris Descartes, 4 avenue de l’Observatoire, Paris, France.
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Applicability of an optimized non-conventional flow cytometry method to detect anti-Trypanosoma cruzi immunoglobulin G for the serological diagnosis and cure assessment following chemotherapeutic treatment of Chagas disease. J Immunol Methods 2011; 369:22-32. [DOI: 10.1016/j.jim.2011.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 12/22/2010] [Accepted: 03/28/2011] [Indexed: 11/23/2022]
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Aparicio-Burgos JE, Ochoa-García L, Zepeda-Escobar JA, Gupta S, Dhiman M, Martínez JS, de Oca-Jiménez RM, Arreola MV, Barbabosa-Pliego A, Vázquez-Chagoyán JC, Garg NJ. Testing the efficacy of a multi-component DNA-prime/DNA-boost vaccine against Trypanosoma cruzi infection in dogs. PLoS Negl Trop Dis 2011; 5:e1050. [PMID: 21625470 PMCID: PMC3098890 DOI: 10.1371/journal.pntd.0001050] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 04/15/2011] [Indexed: 11/19/2022] Open
Abstract
Background Trypanosoma cruzi, the etiologic agent of Chagas Disease, is
a major vector borne health problem in Latin America and an emerging
infectious disease in the United States. Methods We tested the efficacy of a multi-component DNA-prime/DNA-boost vaccine
(TcVac1) against experimental T. cruzi infection in a
canine model. Dogs were immunized with antigen-encoding plasmids and
cytokine adjuvants, and two weeks after the last immunization, challenged
with T. cruzi trypomastigotes. We measured antibody
responses by ELISA and haemagglutination assay, parasitemia and infectivity
to triatomines by xenodiagnosis, and performed electrocardiography and
histology to assess myocardial damage and tissue pathology. Results Vaccination with TcVac1 elicited parasite-and antigen-specific IgM and IgG
(IgG2>IgG1) responses. Upon challenge infection, TcVac1-vaccinated dogs,
as compared to non-vaccinated controls dogs, responded to T.
cruzi with a rapid expansion of antibody response, moderately
enhanced CD8+ T cell proliferation and IFN-γ production,
and suppression of phagocytes’ activity evidenced by decreased
myeloperoxidase and nitrite levels. Subsequently, vaccinated dogs controlled
the acute parasitemia by day 37 pi (44 dpi in non-vaccinated dogs), and
exhibited a moderate decline in infectivity to triatomines. TcVac1-immunized
dogs did not control the myocardial parasite burden and electrocardiographic
and histopatholgic cardiac alterations that are the hallmarks of acute
Chagas disease. During the chronic stage, TcVac1-vaccinated dogs exhibited a
moderate decline in cardiac alterations determined by EKG and
anatomo-/histo-pathological analysis while
chronically-infected/non-vaccinated dogs continued to exhibit severe EKG
alterations. Conclusions Overall, these results demonstrated that TcVac1 provided a partial resistance
to T. cruzi infection and Chagas disease, and provide an
impetus to improve the vaccination strategy against Chagas disease. Immunization of dogs with DNA-prime/DNA-boost vaccine (TcVac1) enhanced the
Trypanosoma cruzi-specific type 1 antibody and
CD8+ T cell responses that resulted in an early control of
acute parasitemia and a moderate decline in pathological symptoms during chronic
phase. Further improvement of vaccine-induced immunity would be required to
achieve clinical and epidemiological benefits and prevent transmission of
parasites from vaccinated/infected dogs to triatomines.
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Affiliation(s)
- José E. Aparicio-Burgos
- Centro de Investigación y Estudios
Avanzados, Universidad Autónoma de Estado de México, Toluca,
México
| | - Laucel Ochoa-García
- Centro de Investigación y Estudios
Avanzados, Universidad Autónoma de Estado de México, Toluca,
México
| | | | - Shivali Gupta
- Department of Microbiology and Immunology,
University of Texas Medical Branch, Galveston, Texas, United States of
America
| | - Monisha Dhiman
- Department of Microbiology and Immunology,
University of Texas Medical Branch, Galveston, Texas, United States of
America
| | - José Simón Martínez
- Centro de Investigación y Estudios
Avanzados, Universidad Autónoma de Estado de México, Toluca,
México
| | | | | | - Alberto Barbabosa-Pliego
- Centro de Investigación y Estudios
Avanzados, Universidad Autónoma de Estado de México, Toluca,
México
| | - Juan C. Vázquez-Chagoyán
- Centro de Investigación y Estudios
Avanzados, Universidad Autónoma de Estado de México, Toluca,
México
- * E-mail: (NJG); (JCV-C)
| | - Nisha Jain Garg
- Department of Microbiology and Immunology,
University of Texas Medical Branch, Galveston, Texas, United States of
America
- Department of Pathology, University of Texas
Medical Branch, Galveston, Texas, United States of America
- Faculty of the Institute for Human Infections
and Immunity, and the Sealy Center for Vaccine Development, University of Texas
Medical Branch, Galveston, Texas, United States of America
- * E-mail: (NJG); (JCV-C)
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Wendling APB, Vitelli-Avelar DM, Sathler-Avelar R, Geiger SM, Teixeira-Carvalho A, Gontijo ED, Elói-Santos SM, Martins-Filho OA. The use of IgG antibodies in conventional and non-conventional immunodiagnostic tests for early prognosis after treatment of Chagas disease. J Immunol Methods 2011; 370:24-34. [PMID: 21620855 DOI: 10.1016/j.jim.2011.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/09/2011] [Accepted: 05/11/2011] [Indexed: 12/24/2022]
Abstract
Treatment success of chronically infected Chagas disease patients is laborious and a positive prognosis often is made only after repetitive serological and/or parasitological examinations with continuous negative results. Recently, we have developed a non-conventional flow-cytometric method in order to detect immunoglobulin G antibodies against live trypomastigote forms of Trypanosoma cruzi and showed its usefulness in the prognosis of treatment success. In the present study, we investigated the performance of flow-cytometric anti-live trypomastigote IgG antibodies (FC-ALTA) and flow-cytometric anti-fixed epimastigote IgG antibodies (FC-AFEA), as well as conventional serological methods, for early monitoring of benznidazole treated Chagas disease patients, e.g. 5years after treatment. The analysis of individual FC-ALTA reactivity along the titration curve before and after treatment, we were able to show, that between 4% and 13% of treated patients under evaluation presented with reduced serological reactivity and segregated from the other patient groups. Similar results were obtained with semi-quantitative, conventional indirect hemagglutination or indirect immunofluorescence. Our data therefore suggest that the combined use of conventional and non-conventional serological methods could provide more suitable cure criteria in early post-therapeutic prognosis of Chagas disease.
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Affiliation(s)
- Ana Paula Barbosa Wendling
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
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Ferreira Filho JCR, Costa PID, Buainain A, Rosa JAD. [Seropositivity for Chagas disease among blood donors in Araraquara, State of São Paulo, between 2004 and 2008]. Rev Soc Bras Med Trop 2011; 44:110-2. [PMID: 21340421 DOI: 10.1590/s0037-86822011000100025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 08/11/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Blood transfusion is an important potential source of Chagas disease transmission. METHODS Files from the Araraquara Regional Blood Center were checked regarding the tests results for Chagas' disease between January 2004 and December 2008. RESULTS Positive serology was diagnosed in 0.04% of 49,541 blood donations that were performed. Seropositive individuals were aged between 51 and 60 years-old. CONCLUSIONS The low rate of seropositive donors may reduce the risk of transfusion transmission of Chagas disease. The high occurrence of inconclusive results indicates that the diagnostic methods must be improved.
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Affiliation(s)
- Julio César Rente Ferreira Filho
- Programa de Pós-Graduação em Biociências e Biotecnologia Aplicada à Farmácia, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Araraquara, SP.
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Schijman AG, Bisio M, Orellana L, Sued M, Duffy T, Mejia Jaramillo AM, Cura C, Auter F, Veron V, Qvarnstrom Y, Deborggraeve S, Hijar G, Zulantay I, Lucero RH, Velazquez E, Tellez T, Sanchez Leon Z, Galvão L, Nolder D, Monje Rumi M, Levi JE, Ramirez JD, Zorrilla P, Flores M, Jercic MI, Crisante G, Añez N, De Castro AM, Gonzalez CI, Acosta Viana K, Yachelini P, Torrico F, Robello C, Diosque P, Triana Chavez O, Aznar C, Russomando G, Büscher P, Assal A, Guhl F, Sosa Estani S, DaSilva A, Britto C, Luquetti A, Ladzins J. International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. PLoS Negl Trop Dis 2011; 5:e931. [PMID: 21264349 PMCID: PMC3019106 DOI: 10.1371/journal.pntd.0000931] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 12/01/2010] [Indexed: 01/01/2023] Open
Abstract
Background A century after its discovery, Chagas disease still represents a major neglected tropical threat. Accurate diagnostics tools as well as surrogate markers of parasitological response to treatment are research priorities in the field. The purpose of this study was to evaluate the performance of PCR methods in detection of Trypanosoma cruzi DNA by an external quality evaluation. Methodology/Findings An international collaborative study was launched by expert PCR laboratories from 16 countries. Currently used strategies were challenged against serial dilutions of purified DNA from stocks representing T. cruzi discrete typing units (DTU) I, IV and VI (set A), human blood spiked with parasite cells (set B) and Guanidine Hidrochloride-EDTA blood samples from 32 seropositive and 10 seronegative patients from Southern Cone countries (set C). Forty eight PCR tests were reported for set A and 44 for sets B and C; 28 targeted minicircle DNA (kDNA), 13 satellite DNA (Sat-DNA) and the remainder low copy number sequences. In set A, commercial master mixes and Sat-DNA Real Time PCR showed better specificity, but kDNA-PCR was more sensitive to detect DTU I DNA. In set B, commercial DNA extraction kits presented better specificity than solvent extraction protocols. Sat-DNA PCR tests had higher specificity, with sensitivities of 0.05–0.5 parasites/mL whereas specific kDNA tests detected 5.10−3 par/mL. Sixteen specific and coherent methods had a Good Performance in both sets A and B (10 fg/µl of DNA from all stocks, 5 par/mL spiked blood). The median values of sensitivities, specificities and accuracies obtained in testing the Set C samples with the 16 tests determined to be good performing by analyzing Sets A and B samples varied considerably. Out of them, four methods depicted the best performing parameters in all three sets of samples, detecting at least 10 fg/µl for each DNA stock, 0.5 par/mL and a sensitivity between 83.3–94.4%, specificity of 85–95%, accuracy of 86.8–89.5% and kappa index of 0.7–0.8 compared to consensus PCR reports of the 16 good performing tests and 63–69%, 100%, 71.4–76.2% and 0.4–0.5, respectively compared to serodiagnosis. Method LbD2 used solvent extraction followed by Sybr-Green based Real time PCR targeted to Sat-DNA; method LbD3 used solvent DNA extraction followed by conventional PCR targeted to Sat-DNA. The third method (LbF1) used glass fiber column based DNA extraction followed by TaqMan Real Time PCR targeted to Sat-DNA (cruzi 1/cruzi 2 and cruzi 3 TaqMan probe) and the fourth method (LbQ) used solvent DNA extraction followed by conventional hot-start PCR targeted to kDNA (primer pairs 121/122). These four methods were further evaluated at the coordinating laboratory in a subset of human blood samples, confirming the performance obtained by the participating laboratories. Conclusion/Significance This study represents a first crucial step towards international validation of PCR procedures for detection of T. cruzi in human blood samples. A century after its discovery, Chagas disease, caused by the parasite Trypanosoma cruzi, still represents a major neglected tropical threat. Accurate diagnostics tools as well as surrogate markers of parasitological response to treatment are research priorities in the field. The polymerase chain reaction (PCR) has been proposed as a sensitive laboratory tool for detection of T. cruzi infection and monitoring of parasitological treatment outcome. However, high variation in accuracy and lack of international quality controls has precluded reliable applications in the clinical practice and comparisons of data among cohorts and geographical regions. In an effort towards harmonization of PCR strategies, 26 expert laboratories from 16 countries evaluated their current PCR procedures against sets of control samples, composed by serial dilutions of T.cruzi DNA from culture stocks belonging to different lineages, human blood spiked with parasite cells and blood samples from Chagas disease patients. A high variability in sensitivities and specificities was found among the 48 reported PCR tests. Out of them, four tests with best performance were selected and further evaluated. This study represents a crucial first step towards device of a standardized operative procedure for T. cruzi PCR.
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Affiliation(s)
- Alejandro G Schijman
- Laboratorio de Biología Molecular de Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina.
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Martín-Rabadán P, Martínez-Ruiz R, Cuadros J, Cañavate C. El laboratorio de microbiología ante las enfermedades parasitarias importadas. Enferm Infecc Microbiol Clin 2010; 28:719-25. [DOI: 10.1016/j.eimc.2010.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 03/09/2010] [Indexed: 11/30/2022]
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Brutus L, Castillo H, Bernal C, Salas NA, Schneider D, Santalla JA, Chippaux JP. Detectable Trypanosoma cruzi parasitemia during pregnancy and delivery as a risk factor for congenital Chagas disease. Am J Trop Med Hyg 2010; 83:1044-7. [PMID: 21036835 DOI: 10.4269/ajtmh.2010.10-0326] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Vector control has led to a drastic decrease in the prevalence of acquired Chagas disease in Latin America, thus redirecting attention to congenital Chagas disease. We report results of a longitudinal study of 359 pregnant women in Yacuiba in southern Bolivia, of whom 147 (40.9%) were infected with Trypanosoma cruzi, to evaluate the relationship between the patency period of the parasitemia and the risk of congenital infection. Maternal infection was assessed by using T. cruzi-specific serologic tests, and parasitemia in mothers and newborns was diagnosed by using microscopic examination of blood in heparinized microhematocrit tubes. Parasitemia was present in 28.6% of the infected women. Its prevalence increased during the third trimester, then decreased at delivery. The likelihood of congenital infection was significantly correlated with the parasite density in the mother's blood. The risk of transmission increased during the third trimester of pregnancy and could explain premature births or low-weight newborns for infected mothers.
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Affiliation(s)
- Laurent Brutus
- IRD UMR216, Mother and Child Facing Tropical Infections, Paris, France.
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ELISA versus PCR for diagnosis of chronic Chagas disease: systematic review and meta-analysis. BMC Infect Dis 2010; 10:337. [PMID: 21108793 PMCID: PMC3004908 DOI: 10.1186/1471-2334-10-337] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 11/25/2010] [Indexed: 11/10/2022] Open
Abstract
Background Most current guidelines recommend two serological tests to diagnose chronic Chagas disease. When serological tests are persistently inconclusive, some guidelines recommend molecular tests. The aim of this investigation was to review chronic Chagas disease diagnosis literature and to summarize results of ELISA and PCR performance. Methods A systematic review was conducted searching remote databases (MEDLINE, LILACS, EMBASE, SCOPUS and ISIWeb) and full texts bibliography for relevant abstracts. In addition, manufacturers of commercial tests were contacted. Original investigations were eligible if they estimated sensitivity and specificity, or reliability -or if their calculation was possible - of ELISA or PCR tests, for chronic Chagas disease. Results Heterogeneity was high within each test (ELISA and PCR) and threshold effect was detected only in a particular subgroup. Reference standard blinding partially explained heterogeneity in ELISA studies, and pooled sensitivity and specificity were 97.7% [96.7%-98.5%] and 96.3% [94.6%-97.6%] respectively. Commercial ELISA with recombinant antigens studied in phase three investigations partially explained heterogeneity, and pooled sensitivity and specificity were 99.3% [97.9%-99.9%] and 97.5% [88.5%-99.5%] respectively. ELISA's reliability was seldom studied but was considered acceptable. PCR heterogeneity was not explained, but a threshold effect was detected in three groups created by using guanidine and boiling the sample before DNA extraction. PCR sensitivity is likely to be between 50% and 90%, while its specificity is close to 100%. PCR reliability was never studied. Conclusions Both conventional and recombinant based ELISA give useful information, however there are commercial tests without technical reports and therefore were not included in this review. Physicians need to have access to technical reports to understand if these serological tests are similar to those included in this review and therefore correctly order and interpret test results. Currently, PCR should not be used in clinical practice for chronic Chagas disease diagnosis and there is no PCR test commercially available for this purpose. Tests limitations and directions for future research are discussed.
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Batista AM, Aguiar C, Almeida EA, Guariento ME, Wanderley JS, Costa SCB. Evidence of Chagas disease in seronegative Brazilian patients with megaesophagus. Int J Infect Dis 2010; 14:e974-7. [PMID: 20833571 DOI: 10.1016/j.ijid.2010.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 02/12/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND After 100 years of research, Chagas disease (CD) remains an important public health problem in Latin America. The symptomatic chronic phase is usually characterized by cardiac or digestive involvement and diagnosis currently relies on the measurement of Trypanosoma cruzi-specific antibodies produced in response to the infection. However, the detection of parasite DNA in seronegative persons has been reported. METHODS The prevalence of CD in a population with esophageal disorders was assessed by conventional serology. We also detected T. cruzi DNA in blood samples of seronegative and inconclusive patients by nested polymerase chain reaction (N-PCR). RESULTS The seroprevalence of CD determined by conventional serologic tests (indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA)) was 79% in 513 patients with esophageal disorders. Out of 41 blood samples, N-PCR was positive in 31 (76%) cases for which serology was negative or inconclusive. CONCLUSIONS As all patients presented with clinical signs suggestive of the digestive form of CD and most of them were born in endemic areas, we highlight the importance of improving diagnosis of the disease and the implications for blood bank screening. Our data suggest that N-PCR is effective in the detection of T. cruzi DNA in patients with inconclusive or negative serology, and it may eventually be useful in the determination of the etiology of megaesophagus.
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Affiliation(s)
- Angelica M Batista
- Universidade Estadual de Campinas - UNICAMP, Faculdade de Ciências Médicas, PO Box 6111, 13083-970 Campinas, São Paulo, Brazil
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Lescure FX, Le Loup G, Freilij H, Develoux M, Paris L, Brutus L, Pialoux G. Chagas disease: changes in knowledge and management. THE LANCET. INFECTIOUS DISEASES 2010; 10:556-70. [PMID: 20670903 DOI: 10.1016/s1473-3099(10)70098-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
More than 100 years after the discovery of human American trypanosomiasis by Carlos Chagas, our knowledge and management of the disease are profoundly changing. Substantial progress made by disease control programmes in most endemic areas contrasts with persisting difficulties in the Gran Chaco region in South America and the recent emergence of the disease in non-endemic areas because of population movements. In terms of pathogenesis, major discoveries have been made about the life cycle and genomics of Trypanosoma cruzi, and the role of the parasite itself in the chronic phase of the disease. From a clinical perspective, a growing number of arguments have challenged the notion of an indeterminate phase, and suggest new approaches to manage patients. New methods such as standardised PCR will be necessary to ensure follow-up of this chronic infection. Although drugs for treatment of Chagas disease are limited, poorly tolerated, and not very effective, treatment indications are expanding. The results of the Benznidazole Evaluation For Interrupting Trypanosomiasis (BENEFIT) trial in 2012 will also help to inform treatment. Mobilisation of financial resources to fund research on diagnosis and randomised controlled trials of treatment are international health priorities.
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Rapid detection of Trypanosoma cruzi in human serum by use of an immunochromatographic dipstick test. J Clin Microbiol 2010; 48:3003-7. [PMID: 20534801 DOI: 10.1128/jcm.02474-09] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated a commercially available immunochromatographic dipstick test to detect Trypanosoma cruzi infection in 366 human serum samples with known serological results from Argentina, Ecuador, Mexico, and Venezuela. One hundred forty-nine of 366 (40.7%) and 171/366 (46.7%) samples tested positive by dipstick and serology, respectively. Dipstick sensitivity was calculated to be 84.8% (range between countries, 77.5 to 95%), and specificity was 97.9% (95.9 to 100%).
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Garisto-Risco JD, Saldaña A, Zebede S, Calzada JE. Cardiac disease in seropositive Chagasic patients in Panama. Rev Esp Cardiol 2009; 62:947-8. [PMID: 19706256 DOI: 10.1016/s1885-5857(09)72665-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Garisto-Risco JD, Saldaña A, Zebede S, Calzada JE. Alteraciones cardiacas en pacientes seropositivos a la infección chagásica en Panamá. Rev Esp Cardiol (Engl Ed) 2009. [DOI: 10.1016/s0300-8932(09)72083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Nieto PD, Boughton R, Dorn PL, Steurer F, Raychaudhuri S, Esfandiari J, Gonçalves E, Diaz J, Malone JB. Comparison of two immunochromatographic assays and the indirect immunofluorescence antibody test for diagnosis of Trypanosoma cruzi infection in dogs in south central Louisiana. Vet Parasitol 2009; 165:241-7. [PMID: 19647943 DOI: 10.1016/j.vetpar.2009.07.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 07/06/2009] [Accepted: 07/08/2009] [Indexed: 11/30/2022]
Abstract
Two rapid tests evaluated in dogs considered to be of high risk of infection with the Chagas parasite Trypanosoma cruzi using two immunochromatographic assays: Trypanosoma Detect for canine, InBios, Seattle, WA and CHAGAS STAT-PAK assay, Chembio Diagnostic Systems, Medford, NY, in south central Louisiana. For this purpose a serological survey was carried out in a total of 122 dogs and a serum bank was created. These 122 animals were first tested by IFAT that was used as the standard test. From the serum bank 50 samples were tested using the two rapid Chagas assays and results compared to the standard test IFAT. The serological survey using IFAT showed a prevalence of T. cruzi infection in 22.1% of the tested dogs. In the immunochromatographic assays, 13 and 11 animals were positive on rapid assay: Trypanosoma Detect for canine, InBios and CHAGAS STAT-PAK, Chembio Diagnostic Systems, respectively compared to 11 positive by IFAT. These two immunochromatographic tests have shown high susceptibility and specificity compared to our standard method IFAT. The rapid, easy and accurate screening assays used in conjunction with confirmatory tests, would be an excellent tool for veterinarians to diagnose T. cruzi infection. Early detection of T. cruzi infection may prevent complications through an effective treatment. Greater awareness by veterinarians of the risk, clinical findings, history along with diagnostic methods will contribute greatly to an understanding of the true prevalence of Chagas disease in dogs in Louisiana.
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Affiliation(s)
- Prixia D Nieto
- Louisiana State University, School of Veterinary Medicine, South Stadium Road, Baton Rouge, LA 70803, USA.
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41
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Houghton RL, Stevens YY, Hjerrild K, Guderian J, Okamoto M, Kabir M, Reed SG, Leiby DA, Morrow WJW, Lorca M, Raychaudhuri S. Lateral flow immunoassay for diagnosis of Trypanosoma cruzi infection with high correlation to the radioimmunoprecipitation assay. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2009; 16:515-20. [PMID: 19211772 PMCID: PMC2668284 DOI: 10.1128/cvi.00383-08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/12/2008] [Accepted: 02/02/2009] [Indexed: 11/20/2022]
Abstract
The incidence of blood donors seropositive for Trypanosoma cruzi in North America has increased with population migration and more rigorous surveillance. The United States, considered nonendemic for T. cruzi, could therefore be at risk to exposure to parasite transmission through blood or organ donations. Current tests show variable reactivity, especially with Central American sera. Here we describe the development of a lateral flow immunoassay for the rapid detection of T. cruzi infection that has a strong correlation to the radioimmunoprecipitation assay (RIPA) "gold standard" in the United States. Such a test could have utility in small blood banks for prescreening donors, as well as in cardiac transplantation evaluation. T. cruzi consensus and/or RIPA-positive sera from Central and South America were evaluated in enzyme immunoassays (EIAs). These included commercial panels from Boston Biomedica, Inc. (BBI) (n = 14), and HemaBio (n = 21). Other sources included RIPA-positive sera from the American Red Cross (ARC) (n = 42), as well as from Chile. Sera were tested with the multiepitope recombinant TcF. All but one of the BBI samples were positive and 7 of 21 HemaBio samples and 6 of 42 ARC samples were low positive or negative. This observation indicated the need for additional antigens. To complement TcF reactivity, we tested the sera with peptides 30, 36, SAPA, and 1.1, 1.2, and 1.3 His fragments of 85-kDa trans-sialidase. We identified a promising combination of the tested antigens and constructed a single recombinant protein, ITC6, that enhanced the relative sensitivity in U.S. blood donor sera compared to that of TcF. The data on its evaluation using RIPA-confirmed positive sera in EIA and lateral flow immunoassay studies are presented, along with an additional recombinant protein, ITC8.2, with two additional sequences for peptide 1 and Kmp-11. The latter, when evaluated in a dipstick assay with consensus positive sera, had a sensitivity of 99.2% and a specificity of 99.1%.
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Campos SV, Strabelli TMV, Amato Neto V, Silva CP, Bacal F, Bocchi EA, Stolf NAG. Risk Factors for Chagas' Disease Reactivation After Heart Transplantation. J Heart Lung Transplant 2008; 27:597-602. [DOI: 10.1016/j.healun.2008.02.017] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 01/06/2008] [Accepted: 02/17/2008] [Indexed: 11/26/2022] Open
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Braz LMA, Amato Neto V, Okay TS. Reactivation of Trypanosoma cruzi infection in immunosuppressed patients: contributions for the laboratorial diagnosis standardization. Rev Inst Med Trop Sao Paulo 2008; 50:65-6. [DOI: 10.1590/s0036-46652008000100015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Braz LMA, Raiz R, Neto A, Amato Neto V, Alárcon RS, Gakyia E, Okay TS. The detection of Trypanosoma cruzi in Triatoma infestans: comparison of a PCR-based assay with microscopical examination. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2007; 101:461-5. [PMID: 17550653 DOI: 10.1179/136485907x176535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- L M A Braz
- LIM/36, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr Enéas Carvalho de Aguiar 647, CEP 05403-900, São Paulo, SP, Brazil.
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45
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Flores-Chávez M, de Fuentes I, Gárate T, Cañavate C. Diagnóstico de laboratorio de la enfermedad de Chagas importada. Enferm Infecc Microbiol Clin 2007. [DOI: 10.1157/13111835] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rocha MOC, Teixeira MM, Ribeiro AL. An update on the management of Chagas cardiomyopathy. Expert Rev Anti Infect Ther 2007; 5:727-43. [PMID: 17678433 DOI: 10.1586/14787210.5.4.727] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, infects nearly 18 million people in Latin America and mainly affects the heart, causing heart failure, arrhythmias, heart block, thromboembolism, stroke and death. In this review, the clinical diagnosis and management of Chagas cardiomyopathy are discussed. Particular emphasis is placed on the clinical staging of patients and the use of various diagnostic tests that may be useful in individualizing treatment of the two most relevant clinical syndromes, that is, heart failure and arrhythmias. The relevance of specific treatments are discussed, stressing the important role of parasite persistence in disease pathogenesis. We also discuss new therapy modalities that may have a role in the treatment of Chagas cardiomyopathy.
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Affiliation(s)
- Manoel O C Rocha
- Internal Medicine Department and Coordinator, Postgraduate Course of Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Garg N, Bhatia V. Current status and future prospects for a vaccine against American trypanosomiasis. Expert Rev Vaccines 2007; 4:867-80. [PMID: 16372882 DOI: 10.1586/14760584.4.6.867] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The clinically relevant pathognomonic consequences of human infection by Trypanosoma cruzi are dilation and hypertrophy of the left ventricle walls and thinning of the apex. The major complications and debilitating evolutionary outcomes of chronic infection include ventricular fibrillation, thromboembolism and congestive heart failure. American trypanosomiasis (Chagas disease) poses serious public healthcare and budgetary concerns. The currently available drugs, although effective against acute infection, are highly toxic and ineffective in arresting or attenuating clinical disease symptoms in chronic patients. The development of an efficacious prophylactic vaccine faces many challenges, and progress is slow, despite several years of effort. Studies in animal models and human patients have revealed the pathogenic mechanisms during disease progression, pathology of disease and features of protective immunity. Accordingly, several antigens, antigen-delivery vehicles and adjuvants have been tested in animal models, and some efforts have been successful in controlling infection and disease. This review will summarize the accumulated knowledge about the parasite and disease, as well as pathogenesis and protective immunity. The authors will discuss the efforts to date, and the challenges faced in achieving an efficient prophylactic vaccine against human American trypanosomiasis, and present the future perspectives.
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Affiliation(s)
- Nisha Garg
- Sealy Center for Vaccine Development, Department of Microbiology, Immunology and Pathology, University of Texas Medical Branch, Galveston TX 77555, USA.
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Vitelli-Avelar DM, Sathler-Avelar R, Wendling APB, Rocha RDR, Teixeira-Carvalho A, Martins NE, Dias JCP, Rassi A, Luquetti AO, Elói-Santos SM, Martins-Filho OA. Non-conventional flow cytometry approaches to detect anti-Trypanosoma cruzi immunoglobulin G in the clinical laboratory. J Immunol Methods 2007; 318:102-12. [PMID: 17161421 DOI: 10.1016/j.jim.2006.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 10/11/2006] [Accepted: 10/12/2006] [Indexed: 11/27/2022]
Abstract
We have recently developed a flow cytometric approach to detect anti-live trypomastigote and anti-fixed epimastigote IgG antibodies (FC-ALTA and FC-AFEA) in sera from individuals infected by Trypanosoma cruzi. Here, we present the first evaluation of the applicability of FC-AFEA-IgG as a diagnostic tool for Chagas disease. Performance analysis demonstrated that FC-AFEA-IgG has a sensitivity of 82% and a specificity of 100%. The assessment for prognosis performed by FC-ALTA-IgG1 and FC-AFEA-IgG, after classification of chagasic patients as belonging to indeterminate (IND), cardiac (CARD) or digestive (DIG) clinical forms, showed that most of IND have higher amounts of IgG than individuals' carrying CARD or DIG Chagas disease. FC-AFEA-IgG was also evaluated as a method to monitor chemotherapy efficacy in individuals classified into three distinct categories: not treated (NT), treated but not cured (TNC), and treated and cured (TC). Performance analysis demonstrated that FC-AFEA-IgG has an extraordinary capacity as a serological criterion to assess cure after therapeutic intervention in Chagas disease. These results represent a great advance in the application of serological techniques for clinical investigations on Chagas disease, and they clearly define new directions and perspectives. We intend to continue this field research focusing our attention on the influence of the degree of clinical damage on the FC-ALTA-IgG1 and FC-AFEA-IgG reactivity.
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Cardinal MV, Reithinger R, Gürtler RE. Use of an immunochromatographic dipstick test for rapid detection of Trypanosoma cruzi in sera from animal reservoir hosts. J Clin Microbiol 2006; 44:3005-7. [PMID: 16891528 PMCID: PMC1594643 DOI: 10.1128/jcm.00552-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated an immunochromatographic dipstick test to detect Trypanosoma cruzi in canine serum samples from areas of endemicity (n = 141) and nonendemicity (n = 28) for Chagas' disease with known serological and xenodiagnostic test results. The dipstick test had a specificity of at least 94% and a sensitivity of at least 96%. The dipstick tested could become the first choice for screening purposes in disease surveillance or intervention programs.
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Affiliation(s)
- Marta V Cardinal
- Department of Ecology, Genetics and Evolution, Universidad de Buenos Aires, Buenos Aires, Argentina
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50
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Chang CD, Cheng KY, Jiang LX, Salbilla VA, Haller AS, Yem AW, Bryant JD, Kirchhoff LV, Leiby DA, Schochetman G, Shah DO. Evaluation of a prototype Trypanosoma cruzi antibody assay with recombinant antigens on a fully automated chemiluminescence analyzer for blood donor screening. Transfusion 2006; 46:1737-44. [PMID: 17002630 DOI: 10.1111/j.1537-2995.2006.00965.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chagas disease is caused by Trypanosoma cruzi, a protozoan parasite that can be transmitted by transfusion. The diagnosis of chronic T. cruzi infection is generally made by detecting specific antibodies that bind to parasite antigens. The aim of this study was to assess the sensitivity and specificity of a new serologic assay for antibodies to T. cruzi on a fully automated analyzer (PRISM, Abbott Laboratories). STUDY DESIGN AND METHODS A prototype chemiluminescent immunoassay based on chimeric recombinant antigens and run on the automated PRISM system was developed for detecting antibodies to T. cruzi in human serum and plasma. Assay specificity was evaluated by testing samples from random blood donors and from a diverse group of specimens from persons with diseases or conditions often associated with false-positive reactions in T. cruzi assays. Sensitivity was determined by testing 377 geographically diverse T. cruzi antibody-positive specimens. RESULTS Six of 7911 samples (0.08%) from random donors were repeatedly reactive in the prototype PRISM Chagas assay. One of these was reactive in three other tests, including the radioimmune precipitation assay and was presumed to be a true positive. Hence, the specificity was 99.94 percent (7905/7910) in the negative donor group studied. All 377 T. cruzi antibody-positive specimens were positive in the prototype assay and thus the sensitivity was 100 percent. CONCLUSION The results obtained to date, in terms of sensitivity as well as specificity, strongly suggest that the PRISM Chagas assay should function well as a tool for screening blood for serologic evidence of T. cruzi infection.
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Affiliation(s)
- Chi-Deu Chang
- Emerging Pathogens R&D, Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, Illinois 60064, USA
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