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Jimenez A, Winokur EJ. Chagas Disease Cardiomyopathy. Dimens Crit Care Nurs 2023; 42:202-210. [PMID: 37219474 DOI: 10.1097/dcc.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.
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Gual-Gonzalez L, Arango-Ferreira C, Lopera-Restrepo LC, Cantillo-Barraza O, Marín DV, Bustamante NR, Triana-Chavez O, Nolan MS. Acute Pediatric Chagas Disease in Antioquia, Colombia: A Geographic Location of Suspected Oral Transmission. Microorganisms 2021; 10:8. [PMID: 35056459 PMCID: PMC8781947 DOI: 10.3390/microorganisms10010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/16/2022] Open
Abstract
Chagas disease, Trypanosoma cruzi infection, is an insidious cause of heart failure in Latin America. Early diagnosis and treatment are critical to prevent irreversible myocardial damage that progressively accumulates over decades. Several structural barriers account for the less than 1% of cases in Colombia being treated, including poor physician knowledge, especially considering that some regions are considered non-endemic. The two cases reported here represent an emerging epidemiologic scenario associated with pediatric Chagas disease. Both cases are suspected oral transmitted parasitic infection in a geographic region of Colombia (Andean region of Antioquia) where no previous oral transmission of Chagas disease had been reported. Their clinical histories and course of disease are presented here to increase physician awareness of the epidemiologic risk factors and clinical manifestations associated with pediatric oral Chagas disease in Antioquia department, Colombia.
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Affiliation(s)
- Lídia Gual-Gonzalez
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Catalina Arango-Ferreira
- Departamento de Pediatría Hospital San Vicente Fundación, Medellin 050010, Colombia;
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, MMedellin 050010, Colombia; (D.V.M.); (N.R.B.)
| | | | - Omar Cantillo-Barraza
- Grupo Biología y Control de Enfermedades Infecciosas, Universidad de Antioquia, Medellin 050010, Colombia; (O.C.-B.); (O.T.-C.)
| | - Daniela Velásquez Marín
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, MMedellin 050010, Colombia; (D.V.M.); (N.R.B.)
| | - Natalia Restrepo Bustamante
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, MMedellin 050010, Colombia; (D.V.M.); (N.R.B.)
| | - Omar Triana-Chavez
- Grupo Biología y Control de Enfermedades Infecciosas, Universidad de Antioquia, Medellin 050010, Colombia; (O.C.-B.); (O.T.-C.)
| | - Melissa S. Nolan
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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Rincón-Acevedo CY, Parada-García AS, Olivera MJ, Torres-Torres F, Zuleta-Dueñas LP, Hernández C, Ramírez JD. Clinical and Epidemiological Characterization of Acute Chagas Disease in Casanare, Eastern Colombia, 2012-2020. Front Med (Lausanne) 2021; 8:681635. [PMID: 34368188 PMCID: PMC8343227 DOI: 10.3389/fmed.2021.681635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/29/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is considered a public health problem in Latin America. In Colombia, it affects more than 437,000 inhabitants, mainly in Casanare, an endemic region with eco-epidemiological characteristics that favor its transmission. The objective of this study was to describe the clinical and epidemiological characteristics of the cases of acute CD in Casanare, eastern Colombia, in the period 2012–2020. Methods: In the present study, 103 medical records of confirmed cases of acute CD were reviewed. The departmental/national incidence and fatality were compared by year; the climatological data of mean temperature, relative humidity, and precipitation per year were reviewed and plotted at IDEAM (Colombian Meteorology Institute) concerning the number of cases of acute CD per month, and it was compared with the frequency of triatomines collected in infested houses by community surveillance. Univariate, bivariate, and multivariate analyses were performed, comparing symptoms and signs according to transmission routes, complications, and age groups. Results: The incidence was 3.16 cases per 100,000 inhabitants, and the fatality rate was 20% in the study period. The most frequent symptoms included: fever 98.1%, myalgia 62.1%, arthralgia 60.2%, and headache 49.5%. There were significant differences in the frequency of myalgia, abdominal pain, and periorbital edema in oral transmission. The main complications were pericardial effusion, myocarditis, and heart failure in the group over 18 years of age. In Casanare, TcI Discrete Typing Unit (DTU) has mainly been identified in humans, triatomines, and reservoirs such as opossums and dogs and TcBat in bats. An increase in the number of acute CD cases was evidenced in March, a period when precipitation increases due to the beginning of the rainy season. Conclusions: The results corroborate the symptomatic heterogeneity of the acute phase of CD, which delays treatment, triggering possible clinical complications. In endemic regions, clinical suspicion, diagnostic capacity, detection, and surveillance programs should be strengthened, including intersectoral public health policies for their prevention and control.
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Affiliation(s)
- Claudia Yaneth Rincón-Acevedo
- Centro de Investigaciones en Microbiología y Biotecnología-UR, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia.,Maestría en Salud Pública, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Andrea Stella Parada-García
- Centro de Investigaciones en Microbiología y Biotecnología-UR, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia.,Maestría en Salud Pública, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | | | | | - Carolina Hernández
- Centro de Investigaciones en Microbiología y Biotecnología-UR, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
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Oral Trypanosoma cruzi Transmission Resulting in Advanced Chagasic Cardiomyopathy in an 11-Month-Old Male. Case Rep Infect Dis 2020; 2020:8828950. [PMID: 33123392 PMCID: PMC7586178 DOI: 10.1155/2020/8828950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 12/02/2022] Open
Abstract
Our case report describes the youngest clinical acute Chagas disease case and their unusual disease presentation of cardiac failure. In parts of the Brazilian Amazon, cultural practices include weaning infants from breastmilk to solid foods with açaí consumption serving as an intermediary. This practice could place infants at an increased risk of oral Trypanosoma cruzi infection and severe Chagasic cardiac disease.
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Souza DDSMD, Araujo MT, dos Santos PRSG, Furtado JCB, Figueiredo MTS, Povoa RMS. Anatomopathological Aspects of Acute Chagas Myocarditis by Oral Transmission. Arq Bras Cardiol 2016; 107:77-80. [PMID: 27533369 PMCID: PMC4976960 DOI: 10.5935/abc.20160110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/14/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | | | | | - Rui M S Povoa
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Alarcón de Noya B, Colmenares C, Díaz-Bello Z, Ruiz-Guevara R, Medina K, Muñoz-Calderón A, Mauriello L, Cabrera E, Montiel L, Losada S, Martínez J, Espinosa R, Abate T. Orally-transmitted Chagas disease: Epidemiological, clinical, serological and molecular outcomes of a school microepidemic in Chichiriviche de la Costa, Venezuela. Parasite Epidemiol Control 2016; 1:188-198. [PMID: 29988179 PMCID: PMC5991850 DOI: 10.1016/j.parepi.2016.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/15/2022] Open
Abstract
Oral transmission of Trypanosoma cruzi is a frequent cause of acute Chagas disease (ChD). In the present cross-sectional study, we report the epidemiological, clinical, serological and molecular outcomes of the second largest outbreak of oral ChD described in the literature. It occurred in March 2009 in Chichiriviche de la Costa, a rural seashore community at the central littoral in Venezuela. The vehicle was an artisanal guava juice prepared at the local school and Panstrongylus geniculatus was the vector involved. TcI genotype was isolated from patients and vector; some showed a mixture of haplotypes. Using molecular markers, parasitic loads were high. Eighty-nine cases were diagnosed, the majority (87.5%) in school children 6-15 years of age. Frequency of symptomatic patients was high (89.9%) with long-standing fever in 87.5%; 82.3% had pericardial effusion detected by echocardiogram and 41% had EKG abnormalities. Three children, a pregnant woman and her stillborn child died (5.6% mortality). The community was addressed by simultaneous determination of specific IgG and IgM, confirmed with indirect hemagglutination and lytic antibodies. Determination of IgG and IgA in saliva had low sensitivity. No individual parasitological or serological technique diagnosed 100% of cases. Culture and PCR detected T. cruzi in 95.5% of examined individuals. Based on the increasing incidence of oral acute cases of ChD, it appears that food is becoming one of the most important modes of transmission in the Amazon, Caribbean and Andes regions of America.
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Affiliation(s)
- Belkisyolé Alarcón de Noya
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
- Cátedra de Parasitología, Escuela de Medicina “Luis Razetti”, Universidad Central de Venezuela, Venezuela
| | - Cecilia Colmenares
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
- Cátedra de Parasitología, Escuela de Medicina “Luis Razetti”, Universidad Central de Venezuela, Venezuela
| | - Zoraida Díaz-Bello
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Raiza Ruiz-Guevara
- Cátedra de Parasitología, Escuela de Medicina “Luis Razetti”, Universidad Central de Venezuela, Venezuela
| | - Karen Medina
- Postgrado Nacional de Parasitología, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Arturo Muñoz-Calderón
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Luciano Mauriello
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Elida Cabrera
- Servicio de Cardiología Infantil, Hospital Militar “Dr. Carlos Arvelo”, Venezuela
| | - Luís Montiel
- Dirección de Epidemiología, Ministerio del Poder Popular para la Salud, Venezuela
| | - Sandra Losada
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Jetzi Martínez
- Dirección de Epidemiología, Estado Vargas, Ministerio del Poder Popular para la Salud, Venezuela
| | - Raúl Espinosa
- Servicio de Cardiología, Hospital “Miguel Pérez Carreño”, Venezuela
| | - Teresa Abate
- Sección de Biología Molecular, Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
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Messenger LA, Miles MA, Bern C. Between a bug and a hard place: Trypanosoma cruzi genetic diversity and the clinical outcomes of Chagas disease. Expert Rev Anti Infect Ther 2015; 13:995-1029. [PMID: 26162928 PMCID: PMC4784490 DOI: 10.1586/14787210.2015.1056158] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the last 30 years, concomitant with successful transnational disease control programs across Latin America, Chagas disease has expanded from a neglected, endemic parasitic infection of the rural poor to an urbanized chronic disease, and now a potentially emergent global health problem. Trypanosoma cruzi infection has a highly variable clinical course, ranging from complete absence of symptoms to severe and often fatal cardiovascular and/or gastrointestinal manifestations. To date, few correlates of clinical disease progression have been identified. Elucidating a putative role for T. cruzi strain diversity in Chagas disease pathogenesis is complicated by the scarcity of parasites in clinical specimens and the limitations of our contemporary genotyping techniques. This article systematically reviews the historical literature, given our current understanding of parasite genetic diversity, to evaluate the evidence for any association between T. cruzi genotype and chronic clinical outcome, risk of congenital transmission or reactivation and orally transmitted outbreaks.
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Affiliation(s)
- Louisa A Messenger
- Department of Pathogen Molecular Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael A Miles
- Department of Pathogen Molecular Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Caryn Bern
- Global Health Sciences, Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Henao-Martínez AF, Agler AH, Watson AM, Hennessy C, Davidson E, Demos-Davies K, McKinsey TA, Wilson M, Schwartz DA, Yang IV. AKT network of genes and impaired myocardial contractility during murine acute Chagasic myocarditis. Am J Trop Med Hyg 2015; 92:523-9. [PMID: 25582694 DOI: 10.4269/ajtmh.14-0433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chagasic disease is associated with high morbidity in Latin America. Acute Chagasic myocarditis is consistently found in acute infections, but little is known about its contribution to chronic cardiomyopathy. The aim of the study was to phenotypically characterize two strains of mice with differential Chagas infection susceptibility and correlate strain myocarditis phenotypes with heart tissue gene expression. C57BL/6J and Balb/c mice were injected intraperitoneally with 0 or 150-200 tissue-derived trypomastigotes (Tulahuen strain). Echocardiograms, brain natriuretic peptide, and troponin were measured. Heart tissue was harvested for histopathological analysis and gene expression profiling on microarrays. Genes differently expressed between infected Balb/c and C57BL/6J mice were identified. Echocardiograms showed differences in Balb/c versus C57BL/6J infected mice in heart rate (413 versus 476 beats per minute; P = 0.0001), stroke volume (31.9 ± 9.3 versus 39.2 ± 5.5 μL; P = 0.03), and cardiac output (13.1 ± 3.5 versus 18.7 ± 3.2 μL/min; P = 0.002). Gene expression at 4 weeks analysis showed 32 statistically significant (q value < 0.05) differentially expressed genes between infected Balb/c and C57BL/6J mice that were enriched for genes related to the protein kinase B (AKT) pathway. These specific phenotypic features of cardiac response during acute Chagasic myocarditis may, in part, be related to host AKT network regulation.
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Affiliation(s)
- Andrés F Henao-Martínez
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Anne Hermetet Agler
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Alan M Watson
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Corinne Hennessy
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Elizabeth Davidson
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Kim Demos-Davies
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Timothy A McKinsey
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Michael Wilson
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - David A Schwartz
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
| | - Ivana V Yang
- Division of Infectious Diseases and Departments of Medicine and Immunology, University of Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Denver, Colorado; Department of Pathology, Denver Health, Denver, Colorado
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Dutra WO, Menezes CAS, Magalhães LMD, Gollob KJ. Immunoregulatory networks in human Chagas disease. Parasite Immunol 2014; 36:377-87. [PMID: 24611805 DOI: 10.1111/pim.12107] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 02/19/2014] [Indexed: 01/11/2023]
Abstract
Chagas disease, caused by the infection with Trypanosoma cruzi, is endemic in all Latin America. Due to the increase in population migration, Chagas disease has spread worldwide and is now considered a health issue not only in endemic countries. While most chronically infected individuals remain asymptomatic, approximately 30% of the patients develop a potentially deadly cardiomyopathy. The exact mechanisms that underlie the establishment and maintenance of the cardiac pathology are not clear. However, there is consistent evidence that immunoregulatory cytokines are critical for orchestrating the immune response and thus influence disease development or control. While the asymptomatic (indeterminate) form represents a state of balance between the host and the parasite, the establishment of the cardiac form represents the loss of this balance. Analysis of data obtained from several studies has led to the hypothesis that the indeterminate form is associated with an anti-inflammatory cytokine profile, represented by high expression of IL-10, while cardiac form is associated with a high production of IFN-gamma and TNF-alpha in relation to IL-10, leading to an inflammatory profile. Here, we discuss the immunoregulatory events that might influence disease outcome, as well as the mechanisms that influence the establishment of these complex immunoregulatory networks.
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Affiliation(s)
- W O Dutra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil; Instituto Nacional de Ciência e Tecnologia - Doenças Tropicais - INCT-DT, Belo Horizonte, MG, Brazil
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