The threat of reintroduction of natural transmission of Chagas' disease in Bambuí, Minas Gerais State, Brazil, due to Panstrongylus megistus

Electrocardiographic and echocardiographic abnormalities in Chagas disease: findings in residents of rural Bolivian communities hyperendemic for Chagas disease

BACKGROUND

Chagas disease is a neglected and preventable tropical disease that causes significant cardiac morbidity and mortality in Latin America.

OBJECTIVES

This study sought to describe cardiac findings among inhabitants of rural communities of the Bolivian Chaco.

METHODS

The cardiac study drew participants from an epidemiologic study in 7 indigenous Guarani communities. All infected participants 10 years or older were asked to undergo a brief physical examination and 12-lead electrocardiogram (ECG). A subset had echocardiograms. ECG and echocardiograms were read by 1 or more cardiologists.

RESULTS

Of 1,137 residents 10 years or older, 753 (66.2%) had Trypanosoma cruzi infection. Cardiac evaluations were performed for 398 infected participants 10 years or older. Fifty-five participants (13.8%) had 1 or more ECG abnormalities suggestive of Chagas cardiomyopathy. The most frequent abnormalities were bundle branch blocks in 42 (11.3%), followed by rhythm disturbances or ventricular ectopy in 13 (3.3%), and atrioventricular blocks (AVB) in 10 participants (2.6%). The prevalence of any abnormality rose from 1.1% among those 10 to 19 years old to 14.2%, 17.3%, and 26.4% among those 20 to 39, 40 to 59, and older than 60 years, respectively. First-degree AVB was seen most frequently in participants 60 years or older, but the 4 patients with third-degree AVB were all under 50 years old. Eighteen and 2 participants had a left ventricular ejection fraction of 40% to 54% and <40%, respectively. An increasing number of ECG abnormalities was associated with progressively larger left ventricular end-diastolic dimensions and lower left ventricular ejection fraction.

CONCLUSIONS

We found a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy. Programs to improve access to basic cardiac care (annual ECG, antiarrhythmics, pacemakers) could have an immediate impact on morbidity and mortality in these highly endemic communities.

Blood meal sources of wild and domestic Triatoma infestans (Hemiptera: Reduviidae) in Bolivia: connectivity between cycles of transmission of Trypanosoma cruzi

Background

Chagas disease is a major public health problem in Latin America. Its etiologic agent, Trypanosoma cruzi, is mainly transmitted through the contaminated faeces of blood-sucking insects called triatomines. Triatoma infestans is the main vector in various countries in South America and recently, several foci of wild populations of this species have been described in Bolivia and other countries. These wild populations are suspected of affecting the success of insecticide control campaigns being carried out in South America. To assess the risk that these T. infestans populations pose to human health, it is helpful to determine blood meal sources.

Methods

In the present work, blood meals were identified in various Bolivian wild T. infestans populations and in three specific areas, in both wild and intra-peridomestic populations to assess the links between wild and domestic cycles of T. cruzi transmission. PCR-HDA and sequencing of Cytb gene were used to identify these blood meal sources.

Results and discussion

Fourteen vertebrate species were identified as wild blood meal sources. Of those, the most prevalent species were two Andean endemic rodents, Octodontomys gliroides (36 %) and Galea musteloides (30 %), while humans were the third most prevalent source (18.7 %). Of 163 blood meals from peridomestic areas, more than half were chickens, and the others were generally domestic animals or humans. Interestingly, blood from wild animals was identified in triatomines captured in the peridomestic and domestic environment, and blood from domestic animals was found in triatomines captured in the wild, revealing links between wild and domestic cycles of T. cruzi transmission.

Conclusion

The current study suggests that wild T. infestans attack humans in the wild, but is also able to bite humans in domestic settings before going back to its natural environment. These results support the risk to human health posed by wild populations of T. infestans.

Occurrence of synanthropic triatomines (Hemiptera: Reduviidae) in the Federal District of Brazil

INTRODUCTION

Entomological surveillance of Chagas disease in the Federal District of Brazil (DF), has recorded the following triatomine species: Panstrongylus megistus, P. geniculatus, P. diasi, Rhodnius neglectus, Triatoma pseudomaculata, and T. sordida. We aimed to analyze the spatial and temporal occurrence of triatomine species collected in DF, and their indices of natural infection with trypanosomes.

METHODS

The Health State Secretariat of DF recorded triatomines between 2002 and 2010 in 20 administrative regions. This retrospective analysis considered the number of adults and nymphs of each species collected and infected in both intradomicile and peridomicile.

RESULTS

A total of 754 triatomines were collected in 252 reported domiciles. Panstrongylus megistus was the most frequent species (65%), followed by T. pseudomaculata (14%). Of the 309 examined insects, only 3 (1%) specimens of P. megistus were infected with flagellates morphologically similar to Trypanosoma cruzi. The spatial occurrence indicated a higher diversity of triatomines and frequency of T. sordida in rural areas. Moreover, there was a predominance of P. megistus in urban areas. The number of records of P. megistus in the rainy season was two times higher than that during the dry season. The largest number of triatomines was collected in November.

CONCLUSIONS

The presence of P. megistus specimens infected with trypanosomes in domiciles, shows the potential risk of human infection in DF. Thus, it is essential to continue entomological surveillance, intensifying it in the rainy season and in regions of greater occurrence.

Hemoculture and Polymerase Chain Reaction Using Primers TCZ1/TCZ2 for the Diagnosis of Canine and Feline Trypanosomiasis

Introduction. American trypanosomiasis, also known as Chagas disease, is a zoonosis caused by Trypanosoma cruzi (T. cruzi). Dogs and cats participate actively in this parasite's transmission cycle. This study aimed at evaluating the occurrence of T. cruzi in dogs and cats from Botucatu, SP, Brazil, as well as at evaluating the technique of hemoculture in LIT (liver infusion tryptose) medium by polymerase chain reaction (PCR). Methods. Blood samples were collected from 50 dogs and 50 cats in Botucatu-SP, Brazil. For hemoculture, the samples were inoculated in LIT medium, and readings were performed for four months. Upon completion of such period, all the hemocultures were processed for parasitic DNA extraction. The PCR reactions were performed by using primers TCZ1/TCZ2. Results. Ten dogs and ten cats (20%) were positive to PCR, and four dogs and three cats (7%) were positive to hemoculture. Only in a one cat sample (1%) there was confirmation of positive hemoculture by PCR for T. cruzi. Conclusions. Results showed that PCR was a suitable tool for the confirmation of the parasite detection in hemoculture samples, and that dogs and cats from Botucatu, SP, Brazil, are maintaining the role of household reservoirs of T. cruzi, which reinforces the need for constant epidemiologic surveillance for this zoonosis.

First report of Panstrongylus megistus sylvatic focus in municipality of Bambuí, state of Minas Gerais, Brazil

In 1943, the Center for the Study and Prophylaxis of Chagas Disease, Oswaldo Cruz Foundation, state of Minas Gerais (MG), was created in the municipality of Bambuí to carry out studies related to Chagas disease in the mid-western region of MG. Since that time, several investigations have been conducted to determine the natural habitat of triatomines, but Panstrongylus megistus colonies have never been found in this region. This paper records the first finding of a P. megistus sylvatic colony in 69 years of research. The characteristics of this ecotope and its implications for the epidemiology of Chagas disease are discussed.

Análise da fonte alimentar de Panstrongylus megistus (Hemiptera, Reduviidae, Triatominae) e sua atual importância como vetor do Trypanosoma cruzi, no Estado de Minas Gerais

INTRODUÇÃO: A pesquisa da fonte alimentar dos triatomíneos auxilia no conhecimento sobre a biologia destes insetos, inclusive para inferir-se a importância dos mesmos como transmissores do Trypanosoma cruzi ao homem. MÉTODOS: O presente estudo objetivou registrar, através da reação de precipitina, a fonte alimentar de triatomíneos provenientes de 54 municípios da região centro-oeste de Minas Gerais, assim como a infecção natural destes para flagelados semelhantes ao Trypanosoma cruzi. RESULTADOS: De julho de 2003 até março de 2007, foram avaliados 416 insetos, todos da espécie Panstrongylus megistus. Somando-se as ocorrências, as aves (70%) e os humanos (22,5%) constituíram as principais fontes sanguíneas. Encontrou-se 16 (3,8%) insetos positivos para flagelados semelhantes ao Trypanosoma cruzi sendo que oito realizaram hematofagia no homem. CONCLUSÕES: Os resultados demonstram necessidade de acentuar a vigilância entomológica na região, visto que foi detectada a possibilidade de ocorrência de novos casos da doença de Chagas através da transmissão vetorial.

[Evaluation of the Chagas Disease Control Program and presence of Panstrongylus megistus in central-western Minas Gerais State, Brazil]

The Brazilian National Chagas Disease Control Program (PCDCh) is currently in the epidemiological surveillance phase and poses one of the principal challenges for maintaining and improving surveillance. With the decentralization of health actions, leading to the transfer of responsibilities over the control of endemic diseases to the State and Municipal governments, some municipalities have faced difficulties in implementing the Program, since they lack experience in controlling this disease. This study analyzes the current situation with epidemiological surveillance of Chagas disease in 54 municipalities (counties) in central-western Minas Gerais State, with a view towards evaluation and improvement of the process. From July 2003 to July 2007, 776 captures were performed, totaling 1,390 triatomine bugs from 37 municipalities. The most prevalent species was Panstrongylus megistus (99.3% of the specimens captured). A total of 8.3% of the specimens were positive for Trypanosoma cruzi-like flagellates. Distribution of the specimens differed between municipalities, and the article discusses some reasons for these differences. As a whole, the findings strongly suggest the need to improve Chagas disease epidemiological surveillance in the region.

Feeding patterns of Triatoma longipennis Usinger (Hemiptera, Reduviidae) in peridomestic habitats of a rural community in Jalisco State, Mexico

We analyzed triatomine blood feeding patterns to evaluate the role of peridomiciles in Trypanosoma cruzi transmission at the rural village of Tepehuaje de Morelos at Jalisco State, Mexico (1999). A total of 206 bugs were collected in 11 out of 26 households (42.3%). Nymphs predominated in the collections (64.9% of the total). Except for one Triatoma barberi female, a species that belongs to the protracta species complex, all adults were Triatoma longipennis, a species of the phyllosoma complex. Triatomines were exclusively present in peridomestic sites mainly piles of tiles and bricks, and none were found indoors. Overall infection rate was 56.6% and no significant differences (P > 0.05) were observed between nymphs and adults or males and females. Identified blood meals were chicken (29.4%), opossum (20.9%), pig (24.5%), murid (20.9%), dog (3.5%), and armadillo (0.7%). No gut content reacted against anti-human, anti-bovine, anti-rabbit, and anti-cat sera. In contrast to fifth nymphs and adults, 87% of the small nymphs fed on one host, indicating that they are less mobile than other stages. Most fifth nymphs and adults fed on domestic hosts, while small nymphs mainly fed on opossum and murid. Infection blood-meal indexes were around 50% for single meals on opossum and murid, stressing their importance as trypanosome donors. Peridomiciles in Tepehuaje could be regarded as interaction sites among domestic and wild and synanthropic mammals and triatomines, which would facilitate circulation of the same T. cruzi strains between domestic and sylvatic cycles. Stone-made walls and building materials, which hold synanthropic rodents and opossums, should be considered as targets for vector control measures.

Chagas disease in a community in Southeast Brazil: I. A serlogic follow-up study on a vectorcontrolled area

The prevalence of Trypanosoma cruzi infection was evaluated in Berilo, Minas Gerais (MG), Brazil, from January to July 1997. A serological survey using the indirect immunofluorescence test (IFT) in dried blood collected on filter-paper was performed in a sample of 2,261 individuals. The overall prevalence rate of T. cruzi infection was 18%, and reached 50% in individuals older than 30 years from rural areas. The percentage of seropositivity was 0.17% among individuals younger than 10 years old, suggesting that vectorial transmission is controlled in the area. A decrease in prevalence rates among people born after 1960 and 1970 was observed and this appears to be correlated with the beginning of control programs. A reduction in T. cruzi infection rates was observed when comparing our results with the rates estimated in a serologic study carried out in Berilo in 1983(11).

Biological and isoenzymatic characterization of Trypanosoma cruzi strains isolated from sylvatic reservoirs and vectors from the state of Santa Catarina, Southern Brazil

Sixty eight Trypanosoma cruzi strains were isolated in the state of Santa Catarina, Southern Brazil, from sylvatic reservoirs or naturally infected vectors and characterized by their biological behaviour in mice, morphology of bloodstream forms and isoenzyme profiles. Twenty eight strains were isolated from the triatomine bug (Panstrongylus megistus), 2 from rodents (Echimys dasythrix and Akodon sp) and 38 from opossums (Didelphis marsupialis). The infectivity in mice of 48 T. cruzi strains showed that 2 (4.2%) were of high virulence, 19 (39.6%) of medium virulence, 15 (31.2%) of low virulence and 12 (25.0%) produced subpatent parasitemia in mice. A morphological study of bloodstream trypomastigotes from 8 T. cruzi strains showed a predominance of stout forms. The isoenzyme pattern of 59 T. cruzi strains showed that 54 (91.5%) belonged to zymodeme Z1, 3 (5.1%) to zymodeme Z2 and 2 (3.4%) to mixed zymodemes, Z1 and Z2. All 34 T. cruzi strains analyzed from opossums were Z1. Three out of 5 strains isolated from adults of P. megistus collected inside houses, belonged to zymodeme Z2 and two strains exhibited mixed zymodemes, Z1 and Z2, in 5 out of 6 enzymes studied. Although the State of Santa Catarina is a non endemic region for human Chagas'disease, the presence of zymodeme Z2 parasites in the sylvatic vector, P. megistus, captured in domiciliary environments suggests the possibility of human and/or domestic mammal infection by T. cruzi.

Inter-relações entre os ciclos de transmissão do Trypanosoma cruzi no município de Bambuí, Minas Gerais, Brasil

Neste trabalho apresentamos um estudo das inter-relações recentes entre os ciclos de transmissão silvestre e doméstico do T. cruzi no município de Bambuí, Minas Gerais, Brasil. No final da década de 1930, o Panstrongylus megistus era encontrado em 75% das casas. Subseqüentemente, o Triatoma infestans tornou-se a espécie predominante, sendo encontrada em 20% das residências urbanas e em mais de 60% das periurbanas. Com as intensas campanhas de borrifação desenvolvidas entre 1956 e 1969, o T. infestans foi erradicado do município, e a transmissão da doença de Chagas ao homem, interrompida, com aparecimento de P. megistus em residências rurais. Amostras de T. cruzi isoladas via xenodiagnóstico e hemocultura de 43 gambás (Didelphis albiventris) capturados em ambiente peridomiciliar e silvestre foram caracterizadas isoenzimaticamente e, independentemente da via de isolamento, apresentaram perfil de zimodema Z1. Por meio do Programa de Vigilância Epidemiológica da doença de Chagas, no período de agosto de 1986 a dezembro de 1988, 154 exemplares de P. megistus foram capturados pela população no peridomicílio e intradomicílio rural, estando 9,8% infectados pelo T. cruzi. Na caracterização isoenzimática de 13 amostras de T. cruzi isoladas desses triatomíneos, seis pertenciam ao zimodema Z1 (ciclo de transmissão silvestre), e sete ao Z2 (ciclo de transmissão doméstico). A captura de exemplares de P. megistus no intradomicílio, naturalmente infectados com parasitas de ambos os ciclos, indica a superposição dos ciclos de transmissão da doença de Chagas no município de Bambuí. Outra evidência da inter-relação dos ciclos pôde ser observada no isolamento de T. cruzi Z2 de um gato e a participação do cão como reservatório de T. cruzi Z1. A presença do P. megistus no peridomicílio representa importante elo entre o ambiente silvestre e o intradomicílio, servindo como veiculador do T. cruzi Z1 e na manutenção de ciclos de transmissão do T. cruzi Z2 no peridomicílio e domicílio, propiciando de forma gradual a reinfestação do município caso a Vigilância Epidemiológica seja interrompida.

Colonização de ecótopos artificiais pelo Panstrongylus megistus na ilha de Santa Catarina, Florianópolis, Santa Catarina, Brasil

Objetivando verificar a colonização de Panstrongylus megistus em ecótopos artificiais em Florianópolis foram examinados, de 1985 a 1992, 779 anexos peridomiciliares (524 galinheiros, 46 currais e 209 ranchos) em 9 localidades e 443 domicílios no distrito de Lagoa, todos na Ilha de Santa Catarina. Todo o ecótopo, incluindo forro e porão das casas, era examinado após aplicação de líquido insentífugo (Pirisa a 5%). A pesquisa nos anexos peri-domiciliares revelou 3 galinheiros e um rancho positivo no distrito de Lagoa, onde foram também encontrados 2 domicílios colonizados pelo P. megistus, com a captura de ovos, ninfas e adultos em todos os ecótopos. Pesquisas dirigidas foram realizadas em dois outros domicílios e em uma escola, nos quais os moradores haviam detectado anteriormente exemplares de P. megistus e, em todos os 3, foi confirmada a colonização pelo triatomíneo. Nos 9 ecótopos artificiais foram coletados 559 ovos, 305 ninfas e 24 adultos de P. megistus, com um índice de infecção pelo T. cruzi de 53,3% (182/329). Índice de infecção semelhante, de 56,5% (78/ 138), foi também encontrado nos adultos de P. megistus oriundos dos ecótopos silvestres e capturados nos domicílios pelos moradores, no período de 1983 a 1991. Os testes de precipitina revelaram, em 94,0% dos insetos examinados (170/181), sangue de uma única fonte alimentar e presença de sangue humano em 80,6% (25/31) dos adultos e em 5,8% (1/17) das ninfas capturados nos domicílios. Os resultados encontrados sugerem a necessidade de adoção de medidas de vigilância epidemiológica com a participação da comunidade, face o risco potencial de domiciliação do P. megistus.