1
|
Altcheh J, Moscatelli G, Caruso M, Moroni S, Bisio M, Miranda MR, Monla C, Vaina M, Valdez M, Moran L, Ramirez T, Patiño OL, Riarte A, Gonzalez N, Fernandes J, Alves F, Ribeiro I, Garcia-Bournissen F. Population pharmacokinetics of benznidazole in neonates, infants and children using a new pediatric formulation. PLoS Negl Trop Dis 2023; 17:e0010850. [PMID: 37256863 DOI: 10.1371/journal.pntd.0010850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/23/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND There is a major need for information on pharmacokinetics (PK) of benznidazole (BNZ) in children with Chagas disease (CD). We conducted a multicentre population PK, safety and efficacy study in children, infants and neonates with CD treated with BNZ (formulated in 100 mg tablets or 12.5 mg dispersible tablets, developed by the pharmaceutical company LAFEPE, in a collaboration with DNDi). METHODS 81 children 0-12 years old were enrolled at 5 pediatric centers in Argentina. Diagnosis of T. cruzi infection was confirmed by direct microscopic examination, or at least two positive conventional serological tests. Subject enrolment was stratified by age: newborns to 2 years (minimum of 10 newborns) and >2-12 years. BNZ 7.5 mg/kg/d was administered in two daily doses for 60 days. Five blood samples per child were obtained at random times within pre-defined time windows at Day 0 at 2-5 h post-dose; during steady state, one sample at Day 7 and at Day 30; and two samples at 12-24 h after final BNZ dose at Day 60. The primary efficacy endpoint was parasitological clearance by qualitative PCR at the end of treatment. RESULTS Forty-one (51%) patients were under 2 years of age (including 14 newborns <1 month of age). Median age at enrolment was 22 months (mean: 43.2; interquartile range (IQR) 7-72 months). The median measured BNZ Cmax was 8.32 mg/L (IQR 5.95-11.8; range 1.79-19.38). Median observed BNZ Cmin (trough) concentration was 2 mg/L (IQR 1.25-3.77; range 0.14-7.08). Overall median simulated Css was 6.3 mg/L (IQR 4.7-8.5 mg/L). CL/F increased quickly during the first month of postnatal life and reached adult levels after approximately 10 years of age. Negative qPCR was observed at the end of treatment in all 76 patients who completed the treatment. Five patients discontinued treatment (3 due to AEs and 2 due to lack of compliance). CONCLUSION We observed lower BNZ plasma concentrations in infants and children than those previously reported in adults treated with comparable mg/kg doses. Despite these lower concentrations, pediatric treatment was well tolerated and universally effective, with a high response rate and infrequent, mild AEs. TRIAL REGISTRATION Registered in clinicaltrials.gov #NCT01549236.
Collapse
Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Martin Caruso
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital de Niños Doctor Hector Quintana, Jujuy, Argentina
| | - Samanta Moroni
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Maria Rosa Miranda
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital de Niños Doctor Hector Quintana, Jujuy, Argentina
| | - Celia Monla
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital Público Materno Infantil, Salta, Argentina
| | - Maria Vaina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital Público Materno Infantil, Salta, Argentina
| | - Maria Valdez
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Hospital Público Materno Infantil, Salta, Argentina
| | - Lucrecia Moran
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Centro de Chagas y Patología Regional, Santiago del Estero, Argentina
| | - Teresa Ramirez
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
| | - Oscar Ledesma Patiño
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Centro de Chagas y Patología Regional, Santiago del Estero, Argentina
| | - Adelina Riarte
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - Nicolas Gonzalez
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Instituto de Investigaciones en Patologias Pediatricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Jayme Fernandes
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Isabela Ribeiro
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Facundo Garcia-Bournissen
- Servicio de Parasitologia y Chagas, Hospital de Niños "Dr Ricardo Gutierrez", Buenos Aires, Argentina
- PEDCHAGAS Network (Hospital de Niños Ricardo Gutiérrez, Hospital de Niños Doctor Hector Quintana, Hospital Público Materno Infantil, Centro de Chagas y Patología Regional de Santiago del Estero, & Instituto Nacional de Parasitología Dr. Mario Fatala Chaben), Argentina
- Division of Paediatric Clinical Pharmacology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
2
|
Ciapponi A, Barreira F, Perelli L, Bardach A, Gascón J, Molina I, Morillo C, Prado N, Riarte A, Torrico F, Villar JC, Reidel S, Gibbons L, Sosa-Estani S. Direct evidence gap on fixed versus adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: Systematic review and individual patient data meta-analysis. Trop Med Int Health 2023; 28:2-16. [PMID: 36420767 DOI: 10.1111/tmi.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the comparative efficacy and safety of a fixed dose of benznidazole (BZN) with an adjusted-dose for Trypanosoma cruzi-seropositive adults without cardiomyopathy. METHODS We conducted a systematic review and individual participant data (IPD) meta-analysis following Cochrane methods, and the PRISMA-IPD statement for reporting. Randomised controlled trials (RCTs) allocating participants to fixed or adjusted doses of BZN for T. cruzi-seropositive adults without cardiomyopathy were included. We searched (December 2021) Cochrane, MEDLINE, EMBASE, LILACS and trial registries and contacted Chagas experts. Selection, data extraction, risk of bias assessment using the Cochrane tool, and a GRADE summary of finding tables were performed independently by pairs of reviewers. We conducted a random-effects IPD meta-analysis using the one-stage strategy, or, if that was impossible, the two-stage strategy. RESULTS Five RCTs (1198 patients) were included, none directly comparing fixed with adjusted doses of BZN. Compared to placebo, BZN therapy was strongly associated with negative qPCR and sustainable parasitological clearance regardless of the type of dose and subgroup analysed. For negative qPCR, the fixed/adjusted rate of odds ratios (RORF/A ) was 8.83 (95% CI 1.02-76.48); for sustained parasitological clearance, it was 4.60 (95% CI 0.40-52.51), probably indicating at least non-inferior effect of fixed doses, with no statistically significant interactions by scheme for global and most subgroup estimations. The RORF/A for treatment interruption due to adverse events was 0.44 (95% CI 0.14-1.38), probably indicating no worse tolerance of fixed doses. CONCLUSIONS We found no direct comparison between fixed and adjusted doses of BZN. However, fixed doses versus placebo are probably not inferior to weight-adjusted doses of BZN versus placebo in terms of parasitological efficacy and safety. Network IPD meta-analysis, through indirect comparisons, may well provide the best possible answers in the near future. REGISTRATION The study protocol was registered in PROSPERO (CRD42019120905).
Collapse
Affiliation(s)
- Agustín Ciapponi
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Fabiana Barreira
- Chagas Clinical Project, Drugs for Neglected Diseases Initiative, Río de Janeiro, Brazil
| | - Lucas Perelli
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,International Health Program, Catalan Institute of Health, Barcelona, Spain
| | - Carlos Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Nilda Prado
- Instituto Nacional de Parasitología Dr. M Fatala Chaben, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Adelina Riarte
- Instituto Nacional de Parasitología Dr. M Fatala Chaben, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Faustino Torrico
- Parasitología y Enfermedades Infecciosas, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Juan Carlos Villar
- Departamento de Investigaciones, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Sara Reidel
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Luz Gibbons
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Chagas Clinical Project, Drugs for Neglected Diseases Initiative, Río de Janeiro, Brazil
| |
Collapse
|
3
|
Guidetto B, Tatta M, Latini V, Gonzales M, Riarte A, Tavella S, Warley E, Altclas J. HIV and Chagas Disease Coinfection, a Tractable Disease? Open Forum Infect Dis 2019; 6:5540644. [PMID: 31363767 PMCID: PMC6663505 DOI: 10.1093/ofid/ofz307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/17/2019] [Indexed: 12/27/2022] Open
Abstract
We present 2 patients born in Argentina who were newly diagnosed with advanced HIV disease and Chagas disease reactivation with central nervous system involvement. The patients received concurrent benznidazole treatment and antiretroviral therapy, showing good response. Improvement in morbidity and mortality due to early treatment makes this treatment appropriate for coinfected patients.
Collapse
Affiliation(s)
- Betiana Guidetto
- Department of Infectious Diseases, Sanatorio de la Trinidad Mitre, CABA, Argentina
| | - Melisa Tatta
- Department of Infectious Diseases, Sanatorio de la Trinidad Mitre, CABA, Argentina
| | - Veronica Latini
- Department of Infectious Diseases, Sanatorio de la Trinidad Mitre, CABA, Argentina
| | - Milene Gonzales
- Department of Infectious Diseases, Sanatorio de la Trinidad Mitre, CABA, Argentina
| | - Adelina Riarte
- Department of Parasitology, Instituto Nacional de Parasitologia Dr. Mario Fatala Chaben, CABA, Argentina
| | - Silvina Tavella
- Department of Infectious Diseases, Hospital Dr. Diego Paroissien, Buenos Aires, Argentina
| | - Eduardo Warley
- Department of Infectious Diseases, Hospital Dr. Diego Paroissien, Buenos Aires, Argentina
| | - Javier Altclas
- Department of Infectious Diseases, Sanatorio de la Trinidad Mitre and Sanatorio Anchorena, CABA, Argentina
| |
Collapse
|
4
|
Ramírez JC, Cura CI, da Cruz Moreira O, Lages-Silva E, Juiz N, Velázquez E, Ramírez JD, Alberti A, Pavia P, Flores-Chávez MD, Muñoz-Calderón A, Pérez-Morales D, Santalla J, Marcos da Matta Guedes P, Peneau J, Marcet P, Padilla C, Cruz-Robles D, Valencia E, Crisante GE, Greif G, Zulantay I, Costales JA, Alvarez-Martínez M, Martínez NE, Villarroel R, Villarroel S, Sánchez Z, Bisio M, Parrado R, Maria da Cunha Galvão L, Jácome da Câmara AC, Espinoza B, Alarcón de Noya B, Puerta C, Riarte A, Diosque P, Sosa-Estani S, Guhl F, Ribeiro I, Aznar C, Britto C, Yadón ZE, Schijman AG. Analytical Validation of Quantitative Real-Time PCR Methods for Quantification of Trypanosoma cruzi DNA in Blood Samples from Chagas Disease Patients. J Mol Diagn 2015; 17:605-15. [PMID: 26320872 PMCID: PMC4698797 DOI: 10.1016/j.jmoldx.2015.04.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/01/2015] [Accepted: 04/03/2015] [Indexed: 01/25/2023] Open
Abstract
An international study was performed by 26 experienced PCR laboratories from 14 countries to assess the performance of duplex quantitative real-time PCR (qPCR) strategies on the basis of TaqMan probes for detection and quantification of parasitic loads in peripheral blood samples from Chagas disease patients. Two methods were studied: Satellite DNA (SatDNA) qPCR and kinetoplastid DNA (kDNA) qPCR. Both methods included an internal amplification control. Reportable range, analytical sensitivity, limits of detection and quantification, and precision were estimated according to international guidelines. In addition, inclusivity and exclusivity were estimated with DNA from stocks representing the different Trypanosoma cruzi discrete typing units and Trypanosoma rangeli and Leishmania spp. Both methods were challenged against 156 blood samples provided by the participant laboratories, including samples from acute and chronic patients with varied clinical findings, infected by oral route or vectorial transmission. kDNA qPCR showed better analytical sensitivity than SatDNA qPCR with limits of detection of 0.23 and 0.70 parasite equivalents/mL, respectively. Analyses of clinical samples revealed a high concordance in terms of sensitivity and parasitic loads determined by both SatDNA and kDNA qPCRs. This effort is a major step toward international validation of qPCR methods for the quantification of T. cruzi DNA in human blood samples, aiming to provide an accurate surrogate biomarker for diagnosis and treatment monitoring for patients with Chagas disease.
Collapse
Affiliation(s)
- Juan Carlos Ramírez
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Carolina Inés Cura
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Otacilio da Cruz Moreira
- Laboratory of Molecular Biology of Endemic Diseases, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Eliane Lages-Silva
- Laboratory of Discipline of Parasitology, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Natalia Juiz
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Elsa Velázquez
- National Institute of Parasitology "Dr. Mario Fatala Chabén", Buenos Aires, Argentina
| | - Juan David Ramírez
- Center for Research in Tropical Microbiology and Parasitology, Universidad de los Andes, Bogota, Colombia
| | - Anahí Alberti
- Institute of Experimental Pathology, CONICET-Universidad Nacional de Salta, Salta, Argentina
| | - Paula Pavia
- Laboratory of Molecular Parasitology, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Arturo Muñoz-Calderón
- Institute of Tropical Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Deyanira Pérez-Morales
- Biomedical Research Institute, Universidad Nacional Autónoma de México, Mexico DF, Mexico
| | - José Santalla
- Laboratory of Parasitology and Molecular Biology, Instituto Nacional de Laboratorios en Salud, La Paz, Bolivia
| | | | - Julie Peneau
- Hospital and University Laboratory-CH Andrée Rosemon, Cayenne, French Guiana
| | - Paula Marcet
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos Padilla
- National Center for Public Health, Instituto Nacional de Salud, Lima, Peru
| | - David Cruz-Robles
- Laboratory of Genomics, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico DF, Mexico
| | - Edward Valencia
- Laboratory for Research in Infectious Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Gonzalo Greif
- Molecular Biology Unit, Instituto Pasteur de Montevideo, Montevideo, Uruguay
| | - Inés Zulantay
- Basic Clinical Parasitology Laboratory, Universidad de Chile, Santiago, Chile
| | - Jaime Alfredo Costales
- Research Center for Infectious Diseases, Pontificia Universidad Católica de Ecuador, Quito, Ecuador
| | - Miriam Alvarez-Martínez
- Microbiology Department, Hospital Clinic and Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | | | | | - Sandro Villarroel
- Laboratory of Molecular Biology, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Zunilda Sánchez
- Research Institute for Health Sciences, Universidad Nacional de Asunción, Asuncion, Paraguay
| | - Margarita Bisio
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Rudy Parrado
- Laboratory of Molecular Biology, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | | | | | - Bertha Espinoza
- Biomedical Research Institute, Universidad Nacional Autónoma de México, Mexico DF, Mexico
| | | | - Concepción Puerta
- Laboratory of Molecular Parasitology, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Adelina Riarte
- National Institute of Parasitology "Dr. Mario Fatala Chabén", Buenos Aires, Argentina
| | - Patricio Diosque
- Institute of Experimental Pathology, CONICET-Universidad Nacional de Salta, Salta, Argentina
| | - Sergio Sosa-Estani
- National Institute of Parasitology "Dr. Mario Fatala Chabén", Buenos Aires, Argentina
| | - Felipe Guhl
- Center for Research in Tropical Microbiology and Parasitology, Universidad de los Andes, Bogota, Colombia
| | - Isabela Ribeiro
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Christine Aznar
- Hospital and University Laboratory-CH Andrée Rosemon, Cayenne, French Guiana
| | - Constança Britto
- Laboratory of Molecular Biology of Endemic Diseases, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Zaida Estela Yadón
- Communicable Diseases and Health Analysis Department, Pan American Health Organization/World Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Alejandro G Schijman
- Laboratory of Molecular Biology of Chagas Disease (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina.
| |
Collapse
|
5
|
Sosa Estani S, Altcheh J, Riarte A, Freilij H, Fernandez M, Lloveras S, Pereiro A, Castellano LG, Salvatella R, Nicholls RS. [Guiding the etiological treatment of Chagas disease]. Medicina (B Aires) 2015; 75:270-271. [PMID: 26339887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Sergio Sosa Estani
- Instituto Nacional de Parasitología Dr. Mario Fatala-Chabén, Argentina. E-mail:
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
BACKGROUND Prevention of chronic chagasic cardiomyopathy (CCC) by treating infected populations with trypanocidal therapy (TT) remains a challenge. Despite a renewed enthusiasm for TT, uncertainty regarding its efficacy, concerns about its safety and limited availability remain barriers for a wider use of conventional drugs. We have updated a previous version of this review. OBJECTIVES To systematically search, appraise, identify and extract data from eligible studies comparing the outcome of cohorts of seropositive individuals to Trypanosoma cruzi exposed to TT versus placebo or no treatment. SEARCH METHODS We sought eligible studies in electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2014); MEDLINE (Ovid, 1946 to January week 5 2014); EMBASE (Ovid, 1980 to 2014 week 6) and LILACS (up to 6 May 2010)) by combining terms related with the disease and the treatment. The search also included a Google search, handsearch for references in review or selected articles, and search of expert files. We applied no language restrictions. SELECTION CRITERIA Review authors screened the retrieved references for eligibility (those dealing with human participants treated with TT) and then assessed the pre-selected studies in full for inclusion. We included randomised controlled trials (RCTs) and observational studies that provided data on either mortality or clinical progression of CCC after at least four years of follow-up. DATA COLLECTION AND ANALYSIS Teams of two review authors independently carried out the study selection, data extraction and risk of bias assessment, with a referee resolving disagreement within the pairs. Data collection included study design, characteristics of the population and interventions or exposures and outcome measures. We defined categories of outcome data as parasite-related (positive serology, xenodiagnosis or polymerase chain reaction (PCR) after TT) and participant-related (including efficacy outcomes such as progression towards CCC, all-cause mortality and side effects of TT). We reported pooled outcome data as Mantel-Haenszel odds ratios (OR) or standardised mean differences (SMD) along with 95% confidence intervals (CI), using a random-effects model. I(2) statistics provided an estimate of heterogeneity across studies. We conducted an exploratory meta-regression analysis of the relationship between positive-serology and progression of CCC or mortality. MAIN RESULTS We included 13 studies involving 4229 participants (six RCTs, n = 1096, five RCTs of intermediate risk of bias, one RCT of high risk of bias; four non-randomised experiments, n = 1639 and three observational studies, n = 1494). Ten studies tested nitroderivative drugs nifurtimox or benznidazole (three exposed participants to allopurinol, one to itraconazole). Five studies were conducted in Brazil, five in Argentina, one in Bolivia, one in Chile and one in Venezuela.TT was associated with substantial, but heterogeneous reductions on parasite-related outcomes such as positive serology (9 studies, OR 0.21, 95% CI 0.10 to 0.44, I(2) = 76%), positive PCR (2 studies, OR 0.50, 95% CI 0.27 to 0.92, I(2) = 0%), positive xenodiagnosis after treatment (6 studies, OR 0.35, 95% CI 0.14 to 0.86, I(2) = 79%), or reduction on antibody titres (3 studies, SMD -0.56, 95% CI -0.89 to -0.23, I(2) = 28%). Efficacy data on patient-related outcomes was largely from non-RCTs. TT with nitroderivatives was associated with potentially important, but imprecise and inconsistent reductions in progression of CCC (4 studies, 106 events, OR 0.74, 95% CI 0.32 to 1.73, I(2) = 66%) and mortality after TT (6 studies, 99 events, OR 0.55, 95% CI 0.26 to 1.14, I(2) = 48%). The overall median incidence of any severe side effects among 1475 individuals from five studies exposed to TT was 2.7%, and the overall discontinuation of this two-month therapy in RCTs (5 studies, 134 events) was 20.5% (versus 4.3% among controls) and 10.4% in other five studies (125 events). AUTHORS' CONCLUSIONS Despite the evidence that TT reduced parasite-related outcomes, the low quality and inconsistency of the data for patient-important outcomes must be treated with caution. More geographically diverse RCTs testing newer forms of TT are warranted in order to 1. estimate efficacy more precisely, 2. explore factors potentially responsible for the heterogeneity of results and 3. increase knowledge on the efficacy/tolerance balance of conventional TT.
Collapse
Affiliation(s)
- Juan Carlos Villar
- Universidad Autónoma de Bucaramanga (Colombia)Department of MedicineGrupo de Cardiología PreventivaUNAB Campus el Bosque Calle 157 No. 19‐55BucaramangaSantanderColombia
| | | | | | - Adelina Riarte
- Instituto Nacional de Parasitología Dr M Fatala ChabenDepartamento de Clínica, Patología y TratamientoAv. Paseo Colon 568Buenos AiresBuenos AiresArgentina1063
| | - Micah Pepper
- Boston UniversitySchool of Public HealthBostonUSA
| | - Jose Antonio Marin‐Neto
- University of Sao PauloMedical School of Ribeirao PretoAv. Bandeirantes, 3900Ribeirao PretoSao PauloBrazil14025‐640
| | - Gordon H Guyatt
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonOntarioCanadaL8N 3Z5
| | | |
Collapse
|
7
|
Altclas J, Salgueira C, Riarte A. Reactivation of Chagas disease after a bone marrow transplant. Blood Transfus 2014; 12 Suppl 1:s380. [PMID: 23867177 PMCID: PMC3934264 DOI: 10.2450/2013.0009-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Javier Altclas
- Trinidad Mitre Hospital, Anchorena Hospital, Buenos Aires, Argentina
| | - Claudia Salgueira
- Trinidad Mitre Hospital, Anchorena Hospital, Buenos Aires, Argentina
| | - Adelina Riarte
- “Dr M Fatala Chaben” National Institute of Parasitology, Buenos Aires, Argentina
| |
Collapse
|
8
|
Acosta DM, Soprano LL, Ferrero MR, Esteva MI, Riarte A, Couto AS, Duschak VG. Structural and immunological characterization of sulphatides: relevance of sulphate moieties in Trypanosoma cruzi glycoconjugates. Parasite Immunol 2013; 34:499-510. [PMID: 22738032 DOI: 10.1111/j.1365-3024.2012.01378.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sulphoglycosphingolipids, present on the surface of diverse cells, participate in the regulation of various cellular events. However, little is known about the structure and the role of sulphoglycosphingolipids in trypanosomatids. Herein, sulphated dihexosylceramide structures - composed mainly of sphingosine as the long chain base acylated with stearic acid - have been determined for the first time in Trypanosoma cruzi epimastigotes by UV-MALDI-TOF-MS analysis. Interestingly, inhibition ELISA assays using cruzipain as antigen and polyclonal rabbit antibodies specific for cruzipain, the major cysteine proteinase of T. cruzi, or for its C-terminal domain, have demonstrated (i) that sulphate epitopes are shared between cruzipain and sulphatides of T. cruzi, (ii) that cross-reactivity maps to the C-terminal domain and (iii) the existence of other antigenic determinants in the glycolipidic structures. These features provide evidence that sulphate groups are antigenic in sulphate-containing parasite glycoconjugates. Furthermore, IgG2 antibody levels inversely correlate with disease severity in chronic Chagas disease patients, suggesting that IgG2 antibodies specific for sulphated epitopes might be associated with protective immunity and might be considered as potential surrogates of the course of chronic Chagas disease.
Collapse
Affiliation(s)
- D M Acosta
- Instituto Nacional de Parasitología Dr Mario Fatala Chaben, ANLIS-Malbrán, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
9
|
Duffy T, Cura CI, Ramirez JC, Abate T, Cayo NM, Parrado R, Bello ZD, Velazquez E, Muñoz-Calderon A, Juiz NA, Basile J, Garcia L, Riarte A, Nasser JR, Ocampo SB, Yadon ZE, Torrico F, de Noya BA, Ribeiro I, Schijman AG. Analytical performance of a multiplex Real-Time PCR assay using TaqMan probes for quantification of Trypanosoma cruzi satellite DNA in blood samples. PLoS Negl Trop Dis 2013; 7:e2000. [PMID: 23350002 PMCID: PMC3547845 DOI: 10.1371/journal.pntd.0002000] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/25/2012] [Indexed: 11/18/2022] Open
Abstract
Background The analytical validation of sensitive, accurate and standardized Real-Time PCR methods for Trypanosoma cruzi quantification is crucial to provide a reliable laboratory tool for diagnosis of recent infections as well as for monitoring treatment efficacy. Methods/Principal Findings We have standardized and validated a multiplex Real-Time quantitative PCR assay (qPCR) based on TaqMan technology, aiming to quantify T. cruzi satellite DNA as well as an internal amplification control (IAC) in a single-tube reaction. IAC amplification allows rule out false negative PCR results due to inhibitory substances or loss of DNA during sample processing. The assay has a limit of detection (LOD) of 0.70 parasite equivalents/mL and a limit of quantification (LOQ) of 1.53 parasite equivalents/mL starting from non-boiled Guanidine EDTA blood spiked with T. cruzi CL-Brener stock. The method was evaluated with blood samples collected from Chagas disease patients experiencing different clinical stages and epidemiological scenarios: 1- Sixteen Venezuelan patients from an outbreak of oral transmission, 2- Sixty three Bolivian patients suffering chronic Chagas disease, 3- Thirty four Argentinean cases with chronic Chagas disease, 4- Twenty seven newborns to seropositive mothers, 5- A seronegative receptor who got infected after transplantation with a cadaveric kidney explanted from an infected subject. Conclusions/Significance The performing parameters of this assay encourage its application to early assessment of T. cruzi infection in cases in which serological methods are not informative, such as recent infections by oral contamination or congenital transmission or after transplantation with organs from seropositive donors, as well as for monitoring Chagas disease patients under etiological treatment. Chagas disease, caused by the parasite Trypanosoma cruzi, is endemic in several Latin American countries and still represents a major neglected tropical threat. It is transmitted to humans by blood-sucking triatomine bugs, congenital transmission, blood transfusion, organ transplantation and by consuming food and juice contaminated with the parasite. Tools for accurate diagnosis and surrogate markers of parasitological response to treatment remain key needs in the field. This study focused on the evaluation of a novel quantitative PCR assay for the diagnosis and follow-up of patients with Chagas disease, on the basis of international guidelines for analytical validation of molecular diagnostic methods. The method allows the simultaneous amplification of parasite satellite DNA sequence and a heterologous internal amplification control that permits rule out false negative results due to inhibitory substances or loss of DNA during sample processing. It was evaluated in peripheral blood samples from acute and chronic patients as well as in umbilical cord blood samples from newborns to seropositive mothers. The performing characteristics of this assay position it as a promising candidate for application to clinical trials and kit developments.
Collapse
Affiliation(s)
- Tomas Duffy
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Carolina I. Cura
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Juan C. Ramirez
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Teresa Abate
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Nelly M. Cayo
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, Jujuy, Argentina
| | | | - Zoraida Diaz Bello
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Elsa Velazquez
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS, Buenos Aires, Argentina
| | - Arturo Muñoz-Calderon
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Natalia A. Juiz
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | - Joaquín Basile
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
| | | | - Adelina Riarte
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS, Buenos Aires, Argentina
| | - Julio R. Nasser
- Laboratorio de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina
| | - Susana B. Ocampo
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, Jujuy, Argentina
| | - Zaida E. Yadon
- Pan-American Health Organization, Washington, D.C., United States of America
| | | | | | - Isabela Ribeiro
- Drugs and Neglected Diseases Initiative, Genève, Switzerland
| | - Alejandro G. Schijman
- Grupo de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr. Héctor N. Torres” (INGEBI-CONICET), Buenos Aires, Argentina
- * E-mail:
| |
Collapse
|
10
|
Salomón OD, Mastrángelo AV, Santini MS, Ruvinsky S, Orduna T, Sinagra A, Luna C, Riarte A, Casas N, Amiotti P. Leishmaniasis visceral: senderos que confluyen, se bifurcan. Salud Colect 2012. [DOI: 10.1590/s1851-82652012000300011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
11
|
Pinazo MJ, Miranda B, Rodríguez-Villar C, Altclas J, Serra MB, García-Otero EC, de Almeida EA, de la Mata García M, Gascon J, Rodríguez MG, Manito N, Camacho AM, Oppenheimer F, Puente SP, Riarte A, Coronas JS, Lletí MS, Sanz GF, Torrico F, Tendero DT, Ussetti P, Shikanai-Yasuda MA. Recommendations for management of Chagas disease in organ and hematopoietic tissue transplantation programs in nonendemic areas. Transplant Rev (Orlando) 2011; 25:91-101. [DOI: 10.1016/j.trre.2010.12.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 12/22/2022]
|
12
|
Sinagra A, Luna C, Abraham D, Iannella MDC, Riarte A, Krolewiecki AJ. The activity of azithromycin against Leishmania (Viannia) braziliensis and Leishmania (Leishmania) amazonensis in the golden hamster model. Rev Soc Bras Med Trop 2008; 40:627-30. [PMID: 18200413 DOI: 10.1590/s0037-86822007000600005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 10/11/2007] [Indexed: 11/21/2022] Open
Abstract
New therapeutic alternatives against leishmaniasis remain a priority. The activity of azithromycin against Leishmania (Leishmania) major has been previously demonstrated. Different responses among species of Leishmania make species-specific drug screening necessary. The activity of azithromycin against Leishmania (Viannia) braziliensis and Leishmania (Leishmania) amazonensis was evaluated in golden hamsters infected through footpad injections of metacyclic promastigotes, and compared with untreated controls and animals treated with meglumine antimoniate. Footpad thickness, lesion cultures and dissemination sites were analyzed. Treatment of golden hamsters with oral azithromycin at 450mg/kg had no activity against infections with Leishmania (Leishmania) amazonensis. For infections due to Leishmania (Viannia) braziliensis, azithromycin demonstrated significant activity relative to untreated controls, but inferior to meglumine antimoniate, for controlling lesion size. Neither drug was able to totally eliminate parasites from the lesions. It was concluded that azithromycin has activity against Leishmania (Viannia) braziliensis but not against Leishmania (Leishmania) amazonensis in this model.
Collapse
Affiliation(s)
- Angel Sinagra
- Instituto Nacional de Parasitología Dr. Mario Fatala Chabén, Buenos Aires, Argentina
| | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Salomon OD, Sinagra A, Nevot MC, Barberian G, Paulin P, Estevez JO, Riarte A, Estevez J. First visceral leishmaniasis focus in Argentina. Mem Inst Oswaldo Cruz 2008; 103:109-11. [DOI: 10.1590/s0074-02762008000100018] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 02/11/2008] [Indexed: 11/22/2022] Open
Affiliation(s)
- OD Salomon
- Ministerio de Salud de la Nación, Argentina
| | - A Sinagra
- Ministerio de Salud de la Nación, Argentina
| | - MC Nevot
- Veterinaria del Oeste, Argentina
| | - G Barberian
- Hospital de Pediatría Dr J.P.Garrahan, Argentina
| | - P Paulin
- Hospital de Pediatría Dr J.P.Garrahan, Argentina
| | | | | | - J Estevez
- Ministerio de Salud Publica, Argentina
| |
Collapse
|
15
|
García GA, Arnaiz MR, Laucella SA, Esteva MI, Ainciart N, Riarte A, Garavaglia PA, Fichera LE, Ruiz AM. Immunological and pathological responses in BALB/c mice induced by genetic administration of Tc 13 Tul antigen of Trypanosoma cruzi. Parasitology 2006; 132:855-66. [PMID: 16478565 DOI: 10.1017/s0031182005009753] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 10/26/2005] [Accepted: 10/28/2005] [Indexed: 01/31/2023]
Abstract
Tc13 is a trans-sialidase family protein of Trypanosoma cruzi, the aetiological agent of Chagas' disease. Recently, in vitro studies had suggested that Tc13 might participate in the pathogenesis of the disease. In order to study the role of Tc13 antigens in an in vivo model, we administered plasmid DNA encoding a Tc13 antigen from the Tulahuén strain (Tc13 Tul) to BALB/c mice and evaluated the immunological and pathological manifestations as well as the capacity of this antigen to confer protection against T. cruzi infection. Tc13 Tul immunization did not elicit a detectable humoral immune response but induced specific memory T-cells with no capacity to produce IFN-gamma. Five months after DNA-immunization with Tc13 Tul, signs of hepatotoxicity and reactive changes in the heart, liver and spleen were observed in 40-80% of mice. When Tc13 Tul DNA-immunized animals were challenged with trypomastigotes, a significant decrease in parasitaemia in early and late acute phase was observed without modification in the survival rate. Surprisingly, Tc13 Tul-immunized mice chronically infected with T. cruzi showed a decrease in the severity of heart damage. We conclude that, in BALB/c mice, genetic immunization with Tc13 Tul mainly induces immune responses associated with pathology.
Collapse
Affiliation(s)
- G A García
- Insituto Nacional de Parasitología Dr. Mario Fatala Chabén, Paseo Colón 568, 1063, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Barcán L, Luna C, Lunaó C, Clara L, Sinagra A, Valledor A, De Rissio AM, De Rissioí AM, Gadano A, Gadanoá A, García MM, de Santibañes E, Riarte A. Transmission of T. cruzi infection via liver transplantation to a nonreactive recipient for Chagas' disease. Liver Transpl 2005; 11:1112-6. [PMID: 16123968 DOI: 10.1002/lt.20522] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas' disease transmission to 3 recipients (liver, kidney, and pancreas-kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84 th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status.
Collapse
Affiliation(s)
- Laura Barcán
- Infectious Disease Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Altclas J, Sinagra A, Dictar M, Luna C, Verón MT, De Rissio AM, García MM, Salgueira C, Riarte A. Chagas disease in bone marrow transplantation: an approach to preemptive therapy. Bone Marrow Transplant 2005; 36:123-9. [PMID: 15908978 DOI: 10.1038/sj.bmt.1705006] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.
Collapse
Affiliation(s)
- J Altclas
- ICTEM Sanatorio Antártida, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
The humoral immune response to epitopes expressed on cruzipain was evaluated in 31 Chagas disease patients (CDP) with different degrees of cardiac dysfunction. We took advantage of the availability of anti-Trypanosoma cruzi microsomal fraction monoclonal antibodies (MoAbs) reactive with epitopes that are recognized (5A9B11) or not recognized (1A10C11) by CDP sera. The 5A9B11- and 1A10C11-like epitopes are expressed on cruzipain. The reactivity of 5A9B11 against cruzipain was completely inhibited by sera of severe cardiopathy patients while a partial inhibition was found with sera from chagasic patients with mild disease. CDP sera did not block cruzipain recognition by 1A10C11. The antigenic determinants recognized by CDP sera appeared to be linear and carbohydrate free. When the overall anti-cruzipain immune response was evaluated, 70% of CDP with severe disease showed cruzipain titers higher than 1/800 while none of them displayed titers lower that 1/400. This report shows for the first time that the humoral immune response against epitopes expressed on cruzipain appeared to be related with the severity of chronic Chagas disease.
Collapse
Affiliation(s)
- V G Duschak
- Instituto de Investigaciones Biotecnólogicas, Universidad Nacional de General San Martín, INTI. Av. Gral. Paz entre Albarellos y Constituyentes (Edificio 24) Casilla de Correo 30 (1650), San Martín, Buenos Aires, Argentina
| | | | | | | |
Collapse
|
19
|
Laucella SA, Riarte A, Prado N, Zapata J, Segura EL. alpha 4 Integrins and sialyl Lewis x modulation in chronic Chagas disease: further evidence of persistent immune activation. Scand J Immunol 2001; 53:514-9. [PMID: 11309161 DOI: 10.1046/j.1365-3083.2001.00916.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have previously shown that titers of soluble platelet selectin (s-P-selectin) and soluble vascular cell adhesion molecule-1 (s-VCAM-1) were increased in sera of patients with chronic Trypanosoma cruzi infection. In this study, we analyzed the expression of CD49d-integrins, that bind to VCAM-1, and sialyl Lewis x (SLe(x)), which binds selectins, in peripheral blood lymphocytes of 27 patients with Chagas' disease at different levels of disease severity. Patients with a mild form of Chagas' disease showed a lower number of CD49d(+) cells, in comparison with those with severe chronic cardiopathy. Decreased levels of CD49d(+) cells were detected in CD3(-) cell populations. Conversely, SLe(x) expression was found to be decreased in patients with severe Chagas' disease. Levels of soluble platelet endothelial cell adhesion molecule-1 (s-PECAM-1) were significantly increased in the plasma of patients with severe Chagas' disease while unaltered levels of MCP-1 were recorded. These data show that VCAM-1 and P-Selectin ligands are differentially expressed during the chronic phase of the Trypanosoma cruzi infection. These findings also reinforce a role of the P-selectin/SLe(x) adhesion pathway rather than very late antigen-4 (VLA-4)/VCAM-1, in the pathogenesis of Chagas' disease.
Collapse
Affiliation(s)
- S A Laucella
- Instituto Nacional de Parasitología Dr Mario Fatala Chabén, Ministerio de Salud y Acción Social, Buenos Aires, Argentina.
| | | | | | | | | |
Collapse
|
20
|
Laucella SA, Segura EL, Riarte A, Sosa ES. Soluble platelet selectin (sP-selectin) and soluble vascular cell adhesion molecule-1 (sVCAM-1) decrease during therapy with benznidazole in children with indeterminate form of Chagas' disease. Clin Exp Immunol 1999; 118:423-7. [PMID: 10594562 PMCID: PMC1905450 DOI: 10.1046/j.1365-2249.1999.01070.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The immune response against Trypanosoma cruzi infection has been associated with both protection and pathogenesis. Central events in host defence system- and immune-mediated damage are tightly regulated by cell adhesion molecules (CAM). Levels of sP-selectin and sVCAM-1 were measured in sera from 41 children with the indeterminate phase of Chagas' disease. Simultaneously, levels of soluble adhesion molecule were also quantified in Chagas' disease children undergoing specific chemotherapy with benznidazole. Levels of sP-selectin and sVCAM-1 were found to be elevated in children with indeterminate Chagas' disease before aetiologic therapy was started. However, a small group of patients showed sP-selectin and sVCAM-1 levels comparable to those of non-infected children. A positive correlation between levels of sVCAM-1 and sP-selectin in sera from Chagas' disease patients was found. There was a significantly greater decrease in the titres of sP-selectin and sVCAM-1 in those children receiving benznidazole therapy compared with those children receiving placebo. Measurement of soluble adhesion molecules revealed differences in the activation of the immune system in children with the indeterminate form of Chagas' disease. The early decrease of sP-selectin and sVCAM-1 levels after anti-parasitic treatment suggests that these molecules might be valuable indicators of effective parasitologic clearance.
Collapse
Affiliation(s)
- S A Laucella
- Instituto Nacional de Parasitología 'Dr Mario Fatala Chabén', Administración Nacional de Institutos de Salud 'Dr Carlos G. Malbrán, Buenos Aires, Argentina.
| | | | | | | |
Collapse
|
21
|
Riarte A, Luna C, Sabatiello R, Sinagra A, Schiavelli R, De Rissio A, Maiolo E, Garcìa MM, Jacob N, Pattin M, Lauricella M, Segura EL, Vázquez M. Chagas' disease in patients with kidney transplants: 7 years of experience 1989-1996. Clin Infect Dis 1999; 29:561-7. [PMID: 10530448 DOI: 10.1086/598634] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chagas' disease was present in 17.22% of persons undergoing kidney transplantation in an Argentine Hospital. The criterion for attributing reactivation of chronic Chagas' disease and transmission of Trypanosoma cruzi to grafts was detection of parasites in blood (patent parasitemia) or tissues. Reactivation was diagnosed in 5 (21.7%) of 23 recipients. Ten (43.4%) of 23 chagasic recipients without reactivation of chronic Chagas' disease had abrogation of serological reactivity. T. cruzi infection was transmitted to 3 (18.7%) of 16 non-chagasic recipients. Reactivation and infection were diagnosed by patent parasitemia or cutaneous panniculitis. For diagnosis, detection of parasites in blood and tissues had more relevance than serology. Sequential monitoring detected early reactivation and infection, permitting application of preemptive or therapeutic therapy with benznidazole, thus inhibiting, in all patients, severe clinical disease produced by a progressive and systemic replication of the parasite.
Collapse
Affiliation(s)
- A Riarte
- Instituto Nacional de Parasitologia Dr. Mario Fatala Chabén, the Hospital Dr. Cosme Argerich, Municipalidad de la Ciudad de Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Altclas J, Sinagra A, Jaimovich G, Salgueira C, Luna C, Requejo A, Milovic V, De Rissio A, Feldman L, Riarte A. Reactivation of chronic Chagas' disease following allogeneic bone marrow transplantation and successful pre-emptive therapy with benznidazole. Transpl Infect Dis 1999; 1:135-7. [PMID: 11428981 DOI: 10.1034/j.1399-3062.1999.010207.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This report shows the early detection of reactivation of chronic Chagas' disease (CCd) in a 27-year-old man with chronic myelogenous leukemia undergoing allogeneic bone marrow transplantation (ABMT). Pre-emptive therapy with benznidazole during a period of 7 weeks led to a rapid recovery of the patient, who remains free of parasitemia 2 years after the bone marrow transplantation.
Collapse
Affiliation(s)
- J Altclas
- Instituto de Criopreservación y Trasplante de médula ósea, IMA, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Sosa Estani S, Campanini A, Sinagra A, Luna C, Peralta M, Coutada V, Medina L, Riarte A, Salomón D, Gómez A, Segura EL. [Clinical features and diagnosis of mucocutaneous leishmaniasis in patients of an endemic area in Salta]. Medicina (B Aires) 1999; 58:685-91. [PMID: 10347960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
A total of 39 patients with a clinical diagnosis of mucocutaneous leishmaniasis, in an endemic area for leishmaniasis in Salta, Argentina, were examined between June 1990 and December 1992. Of these cases, 87% (34/39) presented the cutaneous simple form, 10.3% the cutaneous multiple form and 2.6% the mucosal form. Lesions were more frequently located in legs and arms (71.8%), followed by trunk and multiple location (10.3%). Of the patients, 43% were housewives, students or children, suggesting that the infection could be contracted in the domestic or peridomestic environment. Of 39 patients diagnosed, in 22 (56.4%) the parasite was found. Direct microscopy (smear) permitted a diagnosis in 13 (59.4%) of these 22 patients. Among these, 5 (22.7%) had positive diagnosis by culture, and 9 (40.9%) by inoculation in hamsters. Ten parasite isolates (45.4%) were obtained. The smear is recommended as a diagnostic method for epidemiological surveillance due to the sensibility demonstrated herein and its easy application in the endemic area. The time of clinical evolution, from the appearance of the lesion up to the detection of the patient by Sanitary Agents, was approximately 90 days. This would be related to the frequency of the visits, usually every 3 months. Only one of 30 treated patients had a relapse at 6 months, due to non fulfillment of the treatment.
Collapse
Affiliation(s)
- S Sosa Estani
- Centro Nacional de Diagnóstico e Investigación de Endemo-epidemias (CENDIE)/Administración Nacional de Laboratorios, Institutos de Salud (ANLIS) Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Dictar M, Sinagra A, Verón MT, Luna C, Dengra C, De Rissio A, Bayo R, Ceraso D, Segura E, Koziner B, Riarte A. Recipients and donors of bone marrow transplants suffering from Chagas' disease: management and preemptive therapy of parasitemia. Bone Marrow Transplant 1998; 21:391-3. [PMID: 9509974 DOI: 10.1038/sj.bmt.1701107] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report the clinical course of five adult patients with chronic Chagas' disease (Cd) who underwent BMT. Two patients with non-Hodgkin's lymphoma and one with ALL received an ABMT. Allogeneic BMT was performed in two patients with AML and CML respectively. One donor had chronic Cd. Samples of peripheral blood for parasite investigation by the Strout method, blood culture, and immunological studies by indirect immunofluorescent assay, ELISA and indirect hemagglutination tests were performed weekly from the start of chemotherapy until day +60 for ABMT and during the period of immunosuppression for allogeneic BMT. No prophylaxis was given to any of these patients. In only one ABMT patient were trypomastigotes detected early by blood culture without symptoms of reactivation. Benznidazole as preemptive treatment was administered at 5-8 mg/kg/daily for 30 days. Parasitemia was rapidly cleared and at the end of therapy xenodiagnosis was negative. The other Cd patients showed no evidence of relapse of parasitemia or signs and symptoms of reactivation. In brief, evidence of Cd should be sought in all BMT patients coming from endemic areas because parasitemia and reactivation are potential complications during the period of neutropenia and immunosuppression. The strategy used for early detection and treatment of parasitemia and reactivation was safe and effective.
Collapse
Affiliation(s)
- M Dictar
- Bone Marrow Transplant Unit and Infectious Diseases Service, CP Independencia, Buenos Aires, Capital Federal, Argentina
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Sinagra A, Riarte A, Luna C, Campanini A, Segura EL. Leishmania (Viannia) braziliensis: biological behavior in golden hamsters of isolates from Argentine patients. Am J Trop Med Hyg 1997; 57:115-8. [PMID: 9242330 DOI: 10.4269/ajtmh.1997.57.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study reports intraspecific variations of native isolates of Leishmania (Viannia) braziliensis from patients with leishmaniasis from Salta, Argentina. These isolates induced skin lesions in golden hamsters, initially showing rapid development, reaching their largest size between 28 and 35 days postinfection (PI). Thereafter, the infections were self-limiting and total regression was observed at 80-150 days PI. The majority of the native isolates were characterized by low infectivity in the experimental animals, and a classic pattern of dissemination to systemic organs was established. However, unusual features for L. braziliensis were displayed by two isolates; one showed evidence of high infectivity in hamsters characterized by a short prepatent period and larger, severe and persistent lesions at the inoculation site. The other isolate, of low infectivity, showed cutaneous metastasis and recurrent systemic dissemination in the same animals, suggesting dissociation between infectivity and pathogenicity. Metastasis has been frequently described in hamsters infected with L. (V) guyanensis and L. (V) panamensis, but not in infections induced by L. (V) braziliensis, as was observed in this study. Active and/or regressive histopathologic lesions were observed, depending on the stage of the infection. An exudative and mixed inflammatory pattern with microabscesses and necrotic areas was observed during early infection, while well-defined granulomas and collagen formation were the predominant features detected at a later time. Amastigotes were easily detected in the tissues, although in low numbers. Schaumann bodies were always detected. The characterization of the unique features of these native isolates, and the verification of their reproducibility in vitro and in vivo will be useful tools in tests related to immunoprophylaxis and chemotherapy.
Collapse
Affiliation(s)
- A Sinagra
- Instituto Nacional de Parasitologia Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | | | | | | | | |
Collapse
|
26
|
Laucella S, Salcedo R, Castaños-Velez E, Riarte A, De Titto EH, Patarroyo M, Orn A, Rottenberg ME. Increased expression and secretion of ICAM-1 during experimental infection with Trypanosoma cruzi. Parasite Immunol 1996; 18:227-39. [PMID: 9229375 DOI: 10.1046/j.1365-3024.1996.d01-95.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the present study we demonstrate that spleens and hearts from BALB/c mice infected with the virulent Tulahuén or the low virulent CA-I strains of Trypanosoma cruzi, contain substantially higher ICAM-1 transcripts than uninfected controls. ICAM-1 expression in heart cells was also increased in the protein level, as measured by flow cytometry, ELISA and immunohistochemistry. The adhesive receptor was observed not only on inflammatory cells but also on sarcolemma of cardiac myocytes from T. cruzi infected mice. ICAM-1 expression was higher during the acute phase than in the chronic phase of infection, and paralleled the density of inflammatory leukocytes. Elevated titres of soluble ICAM-1 (s-ICAM-1) were detected in sera from mice during the acute phase of infection with CA-I or Tulahuén parasites. Cytokines, including IFN-gamma, IL-1 alpha, IL-6 and TNF-alpha have been shown to modulate expression of ICAM-1. Spleens and hearts from mice infected with CA-I or Tulahuen strains showed increased accumulation of mRNAs specific for these cytokines, which peaked during the acute phase of infection. However, IFN-gamma activity was not necessary for ICAM-1 induction, as its levels were also increased during infection in IFN-gamma receptor knock-out (IFN-gamma R- ) mice. Upregulation of ICAM-1 expression might be a direct consequence of parasite infection, since its density on cell lines of different lineages was enhanced after 24 or 48 h of infection with T. cruzi.
Collapse
Affiliation(s)
- S Laucella
- Instituto Nacional de Chagas Dr M. Fatala Chaben, Buenos Aires, Agentina
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Riarte A, Sinagra A, Lauricella M, Bolomo N, Moreno M, Cossio P, Arana R, Segura EL. Chronic experimental infection by Trypanosoma cruzi in Cebus apella monkeys. Mem Inst Oswaldo Cruz 1995; 90:733-40. [PMID: 8731369 DOI: 10.1590/s0074-02761995000600014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Twenty young male Cebus apella monkeys were infected with CA1 Trypanosoma cruzi strain and reinfected with CA1 or Tulahuen T. cruzi strains, with different doses and parasite source. Subpatent parasitemia was usually demonstrated in acute and chronic phases. Patent parasitemia was evident in one monkey in the acute phase and in four of them in the chronic phase after re-inoculations with high doses of CA1 strain. Serological conversion was observed in all monkeys; titers were low, regardless of the methods used to investigate anti-T. cruzi specific antibodies. Higher titers were induced only when re-inoculations were performed with the virulent Tulahuén strain or high doses of CA1 strain. Clinical, electrocardiographic and ajmaline test evaluations did not reveal changes between infected and control monkeys. Histopathologically, cardiac lesions were always characterized by focal or multifocal mononuclear infiltrates and/or isolated fibrosis, as seen during the acute and chronic phases; neither amastigote nests nor active inflammation and fibrogenic processes characteristic of human acute and chronic myocarditis respectively, were observed. These morphological aspects more closely resemble those found in the "indeterminate phase" and contrast with the more diffuse and progressive pattern of the human chagasic chronic myocarditis. All monkeys survived and no mortality was observed.
Collapse
Affiliation(s)
- A Riarte
- Instituto Nacional de la Enfermedad de Chagas Dr Mario Fatala Chaben, Indiech, Buenos Aires, Argentina
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Rottenberg ME, Riarte A, Sporrong L, Altcheh J, Petray P, Ruiz AM, Wigzell H, Orn A. Outcome of infection with different strains of Trypanosoma cruzi in mice lacking CD4 and/or CD8. Immunol Lett 1995; 45:53-60. [PMID: 7622189 DOI: 10.1016/0165-2478(94)00221-c] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mice lacking CD4 and/or CD8 gene expression, generated by embryonic stem-cell technology, were used to study the role of CD4+ and CD8+ cells in the resistance to the acute infection with virulent (Tulahuén and RA) or mild (CA-I) strains of Trypanosoma cruzi. The presence of both CD4+ and CD8+ cells contributed to the survival of mice infected with T. cruzi, and each T-cell subtype was able to sustain protective functions in the absence of the other one. However, in certain host-parasite combinations, CD8+ cell-independent mechanisms were able to control the parasite load. Moreover, CD8- mice chronically infected with a low virulent strain of T. cruzi were protected from an otherwise lethal challenge with the parasite. A different organ distribution of parasite nests was observed when mutant (but not wild type) animals infected with different parasite strains were compared. CD4- mice produced high levels of IgG antibodies against peptide antigens or a whole homogenate from the parasite after infection with CA-I strain. A dramatic enhancement of IgG1- and IgG2a-specific antibodies was observed.
Collapse
Affiliation(s)
- M E Rottenberg
- Immunology Laboratory, Karolinska Institute, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Mangone CA, Sica RE, Pereyra S, Genovese O, Segura E, Riarte A, Sanz OP, Segura M. Cognitive impairment in human chronic Chagas' disease. Arq Neuropsiquiatr 1994; 52:200-3. [PMID: 7826247 DOI: 10.1590/s0004-282x1994000200008] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED We proposed to investigate subclinical cognitive impairment secondary to chronic Chagas' disease (CCD). No similar study was previously done. The neuropsychological performance of 45 chronic Chagasic patients and 26 matched controls (age, education place and years of residency in endemic area) was compared using the Mini Mental State Exam (MMSE), Weschler Memory Scale (WMS) and the Weschler Adult Intelligent Scale (WAIS). Non-parametric tests and Chi2 were used to compare group means and multivariate statistics in two way frequency tables for measures of independence and association of categorical variables with the disease. RESULTS Chagasic patients showed lower MMSE scores (p < .004), poor orientation (p < .004), and attention (p < .007). Lower WMS MQ were associated with CCD (Chi2 5.9; p < .01; Fisher test p < .02). Lower WAIS IQ were associated with CCD (Chi2 6.3, p < .01; Fisher test p < .01) being the digit symbol (p < .03), picture completion (p < .03), picture arrangement (p < .01) and object assembly (p < .03) subtests the most affected. The impairment in non-verbal reasoning, speed of information processing, problem solving, learning and sequencing observed in chronic Chagas disease patients resembles the cognitive dysfunction associated with white matter disease.
Collapse
Affiliation(s)
- C A Mangone
- Division Neurologia, Hospital Ramos Mejia, Buenos Aires, Argentina
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Vázquez MC, Riarte A, Pattin M, Lauricella M. Chagas' disease can be transmitted through kidney transplantation. Transplant Proc 1993; 25:3259-60. [PMID: 8266534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M C Vázquez
- Hospital Municipal Dr Cosme Argerich de la Ciudad de Buenos Aires, Argentina
| | | | | | | |
Collapse
|
31
|
Vázquez MC, Riarte A, Pattin M, Campanini A. Evolution of chagasic kidney transplant patients. Transplant Proc 1993; 25:3263-4. [PMID: 8266535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M C Vázquez
- Hospital Municipal Dr Cosme Argerich de la Ciudad de Buenos Aires, Argentina
| | | | | | | |
Collapse
|
32
|
Sinagra A, Riarte A, Lauricella M, Segura EL. Reactivation of experimental chronic T cruzi infection after immunosuppressive treatment by cyclosporine A and betametasone. Transplantation 1993; 55:1431-4. [PMID: 8516831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A Sinagra
- Instituto Nacional de Diagnostico e Investigacion de la Enfermedad de Chagas Dr. Mario Fatala Chaben (INDIECH), Buenos Aires, Argentina
| | | | | | | |
Collapse
|
33
|
Fichera LE, Riarte A. Embryology of Triatoma infestans (Klug), (Hemiptera, Reduviidae), a Chagas' disease vector. Rev Inst Med Trop Sao Paulo 1992; 34:211-6. [PMID: 1342072 DOI: 10.1590/s0036-46651992000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study reports the embryogenesis of T. infestans (Hemiptera, Reduviidae). Morphological parameters of growth sequences from oviposition until hatching (12-14 d 28 degrees C) were established. Five periods, as percent of time of development (TD), were characterized from oviposition until hatching. The most important morphological features were: 1) formation of blastoderm within 7% of TD; 2) germ band and gastrulation within 30% of TD; 3) nerve cord, limb budding, thoracic and abdominal segmentation and formation of body cavity within 50% of TD; 4) nervous system and blastokinesis end, and development of embryonic cuticle within 65% of TD; 5) differentiation of the mouth parts, fat body, and malpighian tubules during final stage and completion of embryo at day 12 to day 14 around hatching. These signals were chosen as appropriate morphological parameters which should enable the evaluation of embryologic modifications due to the action/s of different insecticides.
Collapse
Affiliation(s)
- L E Fichera
- Instituto Nacional de Diagnóstico e Investigación de la Enfermedad de Chagas Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | | |
Collapse
|
34
|
Schweigmann NJ, Alberti A, Pietrokovsky S, Conti O, Riarte A, Montoya S, Wisnivesky-Colli C. A new host of Trypanosoma cruzi from Jujuy, Argentina: Octodontomys gliroides (Gervais & D'Orbigny, 1844) (Rodentia, Octodontidae). Mem Inst Oswaldo Cruz 1992; 87:217-20. [PMID: 1308567 DOI: 10.1590/s0074-02761992000200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To identify wild hosts of Trypanosoma cruzi, surveys were conducted in the subandean valleys of Jujuy Province, Argentina, between June 1986 and March 1987. Seventy two mammals from 13 different species were examined by xenodiagnosis. Fifty two of them were mostly rodents trapped at the localities of Maimará, León and Tilcara, and the remainder had been kept in captivity at the Estación Biológica Experimental, in Jujuy. Trypanosoma cruzi infection was detected only in 2 Octodontomys gliroides (2 pos./8 exam. 25%) from all 72 examined mammals. Isolates were called Octodontomys Argentina 1 and 2 (OA1 and OA2). Both infected animals were caught at the archaelogical ruin of Pucará, at Tilcara. Repeated searches for triatomines in the ruin itself and in neighbour houses rendered negative results. Groups of mice inoculated with either OA1 or OA2 isolates became infected between 7 (OA1) to 12 days (OA2) postinoculation PI. Parasitemia peaks were observed between day 12th-14th PI. Scarce amastigote nests were found in myocardium and skeletal muscle. Mortality was observed only for mice inoculated with OA1. Isoenzyme patterns of OA1 and OA2 were identical to one found in dogs and slightly different from that of human parasites in Argentina. Bones from Octodontomys sp., were recently found in a cave, dated 10200-8600 BC, in Pumamarca, near Tilcara, Jujuy. There are evidences that O. gliroides cohabited with man in ancient times and was associated to the domestic cycle of T. cruzi transmission, playing a role like that of domestic caves in Bolivia.
Collapse
Affiliation(s)
- N J Schweigmann
- Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
35
|
Wisnivesky-Colli C, Schweigmann NJ, Alberti A, Pietrokovsky SM, Conti O, Montoya S, Riarte A, Rivas C. Sylvatic American trypanosomiasis in Argentina. Trypanosoma cruzi infection in mammals from the Chaco forest in Santiago del Estero. Trans R Soc Trop Med Hyg 1992; 86:38-41. [PMID: 1566301 DOI: 10.1016/0035-9203(92)90433-d] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Trypanosoma cruzi infection in sylvatic mammals of the quebracho woods of the eastern part of Santiago del Estero province, Argentina, was studied from October 1984 to December 1987. 301 mammals of 20 different species were caught. T. cruzi, characterized biologically and biochemically, was isolated by xenodiagnosis from 23 of 72 (32%) Didelphis albiventris opposums, 2/36 (5.5%) Conepatus chinga skunks, and one ferret (Galictis cuja). 53 opossum refuges were located and triatomine bugs were found in 2 of them: one male Triatoma infestans, infected with T. cruzi, and 5 uninfected nymphs of T. sordida, had all fed on opossum blood. Electrophoretic zymogram patterns of the T. cruzi populations isolated from opossums and skunks were similar to isoenzyme profiles already described for populations isolated from infected humans in Argentina. The small number of triatomines found in the opossum refuges seems inadequate to account for the prevalence of T. cruzi infection recorded for these mammals, so other possible contaminative routes of infection should be investigated.
Collapse
Affiliation(s)
- C Wisnivesky-Colli
- Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Ciudad Universitaria, Buenos Aires, Argentina
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Aulet F, Riarte A, Pattin M, Segura EL, Vazquez M. Chagas disease and kidney transplantation. Transplant Proc 1991; 23:2653. [PMID: 1926519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- F Aulet
- Hospital Municipal Cosme Argerich de la Ciudad de Buenos Aires, Argentina
| | | | | | | | | |
Collapse
|
37
|
Pietrokovsky SM, Schweigmann NJ, Riarte A, Alberti A, Conti O, Montoya S, Wisnivesky-Colli C. The Skunk Conepatus chinga as New Host of Trypanosoma cruzi in Argentina. J Parasitol 1991. [DOI: 10.2307/3283177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
38
|
Pietrokovsky SM, Schweigmann NJ, Riarte A, Alberti A, Conti O, Montoya S, Wisnivesky-Colli C. The skunk Conepatus chinga as new host of Trypanosoma cruzi in Argentina. J Parasitol 1991; 77:643-5. [PMID: 1907656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report the first systematic epidemiological research carried out in Argentina on the skunk Conepatus chinga. Forty-nine animals were captured in the settlements of Amamá, Trinidad, and nearby forested areas located in the Department of Moreno, Province of Santiago del Estero, between April 1985 and May 1989. Isolation of parasites was done through xenodiagnosis, and their identification as Trypanosoma cruzi was achieved by biological and biochemical criteria. The isolate was highly virulent and pathogenic in inoculated C3H mice. Prevalence was 4.1% (2 of 49). Two facts account for a possible domestic source of infection: both infected skunks were captured near Trinidad, in an area that had never been treated with insecticides, and electrophoretic isoenzyme patterns of the parasites isolated from the skunks were identical to those found in humans. Because extensive deforestation probably would increase the distribution area of C. chinga, further investigation should be performed to evaluate the epidemiological role of this wild mammal.
Collapse
Affiliation(s)
- S M Pietrokovsky
- Unidad Ecología de Reservorios y Vectores de Parásitos, Departamento di Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
39
|
Rottenberg ME, Cardoni RL, Sinagra A, Riarte A, Rodriguez Nantes I, Lauricella M, Segura EL. Trypanosoma cruzi: T-cell-dependent mechanisms of resistance during chronic infection. Exp Parasitol 1991; 73:127-36. [PMID: 1909649 DOI: 10.1016/0014-4894(91)90016-p] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Effector mechanisms of resistance exerted by T cells from BALB/c mice chronically infected with Trypanosoma cruzi, Tulahuén strain, were studied. Spleen cells from chronically infected mice (Chro-SC) prestimulated with heat-killed trypomastigotes (HKT) and/or IL-2 destroyed PHA-labeled p-815 mastocytoma cells, HKT-pulsed macrophages, and normal peritoneal macrophages. However, HKT-stimulated Chro-SC did not affect the infectivity of free bloodstream forms of the parasite. Upon HKT stimulation, Chro-SC or their culture supernatant activated peritoneal macrophages for the destruction of intracellular amastigotes. The effect was abolished after Thy 1.2+ cell depletion. The addition of Cyclosporin A (CyA), which blocks T-cell activation, during HKT-stimulation of Chro-SC, diminished their ability to activate the trypanocidal activity of macrophages. CyA also inhibited the production of both macrophage-activating factors and interferon-gamma by HKT-stimulated Chro-SC. CyA administration to recipients of nylon-wool nonadherent spleen cells from chronically infected mice inhibited their adoptively acquired resistance against T. cruzi, suggesting that the conferred resistance depended on the effect of specifically activated cells. When administered during the chronic stage of the infection, CyA abrogated the antigen-specific delayed type hypersensitivity response but increased the levels of anti-T. cruzi IgG antibodies. Neither parasitemia, tissular parasitism in myocardium or skeletal muscle, nor mortality were detected after CyA treatment, suggesting the presence of a CyA nonsensitive mechanism(s) in the control of T. cruzi during the chronic phase of the infection.
Collapse
Affiliation(s)
- M E Rottenberg
- Instituto Nacional de Diagnóstico e Investigación de la Enfermedad de Chagas Dr. M. Fatala Chabén, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
40
|
Boullon F, Sinagra A, Riarte A, Lauricella M, Barra J, Besanson M, Lejour C, Lopez Blanco O, Favaloro R, Segura EL. Experimental cardiac transplantation and chronic Chagas' disease in dogs. Transplant Proc 1988; 20:432-7. [PMID: 3126576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- F Boullon
- Instituto Nacional de Diagnóstico e Investigación de la Enfermedad de Chagas, Dr M. Fatala Chabén, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Ruiz AM, Esteva M, Riarte A, Subías E, Segura EL. Immunoprotection of mice against Trypanosoma cruzi with a lyophilized flagellar fraction of the parasite plus adjuvant. Immunol Lett 1986; 12:1-4. [PMID: 2870022 DOI: 10.1016/0165-2478(86)90072-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The immunization with the flagellar (F) fraction from epimastigotes of Trypanosoma cruzi has been shown to protect mice against a challenge of bloodstream trypomastigotes of the parasite, both in terms of mortality and decrease in parasitemia. We have compared the immunoprotective properties of the fresh F fraction with those of a lyophilized F (LF) fraction, alone or together with Bordetella pertussis (Bp) as adjuvant. The best results were obtained with LF + Bp: after challenge with 1 X 10(3) metacyclic trypomastigotes, 100% of the mice immunized with LF + Bp survived, and 60% of them showed no signs of parasitemia. Only the animals in which patent parasitemia was demonstrated presented heart and muscle infiltrates.
Collapse
|
42
|
Nagle CA, Riarte A, Quiroga S, Azorero RM, Carril M, Denari JH, Rosner JM. Temporal relationship between follicular development, ovulation, and ovarian hormonal profile in the capuchin monkey (Cebus apella). Biol Reprod 1980; 23:629-35. [PMID: 7448266 DOI: 10.1095/biolreprod23.3.629] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
|
43
|
Nagle CA, Denari JH, Quiroga S, Riarte A, Merlo A, Germino NI, Gómez-Argaña F, Rosner JM. The plasma pattern of ovarian steroids during the menstrual cycle in capuchin monkeys (Cebus apella). Biol Reprod 1979; 21:979-83. [PMID: 118775 DOI: 10.1095/biolreprod21.4.979] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|