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Ledezma AP, Blandon R, Schijman AG, Benatar A, Saldaña A, Osuna A. Mixed infections by different Trypanosoma cruzi discrete typing units among Chagas disease patients in an endemic community in Panama. PLoS One 2020; 15:e0241921. [PMID: 33180799 PMCID: PMC7660484 DOI: 10.1371/journal.pone.0241921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023] Open
Abstract
Background Trypanosoma cruzi, the hemoparasite that causes Chagas disease, is divided into six Discrete Typing Units or DTUs: TcI-TcVI plus Tcbat. This genetic diversity is based on ecobiological and clinical characteristics associated with particular populations of the parasite. The main objective of this study was the identification of DTUs in patients with chronic chagasic infections from a mountainous rural community in the eastern region of Panama. Methods A total of 106 patients were tested for Chagas disease with three serological tests (ELISA, rapid test, and Western blot). Molecular diagnosis and DTU typing were carried out by conventional PCRs and qPCR targeting different genomic markers, respectively. As a control sample for the typing, 28 patients suspected to be chagasic from the metropolitan area of Panama City were included. Results Results showed a positivity in the evaluated patients of 42.3% (33/78); high compared to other endemic regions in the country. In the control group, 20/28 (71.43%) patients presented positive serology. The typing of samples from rural patients showed that 78.78% (26/33) corresponded to TcI, while 9.09% (3/33) were mixed infections (TcI plus TcII/V/VI). Seventy-five percent (15/20) of the patients in the control group presented TcI, and in five samples it was not possible to typify the T. cruzi genotype involved. Conclusions These results confirm that TcI is the main DTU of T. cruzi present in chronic chagasic patients from Panama. However, the circulation of other genotypes (TcII/V/VI) in this country is described for the first time. The eco-epidemiological characteristics that condition the circulation of TcII/V/VI, as well as the immune and clinical impact of mixed infections in this remote mountainous region should be investigated, which will help local action programs in the surveillance, prevention, and management of Chagas disease.
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Affiliation(s)
- Alexa Prescilla Ledezma
- Institute of Biotechnology, Department of Parasitology, University of Granada, Granada, Spain.,Center for Research and Diagnosis of Parasitic Diseases (CIDEP), Faculty of Medicine, University of Panama, Panama, Panama
| | | | - Alejandro G Schijman
- Laboratory of Molecular Biology of Chagas Disease, Institute of Research in Genetic Engineering and Molecular Biology "Dr Héctor Torres" (INGEBI-CONICET), Buenos Aires, Argentina
| | - Alejandro Benatar
- Laboratory of Molecular Biology of Chagas Disease, Institute of Research in Genetic Engineering and Molecular Biology "Dr Héctor Torres" (INGEBI-CONICET), Buenos Aires, Argentina
| | - Azael Saldaña
- Center for Research and Diagnosis of Parasitic Diseases (CIDEP), Faculty of Medicine, University of Panama, Panama, Panama.,Gorgas Memorial Institute of Health Studies (ICGES), Panama, Panama
| | - Antonio Osuna
- Institute of Biotechnology, Department of Parasitology, University of Granada, Granada, Spain
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Rodriguez IG, Loaiza JR. American trypanosomiasis, or Chagas disease, in Panama: a chronological synopsis of ecological and epidemiological research. Parasit Vectors 2017; 10:459. [PMID: 29017584 PMCID: PMC5634828 DOI: 10.1186/s13071-017-2380-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/14/2017] [Indexed: 01/03/2023] Open
Abstract
American trypanosomiasis, or Chagas disease, is a growing public health problem in Panama, and further forest degradation due to human population growth is expected to worsen the situation. Most people infected with the parasite Trypanosoma cruzi are silently ill, and their life expectancy is severely compromised, which contributes to further deterioration of living conditions in endemic regions. Here, we review the outcomes of nearly 100 years of ecological and epidemiological investigation about Chagas disease in Panama, in an attempt to highlight progress, identify needs, and re-orient future efforts. Rhodnius pallescens and Triatoma dimidiata are both primary vectors of T. cruzi in Panama, but R. pallescens seems more efficient in human-altered forest ecosystems due to a greater degree of association with Attalea butyracea. In contrast, T. dimidiata transmits T. cruzi efficiently under more sylvatic conditions (e.g. settlements inside old-growth or secondary forest patches), where its populations reach considerable numbers irrespective of the absence of A. butyracea. A trend of increasing forest degradation, suburbanization, and development of tourism in Panama favoring the establishment of A. butyracea and other palm tree species (Acrocomia sp.) suggests that a colonist species like R. pallescens will continue to play a more prominent role in the transmission of T. cruzi than a forest specialist like T. dimidiata. However, studies about the taxonomic status and ecology of these vectors are still needed in Panama to address their transmission potential fully. The implementation of an active surveillance system and education programs could greatly minimize the risk of Chagas disease transmission in Panama, preventing fatal infections in children from endemic areas.
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Affiliation(s)
- Indra G Rodriguez
- Instituto de Investigaciones Científicas & Servicios de Alta Tecnología, Ciudad del Saber, República de Panamá.,Programa Centroamericano de Maestría en Entomología, Universidad de Panamá, Panamá, República de Panamá
| | - Jose R Loaiza
- Instituto de Investigaciones Científicas & Servicios de Alta Tecnología, Ciudad del Saber, República de Panamá. .,Smithsonian Tropical Research Institute, Balboa Ancón, Republic of Panama. .,Programa Centroamericano de Maestría en Entomología, Universidad de Panamá, Panamá, República de Panamá.
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Saldaña A, Pineda V, Martinez I, Santamaria G, Santamaria AM, Miranda A, Calzada JE. A new endemic focus of Chagas disease in the northern region of Veraguas Province, Western Half Panama, Central America. PLoS One 2012; 7:e34657. [PMID: 22558095 PMCID: PMC3338824 DOI: 10.1371/journal.pone.0034657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 03/08/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chagas disease was originally reported in Panama in 1931. Currently, the best knowledge of this zoonosis is restricted to studies done in historically endemic regions. However, little is known about the distribution and epidemiology of Chagas disease in other rural areas of the country. METHODS AND FINDINGS A cross-sectional descriptive study was carried out between May 2005 - July 2008 in four rural communities of the Santa Fe District, Veraguas Province. The study included an entomologic search to collect triatomines, bloodmeal type identification and infection rate with trypanosomes in collected vectors using a dot- blot and PCR analysis, genotyping of circulating Trypanosoma cruzi (mini-exon gene PCR analysis) and the detection of chagasic antibodies among inhabitants. The vector Rhodnius pallescens was more frequently found in La Culaca and El Pantano communities (788 specimens), where it was a sporadic household visitor. These triatomines presented darker coloration and larger sizescompared with typical specimens collected in Central Panama. Triatoma dimidiata was more common in Sabaneta de El Macho (162 specimens). In one small sub-region (El Macho), 60% of the houses were colonized by this vector. Of the examined R. pallescens, 54.7.0% (88/161) had fed on Didelphis marsupialis, and 24.6% (34/138) of T. dimidiata specimens collected inside houses were positive for human blood. R. pallescens presented an infection index with T. cruzi of 17.7% (24/136), with T. rangeli of 12.5% (17/136) and 50.7% (69/136) were mixed infections. In 117 T. dimidiata domestic specimens the infection index with T. cruzi was 21.4%. Lineage I of T. cruzi was confirmed circulating in these vectors. A T. cruzi infection seroprevalence of 2.3% (24/1,056) was found in this population. CONCLUSIONS This is the first report of Chagas disease endemicity in Santa Fe District, and it should be considered a neglected public health problem in this area of Panama.
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Affiliation(s)
- Azael Saldaña
- Sección de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama City, Panama
- Centro de Investigación y Diagnóstico de Enfermedades Parasitarias (CIDEP), Facultad de Medicina, Universidad de Panama, Panama City, Panama
| | - Vanessa Pineda
- Sección de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama City, Panama
| | - Inri Martinez
- Centro de Salud de Santa Fe, Ministerio de Salud (MINSA), Santiago, Veraguas, Panama
| | - Giovanna Santamaria
- Hospital Dr. Luis Fabrega, Ministerio de Salud de Panamá (MINSA), Santiago, Veraguas, Panama
| | - Ana Maria Santamaria
- Sección de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama City, Panama
| | - Aracelis Miranda
- Sección de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama City, Panama
| | - Jose E. Calzada
- Sección de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama City, Panama
- * E-mail:
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Pineda V, Saldaña A, Monfante I, Santamaría A, Gottdenker N, Yabsley M, Rapoport G, Calzada J. Prevalence of trypanosome infections in dogs from Chagas disease endemic regions in Panama, Central America. Vet Parasitol 2011; 178:360-3. [DOI: 10.1016/j.vetpar.2010.12.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 12/15/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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Calzada JE, Pineda V, Garisto JD, Samudio F, Santamaria AM, Saldaña A. Human trypanosomiasis in the eastern region of the Panama Province: new endemic areas for Chagas disease. Am J Trop Med Hyg 2010; 82:580-2. [PMID: 20348502 DOI: 10.4269/ajtmh.2010.09-0397] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The epidemiology of Chagas disease was studied in five rural communities located in the eastern region of the Panama Province. Serological tests for Trypanosoma cruzi infection revealed a prevalence of 5.88% (12/204). Hemocultures coupled with polymerase chain reaction (PCR) analysis showed a Trypanosoma rangeli infection rate of 5.88% (12/204). An overall trypanosome infection index of 11.76% (24/204) was detected in this population. A total of 121 triatomine specimens were collected in domestic and peridomestic habitats. Rhodnius pallescens was confirmed as the predominant species. Molecular analysis showed that 17.8% (13/73) of the examined insects were positive for T. cruzi, 17.8% (13/73) for T. rangeli, and 35.6% (26/73) presented mixed infections. Among 73 R. pallescens evaluated, 16.4% (12/73) contained opossum blood meals. The epidemiological implications of these findings are discussed.
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Affiliation(s)
- José E Calzada
- Gorgas Memorial Institute of Health Studies, Panama, Republic of Panama.
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de Moraes MH, Guarneri AA, Girardi FP, Rodrigues JB, Eger I, Tyler KM, Steindel M, Grisard EC. Different serological cross-reactivity of Trypanosoma rangeli forms in Trypanosoma cruzi-infected patients sera. Parasit Vectors 2008; 1:20. [PMID: 18611261 PMCID: PMC2475519 DOI: 10.1186/1756-3305-1-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 07/08/2008] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED BACKGROUND American Trypanosomiasis or Chagas disease is caused by Trypanosoma cruzi which currently infects approximately 16 million people in the Americas causing high morbidity and mortality. Diagnosis of American trypanosomiasis relies on serology, primarily using indirect immunofluorescence assay (IFA) with T. cruzi epimastigote forms. The closely related but nonpathogenic Trypanosoma rangeli has a sympatric distribution with T. cruzi and is carried by the same vectors. As a result false positives are frequently generated. This confounding factor leads to increased diagnostic test costs and where false positives are not caught, endangers human health due to the toxicity of the drugs used to treat Chagas disease. RESULTS In the present study, serologic cross-reactivity between the two species was compared for the currently used epimastigote form and the more pathologically relevant trypomastigote form, using IFA and immunoblotting (IB) assays. Our results reveal an important decrease in cross reactivity when T. rangeli culture-derived trypomastigotes are used in IFA based diagnosis of Chagas disease. Western blot results using sera from both acute and chronic chagasic patients presenting with cardiac, indeterminate or digestive disease revealed similar, but not identical, antigenic profiles. CONCLUSION This is the first study addressing the serological cross-reactivity between distinct forms and strains of T. rangeli and T. cruzi using sera from distinct phases of the Chagasic infection. Several T. rangeli-specific proteins were detected, which may have potential as diagnostic tools.
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Affiliation(s)
- Milene H de Moraes
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
| | - Alessandra A Guarneri
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
- Instituto René Rachou, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana P Girardi
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
| | - Juliana B Rodrigues
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
| | - Iriane Eger
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
- Universidade do Vale do Itajaí, Itajaí, Santa Catarina, Brazil
| | - Kevin M Tyler
- Biomedical Research Centre, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, UK
| | - Mário Steindel
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
| | - Edmundo C Grisard
- Departamento de Microbiologia e Parasitologia, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, Santa Catarina, Brazil
- Biomedical Research Centre, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, UK
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Saldaña A, Samudio F, Miranda A, Herrera LM, Saavedra SP, Cáceres L, Bayard V, Calzada JE. Predominance of Trypanosoma rangeli infection in children from a Chagas disease endemic area in the west-shore of the Panama canal. Mem Inst Oswaldo Cruz 2006; 100:729-31. [PMID: 16410959 DOI: 10.1590/s0074-02762005000700008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A total of 206 serum samples from children (3-14 years old) living in the Amador County (La Chorrera District, Province of Panama) were screened by indirect immunofluorescence antibody test (IFAT) for the presence of antibodies against Trypanosoma cruzi. Positive sera were confirmed by recombinant enzyme-linked immunosorbent assay (ELISA) and Western blot analysis. The presence of blood trypanosomes was investigated by hemoculture and subsequently identify by a duplex polymerase chain reaction (PCR) followed by dot blot hybridization. The results indicated a prevalence of 9.7% for trypanosome infections, a seroprevalence of 2.9% against T. cruzi and a predominance of T. rangeli infection (6.8%). The immunological and clinical implications of these findings are discussed.
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Affiliation(s)
- Azael Saldaña
- Gorgas Memorial Institute of Health Studies, PO Box 0816-02593, Panama 5, Republic of Panama.
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Saldaña A, Harris RA, Orn A, Monroy C, Ortega-Barria E, Sousa OE. Antigenic significance of a Trypanosoma rangeli sialidase. J Parasitol 2002; 88:697-701. [PMID: 12197116 DOI: 10.1645/0022-3395(2002)088[0697:asoatr]2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Trypanosoma rangeli-secreted sialidase was purified by bovine submaxillary gland mucin-sepharose affinity chromatography. In immunoblotting analysis, antibodies raised against this molecule recognized polypeptides of 73 kDa in T. rangeli medium supernatant (TrSialr) and of 70 kDa in the cell lysates of T. rangeli (TrSials) and T. cruzi (TcSialL) epimastigotes. TrSialr, TrSials, and TcSialL were subjected to proteolytic cleavage with papain; the resultant peptide pattern displayed differences in the immunoblotting profiles. TrSials was purified by immunoprecipitation, and this protein band was recognized by sera from T. cruzi-infected chronic mice and Chagas' disease patients. In contrast, TrSialr was not recognized by these sera. The antibodies from the infected mice also recognized a band of 70 kDa present in the medium. These preliminary observations imply that the released and somatic sialidases are partially different molecules, with probably different biological roles. The related proteins recognized in T. rangeli and T. cruzi epimastigotes share many antigenic characteristics but have some structural differences, probably related to their function in the parasitic cell. On the basis of the strong antigenicity of TrSials, this molecule is proposed as the antigen for the detection of antibodies arising during T. cruzi infection.
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Affiliation(s)
- Azael Saldaña
- Center for Research and Diagnosis of Parasitic Diseases (CIDEP), Faculty of Medicine, University of Panama, Panama
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Brenière SF, Bosseno MF, Noireau F, Yacsik N, Liegeard P, Aznar C, Hontebeyrie M. Integrate study of a Bolivian population infected by Trypanosoma cruzi, the agent of Chagas disease. Mem Inst Oswaldo Cruz 2002; 97:289-95. [PMID: 12048553 DOI: 10.1590/s0074-02762002000300002] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cross section of a human population (501 individuals) selected at random, and living in a Bolivian community, highly endemic for Chagas disease, was investigated combining together clinical, parasitological and molecular approaches. Conventional serology and polymerase chain reaction (PCR) indicated an active transmission of the infection, a high seroprevalence (43.3%) ranging from around 12% in < 5 years to 94.7% in > 45 years, and a high sensitivity (83.8%) and specificity of PCR. Abnormal ECG tracing was predominant in chagasic patients and was already present among individuals younger than 13 years. SAPA (shed acute phase antigen) recombinant protein and the synthetic peptide R-13 were used as antigens in ELISA tests. The reactivity of SAPA was strongly associated to Trypanosoma cruzi infection and independent of the age of the patients but was not suitable neither for universal serodiagnosis nor for discrimination of specific phases of Chagas infection. Anti-R-13 response was observed in 27.5% only in chagasic patients. Moreover, anti-R13 reactivity was associated with early infection and not to cardiac pathology. This result questioned previous studies, which considered the anti-R-13 response as a marker of chronic Chagas heart disease. The major clonets 20 and 39 (belonging to Trypanosoma cruzi I and T. cruzi II respectively) which circulate in equal proportions in vectors of the studied area, were identified in patients' blood by PCR. Clonet 39 was selected over clonet 20 in the circulation whatever the age of the patient. The only factor related to strain detected in patients' blood, was the anti-R-13 reactivity: 37% of the patients infected by clonet 39 (94 cases) had anti-R13 antibodies contrasting with only 6% of the patients without clonet 39 (16 cases).
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Saldaña A, Sousa OE, Orn A, Harris RA. Trypanosoma rangeli sialidase: kinetics of release and antigenic characterization. Acta Trop 1998; 70:87-99. [PMID: 9707367 DOI: 10.1016/s0001-706x(98)00020-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The epimastigote stage of Trypanosoma rangeli release a sialidase with a high sialic acid hydrolysis capacity. We demonstrate that sialidase secretion is an active process that is reduced at low temperatures and in the presence of sodium azide. The enzyme is continuously released until certain maximally active concentrations are attained in the BHI culture medium when the parasite density reaches 2-3 x 10(6) cells. When introduced into culture medium already containing such enzyme levels, freshly harvested parasites do not secrete additional sialidase. These findings suggest a self-regulating mechanism and a biological role for the secreted T. rangeli sialidase. The secreted enzyme was purified to homogeneity by fractionation with ammonium sulphate and affinity chromatography. Antibodies raised against the purified molecule recognized antigens of similar molecular weights (73 kDa) in western immunoblotting analyses of T. rangeli and T. cruzi whole cell lysates. No antigenic recognition was recorded against T. cruzi active sialidase/trans-sialidase polypeptides or Clostridium perfringens and Vibrio cholerae commercial sialidases. These observations may indicate the expression of different antigenic domains in T. rangeli, T. cruzi and bacterial sialidases.
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Affiliation(s)
- A Saldaña
- Center for Research and Diagnosis of Parasitic Diseases (CIDEP), Faculty of Medicine, University of Panama
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Cuba Cuba A. [Review of the biologic and diagnostic aspects of Trypanosoma (Herpetosoma) rangeli]. Rev Soc Bras Med Trop 1998; 31:207-20. [PMID: 9608240 DOI: 10.1590/s0037-86821998000200007] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This review has three objectives: a) To stimulate further research of this prevalent human infection b) to examine the progress of current diagnostic techniques and c) to emphasise the significance of the flagellate parasite Trypanosoma (Herpetosoma) rangeli in Chagas' Disease endemic areas of South and Central America. Both Trypanosoma rangeli and Trypanosoma cruzi overlap in many of the areas of Latin America utilising the same triatomine vectors. Also a vast range of mammalian species have been found naturally infected with T. rangeli. The biology of the parasitism of T. rangeli is revised and emphasis is given regarding its biological cycle. T. cruzi and T. rangeli share common antigens and cross react serologically. Human infection in the chronic phase may be misdiagnosed as T. cruzi infection. Conventional and modern diagnostic and identification methods are discussed. Unfortunately we do not know the real distribution of T. rangeli infections in most areas and epidemiological studies to examine concomitant dual infections deserve further investigation.
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Affiliation(s)
- A Cuba Cuba
- Departamento de Patologia, Universidade de Brasilia, DF, Brasil
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