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Rojas LZ, Glisic M, Pletsch-Borba L, Echeverría LE, Bramer WM, Bano A, Stringa N, Zaciragic A, Kraja B, Asllanaj E, Chowdhury R, Morillo CA, Rueda-Ochoa OL, Franco OH, Muka T. Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006567. [PMID: 29897909 PMCID: PMC5999094 DOI: 10.1371/journal.pntd.0006567] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/29/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is a major public health concern in Latin America and a potentially serious emerging threat in non-endemic countries. Although the association between CD and cardiac abnormalities is widely reported, study design diversity, sample size and quality challenge the information, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected. We performed to systematically review and meta-analyze population-based studies that compared prevalence of overall and specific ECG abnormalities between CD and non-CD participants in the general population. METHODS Six databases (EMBASE, Ovid Medline, Web of Science, Cochrane Central, Google Scholar and Lilacs) were searched systematically. Observational studies were included. Odds ratios (OR) were computed using random-effects model. RESULTS Forty-nine studies were selected, including 34,023(12,276 CD and 21,747 non-CD). Prevalence of overall ECG abnormalities was higher in participants with CD (40.1%; 95%CIs=39.2-41.0) compared to non-CD (24.1%; 95%CIs=23.5-24.7) (OR=2.78; 95%CIs=2.37-3.26). Among specific ECG abnormalities, prevalence of complete right bundle branch block (RBBB) (OR=4.60; 95%CIs=2.97-7.11), left anterior fascicular block (LAFB) (OR=1.60; 95%CIs=1.21-2.13), combination of complete RBBB/LAFB (OR=3.34; 95%CIs=1.76-6.35), first-degree atrioventricular block (A-V B) (OR=1.71; 95%CIs=1.25-2.33), atrial fibrillation (AF) or flutter (OR=2.11; 95%CIs=1.40-3.19) and ventricular extrasystoles (VE) (OR=1.62; 95%CIs=1.14-2.30) was higher in CD compared to non-CD participants. CONCLUSIONS This systematic review and meta-analysis provides an update and synthesis in this field. This research of observational studies indicates a significant excess in prevalence of ECG abnormalities (40.1%) related to T. cruzi infection in the general population from Chagas endemic regions, being the most common ventricular (RBBB and LAFB), and A-V B (first-degree) node conduction abnormalities as well as arrhythmias (AF or flutter and VE). Also, prevalence of ECG alterations in children was similar to that in adults and suggests earlier onset of cardiac disease.
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Affiliation(s)
- Lyda Z. Rojas
- Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Grupo de Estudios Epidemiológicos y Salud Pública-FCV, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
- * E-mail: ,
| | - Marija Glisic
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Laura Pletsch-Borba
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Luis E. Echeverría
- Grupo de Estudios Epidemiológicos y Salud Pública-FCV, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
- Heart Failure and Heart Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Arjola Bano
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Najada Stringa
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Asija Zaciragic
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bledar Kraja
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eralda Asllanaj
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rajiv Chowdhury
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Carlos A. Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cardiology Division, McMaster University, PHRI-HHSC, Hamilton, Ontario, Canada
| | - Oscar L. Rueda-Ochoa
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Electrocardiography Research Group, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Taulant Muka
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Coura JR, Junqueira AC, Ferreira JMB. Surveillance of seroepidemiology and morbidity of Chagas disease in the Negro River, Brazilian Amazon. Mem Inst Oswaldo Cruz 2018; 113:17-23. [PMID: 29211104 PMCID: PMC5719538 DOI: 10.1590/0074-02760170169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/14/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chagas disease in the Brazilian Amazon Region was previously regarded as an enzootic disease of wild animals. More recently, in situations where humans have penetrated the wild ecotope or where triatomines and/or wild animals (marsupials) have invaded human homes resulting in disease transmission, Chagas disease has come to be regarded as an anthropozoonosis. We found that the highest incidence of infection due to Trypanosoma cruzi and Chagas disease occurred among piassaba fibre gatherers and their families. OBJECTIVES Considering the results of previous surveys, we conducted a new survey of piassaba gatherers and their families in the creeks of the Aracá, Curuduri, Demini, Ererê and Padauiri rivers, which are tributaries on the left bank of the Negro River, in the municipality of Barcelos; Barcelos-Caurés highway; Negro River in Santa Isabel of the Negro River; and Marié River, on the right bank of the Negro River. METHODS A questionnaire was applied to 482 piassaba gatherers and their families who accompanied them. We collected 5-mL blood samples (with permission from each subject), separated the serum, and performed serological tests using indirect immunofluorescence and conventional and recombinant enzyme-linked immunosorbent assays (ELISA). We performed brief clinical examination and electrocardiograms. Only 273 subjects attended our field base for detailed clinical examination and electrocardiogram. FINDINGS AND MAIN CONCLUSIONS The questionnaire revealed that 100% of the 482 patients recognised the triatomine Rhodnius brethesi, which they had seen in the piassaba plantation and 81% in their field huts. A total of 79% of subjects had previously been bitten by this vector and 21% did not know. The 25 subjects seropositive for T. cruzi infection (5.2%) stated that they had been bitten more than 10 times by this insect. Of the 273 subjects who underwent electrocardiogram, 22% showed conditions that were possibly attributable to Chagas disease or other cardiovascular disease.
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Affiliation(s)
- José Rodrigues Coura
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
| | - Angela Cv Junqueira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
| | - João Marcos Bb Ferreira
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brasil
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Coura J, Junqueira A. Ecological diversity of Trypanosoma cruzi transmission in the Amazon basin. The main scenaries in the Brazilian Amazon. Acta Trop 2015; 151:51-7. [PMID: 26254002 DOI: 10.1016/j.actatropica.2015.04.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
The ecological diversity of Trypanosoma cruzi transmission in the Brazilian Amazon region is directly interlinked with the parasite's extensive reservoir, composed of 33 species of wild mammals within the following orders: Marsupialia, Chiroptera, Rodentia, Xenarthra, Carnivora and Primates; and of 16 species of wild triatomines, of which ten may be infected with T. cruzi. Four scenarios for the diversity of T. cruzi transmission in the Brazilian Amazon region are evident: (i) T. cruzi transmission between vectors and wild mammals, which is characterized as a wild enzooty encompassing the entire Amazon basin; (ii) accidental T. cruzi transmission from vectors and wild mammals to humans, when they invade the wild ecotope or when these vectors and wild mammals invade human homes; (iii) occupational Chagas disease among piassava (Leopoldinia piassaba) palm fiber gatherers, transmitted by the vector Rhodnius brethesi, for which these palm trees are the specific ecotope; (IV) oral T. cruzi transmission to humans through food contamination, particularly in juices from plants such as assai, which today is considered to be endemic in the Brazilian Amazon region, with more than 1500 cases notified.
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Coura JR, Junqueira ACV. Surveillance, health promotion and control of Chagas disease in the Amazon Region--Medical attention in the Brazilian Amazon Region: a proposal. Mem Inst Oswaldo Cruz 2015; 110:825-30. [PMID: 26560976 PMCID: PMC4660612 DOI: 10.1590/0074-02760150153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/28/2015] [Indexed: 11/21/2022] Open
Abstract
We refer to Oswaldo Cruz's reports dating from 1913 about the necessities of a healthcare system for the Brazilian Amazon Region and about the journey of Carlos Chagas to 27 locations in this region and the measures that would need to be adopted. We discuss the risks of endemicity of Chagas disease in the Amazon Region. We recommend that epidemiological surveillance of Chagas disease in the Brazilian Amazon Region and Pan-Amazon region should be implemented through continuous monitoring of the human population that lives in the area, their housing, the environment and the presence of triatomines. The monitoring should be performed with periodic seroepidemiological surveys, semi-annual visits to homes by health agents and the training of malaria microscopists and healthcare technicians to identify Trypanosoma cruzi from patients' samples and T. cruzi infection rates among the triatomines caught. We recommend health promotion and control of Chagas disease through public health policies, especially through sanitary education regarding the risk factors for Chagas disease. Finally, we propose a healthcare system through base hospitals, intermediate-level units in the areas of the Brazilian Amazon Region and air transportation, considering the distances to be covered for medical care.
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Affiliation(s)
- José Rodrigues Coura
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias,
Rio de Janeiro, RJ, Brasil
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Barbosa MDGV, Ferreira JMBB, Arcanjo ARL, Santana RAG, Magalhães LKC, Magalhães LKC, Mota DT, Fé NF, Monteiro WM, Silveira H, Guerra JADO. Chagas disease in the State of Amazonas: history, epidemiological evolution, risks of endemicity and future perspectives. Rev Soc Bras Med Trop 2015; 48 Suppl 1:27-33. [DOI: 10.1590/0037-8682-0258-2013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 09/11/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Maria das Graças Vale Barbosa
- Universidade do Estado do Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil; Universidade Nilton Lins, Brazil
| | | | | | | | | | | | | | | | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil
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Coura JR, Marquez MHP, Guerra JADO, Zauza PL, Miguel JC, Pereira JB. A new survey of the serology of human Trypanosoma cruzi infection in the Rio Negro microregion, Brazilian Amazon: a critical analysis. Mem Inst Oswaldo Cruz 2015. [PMID: 24141967 PMCID: PMC3970652 DOI: 10.1590/0074-0276130303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The serology of human
Trypanosoma cruzi
infection in the Rio Negro microregion is very complex because of the large numbers of false-positive cases that result from low antibody titres and cross-reactions with other infections. In the present study, we collected 4,880 blood samples on filter paper; of these, indirect immunofluorescence (IIF) was strongly reactive in 221 (4.5%), which were considered to be positive (IIF strongly reactive; high intensity of fluorescence) and weakly reactive in 302 (6.2%), which were considered to be doubtful (IIF weakly reactive; low intensity of fluorescence). The confirmatory test on the serum using at least two of three techniques (IIF, conventional ELISA and recombinant ELISA) on 137 samples that were positive in the screening test only confirmed 33 cases (24.1%). Of the 178 samples that were considered doubtful in the screening test, only 10 (5.6%) were considered to be positive in the confirmatory test. Finally, we recommend that the serological diagnosis of
T. cruzi
infection in the Amazon region be made using at least two different techniques, for example immunofluorescence and ELISA and confirmed by Western blot analysis when possible.
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Santana RAG, Magalhães LKC, Magalhães LKC, Prestes SR, Maciel MG, da Silva GAV, Monteiro WM, de Brito FR, de Aguiar Raposo Câmara Coelho LI, Barbosa-Ferreira JM, Guerra JAO, Silveira H, das Graças Vale Barbosa M. Trypanosoma cruzi strain TcI is associated with chronic Chagas disease in the Brazilian Amazon. Parasit Vectors 2014; 7:267. [PMID: 24916362 PMCID: PMC4072607 DOI: 10.1186/1756-3305-7-267] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/31/2014] [Indexed: 12/19/2022] Open
Abstract
Background Chagas disease in the Amazon region is considered an emerging anthropozoonosis with a predominance of the discrete typing units (DTUs) TcI and TcIV. These DTUs are responsible for cases of acute disease associated with oral transmission. Chronic disease cases have been detected through serological surveys. However, the mode of transmission could not be determined, or any association of chronic disease with a specific T. cruzi DTU’s. The aim of this study was to characterize Trypanosoma cruzi in patients with chronic Chagas disease in the State of Amazonas, Brazil. Methods Blood culture and xenodiagnosis were performed in 36 patients with positive serology for Chagas disease who participated in a serological survey performed in urban and rural areas of Manaus, Amazonas. DNA samples were extracted from the feces of triatomines used for xenodiagnosis, and the nontranscribed spacer of the mini-exon gene and the mitochondrial gene cytochrome oxidase subunit II (COII) were amplified by PCR and sequenced. Results Blood culture and xenodiagnosis were negative in 100% of samples; however, molecular techniques revealed that in 13 out of 36 (36%) fecal samples from xenodiagnosis, T. cruzi was characterized as the DTU TcI, and different haplotypes were identified within the same DTU. Conclusion The DTU TcI, which is mainly associated with acute cases of Chagas disease in the Amazon region, is also responsible for chronic infection in patients from a region in the State of Amazonas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Henrique Silveira
- Institute of Hygiene and Tropical Medicine (Instituto de Higiene e Medicina Tropical), New University of Lisbon (Universidade Nova de Lisboa), Lisbon, Portugal.
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Martins-Melo FR, Ramos AN, Alencar CH, Heukelbach J. Prevalence of Chagas disease in Brazil: a systematic review and meta-analysis. Acta Trop 2014; 130:167-74. [PMID: 24139912 DOI: 10.1016/j.actatropica.2013.10.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/30/2013] [Accepted: 10/01/2013] [Indexed: 12/14/2022]
Abstract
Chagas disease is a major public health problem in Brazil and Latin America. During the last years, it has become an emerging problem in North America and Europe due to increasing international migration. Here we describe the prevalence of Chagas disease in Brazil through a systematic review. We searched national and international electronic databases, grey literature and reference lists of selected articles for population-based studies on Chagas disease prevalence in Brazil, performed from 1980 until September 2012. Forty-two articles with relevant prevalence data were identified from a total of 4985 references. Prevalence ranged from 0% to 25.1%. Most surveys were performed in the Northeast region, especially in the state of Piauí. We observed a high degree of heterogeneity in most pooled estimates (I(2)>75%; p<0.001). The pooled estimate of Chagas disease prevalence across studies for the entire period was 4.2% (95% CI: 3.1-5.7), ranging from 4.4% (95% CI: 2.3-8.3) in the 1980s to 2.4% (95% CI: 1.5-3.8) after 2000. Females (4.2%; 95% CI: 2.6-6.8), >60 year-olds (17.7%; 95% CI: 11.4-26.5), Northeast (5.0%; 95% CI: 3.1-8.1) and Southeast (5.0%; CI: 2.4-9.9) regions and mixed (urban/rural) areas (6.4%; 95% CI: 4.2-9.4) had the highest pooled prevalence. About 4.6 million (95% CI: 2.9-7.2 million) of people are estimated to be infected with Trypanosoma cruzi. The small number of studies and small-scale samples of the general population in some areas limit interpretation, and findings of this review do not necessarily reflect the situation of the entire country. Systematic population-based studies at regional and national level are recommended to provide more accurate estimates and better define the epidemiology and risk areas of Chagas disease in Brazil.
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Affiliation(s)
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, Brazil
| | - Carlos Henrique Alencar
- Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, Brazil
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, Brazil; Anton Breinl Centre for Public Health and Tropical Medicine, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD 4811, Australia.
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A phospholipase A2 gene is linked to Jack bean urease toxicity in the Chagas' disease vector Rhodnius prolixus. Biochim Biophys Acta Gen Subj 2014; 1840:396-405. [DOI: 10.1016/j.bbagen.2013.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/26/2013] [Accepted: 09/11/2013] [Indexed: 01/10/2023]
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Monteiro WM, Magalhães LKC, Oliveira JC, Guerra JADO, Silveira H, Ferreira LCDL, Toledo MJDO, Barbosa MDGV. Biological behavior of Trypanosoma cruzi stocks obtained from the State of Amazonas, Western Brazilian Amazon, in mice. Rev Soc Bras Med Trop 2012; 45:209-14. [PMID: 22534994 DOI: 10.1590/s0037-86822012000200014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 09/19/2011] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION The biological diversity of circulating Trypanosoma cruzi stocks in the Amazon region most likely plays an important role in the peculiar clinic-epidemiological features of Chagas disease in this area. METHODS Seven stocks of T. cruzi were recently isolated in the State of Amazonas, Brazil, from humans, wild mammals, and triatomines. They belonged to the TcI and Z3 genotypes and were biologically characterized in Swiss mice. Parasitological and histopathological parameters were determined. RESULTS Four stocks did not promote patent parasitemia in mice. Three stocks produced low parasitemia, long pre-patent periods, and a patent period of 1 day or oscillating parasitemia. Maximum parasitemia ranged from 1,400 to 2,800 trypomastigotes/0.1 mL blood. Mice inoculated with the T. cruzi stocks studied showed low positivity during fresh blood examinations, ranging from 0% to 28.6%. In hemoculture, positivity ranged from 0% to 100%. Heart tissue parasitism was observed in mice inoculated with stocks AM49 and AM61. Stock AM49 triggered a moderate inflammatory process in heart tissue. A mild inflammatory process was observed in heart tissue for stocks AM28, AM38, AM61, and AM69. An inflammatory process was frequently observed in skeletal muscle. Examinations of brain tissue revealed inflammatory foci and gliosis in mice inoculated with stock AM49. CONCLUSIONS Biological and histopathological characterization allowed us to demonstrate the low infectivity and virulence of T. cruzi stocks isolated from the State of Amazonas.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, AM.
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Monteiro WM, Magalhães LKC, de Sá ARN, Gomes ML, Toledo MJDO, Borges L, Pires I, de Oliveira Guerra JA, Silveira H, Barbosa MDGV. Trypanosoma cruzi IV causing outbreaks of acute Chagas disease and infections by different haplotypes in the Western Brazilian Amazonia. PLoS One 2012; 7:e41284. [PMID: 22848457 PMCID: PMC3405119 DOI: 10.1371/journal.pone.0041284] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/19/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chagas disease is an emergent tropical disease in the Brazilian Amazon Region, with an increasing number of cases in recent decades. In this region, the sylvatic cycle of Trypanosoma cruzi transmission, which constitutes a reservoir of parasites that might be associated with specific molecular, epidemiological and clinical traits, has been little explored. The objective of this work is to genetically characterize stocks of T. cruzi from human cases, triatomines and reservoir mammals in the State of Amazonas, in the Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS We analyzed 96 T. cruzi samples from four municipalities in distant locations of the State of Amazonas. Molecular characterization of isolated parasites from cultures in LIT medium or directly from vectors or whole human blood was performed by PCR of the non-transcribed spacer of the mini-exon and of the 24 S alfa ribosomal RNA gene, RFLP and sequencing of the mitochondrial cytochrome c oxidase subunit II (COII) gene, and by sequencing of the glucose-phosphate isomerase gene. The T. cruzi parasites from two outbreaks of acute disease were all typed as TcIV. One of the outbreaks was triggered by several haplotypes of the same DTU. TcIV also occurred in isolated cases and in Rhodnius robustus. Incongruence between mitochondrial and nuclear phylogenies is likely to be indicative of historical genetic exchange events resulting in mitochondrial introgression between TcIII and TcIV DTUs from Western Brazilian Amazon. TcI predominated among triatomines and was the unique DTU infecting marsupials. CONCLUSION/SIGNIFICANCE DTU TcIV, rarely associated with human Chagas disease in other areas of the Amazon basin, is the major strain responsible for the human infections in the Western Brazilian Amazon, occurring in outbreaks as single or mixed infections by different haplotypes.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- University of the State of Amazonas, Manaus, Amazonas, Brazil
- Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Laylah Kelre Costa Magalhães
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- University of the State of Amazonas, Manaus, Amazonas, Brazil
| | | | | | | | - Lara Borges
- Instituto de Higiene e Medicina Tropical, Center for Malaria Studies, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Isa Pires
- Instituto de Higiene e Medicina Tropical, Center for Malaria Studies, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Augusto de Oliveira Guerra
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- University of the State of Amazonas, Manaus, Amazonas, Brazil
| | - Henrique Silveira
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Instituto de Higiene e Medicina Tropical, Center for Malaria Studies, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria das Graças Vale Barbosa
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- University of the State of Amazonas, Manaus, Amazonas, Brazil
- Nilton Lins University Center, Manaus, Amazonas, Brazil
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Coura JR, Borges-Pereira J. Chagas disease. What is known and what should be improved: a systemic review. Rev Soc Bras Med Trop 2012; 45:286-96. [PMID: 22760123 DOI: 10.1590/s0037-86822012000300002] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/12/2012] [Indexed: 11/22/2022] Open
Abstract
This study consists of a broad review on what is known and what should be improved regarding knowledge of Chagas disease, not only through analysis on the main studies published on the topics discussed, but to a large extent based on experience of this subject, acquired over the past 50 years (1961-2011). Among the subjects covered, we highlight the pathogenesis and evolution of infection by Trypanosoma cruzi, drugs in use and new strategies for treating Chagas disease; the serological tests for the diagnosis and the controls of cure the infection; the regional variations in prevalence, morbidity and response to treatment of the disease; the importance of metacyclogenesis of T. cruzi in different species of triatomines and its capacity to transmit Chagas infection; the risks of adaptation of wild triatomines to human dwellings; the morbidity and need for a surveillance and control program for Chagas disease in the Amazon region and the need to prioritize initiatives for controlling Chagas disease in Latin America and Mexico and in non-endemic countries, which is today a major international dilemma. Finally, we raise the need for to create a new initiative for controlling Chagas disease in the Gran Chaco, which involves parts of Argentina, Bolivia and Paraguay.
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Affiliation(s)
- José Rodrigues Coura
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
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Coura JR, Junqueira ACV. Risks of endemicity, morbidity and perspectives regarding the control of Chagas disease in the Amazon Region. Mem Inst Oswaldo Cruz 2012; 107:145-54. [DOI: 10.1590/s0074-02762012000200001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 02/01/2011] [Indexed: 11/21/2022] Open
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Magalhães BML, Coelho LIARC, Maciel MG, Ferreira JMBB, Umezawa ES, Coura JR, Guerra JADO, Barbosa MDGV. Serological survey for Chagas disease in the rural areas of Manaus, Coari, and Tefé in the Western Brazilian Amazon. Rev Soc Bras Med Trop 2011; 44:697-702. [DOI: 10.1590/s0037-86822011000600009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 06/17/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Deforestation, uncontrolled forest, human population migration from endemic areas, and the large number of reservoirs and wild vectors naturally infected by Trypanosoma cruzi promote the endemicity of Chagas disease in the Amazon region. METHODS: We conducted an initial serological survey (ELISA) in a sample of 1,263 persons; 1,095 (86.7%) were natives of the State of Amazonas, 666 (52.7%) were male, and 948 (75.1%) were over 20 years old. Serum samples that were found to be reactive, indeterminate, or inconclusive by indirect immunofluorescence (IFI) or positive with low titer by IFA were tested by Western blot (WB). Serologically confirmed patients (WB) were evaluated in terms of epidemiological, clinical, ECG, and echocardiography characteristics. RESULTS: Fifteen patients had serologically confirmed T. cruzi infection, and 12 of them were autochthonous to the state of Amazonas, for an overall seroprevalence of 1.2% and 0.9% for the state of Amazonas. Five of the 15 cases were males, and the average age was 47 years old; most were farmers with low education. One patient who was not autochthonous, having originated from Alagoas, showed right bundle branch block, bundle branch block, and anterosuperior left ventricular systolic dysfunction with an ejection fraction of 54%. CONCLUSIONS: The results of this study ratify the importance of monitoring CD cases in Amazonia, particularly in the state of Amazonas.
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Carvalho EOCD, Rosa JAD, Carvalho AAD, Chaves HCO, Souza EAD, Ostermayer AL, Camargo LMAD. Study on Chagas disease occurrence in the municipality of Monte Negro, State of Rondônia, Brazilian Amazon. Rev Soc Bras Med Trop 2011; 44:703-7. [DOI: 10.1590/s0037-86822011000600010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/01/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Studies on Chagas disease deal with the perspective of its occurrence in the Amazon region, which is directly correlated to the population growth and the spread of the bug biotope. The state of Rondônia has an immense source of vectors (Triatomine) and reservoirs of Trypanosoma cruzi. Environmental changes brought forth by the deforestation in the region may cause vector behavior changes and bring these vectors to a closer contact with humans, increasing the probability of vector infection. METHODS: This study was carried out to check the occurrence of Chagas disease in the municipality of Monte Negro, Rondônia, Brazil, based on a random sampling of the farms and people wherein blood collection from the population and capturing triatomines were done. The blood samples were submitted to serologic tests to detect antibodies of the IgG class against T. cruzi. The triatomines that were collected had their digestive tract checked for the presence of trypanosomatidae with morphology resembling that of the T. cruzi. RESULTS: The population examined was mostly from other states. From the 322 bugs examined on the microscope, 50% showed parasites with morphology compatible with T. cruzi. From the serology of 344 random samples of human blood, 1.2% was found positive, 6% showed inconclusive results, and 92.8% were negative. CONCLUSIONS: Monte Negro shows low prevalence of human infection by T. cruzi and none active vector transmission; however, preventive and surveying measures, which are not performed until now, shall be taken due to the abundance of vectors infected by trypanosomatidae.
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Teixeira ARL, Gomes C, Lozzi SP, Hecht MM, Rosa ADC, Monteiro PS, Bussacos AC, Nitz N, McManus C. Environment, interactions between Trypanosoma cruzi and its host, and health. CAD SAUDE PUBLICA 2009; 25 Suppl 1:S32-44. [PMID: 19287864 DOI: 10.1590/s0102-311x2009001300004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 04/09/2008] [Indexed: 12/14/2022] Open
Abstract
An epidemiological chain involving Trypanosoma cruzi is discussed at the environmental level, and in terms of fine molecular interactions in invertebrate and vertebrate hosts dwelling in different ecosystems. This protozoan has a complex, genetically controlled plasticity, which confers adaptation to approximately 40 blood-sucking triatomine species and to over 1,000 mammalian species, fulfilling diverse metabolic requirements in its complex life-cycle. The Tr. cruzi infections are deeply embedded in countless ecotypes, where they are difficult to defeat using the control methods that are currently available. Many more field and laboratory studies are required to obtain data and information that may be used for the control and prevention of Tr. cruzi infections and their various disease manifestations. Emphasis should be placed on those sensitive interactions at cellular and environmental levels that could become selected targets for disease prevention. In the short term, new technologies for social mobilization should be used by people and organizations working for justice and equality through health information and promotion. A mass media directed program could deliver education, information and communication to protect the inhabitants at risk of contracting Tr. cruzi infections.
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Araújo CA, Waniek PJ, Jansen AM. An Overview of Chagas Disease and the Role of Triatomines on Its Distribution in Brazil. Vector Borne Zoonotic Dis 2009; 9:227-34. [DOI: 10.1089/vbz.2008.0185] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Catarina A.C. Araújo
- Laboratório de Biologia de Tripanosomatídeos, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Peter J. Waniek
- Laboratório de Biologia de Tripanosomatídeos, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Ana M. Jansen
- Laboratório de Biologia de Tripanosomatídeos, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
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Paricio-Talayero JM, Benlloch-Muncharaz MJ, Ignacio Collar-del-Castillo J, Rubio-Soriano A, Serrat-Pérez C, Magraner-Egea J, Landa-Rivera L, Sánchez-Palomares M, Beseler-Soto B, Santos-Serrano L, Ferriol-Camacho M, Mut-Buigues J, Tomás-Vila M, del Carmen Alonso-Jiménez M, Domínguez-Márquez V, Igual-Adell R. Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana. Enferm Infecc Microbiol Clin 2008; 26:609-13. [DOI: 10.1016/s0213-005x(08)75276-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Teixeira ARL, Nitz N, Guimaro MC, Gomes C, Santos-Buch CA. Chagas disease. Postgrad Med J 2006; 82:788-98. [PMID: 17148699 PMCID: PMC2653922 DOI: 10.1136/pgmj.2006.047357] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 07/13/2006] [Indexed: 01/12/2023]
Abstract
Chagas disease is the clinical condition triggered by infection with the protozoan Trypanosoma cruzi. The infection is transmitted by triatomine insects while blood feeding on a human host. Field studies predict that one third of an estimated 18 million T cruzi-infected humans in Latin America will die of Chagas disease. Acute infections are usually asymptomatic, but the ensuing chronic T cruzi infections have been associated with high ratios of morbidity and mortality: Chagas heart disease leads to unexpected death in 37.5% of patients, 58% develop heart failure and die and megacolon or megaoesophagus has been associated with death in 4.5%. The pathogenesis of Chagas disease appears to be related to a parasite-induced mutation of the vertebrate genome. Currently, treatment is unsatisfactory.
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Affiliation(s)
- A R L Teixeira
- Chagas Disease Multidisciplinary Research Laboratory, Faculty of Medicine, University of Brasília, PO Box 04536 70919-970, Federal District, Brazil.
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Xavier SS, Sousa AS, Viñas PA, Junqueira ACV, Bóia MN, Coura JR. Cardiopatia chagásica crônica no Rio Negro, Estado do Amazonas. Relato de três novos casos autóctones, comprovados por exames sorológicos, clínicos, radiográficos do tórax, eletro e ecocardiográficos. Rev Soc Bras Med Trop 2006; 39:211-6. [PMID: 16699652 DOI: 10.1590/s0037-86822006000200015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
São relatados três novos casos de miocardiopatia chagásica crônica em pacientes autóctones do Rio Negro, Estado do Amazonas, confirmados por sorologia (imunofluorescência, ELISA e Western-blot para infecção pelo Trypanosoma cruzi) e por exames clínicos, radiográficos, eletro e ecocardiográficos. Os pacientes nasceram e sempre viveram na região do Rio Negro, tendo sido picados numerosas vezes por triatomíneos silvestres em piaçabais da área. O quadro clínico foi de insuficiência cardíaca congestiva e distúrbio da condução intraventricular nos três casos (BRD com HBAE em dois casos e BRE de terceiro grau em um caso), extra-sístoles ventriculares polimórficas em dois casos e alteração primária da repolarização ventricular em um deles. A avaliação ecocardiográfica revelou importante aumento dos diâmetros cavitários do VE, com fração da ejeção < 36% e padrão segmentar de acometimento miocárdico, incluindo aneurisma apical e acinesia ínfero-posterior nos três pacientes. Estes são os primeiros casos descritos de cardiopatia chagásica crônica autóctone do Amazonas com padrão ecocardiográfico sugestivo da doença.
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Affiliation(s)
- Sérgio Salles Xavier
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ
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Dos Santos-Mallet JR, Junqueira ACV, Moreira CJDC, Andrade Z, Coura JR, Gonçalves TCM. Morphobiological aspects of Rhodnius brethesi Matta, 1919 (Hemiptera:Reduviidae) from the Upper and Middle Negro River, Amazon region of Brazil: I - scanning electron microscopy. Mem Inst Oswaldo Cruz 2005; 100:915-23. [PMID: 16444425 DOI: 10.1590/s0074-02762005000800015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The occurrence of autochthonous cases of Chagas disease in the Amazon region of Brazil over recent decades has motivated an intensification of studies in this area. Different species of triatomines have been identified, and ten of these have be proven to be carriers of the parasite Trypanosoma cruzi or " cruzi-like " parasites. Studies conducted in the municipalities of Santa Isabel do Rio Negro and Barcelos, located on the Upper and Middle of the Negro River, microregion of Negro River, state of Amazonas have confirmed not only that Rhodnius brethesi is present in the palm tree Leopoldinia piassaba, but also that this insect was recognized by palm fiber collectors. A morphological study of eyes, inter-ocular and inter-ocellar regions, antennae, buccula, labrum, rostrum, stridulatory sulcus and feet, including the apex of the tibia, spongy fossette and ctenidium was conducted by scanning electron microscopy. The buccula and the stridulatory sulcus presented notable differences in specimens of different genera and also of different species. These data make it possible to suggest that the details presented in these structures can be included as diagnostic characteristics to be used in new dichotomous keys, thereby contributing towards studies of taxonomy and systematics and furnishing backing for comparative analysis of specimens collected from different localities.
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Viñas Albajar P, Laredo SV, Terrazas MB, Coura JR. Miocardiopatia dilatada em pacientes com infecção chagásica crônica: relato de dois casos fatais autóctones do Rio Negro, Estado do Amazonas. Rev Soc Bras Med Trop 2003. [DOI: 10.1590/s0037-86822003000300013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dois casos fatais de miocardiopatia chagásica crônica dilatada são relatados pela primeira vez em pacientes autóctones do rio Negro, Estado do Amazonas. Ambos os casos, um homem de 45 anos de idade e uma mulher de 44, nasceram e viveram toda a vida na região do Rio Negro, no norte do estado do Amazonas, tendo sido picados numerosas vezes por triatomineos silvestres em piaçabais da área. Os pacientes que tiveram as reações sorológicas positivas para anticorpos anti-Trypanosoma cruzi (imunofluorescência, ELISA e Wertern blot) desenvolveram nos últimos 5-7 anos um quadro de insuficiência cardíaca progressivo, com aumento global da área cardíaca, bloqueios atrioventricular e de ramo esquerdo e extrassístoles ventriculares, faleceram de insuficiência cardíaca irreversível. Um dos casos em que foi feita a biópsia cardíaca cirúrgica pós-mortem, mostrou na histopatologia, miocardite crônica com infiltrado mononuclear difuso, com áreas de adensamento celular, fibrose, dissociação, fragmentação e hialinização de fibras cardíacas, sugestivo de miocardite chagásica crônica e o PCR in situ foi positivo para Trypanosoma cruzi.
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Abstract
Impressive progress has been made in reducing the incidence of Chagas disease, or American trypanosomiasis, in many countries in which the illness is endemic. This has been achieved through expanded blood screening programs and low-technology vector control. Despite the progress made in reducing the number of new cases, the burden of disability and mortality in the endemic countries is enormous and will continue to be so for many years since a substantial portion of the 16 to 18 million persons already infected will develop chronic symptomatic Chagas disease. Unfortunately, no progress has been made in developing new drugs for Trypanosoma cruzi infection, and nifurtimox and benznidazole, both of which lack efficacy and often cause severe side effects, remain the only options for treatment.
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Affiliation(s)
- Louis V. Kirchhoff
- Departments of Internal Medicine (Infectious Diseases) and Epidemiology, 4-403 BSB, University of Iowa, Iowa City, IA 52242, USA.
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