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Rivero R, Santini MS, Lopez-Albizu C, Rodriguez M, Calbosa A, Oliveto D, Esteva M, Bisio M, Bohorquez LC. Comparative evaluation of four rapid diagnostic tests that detect human Trypanosoma cruzi-specific antibodies to support diagnosis of Chagas Disease in urban population of Argentina. PLoS Negl Trop Dis 2024; 18:e0011997. [PMID: 38489395 DOI: 10.1371/journal.pntd.0011997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/27/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is the most important endemic anthropozoonosis in Argentina. Since 2010, the World Health Organization has highlighted the urgent need to validate diagnostic systems that allow rapid detection of T. cruzi, infection in primary healthcare centers. Serological rapid diagnostic tests (RDTs) for T. cruzi, infection could be used to improve case management, as RDTs do not require specialized laboratories or highly trained staff to use them. We aimed to generate unbiased performance data of RDTs in Argentina, to evaluate their usefulness for improving T. cruzi, diagnosis rates. METHODS AND PRINCIPAL FINDINGS This is a retrospective, laboratory-based, diagnostic evaluation study to estimate the clinical sensitivity/specificity of four commercially available RDTs for T. cruzi, using the Chagas disease diagnostic algorithm currently used in Argentina as the reference standard. In total, 400 serum samples were tested, 200 from individuals with chronic T. cruzi infection and 200 from individuals not infected with T. cruzi. All results were registered as the agreement of at least two operators who were blinded to the reference standard results. The sensitivity estimates ranged from 92.5-100% (95% confidence interval (CI) lower bound 87.9-98.2%); for specificity, the range was 76-96% (95% CI lower bound 69.5-92.3%). Most RDTs evaluated showed performances comparable with the reference standard method, showing almost perfect concordance (Kappa 0.76-0.92). CONCLUSIONS Our study demonstrates that, under controlled laboratory conditions, commercially available RDTs for CD have a performance comparable to the Argentinian diagnostic algorithm, which is based on laboratory-based serological tests. For the next stage of our work, the RDTs will be evaluated in real-world settings.
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Affiliation(s)
- Rocío Rivero
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
- CONICET Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - M Soledad Santini
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
- CONICET Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Constanza Lopez-Albizu
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
| | - Marcelo Rodriguez
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
| | - Adriana Calbosa
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
| | - Daniela Oliveto
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
| | - Mónica Esteva
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
| | - Margarita Bisio
- ANLIS Administración Nacional de Laboratorios y Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
- CONICET Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Laura C Bohorquez
- FIND, Foundation for Innovative New Diagnostics, Geneva, Switzerland
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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.
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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
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Gulin JEN, Bisio M, García-Bournissen F. Refining drug administration in a murine model of acute infection with Trypanosoma cruzi. Lab Anim Res 2020; 36:37. [PMID: 33094096 PMCID: PMC7576763 DOI: 10.1186/s42826-020-00071-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background In animal research, “refinement” refers to modifications of husbandry or experimental procedures to enhance animal well-being and minimize or eliminate pain and distress. Evaluation of drug efficacy in mice models, such as those used to study Trypanosoma cruzi infection, require prolonged drug administration by the oral route (e.g. for 20 consecutive days). However, the orogastric gavage method can lead to significant discomfort, upper digestive or respiratory tract lesions, aspiration pneumonia and even accidental death. The aim of this work was to evaluate the effect of two administration methods (conventional oral gavage vs. a refined method using a disposable tip and automatic pipette) on the efficacy of benznidazole in a murine model of T. cruzi infection. Results Both administration methods led to a rapid and persistent reduction in parasitaemia. Absence of T. cruzi DNA (evaluated by real-time PCR) in blood, cardiac and skeletal muscle confirmed that treatment efficacy was not influenced by the administration method used. Conclusions The proposed refined method for long-term oral drug administration may be a suitable strategy for assessing drug efficacy in mice models of Chagas disease and can be applied to similar murine infection models to reduce animal discomfort.
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Affiliation(s)
- Julián Ernesto Nicolás Gulin
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Hospital de Niños "Dr. Ricardo Gutiérrez", CONICET- GCBA, Gallo 1330, 1425 Buenos Aires, Argentina.,Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños "Dr. Ricardo Gutiérrez". Ministerio de Salud. GCBA, Buenos Aires, Argentina
| | - Margarita Bisio
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Hospital de Niños "Dr. Ricardo Gutiérrez", CONICET- GCBA, Gallo 1330, 1425 Buenos Aires, Argentina.,Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños "Dr. Ricardo Gutiérrez". Ministerio de Salud. GCBA, Buenos Aires, Argentina
| | - Facundo García-Bournissen
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Hospital de Niños "Dr. Ricardo Gutiérrez", CONICET- GCBA, Gallo 1330, 1425 Buenos Aires, Argentina.,Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños "Dr. Ricardo Gutiérrez". Ministerio de Salud. GCBA, Buenos Aires, Argentina
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Moscatelli G, Moroni S, García Bournissen F, González N, Ballering G, Schijman A, Corral R, Bisio M, Freilij H, Altcheh J. Longitudinal follow up of serological response in children treated for Chagas disease. PLoS Negl Trop Dis 2019; 13:e0007668. [PMID: 31465522 PMCID: PMC6715178 DOI: 10.1371/journal.pntd.0007668] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/25/2019] [Accepted: 07/28/2019] [Indexed: 01/05/2023] Open
Abstract
Background Evaluation of therapeutic response in chronic Chagas disease is a major challenge, due to prolonged persistence of Trypanosoma cruzi-specific antibodies, lack of sensitivity of parasitological tests, and need for long-term follow-up to observe negative seroconversion of conventional serological tests (CS). The objective of this study was to evaluate F2/3-ELISA serology, a promising early biomarker of therapeutic response, and T.cruzi Polymerase chain reaction (PCR) for T. cruzi Deoxyribonucleic acid (DNA), for neonatal diagnosis and evaluation of parasitemia after treatment. Methods Prospective cohort study, with three-year clinical, serological and parasitological follow-up of pediatric Chagas disease patients treated with benznidazole. Serology was evaluated by Enzyme-Linked ImmunoSorbent Assay (ELISA), Indirect hemagglutination (IHA) and F2/3-ELISA; Parasitemia by microhematocrit (MH) and PCR. Results A cohort of 107 pediatric patients treated with benznidazole was enrolled in the study. ELISA and IHA were initially reactive in 100% of patients, F2/3-ELISA serology was reactive in 80% (86/107) and 91% (97/107) had detectable parasitemia. Seventy-six (71%) patients completed at least 36 months of serological follow up after treatment. Although a similar decreasing linear trend was observed for all serological tests, F2/3-ELISA presented earlier, age dependent, negative seroconversion compared to CS. All patients reaching undetectable CS titers had previously seroreverted by F2/3-ELISA. All patients with persistently decreasing antibody titers had negative PCRs throughout the follow up period. No new cardiological lesions were observed during the 3 years follow-up period. Conclusions The data reported here, using CS, F2/3 ELISA and PCR provide support for the efficacy of benznidazole in congenital Chagas diseases. These results provide support for scaling up of screening, diagnosis and access to benznidazole treatment. Trial registration ClinicalTrials.gov 0028/04 in the Research Council, Secretary of Health Buenos Aires city Goberment. Evaluation of therapeutic response in chronic Chagas disease is a major challenge, particularly in the early post-treatment phase, due to prolonged persistence of Trypanosoma cruzi-specific antibodies and lack of sensitivity of available parasitological tests. The main limitation in evaluating Chagas disease treatment response stems from the need for long-term follow-up to observe negative seroconversion of conventional serological tests. New biomarkers of cure are needed. We evaluated F2/3-ELISA, a promising early serological marker of therapeutic response, and T.cruzi PCR for T.cruzi DNA, for neonatal diagnosis and evaluation of parasitemia after treatment. F2/3-ELISA and PCR proved to be excellent early markers of treatment response that correlate with ELISA and IHA but can identify treatment response or failure at much earlier timepoints. This information can help design future paediatric clinical trials in Chagas disease.
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Affiliation(s)
- Guillermo Moscatelli
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
- * E-mail:
| | - Samanta Moroni
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
| | - Facundo García Bournissen
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
| | - Nicolás González
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Griselda Ballering
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Alejandro Schijman
- Molecular Biology Laboratory of Chagas disease, INGEBI-CONICET, Buenos Aires, Argentina
| | - Ricardo Corral
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Margarita Bisio
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Héctor Freilij
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Jaime Altcheh
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
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Torrico F, Gascon J, Ortiz L, Alonso-Vega C, Pinazo MJ, Schijman A, Almeida IC, Alves F, Strub-Wourgaft N, Ribeiro I, Santina G, Blum B, Correia E, Garcia-Bournisen F, Vaillant M, Morales JR, Pinto Rocha JJ, Rojas Delgadillo G, Magne Anzoleaga HR, Mendoza N, Quechover RC, Caballero MYE, Lozano Beltran DF, Zalabar AM, Rojas Panozo L, Palacios Lopez A, Torrico Terceros D, Fernandez Galvez VA, Cardozo L, Cuellar G, Vasco Arenas RN, Gonzales I, Hoyos Delfin CF, Garcia L, Parrado R, de la Barra A, Montano N, Villarroel S, Duffy T, Bisio M, Ramirez JC, Duncanson F, Everson M, Daniels A, Asada M, Cox E, Wesche D, Diderichsen PM, Marques AF, Izquierdo L, Sender SS, Reverter JC, Morales M, Jimenez W. Treatment of adult chronic indeterminate Chagas disease with benznidazole and three E1224 dosing regimens: a proof-of-concept, randomised, placebo-controlled trial. The Lancet Infectious Diseases 2018; 18:419-430. [DOI: 10.1016/s1473-3099(17)30538-8] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/31/2017] [Accepted: 08/22/2017] [Indexed: 11/29/2022]
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Gulin JEN, Bisio M, Rocco DM, Altcheh J, Solana ME, García-Bournissen F. Molecular and biological characterization of a highly pathogenic Trypanosoma cruzi strain isolated from a patient with congenital infection. Exp Parasitol 2018; 186:50-58. [PMID: 29448038 DOI: 10.1016/j.exppara.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/23/2017] [Accepted: 02/11/2018] [Indexed: 11/16/2022]
Abstract
Although many Trypanosoma cruzi (T. cruzi) strains isolated from a wide range of hosts have been characterized, there is a lack of information about biological features from vertically transmitted strains. We describe the molecular and biological characteristics of the T. cruzi VD strain isolated from a congenital Chagas disease patient. The VD strain was typified as DTU TcVI; in vitro sensitivity to nifurtimox (NFX) and beznidazole (BZ) were 2.88 μM and 6.19 μM respectively, while inhibitory concentrations for intracellular amastigotes were 0.24 μM for BZ, and 0.66 μM for NFX. Biological behavior of VD strain was studied in a mouse model of acute infection, resulting in high levels of parasitemia and mortality with a rapid clearence of bloodstream trypomastigotes when treated with BZ or NFX, preventing mortality and reducing parasitic load and intensity of inflammatory infiltrate in skeletal and cardiac muscle. Treatment-induced parasitological cure, evaluated after immunossupression were 41% and 35% for BZ and NFX treatment respectively, suggesting a partial response to these drugs in elimination of parasite burden. This exhaustive characterization of this T. cruzi strain provides the basis for inclusion of this strain in a panel of reference strains for drug screening and adds a new valuable tool for the study of experimental T. cruzi infection.
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Affiliation(s)
- Julián Ernesto Nicolás Gulin
- Servicio de Parasitología y enfermedad de Chagas - Hospital General de Niños "Dr. Ricardo Gutiérrez", Gallo 1330, CP: 1425, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Margarita Bisio
- Servicio de Parasitología y enfermedad de Chagas - Hospital General de Niños "Dr. Ricardo Gutiérrez", Gallo 1330, CP: 1425, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Daniela Marisa Rocco
- Servicio de Parasitología y enfermedad de Chagas - Hospital General de Niños "Dr. Ricardo Gutiérrez", Gallo 1330, CP: 1425, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Jaime Altcheh
- Servicio de Parasitología y enfermedad de Chagas - Hospital General de Niños "Dr. Ricardo Gutiérrez", Gallo 1330, CP: 1425, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - María Elisa Solana
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médicas (IMPaM), UBA-CONICET, Universidad de Buenos Aires, Paraguay 2155, CP: 1121, Ciudad Autónoma de Buenos Aires, Argentina; Departamento de Cs. Básicas, Universidad Nacional de Luján, Ruta 5 y Avenida Constitución - (6700) Luján, Buenos Aires, Argentina
| | - Facundo García-Bournissen
- Servicio de Parasitología y enfermedad de Chagas - Hospital General de Niños "Dr. Ricardo Gutiérrez", Gallo 1330, CP: 1425, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
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Rivero R, Bisio M, Velázquez EB, Esteva MI, Scollo K, González NL, Altcheh J, Ruiz AM. Rapid detection of Trypanosoma cruzi by colorimetric loop-mediated isothermal amplification (LAMP): A potential novel tool for the detection of congenital Chagas infection. Diagn Microbiol Infect Dis 2017; 89:26-28. [DOI: 10.1016/j.diagmicrobio.2017.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 02/07/2023]
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Lucero R, Brusés B, Cura C, Formichelli L, Juiz N, Fernández G, Bisio M, Deluca G, Besuschio S, Hernández D, Schijman A. Chagas' disease in Aboriginal and Creole communities from the Gran Chaco Region of Argentina: Seroprevalence and molecular parasitological characterization. Infection, Genetics and Evolution 2016; 41:84-92. [DOI: 10.1016/j.meegid.2016.03.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/26/2016] [Accepted: 03/28/2016] [Indexed: 12/17/2022]
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Niborski LL, Grippo V, Lafón SO, Levitus G, García-Bournissen F, Ramirez JC, Burgos JM, Bisio M, Juiz NA, Ayala V, Coppede M, Herrera V, López C, Contreras A, Gómez KA, Elean JC, Mujica HD, Schijman AG, Levin MJ, Longhi SA. Serological based monitoring of a cohort of patients with chronic Chagas disease treated with benznidazole in a highly endemic area of northern Argentina. Mem Inst Oswaldo Cruz 2016; 111:365-71. [PMID: 27223650 PMCID: PMC4909034 DOI: 10.1590/0074-02760160006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/15/2016] [Indexed: 01/24/2023] Open
Abstract
This study aimed to evaluate well-documented diagnostic antigens, named B13, 1F8 and JL7 recombinant proteins, as potential markers of seroconversion in treated chagasic patients. Prospective study, involving 203 patients treated with benznidazole, was conducted from endemic areas of northern Argentina. Follow-up was possible in 107 out of them and blood samples were taken for serology and PCR assays before and 2, 3, 6, 12, 24 and 36 months after treatment initiation. Reactivity against Trypanosoma cruzi lysate and recombinant antigens was measured by ELISA. The rate of decrease of antibody titers showed nonlinear kinetics with an abrupt drop within the first three months after initiation of treatment for all studied antigens, followed by a plateau displaying a low decay until the end of follow-up. At this point, anti-B13, anti-1F8 and anti-JL7 titers were relatively close to the cut-off line, while anti-T. cruzi antibodies still remained positive. At baseline, 60.8% (45/74) of analysed patients tested positive for parasite DNA by PCR and during the follow-up period in 34 out of 45 positive samples (75.5%) could not be detected T. cruzi DNA. Our results suggest that these antigens might be useful as early markers for monitoring antiparasitic treatment in chronic Chagas disease.
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Affiliation(s)
- Leticia L Niborski
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Vanina Grippo
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Sonia O Lafón
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Gabriela Levitus
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | | | - Juan C Ramirez
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Juan M Burgos
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Margarita Bisio
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Natalia A Juiz
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Vilma Ayala
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
| | - María Coppede
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
| | - Verónica Herrera
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
| | - Crescencia López
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
| | - Ana Contreras
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
| | - Karina A Gómez
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Juan C Elean
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
| | - Hugo D Mujica
- Centro Asistencial Cáritas Diocesana, Añatuya, Santiago del Estero,
Argentina
- Hospital Zonal Añatuya, Santiago del Estero, Argentina
| | - Alejandro G Schijman
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Mariano J Levin
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
| | - Silvia A Longhi
- Instituto de Investigaciones en Ingeniería Genética y Biología
Molecular, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Buenos Aires,
Argentina
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10
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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.
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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.
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11
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Cura CI, Duffy T, Lucero RH, Bisio M, Péneau J, Jimenez-Coello M, Calabuig E, Gimenez MJ, Valencia Ayala E, Kjos SA, Santalla J, Mahaney SM, Cayo NM, Nagel C, Barcán L, Málaga Machaca ES, Acosta Viana KY, Brutus L, Ocampo SB, Aznar C, Cuba Cuba CA, Gürtler RE, Ramsey JM, Ribeiro I, VandeBerg JL, Yadon ZE, Osuna A, Schijman AG. Multiplex Real-Time PCR Assay Using TaqMan Probes for the Identification of Trypanosoma cruzi DTUs in Biological and Clinical Samples. PLoS Negl Trop Dis 2015; 9:e0003765. [PMID: 25993316 PMCID: PMC4437652 DOI: 10.1371/journal.pntd.0003765] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/16/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi has been classified into six Discrete Typing Units (DTUs), designated as TcI-TcVI. In order to effectively use this standardized nomenclature, a reproducible genotyping strategy is imperative. Several typing schemes have been developed with variable levels of complexity, selectivity and analytical sensitivity. Most of them can be only applied to cultured stocks. In this context, we aimed to develop a multiplex Real-Time PCR method to identify the six T. cruzi DTUs using TaqMan probes (MTq-PCR). METHODS/PRINCIPAL FINDINGS The MTq-PCR has been evaluated in 39 cultured stocks and 307 biological samples from vectors, reservoirs and patients from different geographical regions and transmission cycles in comparison with a multi-locus conventional PCR algorithm. The MTq-PCR was inclusive for laboratory stocks and natural isolates and sensitive for direct typing of different biological samples from vectors, reservoirs and patients with acute, congenital infection or Chagas reactivation. The first round SL-IR MTq-PCR detected 1 fg DNA/reaction tube of TcI, TcII and TcIII and 1 pg DNA/reaction tube of TcIV, TcV and TcVI reference strains. The MTq-PCR was able to characterize DTUs in 83% of triatomine and 96% of reservoir samples that had been typed by conventional PCR methods. Regarding clinical samples, 100% of those derived from acute infected patients, 62.5% from congenitally infected children and 50% from patients with clinical reactivation could be genotyped. Sensitivity for direct typing of blood samples from chronic Chagas disease patients (32.8% from asymptomatic and 22.2% from symptomatic patients) and mixed infections was lower than that of the conventional PCR algorithm. CONCLUSIONS/SIGNIFICANCE Typing is resolved after a single or a second round of Real-Time PCR, depending on the DTU. This format reduces carryover contamination and is amenable to quantification, automation and kit production.
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Affiliation(s)
- Carolina I. Cura
- Laboratorio 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
| | - Tomas Duffy
- Laboratorio 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
| | - Raúl H. Lucero
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Chaco, Argentina
| | - Margarita Bisio
- Laboratorio 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
| | - Julie Péneau
- Laboratoire Hospitalier et Universitaire-CH Andrée Rosemon, Cayenne, French Guiana, France
| | - Matilde Jimenez-Coello
- Laboratorio Biología Celular, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Eva Calabuig
- Servicio de Medicina Interna, Hospital Politécnico LA FE, Valencia, Spain
| | - María J. Gimenez
- Servicio de Microbiología, Hospital Universitario y Politécnico LA FE, Valencia, Spain
| | - Edward Valencia Ayala
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sonia A. Kjos
- Department of Biology, University of Minnesota Duluth, Duluth, Minnesota, United States of America
| | - José Santalla
- Laboratorio de Parasitología, Instituto Nacional de Laboratorios en Salud, Ministerio de Salud y Deportes de Bolivia, La Paz, Bolivia
| | - Susan M. Mahaney
- Southwest National Primate Research Center and Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Nelly M. Cayo
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, Jujuy, Argentina
| | - Claudia Nagel
- Epidemiología e Infectología Clínica, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Laura Barcán
- Sección Infectología, Servicio de Clínica Médica, Hospital Italiano, Buenos Aires, Argentina
| | - Edith S. Málaga Machaca
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karla Y. Acosta Viana
- Laboratorio Biología Celular, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Laurent Brutus
- Institut de Recherche pour le Développement and University Paris Descartes, UMR 216, Mother and Child Facing Tropical Diseases, Paris, France
| | - Susana B. Ocampo
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, Jujuy, Argentina
| | - Christine Aznar
- Laboratoire Hospitalier et Universitaire-CH Andrée Rosemon, Cayenne, French Guiana, France
| | - Cesar A. Cuba Cuba
- Parasitologia Médica e Biologia de Vetores, Área de Patologia, Faculdade de Medicina, Universidade de Brasilia, Brasilia DF, Brazil
| | - Ricardo E. Gürtler
- Laboratorio de Eco-Epidemiología, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Janine M. Ramsey
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, Mexico
| | - Isabela Ribeiro
- Drugs and Neglected Diseases Initiative, Genève, Switzerland
| | - John L. VandeBerg
- Southwest National Primate Research Center and Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Zaida E. Yadon
- Pan American Health Organization (PAHO), World Health Organization (WHO), Washington, D.C., United States of America
| | - Antonio Osuna
- Institute of Biotechnology, Molecular Parasitology Group, University of Granada, Granada, Spain
| | - Alejandro G. Schijman
- Laboratorio 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:
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12
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Moscatelli G, Moroni S, García-Bournissen F, Ballering G, Bisio M, Freilij H, Altcheh J. Prevention of congenital Chagas through treatment of girls and women of childbearing age. Mem Inst Oswaldo Cruz 2015; 110:507-9. [PMID: 25993401 PMCID: PMC4501414 DOI: 10.1590/0074-02760140347] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/25/2015] [Indexed: 11/22/2022] Open
Abstract
It is currently unknown whether treatment of Chagas disease decreases the risk of congenital transmission from previously treated mothers to their infants. In a cohort of women with Chagas disease previously treated with benznidazole, no congenital transmission of the disease was observed in their newborns. This finding provides support for the treatment of Chagas disease as early as possible.
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Affiliation(s)
- Guillermo Moscatelli
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Samanta Moroni
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Facundo García-Bournissen
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Griselda Ballering
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Margarita Bisio
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Héctor Freilij
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Jaime Altcheh
- Department of Parasitology and Chagas, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
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13
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García-Bournissen F, Moroni S, Marson ME, Moscatelli G, Mastrantonio G, Bisio M, Cornou L, Ballering G, Altcheh J. Limited infant exposure to benznidazole through breast milk during maternal treatment for Chagas disease. Arch Dis Child 2015; 100:90-4. [PMID: 25210104 DOI: 10.1136/archdischild-2014-306358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Benznidazole (BNZ) is safe and effective for the treatment of paediatric Chagas disease. Treatment of adults is also effective in many cases, but discouraged in breastfeeding women because no information on BNZ transfer into breast milk is available. We aimed to evaluate the degree of BNZ transfer into breast milk in lactating women with Chagas disease. PATIENTS AND METHODS Prospective cohort study of lactating women with Chagas disease treated with BNZ administered for 30 days. Patients and their breastfed infants were evaluated at admission, the 7th and 30th day of treatment (and monthly thereafter, for 6 months). BNZ was measured in plasma and milk by high performance liquid chromatography. The protocol was registered in ClinicalTrials.gov (#NCT01547533). RESULTS 12 lactating women with chronic Chagas disease were enrolled (median age 28.5 years, range 20-34). Median BNZ dose was 5.65 mg/kg/day twice daily. Five mothers had adverse drug events (45%), but no adverse drug reactions or any untoward outcomes were observed in the breastfed infants. Median milk BNZ concentration was 3.8 mg/L (range 0.3-5.9) and 6.26 mg/L (range 0.3-12.6) in plasma. Median BNZ milk to plasma ratio was 0.52 (range 0.3-2.79). Median relative BNZ dose received by the infant (assuming a daily breast milk intake of 150 mL/kg/day) was 12.3% of the maternal dose per kg (range 5.5%-17%). CONCLUSIONS The limited transference of BNZ into breast milk and the reassuring normal clinical evaluation of the breastfed babies suggest that maternal BNZ treatment for Chagas disease during breast feeding is unlikely to present a risk for the breastfed infant. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01547533.
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Affiliation(s)
- Facundo García-Bournissen
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Samanta Moroni
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Maria Elena Marson
- Toxicology Area, Biological Sciences Department/PlaPiMu-LaSeISiC, Faculty of Exact Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina PlaPiMu-LaSeISiC, Buenos Aires Committee for Scientific Research, La Plata, Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Guido Mastrantonio
- Toxicology Area, Biological Sciences Department/PlaPiMu-LaSeISiC, Faculty of Exact Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina PlaPiMu-LaSeISiC, Buenos Aires Committee for Scientific Research, La Plata, Buenos Aires, Argentina
| | - Margarita Bisio
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Laura Cornou
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Griselda Ballering
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
| | - Jaime Altcheh
- Parasitology and Chagas Service, Buenos Aires Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
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14
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Blanchet D, Brenière SF, Schijman AG, Bisio M, Simon S, Véron V, Mayence C, Demar-Pierre M, Djossou F, Aznar C. First report of a family outbreak of Chagas disease in French Guiana and posttreatment follow-up. Infection, Genetics and Evolution 2014; 28:245-50. [DOI: 10.1016/j.meegid.2014.10.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
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15
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Altcheh J, Moscatelli G, Mastrantonio G, Moroni S, Giglio N, Marson ME, Ballering G, Bisio M, Koren G, García-Bournissen F. Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults. PLoS Negl Trop Dis 2014; 8:e2907. [PMID: 24853169 PMCID: PMC4031103 DOI: 10.1371/journal.pntd.0002907] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [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: 01/14/2013] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to long term cardiac morbidity. Treatment of children with benznidazole is effective, but no pediatric pharmacokinetics data are available and clinical pharmacology information on the drug is scarce. PATIENTS AND METHODS Prospective population pharmacokinetic (PK) cohort study in children 2-12 years old with Chagas disease treated with oral benznidazole 5-8 mg/kg/day BID for 60 days. (clinicaltrials.gov #NCT00699387). RESULTS Forty children were enrolled in the study. Mean age was 7.3 years. A total of 117 samples were obtained from 38 patients for PK analysis. A one compartment model best fit the data. Weight-corrected clearance rate (CL/F) showed a good correlation with age, with younger patients having a significantly higher CL/F than older children and adults. Simulated median steady-state benznidazole concentrations, based on model parameters, were lower for children in our study than for adults and lowest for children under 7 years of age. Treatment was efficacious in the 37 patients who completed the treatment course, and well tolerated, with few, and mild, adverse drug reactions (ADRs). DISCUSSION Observed benznidazole plasma concentrations in children were markedly lower than those previously reported in adults (treated with comparable mg/kg doses), possibly due to a higher CL/F in smaller children. These lower blood concentrations were nevertheless associated to a high therapeutic response in our cohort. Unlike adults, children have few adverse reactions to the drug, suggesting that there may be a direct correlation between drug concentrations and incidence of ADRs. Our results suggest that studies with lower doses in adults may be warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT00699387.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guido Mastrantonio
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Norberto Giglio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Maria Elena Marson
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Gideon Koren
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Facundo García-Bournissen
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Bisio M, Altcheh J, Lattner J, Moscatelli G, Fink V, Burgos JM, Bournissen FG, Schijman AG, Freilij H. Benznidazole treatment of chagasic encephalitis in pregnant woman with AIDS. Emerg Infect Dis 2014; 19:1490-2. [PMID: 23965334 PMCID: PMC3810932 DOI: 10.3201/eid1909.130667] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of chagasic meningoencephalitis reactivation in a pregnant woman co-infected with Trypanosoma cruzi and HIV that was successfully managed with benznidazole and highly active antiretroviral therapy. Early diagnosis enabled rapid specific treatment that improved the health of the patient and her baby.
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Ortiz S, Zulantay I, Solari A, Bisio M, Schijman A, Carlier Y, Apt W. Presence of Trypanosoma cruzi in pregnant women and typing of lineages in congenital cases. Acta Trop 2012; 124:243-6. [PMID: 22906640 DOI: 10.1016/j.actatropica.2012.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/30/2012] [Accepted: 08/03/2012] [Indexed: 10/28/2022]
Abstract
The objective of this study was to determine the presence of Trypanosoma cruzi in blood samples of mothers with chronic Chagas disease and their newborn by conventional PCR targeted to minicircle kinetoplastidic DNA (kDNA), and to determine the lineages in mother/newborn pairs of the congenital cases by hybridization assays with probes belonging to the TcII, TcI and TcV Discrete Typing Units (DTU). In 63 (57.2%) of the mothers the presence of circulating T. cruzi was demonstrated by PCR immediately before delivery and in three newborn (3%) congenital transmission was confirmed by serial PCR and conventional serology between 1 and 16 months of life, at which point treatment was started. The hybridization signals showed that two of the newborn had the same DTU as their mother (TcI, TcII and TcV), whilst in the third congenital case only TcV was detected in the cord blood, suggesting that in this infant TcI and TcII did not cross the placenta or the parasite was not present at a detectable level. Levels T. cruzi DNA was determined by TaqMan Probe based Real Time PCR assay targeted to nuclear satellite sequences in these three pairs of samples.
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Bisio M, Seidenstein ME, Burgos JM, Ballering G, Risso M, Pontoriero R, Moreau M, Altcheh J, Leguizamón MS, Freilij H, Marceillac M, Schijman AG. Urbanization of congenital transmission of Trypanosoma cruzi: prospective polymerase chain reaction study in pregnancy. Trans R Soc Trop Med Hyg 2011; 105:543-9. [DOI: 10.1016/j.trstmh.2011.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 11/25/2022] Open
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Schijman AG, Bisio M, Orellana L, Sued M, Duffy T, Mejia Jaramillo AM, Cura C, Auter F, Veron V, Qvarnstrom Y, Deborggraeve S, Hijar G, Zulantay I, Lucero RH, Velazquez E, Tellez T, Sanchez Leon Z, Galvão L, Nolder D, Monje Rumi M, Levi JE, Ramirez JD, Zorrilla P, Flores M, Jercic MI, Crisante G, Añez N, De Castro AM, Gonzalez CI, Acosta Viana K, Yachelini P, Torrico F, Robello C, Diosque P, Triana Chavez O, Aznar C, Russomando G, Büscher P, Assal A, Guhl F, Sosa Estani S, DaSilva A, Britto C, Luquetti A, Ladzins J. International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. PLoS Negl Trop Dis 2011; 5:e931. [PMID: 21264349 PMCID: PMC3019106 DOI: 10.1371/journal.pntd.0000931] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [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: 05/20/2010] [Accepted: 12/01/2010] [Indexed: 01/01/2023] Open
Abstract
Background A century after its discovery, Chagas disease still represents a major neglected tropical threat. Accurate diagnostics tools as well as surrogate markers of parasitological response to treatment are research priorities in the field. The purpose of this study was to evaluate the performance of PCR methods in detection of Trypanosoma cruzi DNA by an external quality evaluation. Methodology/Findings An international collaborative study was launched by expert PCR laboratories from 16 countries. Currently used strategies were challenged against serial dilutions of purified DNA from stocks representing T. cruzi discrete typing units (DTU) I, IV and VI (set A), human blood spiked with parasite cells (set B) and Guanidine Hidrochloride-EDTA blood samples from 32 seropositive and 10 seronegative patients from Southern Cone countries (set C). Forty eight PCR tests were reported for set A and 44 for sets B and C; 28 targeted minicircle DNA (kDNA), 13 satellite DNA (Sat-DNA) and the remainder low copy number sequences. In set A, commercial master mixes and Sat-DNA Real Time PCR showed better specificity, but kDNA-PCR was more sensitive to detect DTU I DNA. In set B, commercial DNA extraction kits presented better specificity than solvent extraction protocols. Sat-DNA PCR tests had higher specificity, with sensitivities of 0.05–0.5 parasites/mL whereas specific kDNA tests detected 5.10−3 par/mL. Sixteen specific and coherent methods had a Good Performance in both sets A and B (10 fg/µl of DNA from all stocks, 5 par/mL spiked blood). The median values of sensitivities, specificities and accuracies obtained in testing the Set C samples with the 16 tests determined to be good performing by analyzing Sets A and B samples varied considerably. Out of them, four methods depicted the best performing parameters in all three sets of samples, detecting at least 10 fg/µl for each DNA stock, 0.5 par/mL and a sensitivity between 83.3–94.4%, specificity of 85–95%, accuracy of 86.8–89.5% and kappa index of 0.7–0.8 compared to consensus PCR reports of the 16 good performing tests and 63–69%, 100%, 71.4–76.2% and 0.4–0.5, respectively compared to serodiagnosis. Method LbD2 used solvent extraction followed by Sybr-Green based Real time PCR targeted to Sat-DNA; method LbD3 used solvent DNA extraction followed by conventional PCR targeted to Sat-DNA. The third method (LbF1) used glass fiber column based DNA extraction followed by TaqMan Real Time PCR targeted to Sat-DNA (cruzi 1/cruzi 2 and cruzi 3 TaqMan probe) and the fourth method (LbQ) used solvent DNA extraction followed by conventional hot-start PCR targeted to kDNA (primer pairs 121/122). These four methods were further evaluated at the coordinating laboratory in a subset of human blood samples, confirming the performance obtained by the participating laboratories. Conclusion/Significance This study represents a first crucial step towards international validation of PCR procedures for detection of T. cruzi in human blood samples. A century after its discovery, Chagas disease, caused by the parasite Trypanosoma cruzi, still represents a major neglected tropical threat. Accurate diagnostics tools as well as surrogate markers of parasitological response to treatment are research priorities in the field. The polymerase chain reaction (PCR) has been proposed as a sensitive laboratory tool for detection of T. cruzi infection and monitoring of parasitological treatment outcome. However, high variation in accuracy and lack of international quality controls has precluded reliable applications in the clinical practice and comparisons of data among cohorts and geographical regions. In an effort towards harmonization of PCR strategies, 26 expert laboratories from 16 countries evaluated their current PCR procedures against sets of control samples, composed by serial dilutions of T.cruzi DNA from culture stocks belonging to different lineages, human blood spiked with parasite cells and blood samples from Chagas disease patients. A high variability in sensitivities and specificities was found among the 48 reported PCR tests. Out of them, four tests with best performance were selected and further evaluated. This study represents a crucial first step towards device of a standardized operative procedure for T. cruzi PCR.
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Affiliation(s)
- Alejandro G Schijman
- Laboratorio de Biología Molecular de Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina.
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Burgos JM, Diez M, Vigliano C, Bisio M, Risso M, Duffy T, Cura C, Brusses B, Favaloro L, Leguizamon MS, Lucero RH, Laguens R, Levin MJ, Favaloro R, Schijman AG. Molecular identification of Trypanosoma cruzi discrete typing units in end-stage chronic Chagas heart disease and reactivation after heart transplantation. Clin Infect Dis 2010; 51:485-95. [PMID: 20645859 DOI: 10.1086/655680] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND One hundred years after the discovery of Chagas disease, it remains a major neglected tropical disease. Chronic Chagas heart disease (cChHD) is the most severe manifestation. Heart transplantation is the proper treatment for end-stage heart failure, although reactivation of disease may result after receipt of immunosuppressive therapy. T. cruzi strains cluster into 6 discrete typing units (DTUs; I-VI) associated with different geographical distribution, transmission cycles and varying disease symptoms. In the southern cone of South America, T. cruzi II, V, and VI populations appear to be associated with Chagas disease and T. cruzi I with sylvatic cycles. METHODS Molecular characterization of DTUs, T. cruzi I genotypes (on the basis of spliced-leader gene polymorphisms), and minicircle signatures was conducted using cardiac explant specimens and blood samples obtained from a cohort of 16 Argentinean patients with cChHD who underwent heart transplantation and from lesion samples obtained from 6 of these patients who presented with clinical reactivation of Chagas disease. RESULTS Parasite persistence was associated with myocarditis progression, revealing T. cruzi I (genotype Id) in 3 explant samples and T. cruzi II, V, or VI in 5 explant samples. Post-heart transplantation follow-up examination of bloodstream DTUs identified T. cruzi I in 5 patients (genotypes Ia or Id) and T. cruzi II, V, or VI in 7 patients. T. cruzi I, V, and VI were detected in skin chagoma specimens, and T. cruzi V and VI were detected in samples obtained from patients with myocarditis reactivations. Multiple DTUs or genotypes at diverse body sites and polymorphic minicircle signatures at different cardiac regions revealed parasite histotropism. T. cruzi I infections clustered in northern Argentina (latitude, 23 degrees S-27 degrees S), whereas T. cruzi II, V, or VI DTUs were more ubiquitous. CONCLUSIONS Multiple DTUs coexist in patients with Chagas disease. The frequent finding of T. cruzi I associated with cardiac damage was astounding, revealing its pathogenic role in cChHD at the southern cone.
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Affiliation(s)
- Juan Miguel Burgos
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Duffy T, Bisio M, Altcheh J, Burgos JM, Diez M, Levin MJ, Favaloro RR, Freilij H, Schijman AG. Accurate real-time PCR strategy for monitoring bloodstream parasitic loads in chagas disease patients. PLoS Negl Trop Dis 2009; 3:e419. [PMID: 19381287 PMCID: PMC2667272 DOI: 10.1371/journal.pntd.0000419] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [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: 01/14/2009] [Accepted: 03/24/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This report describes a real-time PCR (Q-PCR) strategy to quantify Trypanosoma cruzi (T. cruzi) DNA in peripheral blood samples from Chagas disease patients targeted to conserved motifs within the repetitive satellite sequence. METHODOLOGY/PRINCIPAL FINDINGS The Q-PCR has a detection limit of 0.1 and 0.01 parasites/mL, with a dynamic range of 10(6) and 10(7) for Silvio X10 cl1 (T. cruzi I) and Cl Brener stocks (T. cruzi IIe), respectively, an efficiency of 99%, and a coefficient of determination (R(2)) of 0.998. In order to express accurately the parasitic loads: (1) we adapted a commercial kit based on silica-membrane technology to enable efficient processing of Guanidine Hydrochloride-EDTA treated blood samples and minimize PCR inhibition; (2) results were normalized incorporating a linearized plasmid as an internal standard of the whole procedure; and (3) a correction factor according to the representativity of satellite sequences in each parasite lineage group was determined using a modified real-time PCR protocol (Lg-PCR). The Q-PCR strategy was applied (1) to estimate basal parasite loads in 43 pediatric Chagas disease patients, (2) to follow-up 38 of them receiving treatment with benznidazole, and (3) to monitor three chronic Chagas heart disease patients who underwent heart-transplantation and displayed events of clinical reactivation due to immunosupression. CONCLUSION/SIGNIFICANCE All together, the high analytical sensitivity of the Q-PCR strategy, the low levels of intra- and inter-assay variations, as well as the accuracy provided by the Lg-PCR based correction factor support this methodology as a key laboratory tool for monitoring clinical reactivation and etiological treatment outcome in Chagas disease patients.
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Affiliation(s)
- Tomas Duffy
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Margarita Bisio
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Jaime Altcheh
- Parasitology Unit of the “Ricardo Gutierrez” Children's Hospital, Buenos Aires, Argentina
| | - Juan Miguel Burgos
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Mirta Diez
- Transplant Unit of the Instituto de Cardiología y Cirugía Cardiovascular, Fundación “René Favaloro”, Buenos Aires, Argentina
| | - Mariano Jorge Levin
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Roberto Rene Favaloro
- Transplant Unit of the Instituto de Cardiología y Cirugía Cardiovascular, Fundación “René Favaloro”, Buenos Aires, Argentina
| | - Hector Freilij
- Parasitology Unit of the “Ricardo Gutierrez” Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
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Miguel BJ, Diez M, Vigliano C, Duffy T, Bisio M, Favaloro L, Levin M, Nagel C, Favaloro N, Schijman A. Molecular Diagnosis, Follow-up and Identification of Natural Trypanosome cruzi Populations in Chagas Heart Disease Patients Undergoing Clinical Reactivation after Heart Transplantation. Int J Infect Dis 2008. [DOI: 10.1016/s1201-9712(08)60027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Burgos JM, Begher S, Bisio M, Levin MJ, Silva HMV, Schijman AG, Duffy T, Macedo AM. Molecular Identification of Trypanosoma cruzi I Tropism for Central Nervous System in Chagas Reactivation Due to AIDS. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.78.294] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Burgos JM, Begher S, Silva HMV, Bisio M, Duffy T, Levin MJ, Macedo AM, Schijman AG. Molecular identification of Trypanosoma cruzi I tropism for central nervous system in Chagas reactivation due to AIDS. Am J Trop Med Hyg 2008; 78:294-297. [PMID: 18256432] [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: 05/25/2023] Open
Abstract
Trypanosoma cruzi lineages, microsatellite allelic polymorphism, and mithocondrial gene haplotypes were directly typified from peripheral blood and cerebrospinal fluid specimens of a Bolivian patient with Chagas disease with accompanying AIDS and central nervous system severe involvement. Of note, the patient's blood was infected by a mixture of T. cruzi I and T. cruzi IId/e polyclonal populations while the cerebrospinal fluid showed only a monoclonal T. cruzi I population. Our findings do not corroborate the original assumption of innocuity for T. cruzi I in the southern cone of the Americas and highlight lineage I tropism for central nervous system causing lethal Chagas reactivation.
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Affiliation(s)
- Juan M Burgos
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
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Burgos JM, Altcheh J, Bisio M, Duffy T, Valadares HMS, Seidenstein ME, Piccinali R, Freitas JM, Levin MJ, Macchi L, Macedo AM, Freilij H, Schijman AG. Direct molecular profiling of minicircle signatures and lineages of Trypanosoma cruzi bloodstream populations causing congenital Chagas disease. Int J Parasitol 2007; 37:1319-27. [PMID: 17570369 DOI: 10.1016/j.ijpara.2007.04.015] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.7] [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: 02/21/2007] [Revised: 04/09/2007] [Accepted: 04/18/2007] [Indexed: 11/18/2022]
Abstract
Congenital transmission of Trypanosoma cruzi may occur in some or all the gestations from a T. cruzi-infected mother. Variable rates of congenital transmission have been reported in different geographical areas where different parasitic strains predominate, suggesting that parasitic genotypes might play a role in the risk of congenital transmission. Moreover, in cases of transmission it is unknown if the whole maternal T. cruzi population or certain clones are preferentially transmitted by the transplacental route. In this study, bloodstream T. cruzi lineages were identified in blood samples from congenitally infected children, transmitting and non-transmitting mothers and unrelated Chagas disease patients, using improved PCR strategies targeted to nuclear genomic markers. T. cruzi IId was the prevalent genotype among 36/38 PCR-positive congenitally infected infants, 5/5 mothers who transmitted congenital Chagas disease, 12/13 mothers who delivered non-infected children and 28/34 unrelated Chagas disease patients, all coming from endemic localities of Argentina and Bolivia. These figures indicate no association between a particular genotype and vertical transmission. Furthermore, minicircle signatures from the maternal and infants' bloodstream trypanosomes were profiled by restriction fragment length polymorphism of the 330-bp PCR-amplified variable regions in seven cases of mothers and congenitally infected infants. Minicircle signatures were nearly identical between each mother and her infant/s and unique to each mother-infant/s case, a feature that was also observed in twin deliveries. Moreover, allelic size polymorphism analysis of microsatellite loci from populations transmitted to twins showed that all clones from the maternal polyclonal population were equally infective to both siblings.
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Affiliation(s)
- Juan M Burgos
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
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Schijman AG, Lauricella MA, Marcet PL, Duffy T, Cardinal MV, Bisio M, Levin MJ, Kitron U, Gürtler RE. Differential detection of Blastocrithidia triatomae and Trypanosoma cruzi by amplification of 24salpha ribosomal RNA genes in faeces of sylvatic triatomine species from rural northwestern Argentina. Acta Trop 2006; 99:50-4. [PMID: 16887092 DOI: 10.1016/j.actatropica.2006.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 10/04/2005] [Revised: 06/27/2006] [Accepted: 06/28/2006] [Indexed: 10/24/2022]
Abstract
Flagellates indistinguishable from Trypanosoma cruzi were detected by microscopy in faecal samples of 2/110 Triatoma guasayana and 2/283 Triatoma garciabesi captured in a rural area of northwestern Argentina. Inoculation of faecal homogenates to mice followed by xenodiagnosis, haemoculture, histopathology and culture from cardiac homogenates, and PCR based on T. cruzi minicircle and nuclear sequences failed to detect T. cruzi infection, pointing to another trypanosomatidean. A PCR strategy targeted to the D7 domain of 24salpha ribosomal DNA genes amplified a 250 bp sequence from one T. guasayana and one T. garciabesi faecal lysate. Sequence analysis revealed 100% identity with 24salpha rDNA amplicons from Blastocrithidia triatomae obtained from faeces of reared Triatoma infestans bugs. Phylogenetic analysis clustered this sequence with C. fasciculata and L. major, separated from the Trypanosoma branch (bootstrap: 968/1000), in concordance with a Neighbour-joining dendrogram based on 18s rDNA sequences. This PCR procedure provides a rapid sensitive tool for differential diagnosis of morphologically similar trypanosomatids in field surveys of Chagas disease vectors and laboratory-reared triatomines used for xenodiagnosis.
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Affiliation(s)
- A G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina.
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Burgos JM, Begher SB, Freitas JM, Bisio M, Duffy T, Altcheh J, Teijeiro R, Lopez Alcoba H, Deccarlini F, Freilij H, Levin MJ, Levalle J, Macedo AM, Schijman AG. Molecular diagnosis and typing of Trypanosoma cruzi populations and lineages in cerebral Chagas disease in a patient with AIDS. Am J Trop Med Hyg 2005; 73:1016-8. [PMID: 16354804] [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: 05/05/2023] Open
Abstract
Trypanosoma cruzi DNA was amplified from an intracranial biopsy and peripheral blood of an HIV patient with encephalitis; this episode was indicative of AIDS and congenital Chagas disease. The analysis of a micro-satellite locus revealed a multiclonal parasite population at the brain lesion with a more complex minicircle signature than that profiled in blood using restriction fragment length polymorphism (RFLP)-PCR and low stringency single primer (LSSP) PCR. Interestingly, different sublineages of T. cruzi II were detected in blood and brain by means of spliced-leader and 24salpha ribosomal-DNA amplifications. Quantitative-competitive PCR monitored the decrease of parasitic load during treatment and secondary prophylaxis with benznidazole. The synergy between parasiticidal plus anti-retroviral treatments probably allowed the patient a longer survival than usually achieved in similar episodes. This is the first case report demonstrating a differential distribution of natural parasite populations and sublineages in Chagas disease reactivation, showing the proliferation of cerebral variants not detectable in peripheral blood.
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Affiliation(s)
- Juan M Burgos
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
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Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, Freilij H. Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother 2003; 52:441-9. [PMID: 12917253 DOI: 10.1093/jac/dkg338] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [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: 11/14/2022] Open
Abstract
OBJECTIVES This prospective study focused on the evaluation of anti-parasitic therapy in congenital Chagas' disease, diagnosed and monitored by PCR and conventional diagnosis. MATERIALS AND METHODS We studied 152 children born to seroreactive mothers, living in a non-endemic area. Fifty infants aged 0-6 months (GA) were diagnosed by microhaematocrit and PCR and 102 children aged 7 months to 17 years (GB) were diagnosed by serology and PCR. Forty treated patients were monitored for 2 or 3 years by PCR and conventional methods. A competitive-quantitative PCR was used to determine pre-therapy parasitic loads and follow their post-treatment evolution. RESULTS In GA, the sensitivities of the PCR and microhaematocrit were 100% and 82.4% and their specificities 97% and 100%, respectively. In GB, the sensitivity of the PCR was 73.8% with a specificity of 100%. Pre-therapy parasitic loads ranged from 12.5 to 125,000 and 12.5 to 125 parasite genomic equivalents/mL of blood in GA and GB, respectively. PCR turned negative in all treated pre-therapy PCR positive patients before or at the end of treatment, which was followed by their seronegativation in 10/10 GA, in 3/5 children initiating therapy at 7 months to 2 years of age but in 0/16 initiating therapy at an older age. Two out of the latter patients were occasionally PCR positive during post-treatment, suggesting no parasitological response. Out of nine pre-therapy PCR negative patients, four turned seronegative after treatment, suggesting that in undetermined patients, undetectable parasitic burdens may lead to better post-treatment prognosis. CONCLUSIONS PCR was useful for sensitive diagnosis and therapy monitoring, allowing early detection of refractory cases.
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Affiliation(s)
- Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular (INGEBI), Buenos Aires, Argentina.
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Stabilini L, Brigli G, Bonomo A, Bisio M, Zanni N, Camera P. [Access to the rectum via a posterior route and via a combined abdominal-posterior route: when and why]. MINERVA CHIR 1997; 52:499-502. [PMID: 9265139] [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: 02/05/2023]
Abstract
The authors report their experience of the posterior rectal access route. They used this route to operate 7 patients with rectal carcinoma during the period February 1989-October 1994; 3 patients were affected by villous adenoma, 3 by adenocarcinoma, and 1 by pelvic recidivation. Of the 3 patients suffering from adenocarcinoma, two underwent palliative treatment owing to their poor general conditions and the systemic nature of the base pathology, consisting in the exeresis of the tumour using a posterior route. The third patient was treated using a combined abdominal-posterior route; the site of the tumour and the presence of a narrow pelvis would in fact have made an "ultra low" front resection highly risky, whereas coloanal anastomosis (pull through) might have jeopardized efficacious anal continence. On the basis of their experience the authors indicate the posterior access route as a therapeutic possibility in the treatment of medium-low rectal tumours at an early or very advanced stage. The posterior approach is only justified in other forms if combined with laparotomic access. An oncologically correct operation is therefore guaranteed in full respect of sphincteric function.
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Affiliation(s)
- L Stabilini
- Divisione di Chirurgia Generale, USL 22 Ospedale S. Giacomo, Novi Ligure, Alessandria
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Stabilini L, Brigli G, Doria F, Ottria G, Bonomo A, Bisio M, Zanni N, Casablanca M. [Hepatic amebiasis. Apropos of two cases]. MINERVA GASTROENTERO 1996; 42:173-8. [PMID: 8924491] [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: 02/03/2023]
Abstract
The authors report 2 cases of amebic hepatic abscess, through to their observation with a little interval of time one from another and both coming from the same small town. Transmission modalities, the diagnostic approach and the therapeutic possibilities are discussed on the basis of personal experience.
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Affiliation(s)
- L Stabilini
- Ospedale S. Giacomo, Divisione di Chirurgia Generale, USL.22, Novi Ligure Alessandria
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Stabilini L, Arnone GB, Brigli G, Bisio M, Bonomo A, Semino G, Vitale B. [Malignant tumors of the pancreas and periampullary area. Our experience]. MINERVA CHIR 1995; 50:835-41. [PMID: 8684629] [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: 02/01/2023]
Abstract
The authors analyse and evaluate the clinical records of 45 patients treated in the last 4 years for pancreatic cancer and neoplasm of the bilioduodenapancreatic area, comparing the results with data available in the literature. In the group of patients treated with resection (12 cases), postoperative morbidity and mortality were respectively 28% and 6%, and three-years survival was 22%. The authors discuss particularly about reconstruction ways after duodenopancreatectomy, showing good results after reconstruction by Y loop sec. Roux and pancreato-jejunal anastomosis.
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Affiliation(s)
- L Stabilini
- Divisione di Chirurgia Generale, Ospedale San Giacomo, Novi Ligure
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Stabilini L, Brigli G, La Paglia V, Bonomo A, Bisio M, Arnone GB, Romagnoli GL, Zanni N. [Axillo-femoral bypass in the treatment of aorta prosthesis infection. A special case]. MINERVA CHIR 1994; 49:1019-23. [PMID: 7808658] [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: 01/27/2023]
Abstract
The authors report a case recently brought to their observation: T.A., a 77 year old patient, operated on in July 1990, for aortic aneurysm with axillo femoral by-pass. The patient was reoperated on the 5th day for ischaemic necrosis of the descending colon. In 1992 he was operated in another hospital for right iliac branch removal of the by-pass and performing of extra-anatomic bifemoral by-pass for right iliac branch infection of anatomic prosthesis. He was brought to our observation in March 1993, after the patient was refused in other Centres because of purulent abscess located near the aortic prosthesis and in the right iliac fossa, with a fistula to right superior anterior iliac crista. The patient was operated on in April 1993, with an explorative laparatomy to drain the abscess and to remove the aortic prosthesis. The aorta was sutured with closed bottom by means of delayed points. The postoperative course was regular and an arteriography performed three months after confirms the good running of the axillo-femoral by-pass and of the bifemoral one previously performed. The authors because of their experience and the bibliographical data underline the goodness of the axillo-femoral by-pass in serious infections of an aortic prosthesis.
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Affiliation(s)
- L Stabilini
- Divisione di Chirurgia Generale, USSL 73-Ospedale S. Giacomo, Novi Ligure, Alessandria
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Stabilini L, Brigli G, Doria F, Bisio M, Bonomo A, Camera PL, Maresca P. [Treatment of inguinal hernia in local anesthesia: our experience with the Shouldice surgical technique]. MINERVA CHIR 1993; 48:1097-101. [PMID: 8309608] [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: 01/29/2023]
Abstract
The authors present their personal experience in the surgical treatment of 256 cases of patients suffering from inguinal hernia, using the Shouldice technique in local anaesthesia. Minor incidence intra and postoperative complications compared with other types of anaesthesia, the possibility to converse with the patient during the operation and if necessary to invite him to cough in order to exclude the presence of other associated hernias or to assay the robustness and the resistance of the plastic, minor frequency of relapses compared with other operating techniques (1.5% in the Shouldice against 3% of the Bassini), and last but not least the possibility of early discharge from hospital and more swift resumption of work, confirm the full validity of this hernial plastic surgery.
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Affiliation(s)
- L Stabilini
- Divisione di Chirurgia Generale, Ospedale S. Giacomo, Novi Ligure, Alessandria
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Stabilini L, Brigli G, Doria F, Bonomo A, Bisio M. [The emergency treatment of perforated colonic diverticula]. MINERVA CHIR 1993; 48:989-92. [PMID: 8290153] [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: 01/29/2023]
Abstract
The authors report their experience of the treatment of 43 cases of perforated colonic diverticula. The operations were: 12 primary resections-anastomoses; 7 resections-anastomoses with protective colostomy; 2 operations of suture and drainage; 22 Hartmann's resections. The authors believe that Hartmann's resection is the operation of first choice in cases of diffuse or stercoraceous peritonitis. This operation another the removal of the sick part of intestines without exposing the patient to the possible complications of an operation "at risk", and allows a late recanalization destitute of risk: in our experience 13 cases of 22 (59%).
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Affiliation(s)
- L Stabilini
- Divisione di Chirurgia Generale, Ospedale S. Giacomo, Novi Ligure, Alessandria
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Stabilini L, Brigli G, Doria F, Bonomo A, Bisio M. [The "emergency" treatment of celiac trunk obliteration diagnosed during duodenocephalopancreatectomy. A case report]. MINERVA CHIR 1993; 48:955-9. [PMID: 7904736] [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: 01/27/2023]
Abstract
The authors report about a case of celiac axis obliteration, noticed during an operation of pancreaticoduodenectomy for pancreatic formation. The arterial flux of sovramesocolic district took place completely through the gastroduodenal artery. To complete the operation the authors were obliged to stop the circulation of the pancreaticoduodenal artery and to rivascular the common hepatic through bypass with aorta. The authors confirm the importance of arteriography for the study of expansive lesions of the pancreas, liable to surgical treatment as well to avoid treating urgently similar cases or due to anatomic variants.
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Affiliation(s)
- L Stabilini
- Divisione di Chirurgia Generale, Novi Ligure (Alessandria), USSL n. 73, Ospedale S. Giacomo
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