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Sereno D, Oury B, Grijalva MJ. Chagas Disease across the Ages: A Historical View and Commentary on Navigating Future Challenges. Microorganisms 2024; 12:1153. [PMID: 38930535 PMCID: PMC11205636 DOI: 10.3390/microorganisms12061153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/14/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Chagas disease, discovered over a century ago, continues to pose a global health challenge, affecting millions mainly in Latin America. This historical review with commentary outlines the disease's discovery, its evolution into a global concern due to migration, and highlights significant advances in diagnostics and treatment strategies. Despite these advancements, the paper discusses ongoing challenges in eradication, including vector control, congenital transmission, the disease's asymptomatic nature, and socioeconomic barriers to effective management. It calls for a multidisciplinary approach, enhanced diagnostics, improved treatment accessibility, and sustained vector control efforts. The review emphasizes the importance of global collaboration and increased funding to reduce Chagas disease's impact.
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Affiliation(s)
- Denis Sereno
- INTERTRYP, University Montpellier, Centre International de Recherche en Agronomie (CIRAD), Institut de Recherche pour le Développement (IRD), GloInsect: Global Infectiology and Entomology Research Group, 34032 Montpellier, France;
| | - Bruno Oury
- INTERTRYP, University Montpellier, Centre International de Recherche en Agronomie (CIRAD), Institut de Recherche pour le Développement (IRD), GloInsect: Global Infectiology and Entomology Research Group, 34032 Montpellier, France;
| | - Mario J. Grijalva
- Infectious and Tropical Disease Institute, Biomedical Sciences Department, Heritage College of Osteopathic Medicine, Athens, OH 45701, USA;
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2
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Deciphering Diets and Lifestyles of Prehistoric Humans through Paleoparasitology: A Review. Genes (Basel) 2023; 14:genes14020303. [PMID: 36833230 PMCID: PMC9957072 DOI: 10.3390/genes14020303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023] Open
Abstract
Parasites have affected and coevolved with humans and animals throughout history. Evidence of ancient parasitic infections, particularly, reside in archeological remains originating from different sources dating to various periods of times. The study of ancient parasites preserved in archaeological remains is known as paleoparasitology, and it initially intended to interpret migration, evolution, and dispersion patterns of ancient parasites, along with their hosts. Recently, paleoparasitology has been used to better understand dietary habits and lifestyles of ancient human societies. Paleoparasitology is increasingly being recognized as an interdisciplinary field within paleopathology that integrates areas such as palynology, archaeobotany, and zooarchaeology. Paleoparasitology also incorporates techniques such as microscopy, immunoassays, PCR, targeted sequencing, and more recently, high-throughput sequencing or shotgun metagenomics to understand ancient parasitic infections and thus interpret migration and evolution patterns, as well as dietary habits and lifestyles. The present review covers the original theories developed in the field of paleoparasitology, as well as the biology of some parasites identified in pre-Columbian cultures. Conclusions, as well as assumptions made during the discovery of the parasites in ancient samples, and how their identification may aid in better understanding part of human history, ancient diet, and lifestyles are discussed.
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3
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Kévin R, Nicolas C, Elsa P, Paolo L, Pasquino P, Raffaella B, Matthieu LB. Gastrointestinal parasite burden in 4th-5th c. CE Florence highlighted by microscopy and paleogenetics. INFECTION GENETICS AND EVOLUTION 2021; 90:104713. [PMID: 33429070 DOI: 10.1016/j.meegid.2021.104713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/25/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
The study of ancient parasites, named paleoparasitology, traditionally focused on microscopic eggs disseminated in past environments and archaeological structures by humans and other animals infested by gastrointestinal parasites. Since the development of paleogenetics in the early 1980s, few paleoparasitological studies have been based on the ancient DNA (aDNA) of parasites, although such studies have clearly proven their utility and reliability. In this paper, we describe our integrative approach for the paleoparasitological study of an ancient population from Florence in Italy, dated to the 4th-5th c. CE. The first stage consisted in the study of sediment samples from the pelvic area of 18 individuals under light microscopy. This allowed us to detect Ascarid-type eggs belonging very probably to the human-infesting roundworm Ascaris lumbricoides. Ten subsamples were selected corresponding to five individuals, and we extracted their whole DNA following sediment aDNA protocols. A targeted approach allowed us to detect two nematodes and one trematode aDNA fragments, namely Ascaris sp., Trichuris trichiura, and Dicrocoelium dendriticum. Among the five individuals tested for microscopic eggs and aDNA, three of them showed the remains of eggs (only Ascarid-type), but all of them tested positive to the presence of at least one parasite aDNA. Microscopic diagnosis first guided our research for the selection of promising samples while the targeted aDNA approach significantly improved our knowledge in terms of parasitic diversity and frequency in this population subgroup. These results enabled us to discuss the possible impact of latent parasitism in this past population at the time of an epidemic, as suggested in Florence. In particular, the singular case of D. dendriticum detection is discussed in light of the present-day scarcity of genuine human infections. Nevertheless, actual infections are known in the paleoparasitological record, and food habits may have led to false parasitism in this historical context. aDNA leaching from overlying strata may also explain this detection. This study strongly pleads for a systematic integrative approach combining microscopy and aDNA in paleoparasitology.
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Affiliation(s)
- Roche Kévin
- Université Bordeaux Montaigne, CNRS UMR 5607 Ausonius, France; Université de Bourgogne Franche-Comté, CNRS UMR 6249 Chrono-Environnement, France.
| | - Capelli Nicolas
- Université de Bourgogne Franche-Comté, CNRS UMR 6249 Chrono-Environnement, France
| | - Pacciani Elsa
- Soprintendenza Archeologia, Belle Arti e Paesaggio of Firenze, Pistoia and Prato, Italy
| | | | - Pallecchi Pasquino
- Soprintendenza Archeologia, Belle Arti e Paesaggio of Firenze, Pistoia and Prato, Italy
| | - Bianucci Raffaella
- Legal Medicine Section, Department of Public Health and Paediatric Sciences, University of Turin, Italy; Warwick Medical School, Biomedical Sciences, University of Warwick, United Kingdom; ADES (UMR 7268), Laboratoire d'Anthropologie bio-culturelle, Droit, Ethique & Santé (Adés), Faculté de Médecine de Marseille, France
| | - Le Bailly Matthieu
- Université de Bourgogne Franche-Comté, CNRS UMR 6249 Chrono-Environnement, France.
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Nystrom KC. Advances in paleopathology in context: A focus on soft tissue paleopathology. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 29:16-23. [PMID: 31481317 DOI: 10.1016/j.ijpp.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/11/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
Skeletal and mummified remains from South America have had a significant impact on the progress of paleopathological research. In 1997, John Verano synthesized the state of paleopathological research, identifying trends and highlighting future potentials. The goal of this contribution is to consider Verano's observations on advances in soft tissue paleopathology within the context of the development of the field of mummy studies. As his article was published near the midpoint between the present and the early 1970s, when the modern form of mummy studies began to form, considering his observations in this context allows researchers the opportunity to consider how the field has progressed since the late 1990s.
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Affiliation(s)
- Kenneth C Nystrom
- Department of Anthropology, State University of New York at New Paltz, New Paltz, NY 12561, USA.
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5
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Sereno D, Akhoundi M, Sayehmri K, Mirzaei A, Holzmuller P, Lejon V, Waleckx E. Noninvasive Biological Samples to Detect and Diagnose Infections due to Trypanosomatidae Parasites: A Systematic Review and Meta-Analysis. Int J Mol Sci 2020; 21:E1684. [PMID: 32121441 PMCID: PMC7084391 DOI: 10.3390/ijms21051684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/24/2022] Open
Abstract
Unicellular eukaryotes of the Trypanosomatidae family include human and animal pathogens that belong to the Trypanosoma and Leishmania genera. Diagnosis of the diseases they cause requires the sampling of body fluids (e.g., blood, lymph, peritoneal fluid, cerebrospinal fluid) or organ biopsies (e.g., bone marrow, spleen), which are mostly obtained through invasive methods. Body fluids or appendages can be alternatives to these invasive biopsies but appropriateness remains poorly studied. To further address this question, we perform a systematic review on clues evidencing the presence of parasites, genetic material, antibodies, and antigens in body secretions, appendages, or the organs or proximal tissues that produce these materials. Paper selection was based on searches in PubMed, Web of Science, WorldWideScience, SciELO, Embase, and Google. The information of each selected article (n = 333) was classified into different sections and data were extracted from 77 papers. The presence of Trypanosomatidae parasites has been tracked in most of organs or proximal tissues that produce body secretions or appendages, in naturally or experimentally infected hosts. The meta-analysis highlights the paucity of studies on human African trypanosomiasis and an absence on animal trypanosomiasis. Among the collected data high heterogeneity in terms of the I2 statistic (100%) is recorded. A high positivity is recorded for antibody and genetic material detection in urine of patients and dogs suffering leishmaniasis, and of antigens for leishmaniasis and Chagas disease. Data on conjunctival swabs can be analyzed with molecular methods solely for dogs suffering canine visceral leishmaniasis. Saliva and hair/bristles showed a pretty good positivity that support their potential to be used for leishmaniasis diagnosis. In conclusion, our study pinpoints significant gaps that need to be filled in order to properly address the interest of body secretion and hair or bristles for the diagnosis of infections caused by Leishmania and by other Trypanosomatidae parasites.
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Affiliation(s)
- Denis Sereno
- Institut de Recherche pour le Dévelopement, Université de Montpellier, UMR INTERTRYP IRD, CIRAD, 34032 Montpellier, France; (V.L.); (E.W.)
- Institut de Recherche pour le Dévelopement, Université de Montpellier, UMR MIVEGEC IRD, CNRS, 34032 Montpellier, France
| | - Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, 93000 Bobigny, France;
| | - Kourosh Sayehmri
- Psychosocial Injuries Research Center, Department of Biostatistics, Ilam University of Medical Sciences, Ilam 6931851147, Iran;
| | - Asad Mirzaei
- Parasitology Department, Paramedical School, Ilam University of Medical Sciences, Ilam 6931851147, Iran;
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam 6931851147, Iran
| | - Philippe Holzmuller
- CIRAD, UMR ASTRE “Animal, Santé, Territoires, Risques et Ecosystèmes”, F-34398 Montpellier, France;
- ASTRE, CIRAD, INRAE, Université de Montpellier (I-MUSE), 34000 Montpellier, France
| | - Veerle Lejon
- Institut de Recherche pour le Dévelopement, Université de Montpellier, UMR INTERTRYP IRD, CIRAD, 34032 Montpellier, France; (V.L.); (E.W.)
| | - Etienne Waleckx
- Institut de Recherche pour le Dévelopement, Université de Montpellier, UMR INTERTRYP IRD, CIRAD, 34032 Montpellier, France; (V.L.); (E.W.)
- Centro de Investigaciones Regionales «Dr Hideyo Noguchi», Universidad autònoma de yucatán, Merida, Yucatán 97000, Mexico
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6
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Zingales B. Trypanosoma cruzi genetic diversity: Something new for something known about Chagas disease manifestations, serodiagnosis and drug sensitivity. Acta Trop 2018; 184:38-52. [PMID: 28941731 DOI: 10.1016/j.actatropica.2017.09.017] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/18/2017] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
Abstract
The genetic diversity of Trypanosoma cruzi, the protozoan agent of Chagas disease, is widely recognized. At present, T. cruzi is partitioned into seven discrete typing units (DTUs), TcI-TcVI and Tcbat. This article reviews the present knowledge on the parasite population structure, the evolutionary relationships among DTUs and their distinct, but not exclusive ecological and epidemiological associations. Different models for the origin of hybrid DTUs are examined, which agree that genetic exchange among T. cruzi populations is frequent and has contributed to the present parasite population structure. The geographic distribution of the prevalent DTUs in humans from the southern United States to Argentina is here presented and the circumstantial evidence of a possible association between T. cruzi genotype and Chagas disease manifestations is discussed. The available information suggests that parasite strains detected in patients, regardless of the clinical presentation, reflect the principal DTU circulating in the domestic transmission cycles of a particular region. In contrast, in several orally transmitted outbreaks, sylvatic strains are implicated. As a consequence of the genotypic and phenotypic differences of T. cruzi strains and the differential geographic distribution of DTUs in humans, regional variations in the sensitivity of the serological tests are verified. The natural resistance to benznidazole and nifurtimox, verified in vivo and in vitro for some parasite stocks, is not associated with any particular DTU, and does not explain the marked difference in the anti-parasitic efficacy of both drugs in the acute and chronic phases of Chagas disease. Throughout this review, it is emphasized that the interplay between parasite and host genetics should have an important role in the definition of Chagas disease pathogenesis, anti-T. cruzi immune response and chemotherapy outcome and should be considered in future investigations.
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Affiliation(s)
- Bianca Zingales
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Avenida Professor Lineu Prestes 748, 05508-000 São Paulo, SP, Brazil.
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Abstract
SUMMARYAncient samples present a number of technical challenges for DNA barcoding, including damaged DNA with low endogenous copy number and short fragment lengths. Nevertheless, techniques are available to overcome these issues, and DNA barcoding has now been used to successfully recover parasite DNA from a wide variety of ancient substrates, including coprolites, cesspit sediment, mummified tissues, burial sediments and permafrost soils. The study of parasite DNA from ancient samples can provide a number of unique scientific insights, for example: (1) into the parasite communities and health of prehistoric human populations; (2) the ability to reconstruct the natural parasite faunas of rare or extinct host species, which has implications for conservation management and de-extinction; and (3) the ability to view in ‘real-time’ processes that may operate over century- or millenial-timescales, such as how parasites responded to past climate change events or how they co-evolved alongside their hosts. The application of DNA metabarcoding and high-throughput sequencing to ancient specimens has so far been limited, but in future promises great potential for gaining empirical data on poorly understood processes such as parasite co-extinction.
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8
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Palaeoparasitology and palaeogenetics: review and perspectives for the study of ancient human parasites. Parasitology 2017; 145:656-664. [DOI: 10.1017/s003118201700141x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
SUMMARYWhile some species of parasites can be identified to species level from archaeological remains using microscopy (i.e.Enterobius vermicularis,Clonorchis sinensis), others can only be identified to family or genus level as different species produce eggs with similar morphology (i.e.Tæniasp. andEchinococcussp.). Molecular and immunological approaches offer the possibility to provide more precise determination at the species level. They can also identify taxa when classic parasite markers such as eggs or cysts have been destroyed over time. However, biomolecules can be poorly preserved and modern reference DNA is available only for a limited number of species of parasites, leading to the conclusion that classic microscopic observation should be combined with molecular analyses. Here we present a review of the molecular approaches used over the past two decades to identify human pathogenic helminths (Ascarissp.,Trichurissp.,E. vermicularis,Fasciolasp. etc.) or protists (Giardiasp.,Trypanosomasp.,Leishmaniasp. etc.). We also discuss the prospects for studying the evolution of parasites with genetics and genomics.
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9
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Sources of Materials for Paleomicrobiology. Microbiol Spectr 2017; 4. [PMID: 27726809 DOI: 10.1128/microbiolspec.poh-0016-2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Paleomicrobiology establishes the diagnosis of ancient infectious diseases by studying ancient pathogens. This recent science also analyzes the evolution of these pathogens, virulence, and their adaptation to their habitat and their vectors. The DNA persists a long time after the death of an organism despite the chemical and enzymatic degradation. The possibility of sequencing bacterial, viral, parasitic and archaeal DNA molecules persists over time.Various sources are used for these studies: frozen tissue and particularly human tissue are a exceptional source for the analysis because at very low temperatures, all biological activity is suspended. The coprolites are a source of choice for studying the human microbiome. Other sources, the ancient bones are the most abundant, however, they may contain only small amounts of DNA due to natural leaching. When the use of the tooth is possible, is a particularly interesting source because of its highly mineralized structure, which gives greater persistence than bone. The calcified tartar deposited on teeth is a source of interest for the study of oral microbiome.All these sources are subject to precautions (gloves and masks hat) at the time of sampling to avoid cross contamination and also be listed in the most precise way because they are precious and rare.
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10
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Pucu E, Cascardo P, Chame M, Felice G, Guidon N, Cleonice Vergne M, Campos G, Roberto Machado-Silva J, Leles D. Study of infectious diseases in archaeological bone material - A dataset. Data Brief 2017; 13:692-695. [PMID: 28725674 PMCID: PMC5506867 DOI: 10.1016/j.dib.2017.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 11/05/2022] Open
Abstract
Bones of human and ground sloth remains were analyzed for presence of Trypanosoma cruzi by conventional PCR using primers TC, TC1 and TC2. Sequence results amplified a fragment with the same product size as the primers (300 and 350pb). Amplified PCR product was sequenced and analyzed on GenBank, using Blast. Although these sequences did not match with these parasites they showed high amplification with species of bacteria. This article presents the methodology used and the alignment of the sequences. The display of this dataset will allow further analysis of our results and discussion presented in the manuscript “Finding the unexpected: a critical view on molecular diagnosis of infectious diseases in archaeological samples” (Pucu et al. 2017) [1].
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Affiliation(s)
- Elisa Pucu
- Laboratório de Biologia Molecular de Parasitos e de Paleoparasitologia, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, n. 101, Bairro São Domingos, Niterói, Rio de Janeiro, Brazil
| | - Paula Cascardo
- Laboratório de Biologia Molecular de Parasitos e de Paleoparasitologia, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, n. 101, Bairro São Domingos, Niterói, Rio de Janeiro, Brazil
| | - Marcia Chame
- Laboratório de Paleoparasitologia, Escola Nacional de Saúde Pública, Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gisele Felice
- Fundação Museu do Homem Americano, São Raimundo Nonato, Piauí, Brazil.,Universidade Federal do Vale do São Francisco, Campus Serra de Capivara, São Raimundo Nonato, Piauí, Brazil
| | - Niéde Guidon
- Fundação Museu do Homem Americano, São Raimundo Nonato, Piauí, Brazil
| | | | - Guadalupe Campos
- Museu de Astronomia e Ciências Afins, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Daniela Leles
- Laboratório de Biologia Molecular de Parasitos e de Paleoparasitologia, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, n. 101, Bairro São Domingos, Niterói, Rio de Janeiro, Brazil
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Reinhard KJ, Araújo A. Prehistoric Pathoecology as Represented by Parasites of a Mummy from the Peruaçu Valley, Brazil. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:585-590. [PMID: 27853115 PMCID: PMC5127542 DOI: 10.3347/kjp.2016.54.5.585] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/31/2016] [Accepted: 09/11/2016] [Indexed: 11/23/2022]
Abstract
Paleopathologists have begun exploring the pathoecology of parasitic diseases in relation to diet and environment. We are summarizing the parasitological findings from a mummy in the site of Lapa do Boquete, a Brazilian cave in the state of Minas Gerais. These findings in context of the archaeology of the site provided insights into the pathoecology of disease transmission in cave and rockshelter environments. We are presenting a description of the site followed by the evidence of hookworm, intestinal fluke, and Trypanosoma infection with resulting Chagas disease in the mummy discovered in the cave. These findings are used to reconstruct the transmission ecology of the site.
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Affiliation(s)
- Karl J Reinhard
- School of Natural Resource Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583-0987, USA
| | - Adauto Araújo
- Escola Nacional de Saude Publica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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12
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Novo SPC, Ferreira LF. The Paleoparasitology in Brazil and Findings in Human Remains from South America: A Review. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:573-583. [PMID: 27853114 PMCID: PMC5127545 DOI: 10.3347/kjp.2016.54.5.573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 12/03/2022]
Abstract
The review article presents some of the history of how paleoparasitology started in Brazil, making highlight the great responsible Dr. Luiz Fernando Ferreira and Dr. Adauto Araújo, the trajectory of paleoparasitology in Brazil since 1978 and its performance in science to the present day. In sequence, it is made a presentation of parasitological findings on human remains found in archaeological sites in South America, highlighting Brazil, Argentina, Chile, and Peru, where major discoveries have occurred. Many of the parasites found in archaeological material and mentioned in this review went out of Africa with the peopling of Europe and from there they dispersed around the world, where climatic conditions allow the transmission. However, humans have acquired other parasites of animals, since humans invaded new habitats or creating new habits adopting new technologies, thus expanding its range of influence on the environment. Thus, this review article is finalized with information that explain the importance of these findings in the interaction between parasites, human host, and ambient.
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Affiliation(s)
- Shênia Patrícia Corrêa Novo
- Fundação Oswaldo Cruz, Fiocruz, Escola Nacional de Saúde Pública Sergio Arouca, ENSP, Departamento de Ciências Biológicas, DCB, Laboratório de Paleoparasitologia Eduardo Marques, Rio de Janeiro, RJ, Brasil
| | - Luiz Fernando Ferreira
- Fundação Oswaldo Cruz, Fiocruz, Escola Nacional de Saúde Pública Sergio Arouca, ENSP, Departamento de Ciências Biológicas, DCB, Laboratório de Paleoparasitologia Eduardo Marques, Rio de Janeiro, RJ, Brasil
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13
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Morrow JJ, Reinhard KJ. Assessing the Archaeoparasitological Potential of Quids As a Source Material for Immunodiagnostic Analyses. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:605-616. [PMID: 27853117 PMCID: PMC5127539 DOI: 10.3347/kjp.2016.54.5.605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/21/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022]
Abstract
In the present study, quids from La Cueva de los Muertos Chiquitos (CMC) were subjected to ELISA tests for 2 protozoan parasites, Toxoplasma gondii (n=45) and Trypanosoma cruzi (n=43). The people who occupied CMC, the Loma San Gabriel, lived throughout much of present-day Durango and Zacatecas in Mexico. The known pathoecology of these people puts them into at-risk categories for the transmission of T. gondii and T. cruzi. Human antibodies created in response to these 2 parasites can be detected in modern saliva using ELISA kits intended for use with human serum. For these reasons, quids were reconstituted and subjected to ELISA testing. All test wells yielded negative results. These results could be a factor of improper methods because there is no precedence for this work in the existing literature. The results could equally be a simple matter of parasite absence among those people who occupied CMC. A final consideration is the taphonomy of human antibodies and whether or not ELISA is a sufficient method for recovering antibodies from archaeological contexts. An additional ELISA test targeting secretory IgA (sIgA) was conducted to further examine the failure to detect parasite-induced antibodies from quids. Herein, the methods used for quid preparation and ELISA procedures are described so that they can be further developed by future researchers. The results are discussed in light of the potential future of quid analysis.
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Affiliation(s)
- Johnica J Morrow
- Pathoecology Laboratory, School of Natural Resources, University of Nebraska-Lincoln, 3310 Holdrege Street, Lincoln, Nebraska 68583-0962, USA
| | - Karl J Reinhard
- Pathoecology Laboratory, School of Natural Resources, University of Nebraska-Lincoln, 3310 Holdrege Street, Lincoln, Nebraska 68583-0962, USA
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14
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Dario MA, Rodrigues MS, Barros JHDS, Xavier SCDC, D’Andrea PS, Roque ALR, Jansen AM. Ecological scenario and Trypanosoma cruzi DTU characterization of a fatal acute Chagas disease case transmitted orally (Espírito Santo state, Brazil). Parasit Vectors 2016; 9:477. [PMID: 27580853 PMCID: PMC5006519 DOI: 10.1186/s13071-016-1754-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/12/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi infection via oral route results in outbreaks or cases of acute Chagas disease (ACD) in different Brazilian regions and poses a novel epidemiological scenario. In the Espírito Santo state (southeastern Brazil), a fatal case of a patient with ACD led us to investigate the enzootic scenario to avoid the development of new cases. At the studied locality, Triatoma vitticeps exhibited high T. cruzi infection rates and frequently invaded residences. METHODS Sylvatic and domestic mammals in the Rio da Prata locality, where the ACD case occurred, and in four surrounding areas (Baia Nova, Buenos Aires, Santa Rita and Todos os Santos) were examined and underwent parasitological and serological tests. Triatomines were collected for a fecal material exam, culturing and mini-exon gene molecular characterization, followed by RFLP-PCR of H3/Alul. Paraffin-embedded cardiac tissue of a patient was washed with xylene to remove paraffin and DNA was extracted using the phenol-chloroform method. For genotype characterization, PCR was performed to amplify the 1f8, GPI and 18S rRNA genes. In the case of V7V8 SSU rRNA, the PCR products were molecularly cloned. PCR products were sequenced and compared to sequences in GenBank. Phylogenetic analysis using maximum likelihood method with 1000 bootstrap replicates was performed. RESULTS None of the animals showed positive hemocultures. Three rodents and two dogs showed signs of infection, as inferred from borderline serological titers. T. vitticeps was the only triatomine species identified and showed T. cruzi infection by DTUs TcI and TcIV. The analysis of cardiac tissue DNA showed mixed infection by T. cruzi (DTUs I, II, III and IV) and Trypanosoma dionisii. CONCLUSIONS Each case or outbreak of ACD should be analyzed as a particular epidemiological occurrence. The results indicated that mixed infections in humans may play a role in pathogenicity and may be more common than is currently recognized. Direct molecular characterization from biological samples is essential because this procedure avoids parasite selection. T. dionisii may under certain and unknown circumstances infect humans. The distribution of T. cruzi DTUS TcIII and TcIV in Brazilian biomes is broader than has been assumed to date.
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Affiliation(s)
- Maria Augusta Dario
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Rio de Janeiro Brazil
| | - Marina Silva Rodrigues
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Rio de Janeiro Brazil
| | | | | | - Paulo Sérgio D’Andrea
- Laboratory of Biology and Parasitology of Wild Reservoir Mammals, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Rio de Janeiro Brazil
| | - André Luiz Rodrigues Roque
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Rio de Janeiro Brazil
| | - Ana Maria Jansen
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Rio de Janeiro Brazil
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Darling MI, Donoghue HD. Insights from paleomicrobiology into the indigenous peoples of pre-colonial America - a review. Mem Inst Oswaldo Cruz 2016; 109:131-9. [PMID: 24714964 PMCID: PMC4015261 DOI: 10.1590/0074-0276140589] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Indexed: 02/06/2023] Open
Abstract
This review investigates ancient infectious diseases in the Americas dated to the
pre-colonial period and considers what these findings can tell us about the history
of the indigenous peoples of the Americas. It gives an overview, but focuses on four
microbial pathogens from this period: Helicobacter pylori,
Mycobacterium tuberculosis, Trypanosoma cruzi
and Coccidioides immitis, which cause stomach ulceration and gastric
cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens
were selected as H. pylori can give insight into ancient human
migrations into the Americas, M. tuberculosis is associated with
population density and urban development, T. cruzi can elucidate
human living conditions and C. immitis can indicate agricultural
development. A range of methods are used to diagnose infectious disease in ancient
human remains, with DNA analysis by polymerase chain reaction one of the most
reliable, provided strict precautions are taken against cross contamination. The
review concludes with a brief summary of the changes that took place after European
exploration and colonisation.
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Affiliation(s)
- Millie I Darling
- Division of Biosciences, Centre for Clinical Microbiology, University College London, London, UK
| | - Helen D Donoghue
- Division of Biosciences, Centre for Clinical Microbiology, University College London, London, UK
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Abstract
Parasite finds in ancient material launched a new field of science: palaeoparasitology. Ever since the pioneering studies, parasites were identified in archaeological and palaeontological remains, some preserved for millions of years by fossilization. However, the palaeoparasitological record consists mainly of parasites found specifically in human archaeological material, preserved in ancient occupation sites, from prehistory until closer to 2015. The results include some helminth intestinal parasites still commonly found in 2015, such as Ascaris lumbricoides, Trichuris trichiura and hookworms, besides others such as Amoebidae and Giardia intestinalis, as well as viruses, bacteria, fungi and arthropods. These parasites as a whole provide important data on health, diet, climate and living conditions among ancient populations. This chapter describes the principal findings and their importance for knowledge on the origin and dispersal of infectious diseases.
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Guhl F, Auderheide A, Ramírez JD. From ancient to contemporary molecular eco-epidemiology of Chagas disease in the Americas. Int J Parasitol 2014; 44:605-12. [DOI: 10.1016/j.ijpara.2014.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/06/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
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Abstract
The ancestor of Trypanosome cruzi was probably introduced to South American via bats approximately 7-10 million years ago. When the first humans arrived in the New World, a sylvatic cycle of Chagas disease was then already well established. Paleoparasitological data suggests that human American trypanosomiasis originated in the Andean area when people founded the first settlements in the coastal region of the Atacama Desert. Identification of T. cruzi as the etiological agent and triatome bugs as the transmission vector of Chagas disease occurred within a few years at the beginning of the 20th century. History also teaches us that human activity leading to environmental changes, in particular deforestation, is the main cause for the spread of Chagas disease. Recently, migration of T. cruzi-infected patients has led to a distribution of Chagas disease from Latin America to non-endemic countries in Europe, North America and western Pacific region.
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Affiliation(s)
- Dietmar Steverding
- BioMedical Research Centre, Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich NR4 7TJ, UK.
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Xavier SCDC, Roque ALR, Bilac D, de Araújo VAL, Neto SFDC, Lorosa ES, da Silva LFCF, Jansen AM. Distantiae transmission of Trypanosoma cruzi: a new epidemiological feature of acute Chagas disease in Brazil. PLoS Negl Trop Dis 2014; 8:e2878. [PMID: 24854494 PMCID: PMC4031066 DOI: 10.1371/journal.pntd.0002878] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/04/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The new epidemiological scenario of orally transmitted Chagas disease that has emerged in Brazil, and mainly in the Amazon region, needs to be addressed with a new and systematic focus. Belém, the capital of Pará state, reports the highest number of acute Chagas disease (ACD) cases associated with the consumption of açaí juice. METHODOLOGY/PRINCIPAL FINDINGS The wild and domestic enzootic transmission cycles of Trypanosoma cruzi were evaluated in the two locations (Jurunas and Val-de Cães) that report the majority of the autochthonous cases of ACD in Belém city. Moreover, we evaluated the enzootic cycle on the three islands that provide most of the açaí fruit that is consumed in these localities. We employed parasitological and serological tests throughout to evaluate infectivity competence and exposure to T. cruzi. In Val-de-Cães, no wild mammal presented positive parasitological tests, and 56% seroprevalence was observed, with low serological titers. Three of 14 triatomines were found to be infected (TcI). This unexpected epidemiological picture does not explain the high number of autochthonous ACD cases. In Jurunas, the cases of ACD could not be autochthonous because of the absence of any enzootic cycle of T. cruzi. In contrast, in the 3 island areas from which the açaí fruit originates, 66.7% of wild mammals and two dogs displayed positive hemocultures, and 15.6% of triatomines were found to be infected by T. cruzi. Genotyping by mini-exon gene and PCR-RFLP (1f8/Akw21I) targeting revealed that the mammals and triatomines from the islands harbored TcI and Trypanosoma rangeli in single and mixed infections. CONCLUSION/SIGNIFICANCE These findings show that cases of Chagas disease in the urban area of Belém may be derived from infected triatomines coming together with the açaí fruits from distant islands. We term this new epidemiological feature of Chagas disease as "Distantiae transmission".
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Affiliation(s)
| | - André Luiz Rodrigues Roque
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniele Bilac
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Sócrates Fraga da Costa Neto
- Laboratory of Biology and Parasitology of Wild Reservoir Mammals, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elias Seixas Lorosa
- International and National Laboratory of Reference for Triatominae Taxonomy, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Maria Jansen
- Laboratory of Trypanosomatid Biology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
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Insights about echinostomiasis by paleomolecular diagnosis. Parasitol Int 2014; 63:646-9. [PMID: 24780138 DOI: 10.1016/j.parint.2014.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 04/01/2014] [Accepted: 04/17/2014] [Indexed: 11/22/2022]
Abstract
Echinostomiasis is a zoonosis caused by intestinal trematodes and transmitted by the ingestion of mollusks, crustaceans, fish, amphibians, and reptiles, either raw or poorly cooked. Today human infection is endemic in Southeast Asia and the Far East, but has been reported more recently in other regions of the world. Interestingly eggs identified as Echinostoma sp. were found in coprolites from a mummified body human in Brazil, dated 560 ± 40 BP (before present). However, the specific diagnosis based on morphology of the eggs has not been resolved at the species level. As a follow-up to the previous finding, the current study now aims to standardize the methodology for molecular diagnosis and apply it to the coprolite, using current Echinostoma paraensei-positive feces as the reference, and also the same fecal material dried in a stove as an experimental coprolite model. Isolated eggs of E. paraensei and adult worm were included to verify the sensibility and as positive control, respectively. An adult worm of E. luisreyi was used for comparison. PCR using primers in-house for ITS1 region (126 bp) and cox1 (123 bp) of Echinostoma spp. and subsequent nucleotide sequencing were performed. This is the first molecular paleoparasitological diagnosis for echinostomiasis. The methodology was able to amplify specific DNA fragments for the genus Echinostoma sp. in all samples: adult worm, feces, and a single egg of the parasite, in both the experimental coprolite and archaeological sample. Additionally we observed that ancient DNA can also be retrieved without rehydrating the material. The nucleotide sequences from E. paraensei and E. luisreyi are very similar in the fragment analyzed that difficult the differentiation these species, but DNA sequence analysis recovered in the parasite found in the mummy showed more similarity with the species E. paraensei.
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Panzer S, Peschel O, Haas-Gebhard B, Bachmeier BE, Pusch CM, Nerlich AG. Reconstructing the life of an unknown (ca. 500 years-old South American Inca) mummy--multidisciplinary study of a Peruvian Inca mummy suggests severe Chagas disease and ritual homicide. PLoS One 2014; 9:e89528. [PMID: 24586848 PMCID: PMC3935882 DOI: 10.1371/journal.pone.0089528] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/20/2014] [Indexed: 11/18/2022] Open
Abstract
The paleopathological, paleoradiological, histological, molecular and forensic investigation of a female mummy (radiocarbon dated 1451–1642 AD) provides circumstantial evidence for massive skull trauma affecting a young adult female individual shortly before death along with chronic infection by Trypanosoma cruzi (Chagas disease). The mummy (initially assumed to be a German bog body) was localized by stable isotope analysis to South America at/near the Peruvian/Northern Chilean coast line. This is further supported by New World camelid fibers attached to her plaits, typical Inca-type skull deformation and the type of Wormian bone at her occiput. Despite an only small transverse wound of the supraorbital region computed tomography scans show an almost complete destruction of face and frontal skull bones with terrace-like margins, but without evidence for tissue reaction. The type of destruction indicates massive blunt force applied to the center of the face. Stable isotope analysis indicates South American origin: Nitrogen and hydrogen isotope patterns indicate an extraordinarily high marine diet along with C4-plant alimentation which fits best to the coastal area of Pacific South America. A hair strand over the last ten months of her life indicates a shift to a more “terrestric” nutrition pattern suggesting either a move from the coast or a change in her nutrition. Paleoradiology further shows extensive hypertrophy of the heart muscle and a distended large bowel/rectum. Histologically, in the rectum wall massive fibrosis alternates with residual smooth muscle. The latter contains multiple inclusions of small intracellular parasites as confirmed by immunohistochemical and molecular ancient DNA analysis to represent a chronic Trypanosoma cruzi infection. This case shows a unique paleopathological setting with massive blunt force trauma to the skull nurturing the hypothesis of a ritual homicide as previously described in South American mummies in an individual that suffered from severe chronic Chagas disease.
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Affiliation(s)
- Stephanie Panzer
- Department of Radiology, Trauma Center Murnau, Murnau, Germany and Biomechanics Laboratory, Paracelsus Medical University Salzburg and Trauma Center Murnau, Murnau, Germany
| | - Oliver Peschel
- Institute of Legal Medicine, Ludwig-Maximilians University, Munich, Germany
| | | | | | - Carsten M. Pusch
- Institute of Anthropology and Human Genetics, Eberhard-Karls-University Tübingen, Germany
| | - Andreas G. Nerlich
- Institute of Pathology, Academic Clinic München-Bogenhausen, Munich, Germany
- * E-mail:
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Frías L, Leles D, Araújo A. Studies on protozoa in ancient remains--a review. Mem Inst Oswaldo Cruz 2013; 108:1-12. [PMID: 23440107 PMCID: PMC3974329 DOI: 10.1590/s0074-02762013000100001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/23/2012] [Indexed: 11/21/2022] Open
Abstract
Paleoparasitological research has made important contributions to the understanding of parasite evolution and ecology. Although parasitic protozoa exhibit a worldwide distribution, recovering these organisms from an archaeological context is still exceptional and relies on the availability and distribution of evidence, the ecology of infectious diseases and adequate detection techniques. Here, we present a review of the findings related to protozoa in ancient remains, with an emphasis on their geographical distribution in the past and the methodologies used for their retrieval. The development of more sensitive detection methods has increased the number of identified parasitic species, promising interesting insights from research in the future.
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Affiliation(s)
- Liesbeth Frías
- Escola Nacional de Saúde Pública, Fiocruz, Rio de Janeiro, RJ, Brasil
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Araujo A, Reinhard K, Ferreira LF, Pucu E, Chieffi PP. Paleoparasitology: the origin of human parasites. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:722-6. [DOI: 10.1590/0004-282x20130159] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Parasitism is composed by three subsystems: the parasite, the host, and the environment. There are no organisms that cannot be parasitized. The relationship between a parasite and its host species most of the time do not result in damage or disease to the host. However, in a parasitic disease the presence of a given parasite is always necessary, at least in a given moment of the infection. Some parasite species that infect humans were inherited from pre-hominids, and were shared with other phylogenetically close host species, but other parasite species were acquired from the environment as humans evolved. Human migration spread inherited parasites throughout the globe. To recover and trace the origin and evolution of infectious diseases, paleoparasitology was created. Paleoparasitology is the study of parasites in ancient material, which provided new information on the evolution, paleoepidemiology, ecology and phylogenetics of infectious diseases.
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Risk of transmission of Trypanosoma cruzi by wild Triatoma infestans (Hemiptera: Reduviidae) in Bolivia supported by the detection of human blood meals. INFECTION GENETICS AND EVOLUTION 2013; 19:141-4. [PMID: 23856437 DOI: 10.1016/j.meegid.2013.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 11/22/2022]
Abstract
We analyzed the food sources of Bolivian wild Triatoma infestans (the main vector of Chagas disease in this country), to assess the role of these populations in the epidemiological context of Chagas disease. Ninety-eight blood meals were identified by heteroduplex assay and sequencing. Most of them were from wild mammals but surprisingly 27 were from humans. This brings to light the occurrence of human-vector contacts at risk of Trypanosoma cruzi transmission in the wild environment by highly infected insects.
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Ferreira LF, Jansen AM, Araújo A. Chagas disease in prehistory. ACTA ACUST UNITED AC 2011; 83:1041-4. [DOI: 10.1590/s0001-37652011005000013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/01/2011] [Indexed: 11/21/2022]
Abstract
The classical hypothesis proposes that Chagas disease has been originated in the Andean region among prehistoric people when they started domesticating animals, changing to sedentary habits, and adopting agriculture. These changes in their way of life happened nearly 6,000 years ago. However, paleoparasitological data based on molecular tools showed that Trypanosoma cruzi infection and Chagas disease were commonly found both in South and North American prehistoric populations long before that time, suggesting that Chagas disease may be as old as the human presence in the American continent. The study of the origin and dispersion of Trypanosoma cruzi infection among prehistoric human populations may help in the comprehension of the clinical and epidemiological questions on Chagas disease that still remain unanswered.
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Botella HG, Vargas JAA, de la Rosa MA, Leles D, Reimers EG, Vicente ACP, Iñiguez AM. Paleoparasitologic, paleogenetic and paleobotanic analysis of XVIII century coprolites from the church La Concepción in Santa Cruz de Tenerife, Canary Islands, Spain. Mem Inst Oswaldo Cruz 2010; 105:1054-6. [DOI: 10.1590/s0074-02762010000800017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022] Open
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Araújo A, Jansen AM, Reinhard K, Ferreira LF. Paleoparasitology of Chagas disease: a review. Mem Inst Oswaldo Cruz 2009; 104 Suppl 1:9-16. [DOI: 10.1590/s0074-02762009000900004] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 06/01/2009] [Indexed: 11/22/2022] Open
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