Estimating the current burden of Chagas disease in Mexico: A systematic review and meta-analysis of epidemiological surveys from 2006 to 2017

One health research to mitigate health burden of American trypanosomiasis in Mexico

American trypanosomiasis (AT), or Chagas disease, is an ancient disease with an interesting history. Despite efforts to control AT, the global burden of this neglected vector-borne disease persists. More than six million people around the world are infected with Trypanosoma cruzi (T. cruzi), and about 75 million are at risk of infection in the Americas. Mexico is one of the countries most affected by AT with 4 million people at risk of infection with T. cruzi. Approximately 60 % of the accumulated confirmed cases occurred in the southeast region; however, an increase in the number of cases was observed in the northern states of the country in recent years. AT control efforts in Mexico focus on interrupting vector-borne disease transmission through integrated triatomine management and eliminating T. cruzi transmission through the congenital and blood transfusion routes. There is no specific prophylaxis beyond vector control. Research revealed the complexity of AT as a vector-borne disease system and its impact on the health of humans, domestic animals, and wildlife, which calls for comprehensive responses focused on transdisciplinary and multisectoral collaboration. One Health (OH) is an unifying approach aiming to achieve optimal health outcomes among people, animals, and their shared environment, which we suggest can be applied in collaborative research to enhance our understanding of AT as a vector-borne disease system with diverse components across epidemiological landscapes. Suggested action to implement OH research is presented herein for sustainable surveillance and control efforts to mitigate the health burden of AT that affects disproportionately poorer rural and semi-rural sectors of the population in Mexico and other Latin American countries.

Serological determination of Trypanosoma cruzi in northern region of the State of Mexico

Chagas disease, caused by Trypanosoma cruzi, remains a significant public health problem in Mexico, particularly challenging to diagnose during its chronic phase, due to low parasitemia and the complex immune response. According to the Pan American Health Organization, no single test is sufficiently sensitive or specific to reliably detect chronic Chagas disease, requiring the use of multiple serological methods when results are inconclusive. This study aimed to assess the seroprevalence of Chagas disease in the largely uncharted municipalities of the North of State of Mexico. A total of 250 serum samples from 17 municipalities were analyzed using a comprehensive approach involving three serological tests: the BIO-CHAGAS commercial kit (MEXLAB®), an ELISA test with antigens derived from an endemic strain, and a confirmatory Western blot analysis. The results revealed that 240 samples were negative, 3 were inconclusive, and 7 were positive, yielding a seroprevalence rate of 2.8% (7/250). The endemicity demonstrated in the municipalities of Hueypoxtla and Tequixquiac, combined with the documented presence of the vector Triatoma barberi in these areas, suggests an ongoing risk of T. cruzi transmission. These findings underscore the urgent need for targeted public health interventions, including increased surveillance, community awareness, vector control programs, screening tests to identify cases, and prompt treatment, to curb the spread of Chagas disease in this region.

Expression Analysis of Thirteen Genes in Response to Nifurtimox and Benznidazole in Mexican Isolates of Trypanosoma cruzi by Digital PCR

Despite being the most relevant and critical option for managing Chagas disease, pharmacological therapy is currently limited by the availability of only two drugs, benznidazole and nifurtimox. Their effectiveness is further restricted in the chronic phase of the infection, as they induce severe side effects and require prolonged treatment. Additionally, the use of these drugs can lead to the emergence of substantial resistance problems, compounded by the potential natural resistance of some parasite isolates. This study analyzes the expression of 13 genes by digital PCR in four Mexican T. cruzi isolates treated with NFX and BZN. Each isolate exhibited a unique combination of enzyme expression in response to the oxidative stress induced by the antichagasic agents. Notably, we observed the overexpression of cruzipain (CZP), L-threonine dehydrogenase (TDH), and detoxification-related enzymes such as Glutathionyl spermidine synthetase (GST) and Superoxide dismutase-A (SOD). These findings highlight the need for further studies to elucidate the molecular mechanisms underlying this resistance, which pose both unexpected challenges for Chagas disease therapy and a biological barrier to the action of these drugs. These findings highlight the need for further studies to understand how these resistance mechanisms contribute to treatment failure and constitute a biological barrier to drug action.

Glycosylation Patterns in Meccus (Triatoma) pallidipennis Gut: Implications for the Development of Vector Control Strategies

The primary mode of transmission for Chagas disease is vector-borne transmission, spread by hematophagous insects of the Triatominae subfamily. In Mexico, the triatomine Meccus pallidipennis is particularly significant in the transmission of Trypanosoma cruzi. This study focused on analyzing protein expression and modifications by glycosylation in different regions of the digestive tract of fifth-instar nymphs of M. pallidipennis. Two gut sections were dissected and extracted: the anterior midgut (AMG) and the proctodeum or rectum (RE). Proteins were extracted from each tissue sample and profiled by one- and two-dimensional electrophoresis; protein glycosylation was analyzed by lectin affinity. Our results showed significant differences in protein expression and glycosylation between both gut regions, with modifications being more frequent in the RE. The proteins HSP70, actin, and tubulin were analyzed, finding a differential expression of the latter two between AMG and RE. Understanding glycosylation patterns provides critical insights into vector-pathogen interactions that could eventually inform novel control approaches. Furthermore, the potential use of lectins as insecticidal agents highlights the broader implications of glycoprotein research in the future development of strategies on vector control to disrupt T. cruzi transmission.

Presence of Trypanosoma cruzi (TcI) in different tissues of Didelphis virginiana from the metropolitan area of Merida, southeastern Mexico: Epidemiological relevance and implications for non-vector transmission routes

BACKGROUND

Trypanosoma cruzi is mainly transmitted to mammals by vectors, but other transmission routes exist. For example, opossums can harbor the infectious form of the parasite in their anal glands, underscoring their potential role in non-vectorial transmission. T. cruzi has been detected in the anal gland secretions of various opossum species, and their infectivity has been confirmed in Didelphis marsupialis and D. albiventris. Vertical transmission has also been proposed in D. virginiana. However, if this occurs in opossums, it remains unclear whether it happens during pregnancy or lactation. In Mexico, Didelphis virginiana and D. marsupialis are the main opossum species. Our objective was to investigate the possible contribution of urban opossums to non-vectorial transmission of T. cruzi in the metropolitan area of Merida, Yucatan, in southeastern Mexico.

METHODOLOGY/PRINCIPAL FINDINGS

Blood, anal gland secretions, and milk were collected from opossums captured in Merida, Mexico, all identified as D. virginiana using taxonomic keys and Cytb sequencing. By PCR, T. cruzi was detected in 16/102 opossums (15.69%) in at least one type of sample. The prevalence was 14.71% (15/102) in blood and 0.98% (1/102) in anal gland secretions. 1/22 milk samples (4.55%) tested positive. Blood of 37 offspring from T. cruzi-positive mothers was collected and tested negative. qPCR revealed that females with offspring tended to have lower parasite load in blood compared to females without offspring and males. Genotyping of the parasite through multiplex PCR revealed only the DTU TcI.

CONCLUSIONS/SIGNIFICANCE

This study agrees with previous works where D. virginiana was the most abundant opossum species in urban areas in southeastern Mexico and confirms that it is associated with TcI. Detection of T. cruzi in a sample of anal gland secretions underscores the potential risk represented by D. virginiana in non-vectorial transmission in urban areas of southeastern Mexico. Detection in the milk of a lactating female, along with the observed tendency towards a lower parasite load in females with offspring, highlight the importance of further investigating vertical transmission in D. virginiana.

Prevalence of Trypanosoma cruzi Infection in Pregnant Women and Risk of Vertical Transmission in Newborns in Chiapas, Mexico

The Mexican state of Chiapas is considered epidemiologically significant for Chagas disease due to the coexistence of infected reservoirs and vectors, including migratory populations from Central and South America. However, there is a lack of monitoring programs for the timely detection of this disease. The objective of this study was to elucidate the prevalence of Trypanosoma cruzi infection in pregnant women and the risk of vertical transmission in newborns at two hospitals located in the Metropolitan Region of Tuxtla Gutierrez, the capital of Chiapas State Mexico. A cross-sectional study was carried out with 193 pregnant women with gestational ages between 32 and 40 weeks, who underwent immunological testing to diagnose Chagas disease. Conventional PCR testing on cord blood revealed the presence of T. cruzi in newborns. The prevalence of T. cruzi infection in pregnant women was 32.12% (95% confidence interval (CI): 0.25, 0.38). The 62 pregnant women who tested positive for Chagas disease gave birth to 63 children, and in 5 newborns (8% (5/62), 95% confidence interval (CI): 0.02, 0.19), PCR tests on umbilical cord blood were positive for T. cruzi. In conclusion, the dataset showed a high prevalence of Chagas disease in the sample of pregnant women studied and a maternal-fetal transmission rate of 8%.

Diagnostic differences in high-resolution esophageal motility in a large Mexican cohort based on geographic distribution

High-resolution esophageal manometry [HRM] has become the gold standard for the evaluation of esophageal motility disorders. It is unclear whether there are HRM differences in diagnostic outcome based on regional or geographic distribution. The diagnostic outcome of HRM in a diverse geographical population of Mexico was compared and determined if there is variability in diagnostic results among referral centers. Consecutive patients referred for HRM during 2016-2020 were included. Four major referral centers in Mexico participated in the study: northeastern, southeastern, and central (Mexico City, two centers). All studies were interpreted by experienced investigators using Chicago Classification 3 and the same technology. A total of 2293 consecutive patients were included. More abnormal studies were found in the center (61.3%) versus south (45.8%) or north (45.2%) P < 0.001. Higher prevalence of achalasia was noted in the south (21.5%) versus center (12.4%) versus north (9.5%) P < 0.001. Hypercontractile disorders were more common in the north (11.0%) versus the south (5.2%) or the center (3.6%) P.001. A higher frequency of weak peristalsis occurred in the center (76.8%) versus the north (74.2%) or the south (69.2%) P < 0.033. Gastroesophageal junction obstruction was diagnosed in (7.2%) in the center versus the (5.3%) in the north and (4.2%) in the south p.141 (ns). This is the first study to address the diagnostic outcome of HRM in diverse geographical regions of Mexico. We identified several significant diagnostic differences across geographical centers. Our study provides the basis for further analysis of the causes contributing to these differences.

Presence of Trypanosoma cruzi TcI and Trypanosoma dionisii in sylvatic bats from Yucatan, Mexico

BACKGROUND

Chagas disease is caused by Trypanosoma cruzi, whose genetic structure is divided into six discrete typing units (DTUs) known as TcI-TcVI. In the Yucatan Peninsula, Mexico, information regarding the DTUs circulating in wild mammals is scarce, while this is important knowledge for our understanding of T. cruzi transmission dynamics.

METHODS

In the current study, we sampled wild mammals in a sylvatic site of the Yucatan Peninsula and assessed their infection with T. cruzi by PCR. Then, for infected mammals, we amplified and sequenced nuclear and mitochondrial T. cruzi genetic markers for DTU identification.

RESULTS

In total, we captured 99 mammals belonging to the orders Chiroptera, Rodentia and Didelphimorphia. The prevalence of infection with T. cruzi was 9% (9/99; 95% CI [5, 16]), and we identified TcI in a Jamaican fruit bat, Artibeus jamaicensis. Moreover, we fortuitously identified Trypanosoma dionisii in another Jamaican fruit bat and detected an unidentified Trypanosoma species in a third specimen. While the latter discoveries were not expected because we used primers designed for T. cruzi, this study is the first to report the identification of T. dionisii in a bat from Yucatan, Mexico, adding to a recent first report of T. dionisii in bats from Veracruz, and first report of this Trypanosoma species in Mexico.

CONCLUSION

Further research is needed to enhance our knowledge of T. cruzi DTUs and Trypanosoma diversity circulating in wildlife in Southeastern Mexico.

Life history data of four populations of Triatoma mexicana (Hemiptera: Reduviidae) from Central Mexico

Triatomine bugs are vectors for the Trypanosoma cruzi Chagas parasites, the etiological agent for Chagas disease. This study evaluated 6 epidemiologically significant behaviors (development time, number of blood meals required for molting to the next instar, mortality rate, aggressiveness, feeding duration, and defecation delay) across 4 populations of Triatoma mexicana Herrich-Schaeffer (Heteroptera: Reduviidae), a major T. cruzi vector in Central Mexico. We collected triatomines from areas characterized by high (HP), medium (MP), medium-high (MHP), and low (LP) prevalence of human T. cruzi infection. The MHP population had the shortest development time, <290 days. Both the HP and MP populations required the most blood meals to molt to the next instar, with a median of 13. Mortality rates varied across all populations, ranging from 44% to 52%. All of the tested populations showed aggressive behavior during feeding. All populations shared similar feeding durations, with most exceeding 13 min and increasing with each instar. Quick defecation, during feeding, immediately after or less than 1 min after feeding, was observed in most nymphs (78%-90%) from the MP and MHP populations and adults (74%-92%) from HP, MP, and MHP populations. Though most parameters suggest a low potential for T. mexicana to transmit T. cruzi, unique feeding and defecation behaviors in 3 populations (excluding the LP group) could elevate their epidemiological importance. These population-specific differences may contribute to the varying prevalence rates of T. cruzi infection in areas where T. mexicana is found.

Trypanosoma cruzi in Wild and Synanthropic Mammals in Two Regions of Mexico: A Fieldwork and Genetic Discrete Typing Unit Review

Background: Marsupials and rodents are the most important wild and synanthropic hosts of Trypanosoma cruzi due to the high frequency of infection, maintenance of diverse genetic populations of the parasite, and their close proximity to interact with both transmission cycles, sylvatic and peridomestic. Our aim was to identify the discrete typing units (DTU) of T. cruzi from different wild and synanthropic hosts in two regions of Mexico and to carry out a review of historical data focusing on current knowledge on the diversity and T. cruzi DTUs of host species. Materials and Methods: One hundred fifteen samples were obtained from two areas in Tabasco and Nayarit state. The presence of T. cruzi was evaluated by PCR. Results: The 12.6% (12/95) of samples from Tabasco and 65% (13/20) from Nayarit were found to be positive for parasite DNA. All the sequences analyzed were grouped in T. cruzi DTU I; low nucleotide diversity was observed in Tabasco (π = 0.00566, and ϴ = 0.00632), while high genetic diversity was observed in Nayarit sequences, up to 8.63 (π) to 11.10 (ϴ) times greater than Tabasco sequences. Genetic flow and migration between Tabasco, and Nayarit were scarce (FST = 0.37329 and Nm = 0.42), and genetic exchange was observed only between nearby areas. The bibliographic review of hosts in Mexico, together with our data, shows a heterogeneous T. cruzi prevalence in Chiroptera and domestic animals. For Atelidae and Canids, prevalence is generally below 25%. However, a high prevalence, greater than 25% and up to 100%, was recorded in Didelphimorphia, and Rodentia. Few studies in regions of Mexico have been described as infected with the parasite; in these, the genetic group with the highest prevalence is the DTU I. Conclusion: Marsupials and rodents are important reservoirs of T. cruzi; DTU I was frequently reported; however, recent genetic and reservoir studies have demonstrated the presence of greater diversity of genetic groups.

Domestic Dog Infection with Trypanosoma cruzi from Northern and Southern Regions of Mexico

Background: Chagas disease or American trypanosomiasis, caused by Trypanosoma cruzi and vectored by triatomines, affects millions of people worldwide. In endemic countries including Mexico, infections in domestic animals, such as dogs, may affect the risk of human disease when they serve as a source of infection to vectors that subsequently infect humans. Materials and Methods: We conducted a cross-sectional study of 296 dogs from two cities near the northern and southern borders of Mexico: Reynosa, Tamaulipas, and Tuxtla Gutierrez, Chiapas. Infection was measured based on testing of blood using T. cruzi quantitative PCR (qPCR) and up to three antibody detection assays. The StatPak immunochromatographic assay was used to screen samples and the indirect fluorescent antibody (IFA) and multiplex microsphere immunoassay (MIA) tests were used as secondary tests on all samples that screened positive and a subset of negatives. Serologic positivity was defined based on reactivity on at least two independent tests. Results: Of the 280 samples tested for parasite DNA, two (0.7%) were positive, one of which (0.4%) was confirmed as T. cruzi discrete typing unit TcIV. Overall, 72 (24.3%) samples were reactive for T. cruzi antibodies via StatPak of which 8 were also positive using MIA and 2 were also positive using IFA (including one of the PCR-positive dogs). Overall, nine dogs (3.4%) met study criteria of positivity based on either/both serology or PCR tests. Positive dogs were found in both regions of Mexico; five (2.7%) from Reynosa and four (3.6%) from Tuxtla Gutierrez. We found no association between infection status and state of origin, sex, age group, breed group, neighborhood, and whether other pets lived in the home. Conclusion: Our results re-emphasize dogs' utility as sentinels for T. cruzi in Mexico and underscore the need for improved veterinary diagnostic tests and parasite surveillance at the household level in endemic countries.

Behavioral and biological parameters of six populations of Triatoma pallidipennis (Heteroptera: Reduviidae) from areas with high and low prevalence rates of Trypanosoma cruzi human infection

In Mexico, more than 30 species of triatomines, vectors of Trypanosoma cruzi, the etiological agent of Chagas disease, have been collected. Among them, Triatoma pallidipennis stands out for its wide geographical distribution, high infection rates and domiciliation. Local populations of triatomines have shown notable biological and behavioral differences, influencing their vectorial capacity. Six behaviors of epidemiological importance, namely, egg-to-adult development time, median number of blood meals to molt to the next instar, instar mortality rates, aggressiveness (delay in initiating a meal), feeding time and defecation delay, were evaluated in this study for six populations of T. pallidipennis. Those populations from central, western and southern Mexico were arranged by pairs with a combination of high (HP) and medium (MP) of Trypanosoma cruzi human infection and most (MFC) and low (CLF) collection frequencies: HP/MFC, HP/CLF, and MP/MFC. The development time was longer in HP/CLF populations (> 220 days). The median number of blood meals to molt was similar (7-9) among five of the six populations. Mortality rates were greater (> 40 %) in HP/CLF and one MP/MFC populations. All studied populations were aggressive but exhibited slight differences among them. The feeding times were similar (≥ 10 min) for all studied populations within instars, increasing as instars progressed. An irregular pattern was observed in defecation behaviors, with marked differences even between the two populations from the same pair. High percentages of young (57.3-87.9 %), and old (62.4-89.8 %) nymphs, of female (61.1-97.3 %) and male (65.7-93.1 %) of all the studied populations defecated quickly (while eating, immediately after finishing feeding or < 1 min postfeeding). Our results indicate that the HP/MFC populations are potentially highly effective vectors for transmitting T. cruzi infections, while HP/CLF populations are potentially less effective vectors T. cruzi infections.

Tumor-Suppressive Cross-Linking of Anti-T. cruzi Antibodies in Acute Lymphoblastic Leukemia

Parasites have been associated with possible anticancer activity, including Trypanosoma cruzi, which has been linked to inhibiting the growth of solid tumors. To better understand this antitumor effect, we investigated the association of anti-T. cruzi antibodies with B cells of the acute lymphoblastic leukemia (ALL) SUPB15 cell line. The antibodies were generated in rabbits. IgGs were purified by affinity chromatography. Two procedures (flow cytometry (CF) and Western blot(WB)) were employed to recognize anti-T. cruzi antibodies on SUPB15 cells. We also used CF to determine whether the anti-T. cruzi antibodies could suppress SUPB15 cells. The anti-T. cruzi antibodies recognized 35.5% of the surface antigens of SUPB15. The complement-dependent cytotoxicity (CDC) results demonstrate the cross-suppression of anti-T. cruzi antibodies on up to 8.4% of SUPB15 cells. For the WB analysis, a band at 100 kDa with high intensity was sequenced using mass spectrometry, identifying the protein as nucleolin. This protein may play a role in the antitumor effect on T. cruzi. The anti-T. cruzi antibodies represent promising polyclonal antibodies that have the effect of tumor-suppressive cross-linking on cancer cells, which should be further investigated.

Prevalence and transmission of the most relevant zoonotic and vector-borne pathogens in the Yucatan peninsula: A review

BACKGROUND

Habitat modification and land use changes impact ecological interactions and alter the relationships between humans and nature. Mexico has experienced significant landscape modifications at the local and regional scales, with negative effects on forest cover and biological biodiversity, especially in the Yucatan peninsula in southeastern Mexico. Given the close relationship between landscape modification and the transmission of zoonotic and vector-borne diseases, it is essential to develop criteria for identifying priority zoonoses in the south of the country.

METHODOLOGY/PRINCIPAL FINDINGS

We reviewed 165 published studies on zoonotic and vector-borne diseases in the region (2015-2024). We identified the most frequent vectors, reservoirs, and hosts, the most prevalent infections, and the factors associated with transmission risk and the anthropogenic landscape modification in urban, rural, ecotone, and sylvatic habitats. The most relevant pathogens of zoonotic risk included Trypanosoma cruzi, arboviruses, Leishmania, Rickettsia, Leptospira, and Toxoplasma gondii. Trypanosoma cruzi was the vector-borne agent with the largest number of infected vertebrate species across habitats, while Leishmania and arboviruses were the ones that affected the greatest number of people. Dogs, cats, backyard animals, and their hematophagous ectoparasites are the most likely species maintaining the transmission cycles in human settlements, while rodents, opossums, bats, and other synanthropic animals facilitate connection and transmission cycles between forested habitats with human-modified landscapes. Pathogens displayed different prevalences between the landscapes, T. cruzi, arbovirus, and Leptospira infections were the most prevalent in urban and rural settlements, whereas Leishmania and Rickettsia had similar prevalence across habitats, likely due to the diversity and abundance of the infected vectors involved. The prevalence of T. gondii and Leptospira spp. may reflect poor hygiene conditions. Additionally, results suggest that prevalence of zoonotic and vector-borne diseases is higher in deforested areas and agricultural aggregates, and in sites with precarious health and infrastructure services.

CONCLUSIONS

Some hosts, vectors, and transmission trends of zoonotic and vector-borne diseases in the YP are well known but others remain poorly recognized. It is imperative to reinforce practices aimed at increasing the knowledge, monitoring, prevention, and control of these diseases at the regional level. We also emphasize the need to perform studies on a larger spatio-temporal scale under the socio-ecosystem perspective, to better elucidate the interactions between pathogens, hosts, vectors, environment, and sociocultural and economic aspects in this and many other tropical regions.

Seroprevalence of Trypanosoma cruzi among children from Veracruz, Mexico: Epidemiological baseline for a control model based on Chagas disease active transmission

Introduction. In 2021, the Secretaría de Salud de México and the Pan American Health Organization launched an initiative to interrupt intra-domiciliary vector transmission of Trypanosoma cruzi based on the prevalence of Chagas disease in children. The Mexican State of Veracruz was leading this initiative. Objective. To estimate the seroprevalence of T. cruzi infection among children under 15 years of age from rural areas of Veracruz, México. Materials and methods. We identified eight localities of high priority from the Municipality of Tempoal, Veracruz, for baseline serology. Blood samples were collected on filter paper from 817 individuals between June and August 2017, for screening with a third-generation enzyme immunoassay. Reactive cases were confirmed by indirect hemagglutination, enzyme-linked immunosorbent assay, and indirect immunofluorescence tests on peripheral blood serum samples. We calculated seroprevalence and 95% confidence intervals (CI). Results. We confirmed Chagas disease cases in children under 15 years of age with a seroprevalence of 1,9% (95 % CI = 1,12-3,16) in the localities of Citlaltepetl, Cornizuelo, Cruz de Palma and Rancho Nuevo. Conclusions. These results indicate recent transmission of T. cruzi in these communities and allow to establish an epidemiological baseline for the design and implementation of a model focused on geographical areas with active transmission to advance toward the elimination of intra-domiciliary vector transmission of this parasite in Mexico.

Mapping the Silent Threat: A Comprehensive Analysis of Chagas Disease Occurrence in Riverside Communities in the Western Amazon

Chagas disease (CD) is a typical tropical illness caused by Trypanosoma cruzi. The objective of this study was to assess the prevalence of Chagas disease in communities in two states of the Brazilian Amazon. Data collection occurred in July in the Alto Juruá region of Acre and in December in the communities of Humaitá, Amazonas, in 2019. A total of 477 participants were included in the study. In the communities of Alto Juruá, triatomine collections and analyses of T. cruzi infection were also carried out. All confirmed cases were found in the state of Acre, resulting in a total prevalence of 1.67. Of these eight cases, seven underwent ECG, all of which were concluded as normal by the physician team's cardiologists. Seventeen triatomine bugs, all belonging to the Rhodnius genus, were captured. The natural infection rate by T. cruzi was 25% in the Nova Cintra community and 66.67% in the Boca do Moa community (Alto Juruá). This research found that more than 1% of the studied population exhibited positive serological results for Chagas disease in the riverine communities during the study period, representing a small portion of cases among those who have not yet been diagnosed.

Trapping Triatominae Bugs Using Mice-Baited Traps along the Peninsula of Baja California, Mexico

During an exploratory fieldtrip along the peninsula of Baja California, Mexico, we used mice-baited traps in search of Triatominae, the vectors of Chagas disease. A total of 433 traps were set in five localities following a latitude gradient along the peninsula. Triatominae were caught in rocky ecotopes in two localities. The specimens were identified as Paratriatoma hirsuta in the first locality, and Dipetalogaster maxima in the second, in accordance with the reported distributions of these species. The overall trap success was 3.1%, with an average of 1.3 bugs per positive trap. In the site with most bugs collected, trap success was 26.8%. To the best of our knowledge, this is the first time that mice-baited traps have been used in this geographic area to collect Triatominae bugs. This short report confirms the usefulness of this trapping system when standardized protocols are needed.

Temporal variation of Triatoma dimidiata abundance and infection with Trypanosoma cruzi in domestic and sylvatic habitats of rural Yucatan, Mexico

In the Yucatan Peninsula, Mexico, Triatoma dimidiata is the main vector of Chagas disease. This is a native species in the region that principally inhabits sylvatic habitats. Nevertheless, it shows a tolerant behavior to anthropogenic disturbance, with adult bugs frequently infesting human dwellings, principally during the warm and dry season. Yet, whether the temporal variation of abundance is independent of the habitat and how this is related to the infection rate with Trypanosoma cruzi in Yucatan is still poorly understood. The objective of this study was to simultaneously analyze the temporal variations of T. dimidiata abundance and infection with T. cruzi in domestic and sylvatic habitats from two localities of rural Yucatan (Sudzal, 20°52'19″N, 88°59'20″W and Teya, 21°02'55″N, 89°04'25″W) to help for the further improvement of locally adapted strategies aimed at controlling T. cruzi vector transmission. Using community participation and a combination of different trapping techniques, we collected T. dimidiata bugs during 29 consecutive months within domestic and sylvatic habitats. We then assessed by PCR the infection of the bugs with T. cruzi. Generalized linear models were used to evaluate the effect of climatic variables on the abundance of T. dimidiata and the effect of bug sex, season and habitat on the prevalence of infection with T. cruzi. Overall, 3640 specimens of T. dimidiata were collected. We clearly observed peaks of maximum abundance in both habitats during the warm and dry season and found a negative association of bug abundance with relative humidity. The overall prevalence of infection of the bugs with T. cruzi was 15.2 %. Additionally, bugs collected in domestic habitats displayed a significantly higher prevalence of infection than sylvatic bugs (19.6% vs. 6.1 %, respectively), suggesting an increased risk of T. cruzi transmission related with anthropogenic disturbance. Our study is the first to describe the annual pattern of abundance of T. dimidiata in sylvatic habitats of rural Yucatan and constitutes a contribution to the knowledge of T. dimidiata ecology and of T. cruzi transmission cycle dynamics in the region. In Yucatan, where the use of mosquito nets has shown to be effective to limit human dwelling infestation by T. dimidiata, reinforcing the awareness of local residents about the increased risk of T. cruzi transmission during the warm and dry season when realizing activities in the sylvatic ambient should be, among others, also considered to improve control strategies and limit the risk of vector transmission.

Effectiveness of Systemic Insecticide Dog Treatment for the Control of Chagas Disease in the Tropics

Chagas disease, caused by Trypanosoma cruzi and transmitted by triatomines, can lead to severe cardiac issues and mortality in many mammals. Recent studies have shown that systemic insecticide treatment of dogs is highly effective in killing triatomines. Here, we assessed the impact of dog treatment on T. cruzi transmission. We developed a mathematical model of T. cruzi transmission among triatomines, dogs, humans, and rodents. We used the model to evaluate the impact of dog treatment regimens on T. cruzi transmission dynamics to determine their effectiveness in reducing T. cruzi infection among hosts. We show that a 3-month treatment regimen may reduce T. cruzi incidence among humans by 59-80% in a high transmission setting, and 26-82% in a low transmission setting. An annual treatment may reduce incidence among humans by 49-74% in a high transmission setting, and by 11-76% in a low transmission setting. However, dog treatment may substantially increase T. cruzi prevalence among dogs if dog consumption of dead triatomines increases. Our model indicates that dog treatment may reduce T. cruzi infections among humans, but it may increase infections in dogs. Therefore, a holistic approach targeting different hosts is necessary for Chagas elimination.

Crossing experiments detect partial reproductive isolation among populations of Triatoma longipennis (Hemiptera: Reduviidae: Triatominae)

Chagas disease is an important vector-borne disease endemic in Mexico. Of the 33 triatomine species found in Mexico, Triatoma longipennis (Usinger) is considered among the most important because of its infection indices, capacity for transmitting Trypanosoma cruzi (Chagas), and its distribution areas. Here, we describe the results of a reproductive isolation analysis among 5 populations of T. longipennis collected from representative areas of Mexico. Fertility and segregation of morphological characteristics were examined in two generations of hybrids. The percentage of pairs with (fertile) offspring varied from 30% to 100% in the parental crosses, while these values varied from 0 to 100% in the intersite crosses. Our results indicate partial reproductive isolation among these populations. These findings shed light on the potential presence of a cryptic species complex of T. longipennis in Mexico.

Biological aspects of crosses between populations of Triatoma mexicana (Hemiptera: Reduviidae: Triatominae)

We examined the degree of reproductive isolation in four populations of Triatoma mexicana Herrich-Schaeffer from Mexico along with fertility and the segregation of morphological characteristics in two generations of offspring from crosses between these populations. The percentage of couples with (fertile) offspring was high among all sets of crosses between cohorts from Peñamiller, Meztitlán, and Orizabita. It was low in crosses involving a cohort from Tierra Blanca, mainly in crosses with Meztitlán. Among sets of crosses involving Tierra Blanca specimens, whole first-generation (F1) individuals were morphologically similar to the specimens from other locations. All F1 individuals of crosses involving Peñamiller looked like Peñamiller. However, in crosses between F1 and F1 progeny of parental crosses, alleles for size, overall color, length of head, ante and post ocular distance, and humeral angle apparently had Mendelian dominant/recessive relationships. The cohorts from Peñamiller and Meztitlán seemed to be dominant with respect to Orizabita and Tierra Blanca. Results indicated that cohorts from Peñamiller, Meztitlán, and Orizabita were not reproductively isolated. In contrast, Tierra Blanca was reproductively isolated from the other three populations of T. mexicana and is apparently undergoing an early divergence process of speciation for allopatry.

Influence of blood meal source on the biological parameters of Triatoma pallidipennis (Heteroptera: Reduviidae) from Mexico

Chagas disease is one of the most important vector-borne diseases in Latin America, including Mexico. Triatoma pallidipennis (Stål) (Hemiptera: Reduviidae) is a Mexican triatomine vector commonly associated with different hosts. The influence of six blood meals (rabbits, rats, mice, dogs, cats and chickens) on six biological parameters of the biology of T. pallidipennis was evaluated. A significant difference was found in the period of egg-to-adult development between the five mammalian feeds (mean 195 days) and the chicken feed (221 days). The probability of survival was significantly lower in the chicken cohort (0.285). The total number of blood meals to moult from the first instar to the adult stage was the highest in the chicken cohort (10-15). This cohort had the significantly highest rate of females at the end cycle. The mean number of eggs laid per female and the egg eclosion rate were similar among the six food sources. Most results seemed to be influenced by the higher nutritional quality of the mammalian blood compared to the bird's blood and the increased energy expenditure required for the digestion of bird blood. These results clearly show that T. pallidipennis, unlike other triatomine species, has a high reproductive capacity when feeding on different hosts.

Impact of home improvements and health education on the transmission of Trypanosoma cruzi Chagas in a rural area of western Mexico

Chagas disease is one of the most important vector-borne diseases in Latin America. Instituting home improvement preventive measures and increasing health education contribute to successful control of the triatomine insect vector. The impact of home and road improvements and health education upon the inhabitants of 37 human dwellings in three small towns in western Mexico were studied. Initially, few house roofs were made of concrete and few walls were cement-lined. Almost all houses initially lacked metal window screens and none used barbed wire fences. One year after the intervention, all of these measures were more common, and almost 100% of houses continued to use window screens and barbed wire fences ten years post-intervention. By ten years post-intervention, >75% of houses had cement-lined walls. Initially, 24.3% of human dwellings were infested with Triatoma longipennis Usinger; at one and ten years post-intervention, only 2.7% of dwellings were infested. The abundance of peridomestic opossums decreased after intervention and remained low ten years later. Approximately 10% of dogs were infected in both surveys. Human infections decreased from 2.98% to zero by 13 years post-intervention. Implementation of these intervention measures led to the successful control of Trypanosoma cruzi Chagas transmission in these towns.

Animal Models of Trypanosoma cruzi Congenital Transmission

Chagas disease, initiated by the etiological agent Trypanosoma cruzi, is an endemic infection in the American continent. Although vectorial transmission of T. cruzi is recognized as the main mode of infection, other routes such as congenital and blood transfusion are also documented as important methods of transmission. T. cruzi maternal-fetal transmission has been recorded in humans and examined by some investigators in naturally and experimentally infected mammals. Dogs are recognized as the major reservoir host in maintaining the domestic transmission of T. cruzi; however, the importance of congenital transmission in preserving the infection cycle in dogs has not been studied in detail. In this article, we reviewed the current knowledge of congenital transmission of T. cruzi in humans and compared the placental architecture of humans and different animals with particular attention to rodents, dogs, and non-human primates that have been used as experimental models of T. cruzi infection, congenital transmission, and Chagas disease pathogenesis. The placentas of humans and animals have some similar and dissimilar characteristics that should inform the study design and interpretation of results when evaluating the efficacy of new anti-parasite drugs and therapies against congenital infection.

Parasitemia and Differential Tissue Tropism in Mice Infected with Trypanosoma cruzi Isolates Obtained from Meccus phyllosoma in the State of Oaxaca, Mexico

Trypanosoma cruzi is a parasite transmitted by the feces of triatomines. Many triatomine species are found in Mexico, and various T. cruzi variants have been isolated from these species, each showing very different virulence and cell tropism. The isolates were obtained from Meccus phyllosoma specimens in three localities in the state of Oaxaca, Mexico: Tehuantitla, Vixhana, and Guichivere. The virulence of each isolate was assessed by quantifying parasitemia, survival, and histopathologic findings. The lineage of each isolate was identified using the mini-exon gene. The expression of the tssa gene during infection was detected in the heart, esophagus, gastrocnemius, and brain. Our results show that the maximum post-infection parasitemia was higher for the Tehuantitla isolate. On genotyping, all isolates were identified as T. cruzi I. The amastigotes in the heart and gastrocnemius were verified for all isolates, but in the brain only for Tehuantitla and Vixhana. The tssa expression allowed us to detect T. cruzi isolates, for Tehuantitla, predominantly in the heart. For Vixhana, a higher tssa expression was detected in gastrocnemius, and for Guichivere, it was higher in the esophagus. Results show that virulence, tropism, and tssa expression can vary, even when the isolates are derived from the same vector species, in the same region, and at similar altitudes.

Life History Data of Dipetalogaster maxima (Hemiptera: Reduviidae)

Dipetalogaster maxima (Uhler) is a triatomine species that has been found to be infected by Trypanosoma cruzi Chagas in the habitats of the most important tourist areas of Mexico. Its behavior and vectorial capacity have been scarcely studied, although such information is necessary to reliably estimate the importance of this species as a vector of T. cruzi in its distribution area. This study reports biological parameters related to the vectorial capacity of D. maxima. In particular, the egg-to-adult development time, number of blood meals required to molt, accumulative mortality, time to beginning of feeding, feeding and defecation times, fecundity, and fertility were examined. D. maxima took a median of 211 d to develop from egg to adult, requiring 11 meals in total. Almost two-thirds (63%) of specimens died during the cycle. The time to beginning of feeding was 1 min in all instars. Feeding times varied from 14 to 27 min. Most nymphs (except first-instar) defecated when feeding or immediately thereafter. A mean of 0.7 eggs/♀/day was recorded, with an eclosion rate of 27.3%. Five of the eight studied parameters (mainly defecation delay) suggest the remarkable potential vectorial capacity of D. maxima, so it is necessary to maintain permanent surveillance of domiciliary populations of D. maxima, because they may be infected with T. cruzi.

Seroprevalence of Trypanosoma cruzi in Eight Blood Banks in Mexico

BACKGROUND

The true prevalence of Chagas disease in Mexico is unknown. However, it has been estimated that 1.1-4 million people are infected with Trypanosoma cruzi, which represents a potential risk for transmission of the disease via contaminated blood.

AIM OF THE STUDY

To determine the Chagas disease seroprevalence in donors from eight blood banks in the north of Mexico City, and the northeast of the State of Mexico.

STUDY DESIGN AND METHODS

Serum samples from blood donors (n = 515,038) were tested to detect the presence of anti-Trypanosoma cruzi antibodies in eight blood banks. The serologic screening test was performed in each of the blood banks. To confirm the seropositive blood donors, only two out of the eight blood banks used a test with a different principle with the aim of identifying anti-Trypanosoma cruzi antibodies. All tests were validated by the Mexican Institute for Epidemiological Diagnosis and Reference.

RESULTS

One thousand two hundred and ten blood donors were seropositive for Trypanosoma cruzi, which represents a 0.23% seroprevalence (95% CI 0.22-0.25%). Of the seropositive blood donors, 97.03 % resided in the northeast area of the State of Mexico, Mexico City, and southern part of the State of Hidalgo.

CONCLUSIONS

Active transmission of Chagas disease may be occurring in non-endemic regions in the northeast of the State of Mexico.

Synanthropic triatomines in Hidalgo state, Mexico: Spatial-temporal distribution, domestic transmission cycle, and natural infection with Trypanosoma cruzi

Triatomine vectors are responsible for the main route of transmission of the protozoan Trypanosoma cruzi, the etiological agent of Chagas disease. This illness is potentially life-threatening and highly disabling and represents a major public health concern in the endemic countries in Latin America. The analysis of the spatial and temporal occurrence of triatomine insects is critical, since control strategies strongly depend on the vector species found within each area. Such knowledge is non-existent in Hidalgo state, an endemic region of Chagas disease in Mexico. A Geographic Information System (GIS) was used to analyze broad-scale spatial and temporal patterns of synanthropic triatomines collected in Hidalgo. Data was taken from the Institute of Epidemiological Diagnosis and Reference (InDRE) of Mexico and the state program of Vector Control of the Secretary of Health, covering the period of 1997-2019. Our analyses demonstrate a differential distribution of Triatoma dimidiata, T. mexicana, T. gerstaeckeri and T. barberi, which are the four predominant species, and that climate, temperature, and precipitation are some of the drivers of their distribution pattern. Notably, we report the presence of T. nitida, T. pallidipennis and T. phyllosoma for the first time in the state. In addition, we found seasonal variations of the populations of T. mexicana and T. gerstaeckeri, but not for T. dimidiata, whose population remains constant throughout the year. The insects were found mainly intradomicile (81.79 %), followed by peridomicile (17.56 %) and non-domestic areas (0.65%), with an average T. cruzi infection of 16.4%. Based on this evidence, priority sites for vector control intervention were identified. Our findings are very valuable for understanding the epidemiology of Chagas disease, the generation of future potential risk maps and for the development and implementation of effective and targeted vector control programs in Hidalgo state.

Trypanosoma cruzi blood trypomastigotes induce intense skeletal and cardiac muscle damage and Th1/ Th2 immune response in the acute phase of mice infected by the oral route

Oral acquisition of Trypanosoma cruzi is a foodborne transmission by juices and fruits contaminated with metacyclic trypomastigotes (MT) or by the ingestion of wild reservoirs infected with blood trypomastigotes (BT). In Mexico, hunting and food consumption of wild animals are current practices, which could represent a risk factor for oral infection in the rural population. In this work, Balb/c mice were inoculated by oral route with BT of a highly virulent T. cruzi Mexican strain (DTU I) to evaluate the establishment of the infection, and the humoral and cellular immune response in the acute phase of the infection. We show that BT induces blood and tissue parasitism producing an inflammatory process in the heart and skeletal muscle and low parasitism and inflammation in the digestive tract of orally infected mice. Besides, in the acute phase, the BT promotes splenomegaly, intense damage in skeletal and cardiac muscles, a humoral response dominated by the IgG isotype, and the expression of pro-inflammatory cytokines.

Presence of Anti-T. cruzi Antibodies in Inhabitants and Dogs of Two Rural Settlements in the Sierra de Los Tuxtlas, Veracruz, Mexico

PURPOSE

The aim of this study was to identify the risk factors associated with house infestation by Triatoma dimidiata as well as with Trypanosoma cruzi infection in humans and owned dogs in two rural communities from the municipality of Catemaco, Veracruz, Mexico.

METHODS

One hundred and 16 human blood samples and 34 dog blood samples were collected. The presence of anti-T. cruzi antibodies was determined using four different ELISA assays. Moreover, reactive ELISA sera from humans and dogs were processed by indirect immunofluorescence (IFI) to confirm the presence of anti-T. cruzi antibodies.

RESULTS

Serologic tests for T. cruzi infection showed a prevalence of 5.1% (6/116) in humans and of 50% (17/34) in owned dogs.

CONCLUSION

The presence of animals (dogs, chickens and wild animals), as well as some characteristics of house construction were identified as risk factors for infestation and infection. Complementary studies must be carried out to allow a better understanding of the transmission dynamics in the state of Veracruz, Mexico, and the implementation of adequate control programs.

Estimating chagas disease prevalence and number of underdiagnosed, and undertreated individuals in Spain

BACKGROUND

Chagas disease constitutes a public health problem, and Spain is the non-endemic country with the highest burden of disease outside the Americas. It represents a model for non-endemic countries regarding health policies to control the disease. This study is aimed to generate estimates of the T.cruzi prevalence and the number of undetected and untreated individuals with the infection in Spain and to compare them with the actual number of cases reported by official sources.

METHODS

Using aggregate data collected from the literature and official sources (Spanish National Statistics Institute; Spanish Agency of Medicines and Medical Devices) from 2010 to 2018, this study estimates the number of Chagas disease cases, plus the underdiagnosis and undertreatment rates.

RESULTS

We estimated that 55,367 out of 2,602,285 migrants originally from endemic countries were living with Chagas disease in Spain in 2018, accounting for a prevalence of 2.1%. Only 1% of these cases(613/455,566) were children aged 14 years or less resulting in a prevalence of 0.1%. Bolivian migrants accounted for 53.9% of the total estimated cases. The index of underdiagnosis and undertreatment were heterogeneous across different Spanish autonomous regions, but the overall index of underdiagnosis was around 71%, and the overall index of undertreatment was 82.5% in patients aged 15 years or older, and 60% in children.

CONCLUSION

The burden of Chagas disease in Spain is considerable. Index of underdiagnosis and undertreatment are high, particularly in women of childbearing age, but they have improved in children since the implementation of antenatal screening programmes.

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Multiparameter Optimization of Trypanocidal Cruzain Inhibitors With In Vivo Activity and Favorable Pharmacokinetics

Cruzain, the main cysteine protease of Trypanosoma cruzi, plays key roles in all stages of the parasite's life cycle, including nutrition acquisition, differentiation, evasion of the host immune system, and invasion of host cells. Thus, inhibition of this validated target may lead to the development of novel drugs for the treatment of Chagas disease. In this study, a multiparameter optimization (MPO) approach, molecular modeling, and structure-activity relationships (SARs) were employed for the identification of new benzimidazole derivatives as potent competitive inhibitors of cruzain with trypanocidal activity and suitable pharmacokinetics. Extensive pharmacokinetic studies enabled the identification of metabolically stable and permeable compounds with high selectivity indices. CYP3A4 was found to be involved in the main metabolic pathway, and the identification of metabolic soft spots provided insights into molecular optimization. Compound 28, which showed a promising trade-off between pharmacodynamics and pharmacokinetics, caused no acute toxicity and reduced parasite burden both in vitro and in vivo.

Chagas Disease in Pregnant Women from Endemic Regions Attending the Hospital General de Mexico, Mexico City

Trypanosoma cruzi infection leads to Chagas disease (CD), a neglected tropical infection of significant public health importance in South and Central America and other, non-endemic, countries. Pregnant women and their children are of particular importance to screen as T. cruzi can be transmitted vertically. The objective of this study was to screen for T. cruzi infection among pregnant women from endemic areas seen at the Hospital General de Mexico for prenatal care, so that they and their children may be quickly connected to CD treatment. Pregnant women were recruited through the hospital prenatal clinic and screened for T. cruzi infection using a series of serological and molecular tests. Of 150 screened patients, mean age 26.8 (SD 6.4), 30 (20.0%) were positive by at least one diagnostic test. Of these, only nine (6%) were positive as determined by PCR. Diagnosis of chronic CD is difficult in endemic places like Mexico due to the limitations of current commercially available diagnostic tests. Further evaluation of diagnostic performance of various assays could improve current CD diagnostic algorithms and proper care management in these regions. Genetic variability in the parasite may also play a role in the differing assay performances seen in this study, and this may be a valuable avenue of further research.

Chagas disease in the context of the 2030 agenda: global warming and vectors

The 2030 Agenda for Sustainable Development is a plan of action for people, planet and prosperity. Thousands of years and centuries of colonisation have passed the precarious housing conditions, food insecurity, lack of sanitation, the limitation of surveillance, health care programs and climate change. Chagas disease continues to be a public health problem. The control programs have been successful in many countries in reducing transmission by T. cruzi; but the results have been variable. WHO makes recommendations for prevention and control with the aim of eliminating Chagas disease as a public health problem. Climate change, deforestation, migration, urbanisation, sylvatic vectors and oral transmission require integrating the economic, social, and environmental dimensions of sustainable development, as well as the links within and between objectives and sectors. While the environment scenarios change around the world, native vector species pose a significant public health threat. The man-made atmosphere change is related to the increase of triatomines’ dispersal range, or an increase of the mobility of the vectors from their sylvatic environment to man-made constructions, or humans getting into sylvatic scenarios, leading to an increase of Chagas disease infection. Innovations with the communities and collaborations among municipalities, International cooperation agencies, local governmental agencies, academic partners, developmental agencies, or environmental institutions may present promising solutions, but sustained partnerships, long-term commitment, and strong regional leadership are required. A new world has just opened up for the renewal of surveillance practices, but the lessons learned in the past should be the basis for solutions in the future.

Convolutional Neural Networks for Chagas' Parasite Detection in Histopathological Images

Chagas disease is a widely spreaded illness caused by the parasite Trypanosoma cruzi (T. cruzi). Most cases go unnoticed until the accumulated myocardial damage affect the patient. The endomyocardium biopsy is a tool to evaluate sustained myocardial damage, but analyzing histopathological images takes a lot of time and its prone to human error, given its subjective nature. The following work presents a deep learning method to detect T. cruzi amastigotes on histopathological images taken from a endomyocardium biopsy during an experimental murine model. A U-Net convolutional neural network architecture was implemented and trained from the ground up. An accuracy of 99.19% and Jaccard index of 49.43% were achieved. The obtained results suggest that the proposed approach can be useful for amastigotes detection in histopathological images.Clinical relevance- The proposed method can be incorporated as automatic detection tool of amastigotes nests, it can be useful for the Chagas disease analysis and diagnosis.

Geographic variations in test reactivity for the serological diagnosis of Trypanosoma cruzi infection

Chagas disease is a neglected disease caused by Trypanosoma cruzi parasites. Most diagnosis is based on serological tests, but the lack of a gold standard test complicates the measurement of test performance. To overcome this limitation, we used samples from a cohort of well-characterized T. cruzi-infected women to evaluate the reactivity of two rapid diagnostic tests and one enzyme-linked immunosorbent assay (ELISA). Our cohort was derived from a previous study on congenital transmission of T. cruzi and consisted of 481 blood/plasma samples from Argentina (n = 149), Honduras (n = 228), and Mexico (n = 104), with at least one positive T. cruzi PCR. Reactivity of the three tests ranged from 70.5% for the Wiener ELISA to 81.0% for the T-Detect and 90.4% for the Stat-Pak rapid tests. Test reactivity varied significantly among countries and was highest in Argentina and lowest in Mexico. When considering at least two reactive serological tests to confirm seropositivity, over 12% of T. cruzi infection cases from Argentina were missed by serological tests, over 21% in Honduras, and an alarming 72% in Mexico. Differences in test performance among countries were not due to differences in parasitemia, but differences in antibody levels against ELISA antigens were observed. Geographic differences in T. cruzi parasite strains as well as genetic differences among human populations both may contribute to the discrepancies in serological testing. Improvements in serological diagnostics for T. cruzi infections are critically needed to ensure an optimum identification of cases.

Diversity of Trypanosoma cruzi parasites infecting Triatoma dimidiata in Central Veracruz, Mexico, and their One Health ecological interactions

Triatoma dimidiata is the main vector of Trypanosoma cruzi parasites in Veracruz, Mexico, and its association with human housing appears variable. Also, in spite of a high seroprevalence of T. cruzi infection in humans, parasite transmission remains poorly understood. Therefore, we aimed to identify T. dimidiata blood feeding sources and its parasite and microbial diversity to reconstruct T. cruzi parasite transmission ecology in central Veracruz, Mexico, within a One Health/Ecohealth framework. We used a metabarcoding and deep sequencing approach of specific markers for the simultaneous identification of T. dimidiata haplogroup (ITS-2), vertebrate blood meals (12 s gene), T. cruzi parasites (mini-exon gene), and gut microbiota (bacterial 16 s). Twelve species of domestic/synanthropic animals and humans were identified as blood sources, with multiple feeding on 4.2 ± 0.4 hosts per bug. The feeding/parasite transmission network was strongly centered on humans, emphasizing a significant risk of infection. We also unambiguously confirmed the presence of TcI, TcII, TcV and TcVI DTUs in T. dimidiata, and sequences from Veracruz tended to cluster apart from parasites from other regions, suggesting some level of local differentiation. Analysis of T. dimidiata microbiota suggested that several bacterial families may be associated with the presence/absence of T. cruzi, and some of these associations may also be parasite DTU-specific. Such integrative approaches within the EcoHealth/One Health framework provide key insights on T. cruzi transmission and potential novel strategies for disease control.

Historical Spatial Distribution of Zoonotic Diseases in Domestic, Synanthropic, and Wild Animals in the Mexican Territory of the Yucatan Peninsula

The Mexican territory of the Yucatan Peninsula has a tropical climate and harbors a wide variety of domestic, synanthropic, and wild animals, as well as disease vectors. To determine the distribution of recorded zoonotic diseases in the Yucatan Peninsula, scientific publications referring to these diseases in animals and containing geographic coordinates of disease occurrence, were studied. The epidemiological bulletins of the national government were also consulted to obtain information on zoonotic diseases reported in humans in the territory. The territory harbors a wide variety of tropical zoonotic pathogens, including Trypanosoma cruzi, Leptospira interrogans, Toxoplasma gondii, Leishmania mexicana, Dirofilaria immitis, and Rickettsia felis. A variety of domestic, synanthropic, and wild animals act as hosts or reservoirs in the transmission cycle of the zoonotic diseases in the Yucatan Peninsula, and some spillover into human populations has also been recorded. There are still zoonotic diseases that have rarely or never been reported in humans, but it is not clear whether this is because these diseases in humans are not common, there is a lack of viable transmission cycle or there is a lack of appropriate diagnosis. It is necessary to continue monitoring vectors, animal hosts, and humans to identify risk factors for zoonotic diseases in the Yucatan Peninsula.

Phenylbenzothiazole derivatives: effects against a Trypanosoma cruzi infection and toxicological profiles

Current treatments for Chagas disease have a limited impact during the chronic stage and trigger severe side effects. Treatments target Trypanosoma cruzi, the etiological agent of the disease. The aims of this study were to evaluate the trypanocidal activity of four 2-phenylbenzothiazole derivatives (BZT1-4) in vitro by using the infectious and non-infectious forms of T. cruzi (trypomastigotes and epimastigotes, respectively) and to test the most promising compound (BZT4) in vivo in mice. Additionally, the toxicological profile and possible neuronal damage were examined. In relation to trypomastigotes, BZT4 was more selective and effective than the reference drug (benznidazole) during this infective stage, apparently due to the synergistic action of the CF₃ and COOH substituents in the molecule. During the first few hours post-administration of BZT4, parasitemia decreased by 40% in an in vivo model of short-term treatment, but parasite levels later returned to the basal state. In the long-term assessment, the compound did not produce a significant antiparasitic effect, only attaining a 30% reduction in parasitemia by day 20 with the dose of 16 mg/kg. The toxicity test was based on repeated dosing of BZT4 (administered orally) during 21 days, which did not cause liver damage. However, the compound altered the concentration of proteins and the proteinic profile of neuronal cells in vitro, perhaps leading to an effect on the central nervous system. Further research on the low trypanocidal activity in vivo compared to the better in vitro effect could possibly facilitate molecular redesign to improve trypanocidal activity.

Risk of COVID-19 in Chagas Disease Patients: What Happen with Cardiac Affectations?

BACKGROUND

Chagas disease is considered a neglected tropical disease. The acute phase of Chagas disease is characterized by several symptoms: fever, fatigue, body aches, headache and cardiopathy's. Chronic phase could be asymptomatic or symptomatic with cardiac compromise. Since the emergence of the pandemic caused by the SARS-CoV-2 virus, the cardiovascular involvement has been identified as a complication commonly reported in coronavirus disease 2019 (COVID-19). Due to the lack of knowledge of the cardiac affectations that this virus could cause in patients with Chagas disease, the aim of this review is to describe the possible cardiac affectations, as well as the treatment and recommendations that patients with both infections should carry out.

METHODS

The authors revised the recent and relevant literature concerning the topic and discussed advances and limitations of studies on COVID-19 and their impact in Chagas disease patients, principally with cardiac affectations.

RESULTS

There currently exists little information about the consequences that Chagas disease patients can suffer when they are infected with COVID-19.

CONCLUSIONS

This review highlights the emerging challenges of access to medical care and future research needs in order to understand the implications that co-infections (SARS-CoV-2 or other viruses) can generate in Chagas disease-infected people.

Risk factors for infestation by Triatoma dimidiata in a rural locality of Veracruz, Mexico, with active transmission of Trypanosoma cruzi: weather and rain as factors

OBJECTIVE

To analyse the ecological and social factors involved in infestation of houses by Triatoma dimidiata in a rural locality of Veracruz, Mexico, where active transmission of the parasite is occurring.

METHODS

A survey was applied to the households of the locality to obtain sociodemographic data. In parallel, T. dimidiata insects were collected during one year through community participation. Using PCR, the insects were genotyped, their infection status was assessed, and parasite genotypes infecting the insects were identified. The vector's blood meal sources were identified using a polymerase-heteroduplex chain reaction assay.

RESULTS

Seasonal variations in the patterns of infestation by T. dimidiata were observed. An overall infestation rate of 19.46%, a colonisation index of 9.09%, a dispersion rate of 22.15% and a synanthropy index of 80.6% were found. The collected insects were identified as ITS-2 group 2 insects, and a natural infection with T. cruzi of 54.35% was found. TcI and no-TcI genotypes of T. cruzi were found in infected insects. Factors such as rain (P = 0.0006) and temperature (P < 0.0001) were associated with infestation. Analysis of the blood meal sources indicated frequent feeding upon humans and mice. Furthermore, house materials and peridomiciles were found to play an important role in the dynamics of infestation.

CONCLUSIONS

The contribution of this study is important for understanding the epidemiology of Chagas disease in rural areas of the state of Veracruz and will help to the establishment of an entomological surveillance system and implementation of prevention and control measures in accordance with the reality of the area.

Chemoinformatics Studies on a Series of Imidazoles as Cruzain Inhibitors

Natural products based on imidazole scaffolds have inspired the discovery of a wide variety of bioactive compounds. Herein, a series of imidazoles that act as competitive and potent cruzain inhibitors was investigated using a combination of ligand- and structure-based drug design strategies. Quantitative structure-activity relationships (QSARs) were generated along with the investigation of enzyme-inhibitor molecular interactions. Predictive hologram QSAR (HQSAR, r²_pred = 0.80) and AutoQSAR (q² = 0.90) models were built, and key structural properties that underpin cruzain inhibition were identified. Moreover, comparative molecular field analysis (CoMFA, r²_pred = 0.81) and comparative molecular similarity indices analysis (CoMSIA, r²_pred = 0.73) revealed 3D molecular features that strongly affect the activity of the inhibitors. These findings were examined along with molecular docking studies and were highly compatible with the intermolecular contacts that take place between cruzain and the inhibitors. The results gathered herein revealed the main factors that determine the activity of the imidazoles studied and provide novel knowledge for the design of improved cruzain inhibitors.

Making Sense of Chagas Disease among Mexican Immigrants in California

Mexican immigrants are affected by Chagas disease (CD) in California. It is through the representation of Chagas as a rare disease that participants make sense of the disease. A positive diagnosis has meant the disruption of patients' sense of normality and self-image, as well as their memories of homeland both reproducing and challenging hegemonic and stigmatized ideas of the disease associated with rurality and poverty. Access to treatment and medical care was the major coping mechanism. Health programs on CD should consider the emotional and social impact of the disease on people's self-perceptions to develop better medical care and prevention.

Vaccine-linked chemotherapy induces IL-17 production and reduces cardiac pathology during acute Trypanosoma cruzi infection

Chagas disease resulting from Trypanosoma cruzi infection leads to a silent, long-lasting chronic neglected tropical disease affecting the poorest and underserved populations around the world. Antiparasitic treatment with benznidazole does not prevent disease progression or death in patients with established cardiac disease. Our consortium is developing a therapeutic vaccine based on the T. cruzi flagellar—derived antigen Tc24-C4 formulated with a Toll-like receptor 4 agonist adjuvant, to complement existing chemotherapy and improve treatment efficacy. Here we demonstrate that therapeutic treatment of acutely infected mice with a reduced dose of benznidazole concurrently with vaccine treatment – also known as “vaccine-linked chemotherapy”—induced a T_H17 like immune response, with significantly increased production of antigen specific IL-17A, IL-23 and IL-22, and CD8 + T lymphocytes, as well as significantly increased T. cruzi specific IFNγ-producing CD4 + T lymphocytes. Significantly reduced cardiac inflammation, fibrosis, and parasite burdens and improved survival were achieved by vaccine-linked chemotherapy and individual treatments. Importantly, low dose treatments were comparably efficacious to high dose treatments, demonstrating potential dose sparing effects. We conclude that through induction of T_H17 immune responses vaccine-linked chemotherapeutic strategies could bridge the tolerability and efficacy gaps of current drug treatment in Chagasic patients.

The Case for the Development of a Chagas Disease Vaccine: Why? How? When?

Chagas disease is a major neglected tropical disease, transmitted predominantly by triatomine insect vectors, but also through congenital and oral routes. While endemic in the Americas, it has turned into a global disease. Because of the current drug treatment limitations, a vaccine would represent a major advancement for better control of the disease. Here, we review some of the rationale, advances, and challenges for the ongoing development of a vaccine against Chagas disease. Recent pre-clinical studies in murine models have further expanded (i) the range of vaccine platforms and formulations tested; (ii) our understanding of the immune correlates for protection; and (iii) the extent of vaccine effects on cardiac function, beyond survival and parasite burden. We further discuss outstanding issues and opportunities to move Chagas disease development forward in the near future.

Pattern of climate connectivity and equivalent niche of Triatominae species of the Phyllosoma complex

The Phyllosoma complex is a Triatominae (Hemiptera: Reduviidae) group of medical importance involved in Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) transmission. Most of the members of this group are endemic and sympatric species with distribution in Mexico and the southern U.S.A. We employed MaxEnt to construct ecological niche models of nine species of Triatominae to test three hypothesis: (a) whether species with a broad climatic niche breadth occupy a broader geographical range than species with a narrow climatic breadth, (b) whether species with broad distribution present high degree of climatic fragmentation/isolation, which was tested through landscape metrics; and (c) whether the species share the same climatic niche space (niche conservatism) considered through an equivalence test implemented in ENMtools. Overall, our results suggest that the geographical distribution of this complex is influenced mainly by temperature seasonality where all suitable areas are places of current and potential transmission of T. cruzi. Niche breadth in the Phyllosoma complex is associated with the geographical distribution range, and the geographical range affects the climatic connectivity. We found no strong evidence of niche climatic divergence in members of this complex. We discuss the epidemiological implications of these results.

Including unpublished surveys in reviews on Chagas disease in Mexico

A consequence of the late awareness of Chagas disease in North America is that many early studies were never published in peer-reviewed journals and are not easily accessible for inclusion in systematic reviews. We reviewed data from the state of Guanajuato, Mexico, as an illustration. Three population-based surveys have been performed between 1991 and 2002 and were never fully published. Systematic reviews should recognize this publication bias.