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Majeau A, Dumonteil E, Herrera C. Identification of highly conserved Trypanosoma cruzi antigens for the development of a universal serological diagnostic assay. Emerg Microbes Infect 2024; 13:2315964. [PMID: 38381980 PMCID: PMC10883094 DOI: 10.1080/22221751.2024.2315964] [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: 08/23/2023] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
Chagas Disease is an important neglected tropical disease caused by Trypanosoma cruzi. There is no gold standard for diagnosis and commercial serological tests perform poorly in certain locations. By aligning T. cruzi genomes covering parasite genetic and geographic diversity, we identified highly conserved proteins that could serve as universal antigens for improved diagnosis. Their antigenicity was tested in high-density peptide microarrays using well-characterized plasma samples, including samples presenting true infections but discordant serology. Individual and combination of epitopes were also evaluated in peptide-ELISAs. We identified >1400 highly conserved T. cruzi proteins evaluated in microarrays. Remarkably, T. cruzi positive controls had a different epitope recognition profile compared to serologically discordant samples. In particular, multiple T. cruzi antigens used in current tests and their strain-variants, and novel epitopes thought to be broadly antigenic failed to be recognized by discordant samples. Nonetheless, >2000 epitopes specifically recognized by IgGs from both positive controls and discordant samples were identified. Evaluation of selected peptides in ELISA further illustrated the extensive variation in antibody profiles among subjects and a peptide combination could outperform a commercial ELISA, increasing assay sensitivity from 52.3% to 72.7%. Individual variation in antibody profiles rather than T. cruzi diversity appears to be the main factor driving differences in serological diagnostic performance according to geography, which will be important to further elucidate. ELISA with a combination of peptides recognized by a greater number of individuals could better capture infections, and further development may lead to an optimal antigen mixture for a universal diagnostic assay.
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Affiliation(s)
- Alicia Majeau
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, LA, USA
| | - Eric Dumonteil
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, LA, USA
| | - Claudia Herrera
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, LA, USA
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2
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Fernández-Moya A, Oviedo B, Liempi A, Guerrero-Muñoz J, Rivas C, Arregui R, Araneda S, Cornet-Gomez A, Maya JD, Müller M, Osuna A, Castillo C, Kemmerling U. Trypanosoma cruzi-derived exovesicles contribute to parasite infection, tissue damage, and apoptotic cell death during ex vivo infection of human placental explants. Front Cell Infect Microbiol 2024; 14:1437339. [PMID: 39469456 PMCID: PMC11513395 DOI: 10.3389/fcimb.2024.1437339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 09/11/2024] [Indexed: 10/30/2024] Open
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, can be congenitally transmitted by crossing the placental barrier. This study investigates the role of T. cruzi-derived exovesicles (TcEVs) in facilitating parasite infection and the consequent tissue damage and apoptotic cell death in human placental explants (HPEs). Our findings demonstrate that TcEVs significantly enhance the parasite load and induce tissue damage in HPEs, both in the presence and absence of the parasite. Through histopathological and immunohistochemical analyses, we show that TcEVs alone can disrupt the placental barrier, affecting the basal membrane and villous stroma. The induction of apoptotic cell death is evidenced by DNA fragmentation, caspase 8 and 3, and p18 fragment immunodetection. This damage is exacerbated when TcEVs are combined with T. cruzi infection. These findings suggest that TcEVs play a critical role in the pathogenesis of congenital Chagas disease by disrupting the placental barrier and facilitating parasite transmission to the fetus. This study provides new insights into the mechanisms of transplacental transmission of T. cruzi and highlights the potential of targeting TcEVs as a therapeutic strategy against congenital Chagas disease.
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Affiliation(s)
- Alejandro Fernández-Moya
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Instituto de Ciencias Naturales, Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Santiago, Chile
| | - Bielca Oviedo
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ana Liempi
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jesús Guerrero-Muñoz
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Cristian Rivas
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rocío Arregui
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Sebastian Araneda
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Patología y Medicina Oral, Facultad de Odontología, Universidad de Chile, Santiago, Chile
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Alberto Cornet-Gomez
- Departamento de Parasitología, Instituto de Biotecnología, Universidad de Granada, Granada, Spain
| | - Juan Diego Maya
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Marioly Müller
- Departamento de Tecnología Médica Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Antonio Osuna
- Departamento de Parasitología, Instituto de Biotecnología, Universidad de Granada, Granada, Spain
| | - Christian Castillo
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ulrike Kemmerling
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Bhattacharyya T, Murphy N, Miles MA. Diversity of Chagas disease diagnostic antigens: Successes and limitations. PLoS Negl Trop Dis 2024; 18:e0012512. [PMID: 39352878 PMCID: PMC11444392 DOI: 10.1371/journal.pntd.0012512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, remains a public health issue in endemic regions of the Americas, and is becoming globalised due to migration. In the chronic phase, 2 accordant serological tests are required for diagnosis. In addition to "in-house" assays, commercial tests are available (principally ELISA and rapid diagnostic tests). Herein, we discuss the discovery era of defined T. cruzi serological antigens and their utilisation in commercialised tests. A striking feature is the re-discovery of the same antigens from independent studies, and their overlapping use among commonly reported commercial serological tests. We also consider reports of geographical variation in assay sensitivity and areas for refinement including applications to congenital diagnosis, treatment monitoring, and lineage-specific antigens.
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Affiliation(s)
- Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Niamh Murphy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Michael A. Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
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Moraes FCAD, Souza MEC, Dal Moro L, Donadon IB, da Silva ER, de Souza DDSM, Burbano RMR. Prevention of congenital chagas disease by trypanocide treatment in women of reproductive age: A meta-analysis of observational studies. PLoS Negl Trop Dis 2024; 18:e0012407. [PMID: 39236037 PMCID: PMC11376591 DOI: 10.1371/journal.pntd.0012407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/26/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Maternal-foetal transmission of Chagas disease (CD) affects newborns worldwide. Although Benznidazole and Nifurtimox therapies are the standard treatments, their use during pregnancy is contra-indicated. The effectiveness of trypanocidal medications in preventing congenital Chagas Disease (cCD) in the offsprings of women diagnosed with CD was highly suggested by other studies. METHODS We performed a systematic review and meta-analysis of studies evaluating the effectiveness of treatment for CD in women of childbearing age and reporting frequencies of cCD in their children. PubMed, Scopus, Web of Science, Cochrane Library, and LILACS databases were systematically searched. Statistical analysis was performed using Rstudio 4.2 using DerSimonian and Laird random-effects models. Heterogeneity was examined with the Cochran Q test and I2 statistics. A p-value of <0.05 was considered statistically significant. RESULTS Six studies were included, comprising 744 children, of whom 286 (38.4%) were born from women previously treated with Benznidazole or Nifurtimox, trypanocidal agents. The primary outcome of the proportion of children who were seropositive for cCD, confirmed by serology, was signigicantly lower among women who were previously treated with no congenital transmission registered (OR 0.05; 95% Cl 0.01-0.27; p = 0.000432; I2 = 0%). In women previously treated with trypanocidal drugs, the pooled prevalence of cCD was 0.0% (95% Cl 0-0.91%; I2 = 0%), our meta-analysis confirms the excellent effectiveness of this treatment. The prevalence of adverse events in women previously treated with antitrypanocidal therapies was 14.01% (95% CI 1.87-26.14%; I2 = 80%), Benznidazole had a higher incidence of side effects than Nifurtimox (76% vs 24%). CONCLUSION The use of trypanocidal therapy in women at reproductive age with CD is an effective strategy for the prevention of cCD, with a complete elimination of congenital transmission of Trypanosoma cruzi in treated vs untreated infected women.
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Paternina-Caicedo A, Alger J, Cafferata ML, Carlier Y, Dumonteil E, Gibbons L, Hammerman T, Herrera C, Buekens P. Trypanosoma cruzi Infection in Pregnancies without Congenital Transmission Is Associated with Reduced Fetal Growth: A Cross-Sectional Study in Argentina, Honduras, and Mexico. Am J Trop Med Hyg 2024; 111:64-72. [PMID: 38834059 PMCID: PMC11229638 DOI: 10.4269/ajtmh.23-0493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/02/2024] [Indexed: 06/06/2024] Open
Abstract
We aimed to measure the association between Trypanosoma cruzi infection in pregnancy and reduced fetal growth in the absence of T. cruzi congenital transmission. We conducted a cross-sectional study of secondary data of all singleton live births between 2011 and 2013 in five hospitals from Argentina, Honduras, and Mexico. We excluded newborns with T. cruzi infection. Noninfected pregnant people were those without any positive rapid tests. The main study outcomes were birth weight, head circumference, and length for gestational age and sex. Logistic regression models were adjusted for country, age, education level, and obstetric history. Of the 26,544 deliveries, 459 (1.7%) pregnant people were found by rapid tests to be positive for T. cruzi. Of these, 320 were positive by enzyme-linked immunosorbent assay and 231 had a positive polymerase chain reaction (PCR) test. Uninfected newborns from T. cruzi-infected pregnant people were more likely to have birth weights below the 5th and 10th percentiles and head circumferences below the 3rd and 10th percentiles. Among T. cruzi-infected pregnant people diagnosed by PCR, the odds ratios were 1.58 for birth weight below the 10th percentile (95% CI, 1.12-2.23) and 1.57 for birth weight below the 5th percentile (95% CI, 1.02-2.42). Higher T. cruzi parasitic loads in pregnancy had a stronger association with reduced fetal growth (both in birth weight and head circumference), with an odds ratio of 2.31 (95% CI, 1.36-3.91) for a birth weight below the 5th percentile. The association shows, irrespective of causality, that newborns of pregnancies with T. cruzi have an increased risk of reduced fetal growth. We recommend further studies to assess other potential confounders and the causality of these associations.
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Affiliation(s)
- Angel Paternina-Caicedo
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jackeline Alger
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Maria Luisa Cafferata
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | - Yves Carlier
- Laboratoire de Parasitologie and European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Eric Dumonteil
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Tamara Hammerman
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Claudia Herrera
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Pierre Buekens
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Flores A, Alonso-Vega C, Hermann E, Torrico MC, Montaño Villarroel NA, Torrico F, Carlier Y, Truyens C. Monocytes from Uninfected Neonates Born to Trypanosoma cruzi-Infected Mothers Display Upregulated Capacity to Produce TNF-α and to Control Infection in Association with Maternally Transferred Antibodies. Pathogens 2023; 12:1103. [PMID: 37764911 PMCID: PMC10536721 DOI: 10.3390/pathogens12091103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Activated monocytes/macrophages that produce inflammatory cytokines and nitric oxide are crucial for controlling Trypanosoma cruzi infection. We previously showed that uninfected newborns from T. cruzi infected mothers (M+B- newborns) were sensitized to produce higher levels of inflammatory cytokines than newborns from uninfected mothers (M-B- newborns), suggesting that their monocytes were more activated. Thus, we wondered whether these cells might help limit congenital infection. We investigated this possibility by studying the activation status of M+B- cord blood monocytes and their ability to control T. cruzi in vitro infection. We showed that M+B- monocytes have an upregulated capacity to produce the inflammatory cytokine TNF-α and a better ability to control T. cruzi infection than M-B- monocytes. Our study also showed that T. cruzi-specific Abs transferred from the mother play a dual role by favoring trypomastigote entry into M+B- monocytes and inhibiting intracellular amastigote multiplication. These results support the possibility that some M+B- fetuses may eliminate the parasite transmitted in utero from their mothers, thus being uninfected at birth.
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Affiliation(s)
- Amilcar Flores
- Facultad de Medicina, Universidad Mayor de San Simon (U.M.S.S.), Cochabamba 2500, Bolivia
| | - Cristina Alonso-Vega
- Facultad de Medicina, Universidad Mayor de San Simon (U.M.S.S.), Cochabamba 2500, Bolivia
| | - Emmanuel Hermann
- Laboratory of Parasitology, Faculty of Medicine, ULB Center for Research in Immunology (UCRI), Université Libre de Bruxelles (U.L.B.), 1070 Brussels, Belgium
| | - Mary-Cruz Torrico
- Facultad de Medicina, Universidad Mayor de San Simon (U.M.S.S.), Cochabamba 2500, Bolivia
| | | | - Faustino Torrico
- Facultad de Medicina, Universidad Mayor de San Simon (U.M.S.S.), Cochabamba 2500, Bolivia
| | - Yves Carlier
- Laboratory of Parasitology, Faculty of Medicine, ULB Center for Research in Immunology (UCRI), Université Libre de Bruxelles (U.L.B.), 1070 Brussels, Belgium
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70118, USA
| | - Carine Truyens
- Laboratory of Parasitology, Faculty of Medicine, ULB Center for Research in Immunology (UCRI), Université Libre de Bruxelles (U.L.B.), 1070 Brussels, Belgium
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Lynn MK, Rodriguez Aquino MS, Cornejo Rivas PM, Kanyangarara M, Self SCW, Campbell BA, Nolan MS. Chagas Disease Maternal Seroprevalence and Maternal-Fetal Health Outcomes in a Parturition Cohort in Western El Salvador. Trop Med Infect Dis 2023; 8:tropicalmed8040233. [PMID: 37104358 PMCID: PMC10146685 DOI: 10.3390/tropicalmed8040233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.
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Affiliation(s)
- Mary K Lynn
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | | | | | - Mufaro Kanyangarara
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Stella C W Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Berry A Campbell
- Department of Obstetrics and Gynecology, Prisma Health, Columbia, SC 29203, USA
| | - Melissa S Nolan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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Becker I, Miranda-Ortiz H, Fernández-Figueroa EA, Sánchez-Montes S, Colunga-Salas P, Grostieta E, Juárez-Gabriel J, Lozano-Sardaneta YN, Arce-Fonseca M, Rodríguez-Morales O, Meneses-Ruíz G, Pastén-Sánchez S, López Martínez I, González-Guzmán S, Paredes-Cervantes V, Moreira OC, Finamore-Araujo P, Canseco-Méndez JC, Coquis-Navarrete U, Rengifo-Correa L, González-Salazar C, Alfaro-Cortés MM, Falcón-Lezama JA, Tapia-Conyer R, Stephens CR. The Low Variability of Tc24 in Trypanosoma cruzi TcI as an Advantage for Chagas Disease Prophylaxis and Diagnosis in Mexico. Pathogens 2023; 12:pathogens12030368. [PMID: 36986290 PMCID: PMC10057631 DOI: 10.3390/pathogens12030368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
(1) Background: Chagas disease is the main neglected tropical disease in America. It is estimated that around 6 million people are currently infected with the parasite in Latin America, and 25 million live in endemic areas with active transmission. The disease causes an estimated economic loss of USD 24 billion dollars annually, with a loss of 75,200 working years per year of life; it is responsible for around ~12,000 deaths annually. Although Mexico is an endemic country that recorded 10,186 new cases of Chagas disease during the period of 1990–2017, few studies have evaluated the genetic diversity of genes that could be involved in the prophylaxis and/or diagnosis of the parasite. One of the possible candidates proposed as a vaccine target is the 24 kDa trypomastigote excretory–secretory protein, Tc24, whose protection is linked to the stimulation of T. cruzi-specific CD8+ immune responses. (2) Methods: The aim of the present study was to evaluate the fine-scale genetic diversity and structure of Tc24 in T. cruzi isolates from Mexico, and to compare them with other populations reported in the Americas with the aim to reconsider the potential role of Tc24 as a key candidate for the prophylaxis and improvement of the diagnosis of Chagas disease in Mexico. (3) Results: Of the 25 Mexican isolates analysed, 48% (12) were recovered from humans and 24% (6) recovered from Triatoma barberi and Triatoma dimidiata. Phylogenetic inferences revealed a polytomy in the T. cruzi clade with two defined subgroups, one formed by all sequences of the DTU I and the other formed by DTU II–VI; both subgroups had high branch support. Genetic population analysis detected a single (monomorphic) haplotype of TcI throughout the entire distribution across both Mexico and South America. This information was supported by Nei’s pairwise distances, where the sequences of TcI showed no genetic differences. (4) Conclusions: Given that both previous studies and the findings of the present work confirmed that TcI is the only genotype detected from human isolates obtained from various states of Mexico, and that there is no significant genetic variability in any of them, it is possible to propose the development of in silico strategies for the production of antigens that optimise the diagnosis of Chagas disease, such as quantitative ELISA methods that use this region of Tc24.
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Affiliation(s)
- Ingeborg Becker
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Correspondence: (I.B.); (C.R.S.)
| | - Haydee Miranda-Ortiz
- Unidad de Secuenciación, Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
| | | | - Sokani Sánchez-Montes
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Laboratorio de Diagnóstico, Facultad de Ciencias Biológicas y Agropecuarias Región Poza Rica-Tuxpan, Universidad Veracruzana, Tuxpan de Rodríguez Cano 92870, Mexico
| | - Pablo Colunga-Salas
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Instituto de Biotecnología y Ecología Aplicada, Universidad Veracruzana, Xalapa de Enríquez 91090, Mexico
| | - Estefanía Grostieta
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Javier Juárez-Gabriel
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Laboratorio de Diagnóstico, Facultad de Ciencias Biológicas y Agropecuarias Región Poza Rica-Tuxpan, Universidad Veracruzana, Tuxpan de Rodríguez Cano 92870, Mexico
| | - Yokomi N. Lozano-Sardaneta
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Minerva Arce-Fonseca
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Mexico City 14080, Mexico
| | - Olivia Rodríguez-Morales
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Mexico City 14080, Mexico
| | - Gabriela Meneses-Ruíz
- Departamento de Parasitología, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico City 01480, Mexico
| | - Sergio Pastén-Sánchez
- Departamento de Parasitología, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico City 01480, Mexico
| | - Irma López Martínez
- Departamento de Parasitología, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico City 01480, Mexico
| | - Saúl González-Guzmán
- Laboratorio del Banco Central de Sangre del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
- Departamento de Investigación, Hospital Regional de Alta Especialidad de Zumpango, Zumpango 55600, Mexico
| | - Vladimir Paredes-Cervantes
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
| | - Otacilio C. Moreira
- Laboratorio de Biología Molecular e Doencas Endêmicas, Instituto Oswaldo Cruz, Fiocruz 21040900, RJ, Brazil
| | - Paula Finamore-Araujo
- Laboratorio de Biología Molecular e Doencas Endêmicas, Instituto Oswaldo Cruz, Fiocruz 21040900, RJ, Brazil
| | | | - Uriel Coquis-Navarrete
- Departamento de Genómica Poblacional, Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
| | - Laura Rengifo-Correa
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | | | | | - Jorge A. Falcón-Lezama
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Mexico
| | - Roberto Tapia-Conyer
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Christopher R. Stephens
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Correspondence: (I.B.); (C.R.S.)
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Caroli AP, Mansoldo FRP, Cardoso VS, Lage CLS, Carmo FL, Supuran CT, Beatriz Vermelho A. Are patents important indicators of innovation for Chagas disease treatment? Expert Opin Ther Pat 2023; 33:193-209. [PMID: 36786067 DOI: 10.1080/13543776.2023.2176219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Chagas disease is a neglected, endemic disease in 21 countries, spreading to non-endemic countries too. Like other neglected diseases affecting primarily low- and middle-income countries, low investment and the absence of new chemical entities from the industry occurred. Increased knowledge about the parasite, drug targets, and vector control has been observed, but this was not translated into new drugs. The partnerships of pharmaceutical companies with academies and consolidated networks to increment the new drugs and treatment research in Chagas disease are shown. The current review analyzes in detail the patents dealing with compounds candidates for new drugs and treatment. The patent search was performed using Orbit Intelligence® software in the 2001-2021 period. AREAS COVERED The author focused specifically on patents for the treatment, the new candidates disclosed in the patents, and the barriers to innovation. EXPERT OPINION Patents in Chagas disease have been increasing in the last years, although they do not bring new compounds to an effective treatment.
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Affiliation(s)
- Andrea Pestana Caroli
- Federal University of Rio de Janeiro (UFRJ), Institute of Microbiology Paulo de Góes, BIOINOVAR - Biocatalysis, Bioproducts and Bioenergy, Rio de Janeiro, Brazil
| | - Felipe R P Mansoldo
- Federal University of Rio de Janeiro (UFRJ), Institute of Microbiology Paulo de Góes, BIOINOVAR - Biocatalysis, Bioproducts and Bioenergy, Rio de Janeiro, Brazil
| | - Veronica S Cardoso
- Federal University of Rio de Janeiro (UFRJ), Institute of Microbiology Paulo de Góes, BIOINOVAR - Biocatalysis, Bioproducts and Bioenergy, Rio de Janeiro, Brazil
| | - Celso Luiz Salgueiro Lage
- National Institute of Intellectual Property (INPI), Graduate and Research Division, Rio de Janeiro-RJ, Brazil
| | - Flavia L Carmo
- Federal University of Rio de Janeiro (UFRJ), Institute of Microbiology Paulo de Góes, LEMM - Molecular Microbial Ecology Laboratory
| | - Claudiu T Supuran
- NEUROFARBA Department Sezione di Scienze Farmaceutiche, Università degli Studi di Firenze, Sesto Fiorentino (Florence), Italy
| | - Alane Beatriz Vermelho
- Federal University of Rio de Janeiro (UFRJ), Institute of Microbiology Paulo de Góes, BIOINOVAR - Biocatalysis, Bioproducts and Bioenergy, Rio de Janeiro, Brazil
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10
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TORCH Congenital Syndrome Infections in Central America's Northern Triangle. Microorganisms 2023; 11:microorganisms11020257. [PMID: 36838223 PMCID: PMC9964893 DOI: 10.3390/microorganisms11020257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
TORCH pathogens are a group of globally prevalent infectious agents that may cross the placental barrier, causing severe negative sequalae in neonates, including fetal death and lifelong morbidity. TORCH infections are classically defined by Toxoplasma gondii, other infectious causes of concern (e.g., syphilis, Zika virus, malaria, human immunodeficiency virus), rubella virus, cytomegalovirus, and herpes simplex viruses. Neonatal disorders and congenital birth defects are the leading causes of neonatal mortality in Central America's Northern Triangle, yet little is known about TORCH congenital syndrome in this region. This review synthesizes the little that is known regarding the most salient TORCH infections among pregnant women and neonates in Central America's Northern Triangle and highlights gaps in the literature that warrant further research. Due to the limited publicly available information, this review includes both peer-reviewed published literature and university professional degree theses. Further large-scale studies should be conducted to clarify the public health impact these infections in this world region.
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11
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Matthews S, Tannis A, Puchner KP, Bottazzi ME, Cafferata ML, Comandé D, Buekens P. Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010376. [PMID: 36342961 PMCID: PMC9671465 DOI: 10.1371/journal.pntd.0010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/17/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.
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Affiliation(s)
- Sarah Matthews
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Ayzsa Tannis
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | | | - Maria Elena Bottazzi
- National School of Tropical Medicine, Department of Pediatrics, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States of America
- Texas Children’s Hospital Center for Vaccine Development, Houston, Texas, United States of America
| | - Maria Luisa Cafferata
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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12
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Desale H, Buekens P, Alger J, Cafferata ML, Harville EW, Herrera C, Truyens C, Dumonteil E. Epigenetic signature of exposure to maternal Trypanosoma cruzi infection in cord blood cells from uninfected newborns. Epigenomics 2022; 14:913-927. [PMID: 36039408 PMCID: PMC9475499 DOI: 10.2217/epi-2022-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To assess the epigenetic effects of in utero exposure to maternal Trypanosoma cruzi infection. Methods: We performed an epigenome-wide association study to compare the DNA methylation patterns of umbilical cord blood cells from uninfected babies from chagasic and uninfected mothers. DNA methylation was measured using Infinium EPIC arrays. Results: We identified a differential DNA methylation signature of fetal exposure to maternal T. cruzi infection, in the absence of parasite transmission, with 12 differentially methylated sites in B cells and CD4+ T cells, including eight protein-coding genes. Conclusion: These genes participate in hematopoietic cell differentiation and the immune response and may be involved in immune disorders. They also have been associated with several developmental disorders and syndromes.
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Affiliation(s)
- Hans Desale
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine & Tulane University Vector-Borne & Infectious Disease Research Center, New Orleans, LA 70112, USA
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA
| | - Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, Honduras.,Ministry of Health, Hospital Escuela, Tegucigalpa, Honduras
| | - Maria Luisa Cafferata
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Hospital de Clínicas, Montevideo, 11600, Uruguay
| | - Emily Wheeler Harville
- Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA
| | - Claudia Herrera
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine & Tulane University Vector-Borne & Infectious Disease Research Center, New Orleans, LA 70112, USA
| | - Carine Truyens
- Laboratory of Parasitology, Faculty of Medicine, & ULB Center for Research in Immunology (UCRI), Université Libre de Bruxelles, Brussels, Belgium
| | - Eric Dumonteil
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine & Tulane University Vector-Borne & Infectious Disease Research Center, New Orleans, LA 70112, USA
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13
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Jones KM, Poveda C, Versteeg L, Bottazzi ME, Hotez PJ. Preclinical advances and the immunophysiology of a new therapeutic chagas disease vaccine. Expert Rev Vaccines 2022; 21:1185-1203. [PMID: 35735065 DOI: 10.1080/14760584.2022.2093721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic infection with the protozoal parasite Trypanosoma cruzi leads to a progressive cardiac disease, known as chronic Chagasic cardiomyopathy (CCC). A new therapeutic Chagas disease vaccine is in development to augment existing antiparasitic chemotherapy drugs. AREAS COVERED We report on our current understanding of the underlying immunologic and physiologic mechanisms that lead to CCC, including parasite immune escape mechanisms that allow persistence and the subsequent inflammatory and fibrotic processes that lead to clinical disease. We report on vaccine design and the observed immunotherapeutic effects including induction of a balanced TH1/TH2/TH17 immune response that leads to reduced parasite burdens and tissue pathology. Further, we report vaccine-linked chemotherapy, a dose sparing strategy to further reduce parasite burdens and tissue pathology. EXPERT OPINION Our vaccine-linked chemotherapeutic approach is a multimodal treatment strategy, addressing both the parasite persistence and the underlying deleterious host inflammatory and fibrotic responses that lead to cardiac dysfunction. In targeting treatment towards patients with chronic indeterminate or early determinate Chagas disease, this vaccine-linked chemotherapeutic approach will be highly economical and will reduce the global disease burden and deaths due to CCC.
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Affiliation(s)
- Kathryn M Jones
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Cristina Poveda
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Leroy Versteeg
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America.,Cell Biology and Immunology Group, Wageningen University & Research, De Elst 1, 6708 WD Wageningen, The Netherlands
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Biology, Baylor University, Waco, Texas, United States of America
| | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Biology, Baylor University, Waco, Texas, United States of America.,James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America.,Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America
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14
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Schijman AG, Alonso-Padilla J, Longhi SA, Picado A. Parasitological, serological and molecular diagnosis of acute and chronic Chagas disease: from field to laboratory. Mem Inst Oswaldo Cruz 2022; 117:e200444. [PMID: 35613155 PMCID: PMC9164950 DOI: 10.1590/0074-02760200444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
There is no consensus on the diagnostic algorithms for many scenarios of Trypanosoma cruzi infection, which hinders the establishment of governmental guidelines in endemic and non-endemic countries. In the acute phase, parasitological methods are currently employed, and standardised surrogate molecular tests are being introduced to provide higher sensitivity and less operator-dependence. In the chronic phase, IgG-based serological assays are currently used, but if a single assay does not reach the required accuracy, PAHO/WHO recommends at least two immunological tests with different technical principles. Specific algorithms are applied to diagnose congenital infection, screen blood and organ donors or conduct epidemiological surveys. Detecting Chagas disease reactivation in immunosuppressed individuals is an area of increasing interest. Due to its neglect, enhancing access to diagnosis of patients at risk of suffering T. cruzi infection should be a priority at national and regional levels.
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Affiliation(s)
- Alejandro Gabriel Schijman
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Hector Torres, CONICET, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Ciudad de Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | - Silvia Andrea Longhi
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Hector Torres, CONICET, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Ciudad de Buenos Aires, Argentina
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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15
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Shikanai Yasuda MA. Emerging and reemerging forms of Trypanosoma cruzi transmission. Mem Inst Oswaldo Cruz 2022; 117:e210033. [PMID: 35584508 PMCID: PMC9113729 DOI: 10.1590/0074-02760210033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/13/2023] Open
Abstract
This review aims to update and discuss the main challenges in controlling emergent and reemergent forms of Trypanosoma cruzi transmission through organ transplantation, blood products and vertical transmission in endemic and non-endemic areas as well as emergent forms of transmission in endemic countries through contaminated food, currently representing the major cause of acute illness in several countries. As a neglected tropical disease potentially controllable with a major impact on morbimortality and socioeconomic aspects, Chagas disease (CD) was approved at the WHO global plan to interrupt four transmission routes by 2030 (vector/blood transfusion/organ transplant/congenital). Implementation of universal or target screening for CD are highly recommended in blood banks of non-endemic regions; in organ transplants donors in endemic/non-endemic areas as well as in women at risk from endemic areas (reproductive age women/pregnant women-respective babies). Moreover, main challenges for surveillance are the application of molecular methods for identification of infected babies, donor transmitted infection and of live parasites in the food. In addition, the systematic recording of acute/non-acute cases and transmission sources is crucial to establish databases for control and surveillance purposes. Remarkably, antiparasitic treatment of infected reproductive age women and infected babies is essential for the elimination of congenital CD by 2030.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Ptarasitárias, São Paulo, SP, Brasil,Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Laboratório de Imunologia, São Paulo, SP, Brasil,WHO Technical Group IVb on Prevention and Control of Transmission and Case Management of Trypanosoma cruzi Infections, WHO, Geneva, Switzerland,+ Corresponding author:
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16
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Eberhard FE, Klimpel S, Guarneri AA, Tobias NJ. Exposure to Trypanosoma parasites induces changes in the microbiome of the Chagas disease vector Rhodnius prolixus. MICROBIOME 2022; 10:45. [PMID: 35272716 PMCID: PMC8908696 DOI: 10.1186/s40168-022-01240-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/31/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND The causative agent of Chagas disease, Trypanosoma cruzi, and its nonpathogenic relative, Trypanosoma rangeli, are transmitted by haematophagous triatomines and undergo a crucial ontogenetic phase in the insect's intestine. In the process, the parasites interfere with the host immune system as well as the microbiome present in the digestive tract potentially establishing an environment advantageous for development. However, the coherent interactions between host, pathogen and microbiota have not yet been elucidated in detail. We applied a metagenome shotgun sequencing approach to study the alterations in the microbiota of Rhodnius prolixus, a major vector of Chagas disease, after exposure to T. cruzi and T. rangeli focusing also on the functional capacities present in the intestinal microbiome of the insect. RESULTS The intestinal microbiota of R. prolixus was dominated by the bacterial orders Enterobacterales, Corynebacteriales, Lactobacillales, Clostridiales and Chlamydiales, whereas the latter conceivably originated from the blood used for pathogen exposure. The anterior and posterior midgut samples of the exposed insects showed a reduced overall number of organisms compared to the control group. However, we also found enriched bacterial groups after exposure to T. cruzi as well as T rangeli. While the relative abundance of Enterobacterales and Corynebacteriales decreased considerably, the Lactobacillales, mainly composed of the genus Enterococcus, developed as the most abundant taxonomic group. This applies in particular to vectors challenged with T. rangeli and at early timepoints after exposure to vectors challenged with T. cruzi. Furthermore, we were able to reconstruct four metagenome-assembled genomes from the intestinal samples and elucidate their unique metabolic functionalities within the triatomine microbiome, including the genome of a recently described insect symbiont, Candidatus Symbiopectobacterium, and the secondary metabolites producing bacteria Kocuria spp. CONCLUSIONS Our results facilitate a deeper understanding of the processes that take place in the intestinal tract of triatomine vectors during colonisation by trypanosomal parasites and highlight the influential aspects of pathogen-microbiota interactions. In particular, the mostly unexplored metabolic capacities of the insect vector's microbiome are clearer, underlining its role in the transmission of Chagas disease. Video Abstract.
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Affiliation(s)
- Fanny E. Eberhard
- Institute for Ecology, Evolution and Diversity, Goethe University Frankfurt, Biologicum Campus Riedberg, Max-von-Laue-Str. 13, 60439 Frankfurt/Main, Germany
| | - Sven Klimpel
- Institute for Ecology, Evolution and Diversity, Goethe University Frankfurt, Biologicum Campus Riedberg, Max-von-Laue-Str. 13, 60439 Frankfurt/Main, Germany
- LOEWE Centre for Translational Biodiversity Genomics (LOEWE TBG), Senckenberganlage 25, 60325 Frankfurt/Main, Germany
- Senckenberg Gesellschaft für Naturforschung, Senckenberg Biodiversity and Climate Research Centre, Senckenberganlage 25, 60325 Frankfurt/Main, Germany
| | - Alessandra A. Guarneri
- Vector Behaviour and Pathogen Interaction Group, Instituto René Rachou, Avenida Augusto de Lima,1715, Belo Horizonte, MG CEP 30190-009 Brazil
| | - Nicholas J. Tobias
- LOEWE Centre for Translational Biodiversity Genomics (LOEWE TBG), Senckenberganlage 25, 60325 Frankfurt/Main, Germany
- Senckenberg Gesellschaft für Naturforschung, Senckenberg Biodiversity and Climate Research Centre, Senckenberganlage 25, 60325 Frankfurt/Main, Germany
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17
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Chakravarti I, Miranda-Schaeubinger M, Ruiz-Remigio A, Briones-Garduño C, Fernández-Figueroa EA, Villanueva-Cabello CC, Borge-Villareal A, Bejar-Ramírez Y, Pérez-González A, Rivera-Benitez C, Oren E, Brown HE, Becker I, Gilman RH. Chagas Disease in Pregnant Women from Endemic Regions Attending the Hospital General de Mexico, Mexico City. Trop Med Infect Dis 2022; 7:8. [PMID: 35051124 PMCID: PMC8779423 DOI: 10.3390/tropicalmed7010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/01/2023] Open
Abstract
Trypanosoma cruzi infection leads to Chagas disease (CD), a neglected tropical infection of significant public health importance in South and Central America and other, non-endemic, countries. Pregnant women and their children are of particular importance to screen as T. cruzi can be transmitted vertically. The objective of this study was to screen for T. cruzi infection among pregnant women from endemic areas seen at the Hospital General de Mexico for prenatal care, so that they and their children may be quickly connected to CD treatment. Pregnant women were recruited through the hospital prenatal clinic and screened for T. cruzi infection using a series of serological and molecular tests. Of 150 screened patients, mean age 26.8 (SD 6.4), 30 (20.0%) were positive by at least one diagnostic test. Of these, only nine (6%) were positive as determined by PCR. Diagnosis of chronic CD is difficult in endemic places like Mexico due to the limitations of current commercially available diagnostic tests. Further evaluation of diagnostic performance of various assays could improve current CD diagnostic algorithms and proper care management in these regions. Genetic variability in the parasite may also play a role in the differing assay performances seen in this study, and this may be a valuable avenue of further research.
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Affiliation(s)
- Indira Chakravarti
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21215, USA;
| | | | - Adriana Ruiz-Remigio
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
| | - Carlos Briones-Garduño
- Servicio de Ginecología y Obstetricia, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (C.B.-G.); (A.B.-V.)
| | - Edith A. Fernández-Figueroa
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
- Computational and Integrative Genomics, National Institute of Genomic Medicine, Ciudad de México 14610, Mexico
| | - Concepción Celeste Villanueva-Cabello
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
| | - Alejandra Borge-Villareal
- Servicio de Ginecología y Obstetricia, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (C.B.-G.); (A.B.-V.)
| | - Yadira Bejar-Ramírez
- Banco de Sangre, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (Y.B.-R.); (A.P.-G.)
| | - Alejandro Pérez-González
- Banco de Sangre, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (Y.B.-R.); (A.P.-G.)
| | - César Rivera-Benitez
- Servicio de Infectología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico;
| | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA;
| | - Heidi E. Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Ingeborg Becker
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21215, USA;
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Pérez-Molina JA, Crespillo-Andújar C, Bosch-Nicolau P, Molina I. Trypanocidal treatment of Chagas disease. ACTA ACUST UNITED AC 2021; 39:458-470. [PMID: 34736749 DOI: 10.1016/j.eimce.2020.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/18/2020] [Indexed: 11/24/2022]
Abstract
Chagas disease is a neglected parasitosis caused by the protozoan parasite Trypanosoma cruzi. This infection is present in most Latin American countries, although, due to migratory movements, it is a growing cause for concern in non-endemic countries. The only two drugs currently available for its treatment-benznidazole and nifurtimox-were marketed 50 years ago. While they are very effective for acute and recent infection, and for the prevention of maternofoetal transmission, their efficacy declines in people who have chronic infection, especially those older than 18 years of age. In the presence of visceral involvement, parasiticidal treatment is of little or no value. The safety profile of both drugs is far from ideal, with frequent adverse events and high rates of drug discontinuation, mainly in adults. So far, new drugs and new strategies have not been shown to improve the results of the current nitroimidazoles, although the results are promising. In this review, we focus on the aspects that allow clinicians to make the best use of currently available drugs. In addition, we discuss new therapeutic options and ongoing research in the field.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Pau Bosch-Nicolau
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Instituto René Rachou-FIOCRUZ Minas, Chagas Disease Research Group, Belo Horizonte, MG, Brazil
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19
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Geographic variations in test reactivity for the serological diagnosis of Trypanosoma cruzi infection. J Clin Microbiol 2021; 59:e0106221. [PMID: 34469183 PMCID: PMC8601237 DOI: 10.1128/jcm.01062-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chagas disease is a neglected disease caused by Trypanosoma cruzi parasites. Most diagnosis is based on serological tests, but the lack of a gold standard test complicates the measurement of test performance. To overcome this limitation, we used samples from a cohort of well-characterized T. cruzi-infected women to evaluate the reactivity of two rapid diagnostic tests and one enzyme-linked immunosorbent assay (ELISA). Our cohort was derived from a previous study on congenital transmission of T. cruzi and consisted of 481 blood/plasma samples from Argentina (n = 149), Honduras (n = 228), and Mexico (n = 104), with at least one positive T. cruzi PCR. Reactivity of the three tests ranged from 70.5% for the Wiener ELISA to 81.0% for the T-Detect and 90.4% for the Stat-Pak rapid tests. Test reactivity varied significantly among countries and was highest in Argentina and lowest in Mexico. When considering at least two reactive serological tests to confirm seropositivity, over 12% of T. cruzi infection cases from Argentina were missed by serological tests, over 21% in Honduras, and an alarming 72% in Mexico. Differences in test performance among countries were not due to differences in parasitemia, but differences in antibody levels against ELISA antigens were observed. Geographic differences in T. cruzi parasite strains as well as genetic differences among human populations both may contribute to the discrepancies in serological testing. Improvements in serological diagnostics for T. cruzi infections are critically needed to ensure an optimum identification of cases.
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Castro-Sesquen YE, Tinajeros F, Bern C, Galdos-Cardenas G, Malaga ES, Valencia Ayala E, Hjerrild K, Clipman SJ, Lescano AG, Bayangos T, Castillo W, Menduiña MC, Talaat KR, Gilman RH. The Immunoglobulin M-Shed Acute Phase Antigen (SAPA)-test for the Early Diagnosis of Congenital Chagas Disease in the Time of the Elimination Goal of Mother-to-Child Transmission. Clin Infect Dis 2021; 73:e477-e484. [PMID: 32667981 DOI: 10.1093/cid/ciaa986] [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: 03/24/2020] [Accepted: 07/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Diagnosis of congenital Chagas disease (CChD) in most endemic areas is based on low-sensitive microscopy at birth and 9-month immunoglobulin G (IgG), which has poor adherence. We aim to evaluate the accuracy of the Immunoglobulin M (IgM)-Shed Acute Phase Antigen (SAPA) test in the diagnosis of CChD at birth. METHODS Two cohort studies (training and validation cohorts) were conducted in 3 hospitals in the department of Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease, and all infants born to seropositive mothers were followed for up to 9 months to diagnose CChD. A composite reference standard was used to determine congenital infection and was based on the parallel use of microscopy, quantitative polymerase chain reaction (qPCR), and IgM-trypomastigote excreted-secreted antigen (TESA) blot at birth and/or 1 month, and/or the detection of anti-Trypanosoma cruzi IgG at 6 or 9 months. The diagnostic accuracy of the IgM-SAPA test was calculated at birth against the composite reference standard. RESULTS Adherence to the 6- or 9-month follow-up ranged from 25.3% to 59.7%. Most cases of CChD (training and validation cohort: 76.5% and 83.7%, respectively) were detected during the first month of life using the combination of microscopy, qPCR, and/or IgM-TESA blot. Results from the validation cohort showed that when only 1 infant sample obtained at birth was evaluated, the qPCR and the IgM-SAPA test have similar accuracy (sensitivity: range, 79.1%-97.1% and 76.7%-94.3%, respectively, and specificity: 99.5% and 92.6%, respectively). CONCLUSIONS The IgM-SAPA test has the potential to be implemented as an early diagnostic tool in areas that currently rely only on microscopy.
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Affiliation(s)
- Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Freddy Tinajeros
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Asociación Benéfica PRISMA, Lima, Peru
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Gerson Galdos-Cardenas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edith S Malaga
- Infectious Diseases Research Laboratory, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edward Valencia Ayala
- Infectious Diseases Research Laboratory, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Steven J Clipman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrés G Lescano
- Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tabitha Bayangos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Kawsar R Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Benatar AF, Danesi E, Besuschio SA, Bortolotti S, Cafferata ML, Ramirez JC, Albizu CL, Scollo K, Baleani M, Lara L, Agolti G, Seu S, Adamo E, Lucero RH, Irazu L, Rodriguez M, Poeylaut-Palena A, Longhi SA, Esteva M, Althabe F, Rojkin F, Bua J, Sosa-Estani S, Schijman AG. Prospective multicenter evaluation of real time PCR Kit prototype for early diagnosis of congenital Chagas disease. EBioMedicine 2021; 69:103450. [PMID: 34186488 PMCID: PMC8243352 DOI: 10.1016/j.ebiom.2021.103450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Current algorithm for Congenital Chagas Disease (cCD) diagnosis is unsatisfactory due to low sensitivity of the parasitological methods. Moreover, loss to follow-up precludes final serodiagnosis after nine months of life in many cases. A duplex TaqMan qPCR kit for Trypanosoma cruzi DNA amplification was prospectively evaluated in umbilical cord (UCB) and peripheral venous blood (PVB) of infants born to CD mothers at endemic and non-endemic sites of Argentina. METHODS We enrolled and followed-up 370 infants; qPCR was compared to gold-standard cCD diagnosis following studies of diagnostic accuracy guidelines. FINDINGS Fourteen infants (3·78%) had cCD. The qPCR sensitivity and specificity were higher in PVB (72·73%, 99·15% respectively) than in UCB (66·67%, 96·3%). Positive and negative predictive values were 80 and 98·73% and 50 and 98·11% for PVB and UCB, respectively. The Areas under the Curve (AUC) of ROC analysis for qPCR and micromethod (MM) were 0·81 and 0·67 in UCB and 0·86 and 0·68 in PVB, respectively. Parasitic loads ranged from 37·5 to 23,709 parasite equivalents/mL. Discrete typing Unit Tc V was identified in five cCD patients and in six other cCD cases no distinction among Tc II, Tc V or Tc VI was achieved. INTERPRETATION This first prospective field study demonstrated that qPCR was more sensitive than MM for early cCD detection and more accurate in PVB than in UCB. Its use, as an auxiliary diagnostic tool to MM will provide more accurate records on cCD incidence. FUNDING FITS SALUD 001-CHAGAS (FONARSEC, MINCyT, Argentina) to the Public-Private Consortium (INGEBI-CONICET, INP-ANLIS MALBRAN and Wiener Laboratories); ERANET-LAC-HD 328 to AGS and PICT 2015-0074 (FONCYT, MinCyT) to AGS and FA.
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Affiliation(s)
- Alejandro Francisco Benatar
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Emmaría Danesi
- Centro Nacional de Diagnóstico e Investigación en Endemoepidemias (ANLIS Dr. C. G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina)
| | - Susana Alicia Besuschio
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Santiago Bortolotti
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - María Luisa Cafferata
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Carlos Ramirez
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Constanza Lopez Albizu
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Karenina Scollo
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - María Baleani
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - Laura Lara
- Instituto de Maternidad y Ginecología "Nuestra Señora de las Mercedes", San Miguel de Tucumán, Pcia. de Tucumán, Argentina
| | - Gustavo Agolti
- Hospital "Dr. Julio César Perrando", Resistencia, Pcia. de Chaco, Argentina
| | - Sandra Seu
- Hospital Regional "Dr. Ramón Carrillo", Santiago del Estero, Pcia. de Santiago del Estero, Argentina
| | - Elsa Adamo
- Centro Integral de Salud La Banda, La Banda, Pcia. de Santiago del Estero, Argentina
| | - Raúl Horacio Lucero
- Instituto de Medicina Regional, Universidad Nacional del Nordeste (IMR-UNNE) Resistencia, Provincia de Chaco, Argentina
| | - Lucía Irazu
- Departamento de Calidad. Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán)
| | - Marcelo Rodriguez
- Departamento de Calidad. Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán)
| | - Andrés Poeylaut-Palena
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - Silvia Andrea Longhi
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Esteva
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Althabe
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Federico Rojkin
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
| | - Congenital Chagas Disease Study Group
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh) Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres” (INGEBI) - Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET; Ciudad Autónoma de Buenos Aires, Argentina
- Centro Nacional de Diagnóstico e Investigación en Endemoepidemias (ANLIS Dr. C. G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina)
- Centro de Investigación y Biotecnología (CIBIO) de Wiener Laboratorios SAIC, Rosario, Pcia. de Santa Fe, Argentina
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén; Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán); Ciudad Autónoma de Buenos Aires, Argentina
- Instituto de Maternidad y Ginecología "Nuestra Señora de las Mercedes", San Miguel de Tucumán, Pcia. de Tucumán, Argentina
- Hospital "Dr. Julio César Perrando", Resistencia, Pcia. de Chaco, Argentina
- Hospital Regional "Dr. Ramón Carrillo", Santiago del Estero, Pcia. de Santiago del Estero, Argentina
- Centro Integral de Salud La Banda, La Banda, Pcia. de Santiago del Estero, Argentina
- Instituto de Medicina Regional, Universidad Nacional del Nordeste (IMR-UNNE) Resistencia, Provincia de Chaco, Argentina
- Departamento de Calidad. Administración Nacional de Laboratorios e Institutos de Salud Carlos G. Malbrán (ANLIS-Malbrán)
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Polonio R, López-Domínguez J, Herrera C, Dumonteil E. Molecular ecology of Triatoma dimidiata in southern Belize reveals risk for human infection and the local differentiation of Trypanosoma cruzi parasites. Int J Infect Dis 2021; 108:320-329. [PMID: 34098097 DOI: 10.1016/j.ijid.2021.05.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE In Belize, the main vector for Trypanosoma cruzi, the agent of Chagas disease, is Triatoma dimidiata, but transmission cycles and the risk for human infection are unclear. Therefore, the aim of this study was to identify T. dimidiata blood feeding sources and its parasite and microbial diversity, in order to reconstruct T. cruzi parasite transmission ecology in southern Belize. METHODS A metabarcoding approach based on deep sequencing of markers was used for bug taxonomy, blood meal sources, T. cruzi genotypes, and microbiota composition. Bugs were collected in 13 villages of Toledo district. RESULTS Bugs fed on at least 13 species, from domestic hosts such as humans, dogs, cows, and pigs, to synanthropic species such as mice, rats, and opossums, and sylvatic species such as deer, peccary, and kinkajou, in agreement with an opportunistic feeding behavior. Nonetheless, most feeding focused on a few species, including humans. Infection with T. cruzi was detected in 24 of 39 bugs (62%), and the analysis of 242 T. cruzi mini-exon sequences (average 10 ± 5 haplotypes per bug) indicated the presence of TcI and TcIV parasite discrete typing units (DTUs). However, for both DTUs, sequences from Belize mostly clustered apart from sequences from North and South America, suggesting the local differentiation of parasites. T. dimidiata also harbored a diverse bacterial microbiota, with ontogenic changes suggesting microbiota maturation during nymphal development. CONCLUSIONS Together, these results indicate a significant risk for T. cruzi infection in humans. They also highlight the need to better characterize the diversity of T. cruzi strains in the region and its impact on disease epidemiology.
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Affiliation(s)
- Roy Polonio
- University of Belize, Punta Gorda, Toledo, Belize
| | - Jaime López-Domínguez
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, LA, USA; LADISER Inmunología y Biología Molecular, Facultad de Ciencias Químicas, Universidad Veracruzana, Orizaba, Veracruz, Mexico; Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Claudia Herrera
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, LA, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, LA, USA.
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23
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Lascano F, Altcheh J. An evaluation of nifurtimox for Chagas disease in children. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1933431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Fernanda Lascano
- Servicio de Parasitologia-Chagas, Hospital de Niños Ricardo Gutierrez, Instituto Multidisciplinario de Investigacion en Patologias Pediatricas (IMIPP) CONICET-GCBA, Buenos Aires, Argentina
| | - Jaime Altcheh
- Servicio de Parasitologia-Chagas, Hospital de Niños Ricardo Gutierrez, Instituto Multidisciplinario de Investigacion en Patologias Pediatricas (IMIPP) CONICET-GCBA, Buenos Aires, Argentina
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24
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Sanchez L, Messenger LA, Bhattacharyya T, Gilman RH, Mayta H, Colanzi R, Bozo R, Verástegui M, Miles MA, Bern C. Congenital Chagas disease in Santa Cruz Department, Bolivia, is dominated by Trypanosoma cruzi lineage V. Trans R Soc Trop Med Hyg 2021; 116:80-84. [PMID: 34134129 DOI: 10.1093/trstmh/trab089] [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: 01/31/2021] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study identified Trypanosoma cruzi discrete typing units (DTUs) in maternal and infant specimens collected from two hospitals in Bolivia, using conventional genotyping and DTU-specific serotyping. METHODS Specimens from 142 mothers were used, including 24 seronegative and 118 seropositive individuals; 29 women transmitted T. cruzi to their infants. Maternal and infant parasite loads were determined by quantitative real-time PCR. Maternal sera were tested with an in-house parasite lysate ELISA and serotyped by a lineage-specific peptide ELISA, targeting the trypomastigote small surface antigen (TSSA). Trypanosoma cruzi genotypes in infected infants were determined by a triple PCR-RFLP assay. RESULTS All infant specimens were genotyped as TcV. Maternal parasite loads and absorbance values by the lysate ELISA were significantly higher for transmitters compared with non-transmitters. Among seropositive mothers, 65.3% had positive results by the TSSA II/V/VI peptide ELISA. No significant difference in reactivity to TSSA II/V/VI was observed for transmitters compared with non-transmitters (79.3% vs 60.7%, respectively). CONCLUSIONS Our findings reinforce the difficulty in obtaining sufficient sample numbers and parasite DNA to investigate the interaction between parasite genetics and the risk of congenital transmission and argue for the inclusion of DTU-specific serotyping in prospective studies.
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Affiliation(s)
- Leny Sanchez
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú
| | - Louisa A Messenger
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Tapan Bhattacharyya
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Robert H Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, Maryland 21205, USA
| | - Holger Mayta
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú
| | - Rony Colanzi
- Hospital Japonés de Tercer Nivel, Santa Cruz de la Sierra, Plurinational State of Bolivia
| | - Ricardo Bozo
- Hospital Municipal Camiri, Camiri, Plurinational State of Bolivia
| | - Manuela Verástegui
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú
| | - Michael A Miles
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St, San Francisco, California 94158, USA
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25
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Klein MD, Proaño A, Noazin S, Sciaudone M, Gilman RH, Bowman NM. Risk factors for vertical transmission of Chagas disease: A systematic review and meta-analysis. Int J Infect Dis 2021; 105:357-373. [PMID: 33618005 PMCID: PMC8370023 DOI: 10.1016/j.ijid.2021.02.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vertical transmission of Trypanosoma cruzi infection from mother to infant accounts for a growing proportion of new Chagas disease cases. However, no systematic reviews of risk factors for T. cruzi vertical transmission have been performed. METHODS We performed a systematic review of the literature in PubMed, LILACS, and Embase databases, following PRISMA guidelines. Studies were not excluded based on language, country of origin, or publication date. RESULTS Our literature review yielded 27 relevant studies examining a wide variety of risk factors, including maternal age, parasitic load, immunologic factors and vector exposure. Several studies suggested that mothers with higher parasitic loads may have a greater risk of vertical transmission. A meta-analysis of 2 studies found a significantly higher parasitic load among transmitting than non-transmitting mothers with T. cruzi infection. A second meta-analysis of 10 studies demonstrated that maternal age was not significantly associated with vertical transmission risk. CONCLUSIONS The literature suggests that high maternal parasitic load may be a risk factor for congenital Chagas disease among infants of T. cruzi seropositive mothers. Given the considerable heterogeneity and risk of bias among current literature, additional studies are warranted to assess potential risk factors for vertical transmission of T. cruzi infection.
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Affiliation(s)
- Melissa D Klein
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sassan Noazin
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Sciaudone
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natalie M Bowman
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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Majeau A, Murphy L, Herrera C, Dumonteil E. Assessing Trypanosoma cruzi Parasite Diversity through Comparative Genomics: Implications for Disease Epidemiology and Diagnostics. Pathogens 2021; 10:212. [PMID: 33669197 PMCID: PMC7919814 DOI: 10.3390/pathogens10020212] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/21/2023] Open
Abstract
Chagas disease is an important vector-borne neglected tropical disease that causes great health and economic losses. The etiological agent, Trypanosoma cruzi, is a protozoan parasite endemic to the Americas, comprised by important diversity, which has been suggested to contribute to poor serological diagnostic performance. Current nomenclature describes seven discrete typing units (DTUs), or lineages. We performed the first large scale analysis of T. cruzi diversity among 52 previously published genomes from strains covering multiple countries and parasite DTUs and assessed how different markers summarize this genetic diversity. We also examined how seven antigens currently used in commercial serologic tests are conserved across this diversity of strains. DTU structuration was confirmed at the whole-genome level, with evidence of sub-DTU diversity, associated in part to geographic structuring. We observed very comparable phylogenetic tree topographies for most of the 32 markers investigated, with clear clustering of sequences by DTU, and a few of these markers suggested some degree of intra-lineage diversity. At least three of the currently used antigens represent poorly conserved sequences, with sequences used in tests quite divergent from sequences in many strains. Most markers are well suited for estimating parasite diversity to DTU level, and a few are particularly well-suited to assess intra-DTU diversity. Analysis of antigen sequences across all strains indicates that antigenic diversity is a likely explanation for limited diagnostic performance in Central and North America.
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Affiliation(s)
| | | | - Claudia Herrera
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector Borne Infectious Disease Research Center, Tulane University, New Orleans, LA 70112, USA; (A.M.); (L.M.)
| | - Eric Dumonteil
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector Borne Infectious Disease Research Center, Tulane University, New Orleans, LA 70112, USA; (A.M.); (L.M.)
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27
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Cruz-Chan JV, Villanueva-Lizama LE, Versteeg L, Damania A, Villar MJ, González-López C, Keegan B, Pollet J, Gusovsky F, Hotez PJ, Bottazzi ME, Jones KM. Vaccine-linked chemotherapy induces IL-17 production and reduces cardiac pathology during acute Trypanosoma cruzi infection. Sci Rep 2021; 11:3222. [PMID: 33547365 PMCID: PMC7865072 DOI: 10.1038/s41598-021-82930-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
Chagas disease resulting from Trypanosoma cruzi infection leads to a silent, long-lasting chronic neglected tropical disease affecting the poorest and underserved populations around the world. Antiparasitic treatment with benznidazole does not prevent disease progression or death in patients with established cardiac disease. Our consortium is developing a therapeutic vaccine based on the T. cruzi flagellar—derived antigen Tc24-C4 formulated with a Toll-like receptor 4 agonist adjuvant, to complement existing chemotherapy and improve treatment efficacy. Here we demonstrate that therapeutic treatment of acutely infected mice with a reduced dose of benznidazole concurrently with vaccine treatment – also known as “vaccine-linked chemotherapy”—induced a TH17 like immune response, with significantly increased production of antigen specific IL-17A, IL-23 and IL-22, and CD8 + T lymphocytes, as well as significantly increased T. cruzi specific IFNγ-producing CD4 + T lymphocytes. Significantly reduced cardiac inflammation, fibrosis, and parasite burdens and improved survival were achieved by vaccine-linked chemotherapy and individual treatments. Importantly, low dose treatments were comparably efficacious to high dose treatments, demonstrating potential dose sparing effects. We conclude that through induction of TH17 immune responses vaccine-linked chemotherapeutic strategies could bridge the tolerability and efficacy gaps of current drug treatment in Chagasic patients.
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Affiliation(s)
- Julio V Cruz-Chan
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Liliana E Villanueva-Lizama
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Leroy Versteeg
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Cell Biology and Immunology Group, Wageningen University & Research, De Elst 1, 6708 WD, Wageningen, The Netherlands
| | - Ashish Damania
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria José Villar
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Cristina González-López
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Brian Keegan
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jeroen Pollet
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn M Jones
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. .,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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Moo-Llanes DA, Montes de Oca-Aguilar AC, Rodríguez-Rojas JJ. Pattern of climate connectivity and equivalent niche of Triatominae species of the Phyllosoma complex. MEDICAL AND VETERINARY ENTOMOLOGY 2020; 34:440-451. [PMID: 32697402 DOI: 10.1111/mve.12461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/03/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
The Phyllosoma complex is a Triatominae (Hemiptera: Reduviidae) group of medical importance involved in Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) transmission. Most of the members of this group are endemic and sympatric species with distribution in Mexico and the southern U.S.A. We employed MaxEnt to construct ecological niche models of nine species of Triatominae to test three hypothesis: (a) whether species with a broad climatic niche breadth occupy a broader geographical range than species with a narrow climatic breadth, (b) whether species with broad distribution present high degree of climatic fragmentation/isolation, which was tested through landscape metrics; and (c) whether the species share the same climatic niche space (niche conservatism) considered through an equivalence test implemented in ENMtools. Overall, our results suggest that the geographical distribution of this complex is influenced mainly by temperature seasonality where all suitable areas are places of current and potential transmission of T. cruzi. Niche breadth in the Phyllosoma complex is associated with the geographical distribution range, and the geographical range affects the climatic connectivity. We found no strong evidence of niche climatic divergence in members of this complex. We discuss the epidemiological implications of these results.
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Affiliation(s)
- D A Moo-Llanes
- Centro Regional de Investigación en Salud Pública (CRISP), Instituto Nacional de Salud Pública (INSP), 19 Poniente, Tapachula, Chiapas, 30700, Mexico
| | | | - J J Rodríguez-Rojas
- Universidad Autónoma de Nuevo León (UANL), Centro de Investigación y Desarrollo en Ciencias de la Salud (CIDICS), Unidad de Patógenos Emergentes y Vectores, Monterrey, Nuevo León, 64460, Mexico
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30
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Abstract
INTRODUCTION Background cross-reactivity with other coronaviruses may reduce the specificity of COVID-19 rapid serologic tests. The vast majority of women attend prenatal care, which is a unique source of population-based blood samples appropriate for validation studies. We used stored 2018 serum samples from an existing pregnancy cohort study to evaluate the specificity of COVID-19 serologic rapid diagnostic tests. METHODS We randomly selected 120 stored serum samples from pregnant women enrolled in a cohort in 2018 in Tegucigalpa, Honduras, at least 1 year before the COVID-19 pandemic. We used stored serum to evaluate four lateral flow rapid diagnostic tests, following manufacturers' instructions. Pictures were taken for all tests and read by two blinded trained evaluators. RESULTS We evaluated 120, 80, 90, and 90 samples, respectively. Specificity for both IgM and IgG was 100% for the first two tests (95% confidence intervals [CI] 97.0-100 and 95.5-100, respectively). The third test had a specificity of 98.9% (95% CI 94.0-100) for IgM and 94.4% (95% CI 87.5-98.2) for IgG. The fourth test had a specificity of 88.9% (95% CI 80.5-94.5) for IgM and 100% (95% CI 96.0-100) for IgG. DISCUSSION COVID-19 serologic rapid tests are of variable specificity. Blood specimens from sentinel prenatal clinics provide an opportunity to validate serologic tests with population-based samples.
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31
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Pérez-Molina JA, Crespillo-Andújar C, Bosch-Nicolau P, Molina I. Trypanocidal treatment of Chagas disease. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30193-2. [PMID: 32527494 DOI: 10.1016/j.eimc.2020.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/02/2020] [Accepted: 04/18/2020] [Indexed: 01/16/2023]
Abstract
Chagas disease is a neglected parasitosis caused by the protozoan parasite Trypanosoma cruzi. This infection is present in most Latin American countries, although, due to migratory movements, it is a growing cause for concern in non-endemic countries. The only two drugs currently available for its treatment-benznidazole and nifurtimox-were marketed 50 years ago. While they are very effective for acute and recent infection, and for the prevention of maternofoetal transmission, their efficacy declines in people who have chronic infection, especially those older than 18 years of age. In the presence of visceral involvement, parasiticidal treatment is of little or no value. The safety profile of both drugs is far from ideal, with frequent adverse events and high rates of drug discontinuation, mainly in adults. So far, new drugs and new strategies have not been shown to improve the results of the current nitroimidazoles, although the results are promising. In this review, we focus on the aspects that allow clinicians to make the best use of currently available drugs. In addition, we discuss new therapeutic options and ongoing research in the field.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Pau Bosch-Nicolau
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Instituto René Rachou-FIOCRUZ Minas, Chagas Disease Research Group, Belo Horizonte, MG, Brazil
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32
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Santana KH, Oliveira LGR, Barros de Castro D, Pereira M. Epidemiology of Chagas disease in pregnant women and congenital transmission of
Trypanosoma cruzi
in the Americas: systematic review and meta‐analysis. Trop Med Int Health 2020; 25:752-763. [DOI: 10.1111/tmi.13398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kaio Henrique Santana
- Center of Biological and Health Sciences Universidade Federal do Oeste da Bahia Barreiras Brazil
| | | | | | - Marcos Pereira
- Collective Health Institute Universidade Federal da Bahia Salvador Brazil
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33
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Danesi E, Fabbro DL, Segura EL, Sosa-Estani S. Higher congenital transmission rate of Trypanosoma cruzi associated with family history of congenital transmission. Rev Soc Bras Med Trop 2020; 53:e20190560. [PMID: 32348431 PMCID: PMC7198065 DOI: 10.1590/0037-8682-0560-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION: Congenital transmission (CT) of Trypanosoma cruzi has led to globalization of Chagas disease and its growing relevance as a public health problem. Although the occurrence of CT has been associated with several factors, its mechanisms are still unknown. This study aimed to analyze the geographical and familiar variables of mothers and their association with CT of Chagas disease in a population living in non-endemic areas of Argentina for the last decades. METHODS: We developed a retrospective cohort study in a sample of 2120 mother-child pairs who attended three reference centers in the cities of Buenos Aires, Santa Fe, and Salta between 2002 and 2015. RESULTS: The highest CT rates were observed in children born to Argentinean mothers (10.7%) and in children born to mothers from Buenos Aires (11.7%). Considering the areas of origin of the mothers, those from areas of null-low risk for vector-borne infection had higher CT rates than those from areas of medium-high risk (11.1% vs 8.2%). We also observed a significant intra-familiar “cluster effect,” with CT rates of 35.9% in children with an infected sibling, compared to 8.2% in children without infected siblings (RR=4.4 95% CI 2.3-8.4). CONCLUSIONS: The associations observed suggest a higher CT rate in children born to mothers who acquired the infection congenitally, with familiar antecedents, and from areas without the presence of vectors. These observations are considered new epidemiological evidence about Chagas disease in a contemporary urban population, which may contribute to the study of CT and may also be an interesting finding for healthcare professionals.
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Affiliation(s)
- Emmaría Danesi
- Administración Nacional de Laboratorio e Institutos de Salud, Centro Nacional de Diagnóstico e Investigación en Endemo-epidemias, Buenos Aires, Argentina
| | - Diana Lucrecia Fabbro
- Centro de Investigaciones sobre Endemias Nacionales, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Elsa Leonor Segura
- Administración Nacional de Laboratorio e Institutos de Salud, Centro Nacional de Diagnóstico e Investigación en Endemo-epidemias, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Administración Nacional de Laboratorio e Institutos de Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
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34
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Kendricks AL, Gray SB, Wilkerson GK, Sands CM, Abee CR, Bernacky BJ, Hotez PJ, Bottazzi ME, Craig SL, Jones KM. Reproductive Outcomes in Rhesus Macaques ( Macaca mulatta) with Naturally-acquired Trypanosoma cruzi Infection. Comp Med 2020; 70:152-159. [PMID: 32183928 DOI: 10.30802/aalas-cm-19-000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chagas disease is a zoonotic vector-borne disease caused by infection with the protozoan parasite Trypanosoma cruzi. T. cruzi is found in Latin America and the Southern United States, where it infects many species, including humans and nonhuman primates (NHPs). NHPs are susceptible to natural infection and can develop clinical symptoms consistent with human disease, including Chagasic cardiomyopathy, gastrointestinal disease and transplacental transmission, leading to congenital infection. Due to evidence of Chagas transmission in Texas, this study hypothesized T. cruzi infection was present in a closed, outdoor-housed breeding colony of rhesus macaques (Macaca mulatta) located at a biomedical research facility in Central Texas. In addition, we questioned whether seropositive female rhesus macaques might experience reproductive complications consistent with maternal-fetal Chagas disease. The seroprevalence of T. cruzi infection in the colony was assessed using an Enzyme Linked Immunosorbant Assay (ELISA) to detect antibodies against Tc24 antigen as a screening assay, and a commercially available immunochromatographic test (Chagas Stat Pak) as a confirmatory assay. Retrospective serologic analysis was performed to confirm the status of all T. cruzi-infected animals between the years 2012 to 2016. The medical history of all seropositive and seronegative breeding females within the colony from 2012 to 2016 was reviewed to determine each animals' level of reproductive fitness. The percentage of T. cruzi-seropositive animals ranged from 6.7% to 9.7% in adult animals and 0% to 0.44% in juveniles or weanling animals, depending on the year. An overall 3.9% seroprevalence of T. cruzi infection was found in the total population. No significant differences in any measure of reproductive outcomes were identified between seropositive and seronegative females from 2012 to 2016. The lack of significant adverse reproductive outcomes reported here may help inform future management decisions regarding seropositive female rhesus macaques within breeding colonies.
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Affiliation(s)
- April L Kendricks
- Southwest Electronic Energy Medical Research Institute, Houston, Texas; Baylor College of Medicine, Houston, Texas;,
| | - Stanton B Gray
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine, Bastrop, Texas
| | - Gregory K Wilkerson
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine, Bastrop, Texas
| | | | - Christian R Abee
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine, Bastrop, Texas
| | | | - Peter J Hotez
- Baylor College of Medicine, Houston, Texas; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital Center for Vaccine Development, Houston, Texas; Department of Biology, Baylor University, Waco, Texas
| | - Maria Elena Bottazzi
- Baylor College of Medicine, Houston, Texas; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital Center for Vaccine Development, Houston, Texas; Department of Biology, Baylor University, Waco, Texas
| | - Suzanne L Craig
- Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn M Jones
- Baylor College of Medicine, Houston, Texas; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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35
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Rios L, Campos EE, Menon R, Zago MP, Garg NJ. Epidemiology and pathogenesis of maternal-fetal transmission of Trypanosoma cruzi and a case for vaccine development against congenital Chagas disease. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165591. [PMID: 31678160 PMCID: PMC6954953 DOI: 10.1016/j.bbadis.2019.165591] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
Trypanos o ma cruzi (T. cruzi or Tc) is the causative agent of Chagas disease (CD). It is common for patients to suffer from non-specific symptoms or be clinically asymptomatic with acute and chronic conditions acquired through various routes of transmission. The expecting women and their fetuses are vulnerable to congenital transmission of Tc. Pregnant women face formidable health challenges because the frontline antiparasitic drugs, benznidazole and nifurtimox, are contraindicated during pregnancy. However, it is worthwhile to highlight that newborns can be cured if they are diagnosed and given treatment in a timely manner. In this review, we discuss the pathogenesis of maternal-fetal transmission of Tc and provide a justification for the investment in the development of vaccines against congenital CD.
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Affiliation(s)
- Lizette Rios
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - E Emanuel Campos
- Instituto de Patología Experimental, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - M Paola Zago
- Instituto de Patología Experimental, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.
| | - Nisha J Garg
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX, USA; Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA.
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36
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Edwards MS, Stimpert KK, Bialek SR, Montgomery SP. Evaluation and Management of Congenital Chagas Disease in the United States. J Pediatric Infect Dis Soc 2019; 8:461-469. [PMID: 31016324 PMCID: PMC10186111 DOI: 10.1093/jpids/piz018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/26/2019] [Indexed: 01/18/2023]
Abstract
Chagas disease is underappreciated as a health concern in the United States. Approximately 40 000 women of childbearing age living in the United States have chronic Chagas disease. Most of them are unaware that they have an infection that is transmissible to their offspring. The estimated US maternal-to-infant transmission rate of Trypanosoma cruzi is 1% to 5%. Ten percent to 40% of neonates with congenital T cruzi infection have clinical signs consistent with a congenital infection but no findings are unique to Chagas disease. If left untreated, 20% to 40% of infants with Chagas disease will later develop potentially fatal cardiac manifestations. Molecular testing can confirm the diagnosis in neonates. Treatment is well tolerated in infancy and usually results in cure. Screening of at-risk women during pregnancy can identify maternal infection and allow early assessment and treatment for congenital T cruzi infection.
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Affiliation(s)
- Morven S Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kelly K Stimpert
- IHRC, Inc, Atlanta, Georgia.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie R Bialek
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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37
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Carlier Y, Altcheh J, Angheben A, Freilij H, Luquetti AO, Schijman AG, Segovia M, Wagner N, Albajar Vinas P. Congenital Chagas disease: Updated recommendations for prevention, diagnosis, treatment, and follow-up of newborns and siblings, girls, women of childbearing age, and pregnant women. PLoS Negl Trop Dis 2019; 13:e0007694. [PMID: 31647811 PMCID: PMC6812740 DOI: 10.1371/journal.pntd.0007694] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Jaime Altcheh
- Servicio de Parasitología, Hospital de Niños Ricardo Gutiérrez (Centro colaborador en Chagas pediátrico OPS/OMS), Instituto Multidisciplinario de Investigación en Patologías Pediátricas (IMIPP), CONICET-GCBA, Buenos Aires, Argentina
| | - Andrea Angheben
- Centro per le Malattie Tropicali, IRCCS Ospedale “Sacro Cuore—Don Calabria,” Negrar (Verona), Italy
| | - Hector Freilij
- Servicio de Parasitología, Hospital de Niños Ricardo Gutiérrez (Centro colaborador en Chagas pediátrico OPS/OMS), Instituto Multidisciplinario de Investigación en Patologías Pediátricas (IMIPP), CONICET-GCBA, Buenos Aires, Argentina
| | - Alejandro O. Luquetti
- Laboratório de Chagas, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Alejandro G. Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, INGEBI-CONICET, Buenos Aires, Argentina
| | - Manuel Segovia
- Unidad Regional de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar (Murcia), Spain
| | - Noemie Wagner
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pedro Albajar Vinas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Herrera C, Truyens C, Dumonteil E, Alger J, Sosa-Estani S, Cafferata ML, Gibbons L, Ciganda A, Matute ML, Zuniga C, Carlier Y, Buekens P. Phylogenetic Analysis of Trypanosoma cruzi from Pregnant Women and Newborns from Argentina, Honduras, and Mexico Suggests an Association of Parasite Haplotypes with Congenital Transmission of the Parasite. J Mol Diagn 2019; 21:1095-1105. [PMID: 31450011 DOI: 10.1016/j.jmoldx.2019.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/26/2019] [Accepted: 07/25/2019] [Indexed: 12/20/2022] Open
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, exhibits a high genetic variability and has been classified into six discrete typing units (DTUs) named TcI through TcVI. This genetic diversity is believed to be associated with clinical characteristics and outcomes, but evidence supporting such associations has been limited. Herein, we performed a phylogenetic analysis of T. cruzi sequences of the mini-exon intergenic region obtained from a large cohort of pregnant women and newborns from Argentina, Honduras, and Mexico, to assess parasite genetic diversity and possible associations with congenital transmission. Analysis of 105 samples (including five paired samples) from maternal and umbilical cord blood indicated that T. cruzi DTU distribution was similar among pregnant women and newborns from these three countries, with a high frequency of TcII-TcV-TcVI DTUs, including mixed infections with TcI. However, phylogenetic analysis revealed that although the same parasite haplotypes circulated in these three countries, they were present at different frequencies, leading to significant geographic differences. Of importance, a strong association was observed between parasite haplotypes and congenital infection of newborns. Thus, the identification of parasite haplotypes in pregnant women, but not of parasite DTUs, may help predict congenital transmission of T. cruzi.
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Affiliation(s)
- Claudia Herrera
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | | | - Eric Dumonteil
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autonoma de Yucatan, Merida, Mexico
| | - Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, Honduras; Hospital Escuela Universitario, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras
| | - Sergio Sosa-Estani
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben,", Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Administracion Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbran" (ANLIS), Buenos Aires, Argentina
| | - Maria L Cafferata
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Unidad de Investigacion Clinica y Epidemiologica Montevideo, Montevideo, Uruguay
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Alvaro Ciganda
- Unidad de Investigacion Clinica y Epidemiologica Montevideo, Montevideo, Uruguay
| | - Maria L Matute
- Laboratorio Nacional de Vigilancia de la Salud, Secretaria de Salud de Honduras, Tegucigalpa, Honduras
| | - Concepcion Zuniga
- Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, Honduras; Hospital Escuela Universitario, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras
| | - Yves Carlier
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Kemmerling U, Osuna A, Schijman AG, Truyens C. Congenital Transmission of Trypanosoma cruzi: A Review About the Interactions Between the Parasite, the Placenta, the Maternal and the Fetal/Neonatal Immune Responses. Front Microbiol 2019; 10:1854. [PMID: 31474955 PMCID: PMC6702454 DOI: 10.3389/fmicb.2019.01854] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Chagas disease (CD), caused by the protozoan parasite Trypanosoma cruzi, is considered a neglected tropical disease by the World Health Organization. Congenital transmission of CD is an increasingly relevant public health problem. It progressively becomes the main transmission route over others and can occur in both endemic and non-endemic countries. Though most congenitally infected newborns are asymptomatic at birth, they display higher frequencies of prematurity, low birth weight, and lower Apgar scores compared to uninfected ones, and some suffer from severe symptoms. If not diagnosed and treated, infected newborns are at risk of developing disabling and life-threatening chronic pathologies later in life. The success or failure of congenital transmission depends on interactions between the parasite, the placenta, the mother, and the fetus. We review and discuss here the current knowledge about these parameters, including parasite virulence factors such as exovesicles, placental tropism, potential placental defense mechanisms, the placental transcriptome of infected women, gene polymorphism, and the maternal and fetal/neonatal immune responses, that might modulate the risk of T. cruzi congenital transmission.
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Affiliation(s)
- Ulrike Kemmerling
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Antonio Osuna
- Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Instituto de Biotecnología, Universidad de Granada, Granada, Spain
| | - Alejandro Gabriel Schijman
- Molecular Biology of Chagas Disease Laboratory, Genetic Engineering and Molecular Biology Research Institute Dr. Héctor Torres (INGEBI-CONICET), Buenos Aires, Argentina
| | - Carine Truyens
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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40
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Congenital Chagas disease: current diagnostics, limitations and future perspectives. Curr Opin Infect Dis 2019; 31:415-421. [PMID: 30095485 DOI: 10.1097/qco.0000000000000478] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Congenital transmission is an important route of Trypanosoma cruzi infection, both in Latin America and internationally, with considerable populations of infected women of child-bearing age residing in the United States and Europe. This review examines recent literature on congenital Chagas disease, with a focus on the changing clinical spectrum and potential new diagnostic tools. RECENT FINDINGS Vertical transmission occurs in approximately 5-10% of births from T. cruzi-infected mothers. Historically, congenital Chagas disease was associated with high levels of neonatal morbidity and mortality. Bolivian birth cohort data from the early 1990s to the present indicate that the incidence of symptomatic neonatal disease has declined. Treatment with trypanocides is greater than 90% effective and well tolerated in infants. Current programs face challenges from the multistep screening algorithm, low sensitivity of microscopy and high loss to follow-up. SUMMARY Congenital Chagas disease remains an important contributor to the global disease burden because of T. cruzi. PCR and related molecular techniques represent the most sensitive diagnostic modalities for early detection but require further optimization for resource-limited settings. Several novel diagnostic tests show promise for the future but further validation and adaptation to field settings are needed.
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41
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Vera-Ku M, Meza-González G, Carlier Y, Truyens C, Gamboa-León R. Comparison of methodologies for detecting Trypanosoma cruzi parasites by microscopic observation of microhematocrit capillary tubes. Rev Soc Bras Med Trop 2019; 52:e20180505. [PMID: 31271620 DOI: 10.1590/0037-8682-0505-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/11/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The microscopic examination of microhematocrit tubes (mHCT) has been proposed as the gold standard for acute and congenital Chagas disease diagnosis. We compared different mHCT methodologies detecting T. cruzi parasites in the blood. METHODS The rotating method, water mount, and immersion oil methods were compared for their suitability, sensitivity, and specificity. RESULTS The rotating method was easier, faster, and more sensitive than the others with 100% specificity. CONCLUSIONS The rotating method is feasible for laboratory technicians with standard training in microscopic techniques and is recommended for the diagnosis of acute Chagas disease in primary health care facilities.
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Affiliation(s)
- Marina Vera-Ku
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi" Universidad Autónoma de Yucatán, Mérida, Yucatán, México.,Unidad de Recursos Naturales, Centro de Investigación Científica de Yucatán, Mérida, Yucatán, México
| | - Guillermo Meza-González
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi" Universidad Autónoma de Yucatán, Mérida, Yucatán, México.,Subdelegación Agropecuaria, Secretaria de Agricultura y Desarrollo Rural, Mexicali, Baja California Norte, México
| | - Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium
| | - Rubí Gamboa-León
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi" Universidad Autónoma de Yucatán, Mérida, Yucatán, México.,Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America.,Laboratorio de Ciencias Biomédicas, Coordinación Académica Región Huasteca Sur, Universidad Autónoma de San Luis Potosí, Tamazunchale, San Luis Potosí, México
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42
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Momper JD, Hanan NJ, Rossi SS, Mirochnick MH, Cafferata ML, Lavenia A, Flores I, Gibbons L, Ciganda A, Sosa Estani S, Capparelli EV, Buekens P. Determination of Benznidazole in Human Dried Blood Spots by Liquid Chromatography-Mass Spectrometry to Monitor Adherence to Trypanosoma cruzi Infection Treatment in Infants and Children. Am J Trop Med Hyg 2019; 101:116-122. [PMID: 31115303 DOI: 10.4269/ajtmh.18-0852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Medication adherence is critical to the effectiveness of benznidazole (BZ) therapy for the treatment of Chagas disease. Assessing BZ adherence using traditional plasma sampling methods presents numerous challenges in resource-limited settings. Dried blood spot (DBS) sampling of BZ can be used to overcome logistical barriers and provides a less invasive method for assessing BZ levels. A BZ DBS assay using liquid chromatography-tandem mass spectrometry was developed and applied to a clinical study of infants and children being treated with BZ for Trypanosoma cruzi infection in Argentina. The assay was validated over a concentration range of 9.8-5,000 ng/mL. Inter-assay and intra-assay measures ranged from -2.9% to 2.7% and 0.5% to 8.3% for accuracy and from 3.5% to 12% and 1.6% to 13.6% for precision, respectively. The mean recovery of BZ was greater than 91%. Partitioning ratios for DBSs/plasma ranged from 0.95 to 1.02. A cohort of 10 infants and six children with T. cruzi infection being treated with BZ had median BZ concentrations of 1.2 (IQR 0.29, 2.14) µg/mL with seven of 65 (11%) samples above the BZ treatment goal of 3 μg/mL for adults. The reported DBS assay is a simple and accurate method for the quantitative measurement of BZ that can be applied to facilitate urgently needed clinical studies of BZ for the treatment of Chagas disease and assess BZ adherence in resource-limited settings.
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Affiliation(s)
| | - Nathan J Hanan
- University of California, San Diego, La Jolla, California
| | - Steven S Rossi
- University of California, San Diego, La Jolla, California
| | | | | | - Antonia Lavenia
- Ministerio de Salud Pública de la Provincia de Tucumán, Tucumán, Argentina
| | - Isolina Flores
- Ministerio de Salud Pública de la Provincia de Tucumán, Tucumán, Argentina
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Alvaro Ciganda
- Unidad de Investigación Clínica Montevideo (UNICEM), Montevideo, Uruguay
| | - Sergio Sosa Estani
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben," Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Administracion Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbran" (ANLIS), Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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43
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Peterson JK, Yoshioka K, Hashimoto K, Caranci A, Gottdenker N, Monroy C, Saldaña A, Rodriguez S, Dorn P, Zúniga C. Chagas Disease Epidemiology in Central America: an Update. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Arnal A, Waleckx E, Rico-Chávez O, Herrera C, Dumonteil E. Estimating the current burden of Chagas disease in Mexico: A systematic review and meta-analysis of epidemiological surveys from 2006 to 2017. PLoS Negl Trop Dis 2019; 13:e0006859. [PMID: 30964871 PMCID: PMC6474657 DOI: 10.1371/journal.pntd.0006859] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/19/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Mexico, estimates of Chagas disease prevalence and burden vary widely. Updating surveillance data is therefore an important priority to ensure that Chagas disease does not remain a barrier to the development of Mexico's most vulnerable populations. METHODOLOGY/PRINCIPAL FINDINGS The aim of this systematic review and meta-analysis was to analyze the literature on epidemiological surveys to estimate Chagas disease prevalence and burden in Mexico, during the period 2006 to 2017. A total of 2,764 articles were screened and 36 were retained for the final analysis. Epidemiological surveys have been performed in most of Mexico, but with variable study scale and geographic coverage. Based on studies reporting confirmed cases (i.e. using at least 2 serological tests), and taking into account the differences in sample sizes, the national estimated seroprevalence of Trypanosoma cruzi infection was 3.38% [95%CI 2.59-4.16], suggesting that there are 4.06 million cases in Mexico. Studies focused on pregnant women, which may transmit the parasite to their newborn during pregnancy, reported an estimated seroprevalence of 2.21% [95%CI 1.46-2.96], suggesting that there are 50,675 births from T. cruzi infected pregnant women per year, and 3,193 cases of congenitally infected newborns per year. Children under 18 years had an estimated seropositivity rate of 1.51% [95%CI 0.77-2.25], which indicate ongoing transmission. Cases of T. cruzi infection in blood donors have also been reported in most states, with a national estimated seroprevalence of 0.55% [95%CI 0.43-0.66]. CONCLUSIONS/SIGNIFICANCE Our analysis suggests a disease burden for T. cruzi infection higher than previously recognized, highlighting the urgency of establishing Chagas disease surveillance and control as a key national public health priority in Mexico, to ensure that it does not remain a major barrier to the economic and social development of the country's most vulnerable populations.
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Affiliation(s)
- Audrey Arnal
- Departamento de Ecología de la Biodiversidad, Instituto de Ecología, Universidad Nacional Autónoma de México, Ciudad de México, México
- Centro de Investigaciones Regionales Dr Hideyo Noguchi, Universidad Autónoma de Yucatán, calle 96 s/n x av. Jacinto Canek y calle 47, Col. Paseo de las Fuentes, CP 97225, Mérida, Yucatán, México
| | - Etienne Waleckx
- Centro de Investigaciones Regionales Dr Hideyo Noguchi, Universidad Autónoma de Yucatán, calle 96 s/n x av. Jacinto Canek y calle 47, Col. Paseo de las Fuentes, CP 97225, Mérida, Yucatán, México
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD, CIRAD, Université de Montpellier, Montpellier, France
| | - Oscar Rico-Chávez
- Departamento de Etología, Fauna Silvestre y Animales de Laboratorio, Facultad de Medicina Veterinaria Zootecnia, Universidad Nacional Autónoma de México, 04510 Ciudad de México, México
| | - Claudia Herrera
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St., New Orleans, LA 70112, United States of America
| | - Eric Dumonteil
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St., New Orleans, LA 70112, United States of America
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Villanueva-Lizama L, Teh-Poot C, Majeau A, Herrera C, Dumonteil E. Molecular Genotyping of Trypanosoma cruzi by Next-Generation Sequencing of the Mini-Exon Gene Reveals Infections With Multiple Parasite Discrete Typing Units in Chagasic Patients From Yucatan, Mexico. J Infect Dis 2019; 219:1980-1988. [DOI: 10.1093/infdis/jiz047] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Liliana Villanueva-Lizama
- Laboratorio de Parasitologia, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autonoma de Yucatan, Merida, Mexico
| | - Christian Teh-Poot
- Laboratorio de Parasitologia, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autonoma de Yucatan, Merida, Mexico
| | - Alicia Majeau
- Department of Tropical Medicine, School of Public Health and Tropical Medicine
- Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, Louisiana
| | - Claudia Herrera
- Department of Tropical Medicine, School of Public Health and Tropical Medicine
- Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, Louisiana
| | - Eric Dumonteil
- Department of Tropical Medicine, School of Public Health and Tropical Medicine
- Vector-Borne and Infectious Disease Research Center, Tulane University, New Orleans, Louisiana
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46
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Picado A, Cruz I, Redard-Jacot M, Schijman AG, Torrico F, Sosa-Estani S, Katz Z, Ndung’u JM. The burden of congenital Chagas disease and implementation of molecular diagnostic tools in Latin America. BMJ Glob Health 2018; 3:e001069. [PMID: 30364393 PMCID: PMC6195131 DOI: 10.1136/bmjgh-2018-001069] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.
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Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Maël Redard-Jacot
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor Torres", Buenos Aires, Argentina
| | - Faustino Torrico
- Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Fundación CEADES, Cochabamba, Bolivia
| | - Sergio Sosa-Estani
- Centro de Investigación de Epidemiología y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
- Drugs for Neglected Diseases initiative (DNDi), Rio de Janeiro, Brazil
| | - Zachary Katz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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