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Alger J, Cafferata ML, López R, Wiggins LD, Callejas A, Castillo M, Fúnes J, Rico F, Valencia D, Varela D, Alvarez Z, Berrueta M, Bock H, Bustillo C, Calderón A, Ciganda A, García-Aguilar J, García K, Gibbons L, Gilboa SM, Harville EW, Hernández G, López W, Lorenzana I, Luque MT, Maldonado C, Moore C, Ochoa C, Parham L, Pastrana K, Paternina-Caicedo A, Rodríguez H, Stella C, Tannis AF, Wesson DM, Zúniga C, Tong VT, Buekens P. Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people. Pediatr Res 2024; 95:566-572. [PMID: 38057577 PMCID: PMC11045253 DOI: 10.1038/s41390-023-02951-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
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Affiliation(s)
- Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras.
| | | | - Raquel López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Callejas
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Mario Castillo
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Jenny Fúnes
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Fátima Rico
- Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas Varela
- Servicio de Neurología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Zulma Alvarez
- Unidad de Vigilancia de la Salud, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Harry Bock
- Dirección General, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Dra. Nerza Paz, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carolina Bustillo
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Alejandra Calderón
- Centro de Salud Alonso Suazo, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Villanueva, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Alvaro Ciganda
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jorge García-Aguilar
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Kimberly García
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gustavo Hernández
- Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Wendy López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Marco T Luque
- Servicio de Infectología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Carlos Maldonado
- Servicio de Oftalmología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Cynthia Moore
- Goldbelt Professional Services, LLC, Chesapeake, VA, USA
| | - Carlos Ochoa
- Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Leda Parham
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Karla Pastrana
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Angel Paternina-Caicedo
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Heriberto Rodríguez
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Candela Stella
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Dawn M Wesson
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Van T Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Araujo Flores GV, Sandoval Pacheco CM, Ferreira AF, Tomokane TY, Nunes JB, Colombo FA, Sosa-Ochoa WH, Zúniga C, Silveira FT, Corbett CEP, Laurenti MD. Leishmania (L.) infantum chagasi isolated from skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis lead to visceral lesion in hamsters. Parasitol Int 2023; 93:102723. [PMID: 36566911 DOI: 10.1016/j.parint.2022.102723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
In Central America, Leishmania (L.) infantum chagasi infection causes visceral leishmaniasis (VL) and non-ulcerated cutaneous leishmaniasis (NUCL). The aim of the present study was to evaluate the course of an experimental infection in hamsters caused by L. (L.) infantum chagasi isolated from patients affected by NUCL compared with a strain isolated from a patient with VL. Stationary phase parasites in culture were inoculated through subcutaneous and intraperitoneal routes in hamsters. Following the post-infection times, a histopathological study, parasite load and cytokine determination in skin from the cutaneous inoculation site and viscera were performed. Animals subcutaneously infected with the different strains did not develop macroscopic lesions at the inoculation site, and the histopathological changes in the dermis were very slight. Regarding the histopathological study of the viscera, we observed the portal mononuclear inflammatory infiltrate, the presence of nodules in the hepatic parenchyma and the proliferation of macrophages in the spleen, which increased over the infection course. Overall, the parasite load in the liver and spleen and in the total IgG titres in the sera of infected hamster showed an increase with the time of infection, regardless of the route of inoculation. Regarding cellular immunity, we did not observe an increase or decrease in pro- and anti-inflammatory cytokines compared to the healthy control, except for IL-10, which was evident in the infected animals. The data showed that strains isolated from NUCL cause visceral lesions in the hamsters regardless of the route of inoculation, and they were similar to parasites isolated from VL humans.
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Affiliation(s)
- Gabriela V Araujo Flores
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carmen M Sandoval Pacheco
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aurea F Ferreira
- Laboratório de Investigação Médica, LIM50, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, HCFMUSP, SP, Brazil
| | - Thaise Yumie Tomokane
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Wilfredo H Sosa-Ochoa
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Investigaciones en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Fernando T Silveira
- Instituto Evandro Chagas, Belém, PA, Brazil; Universidade Federal do Pará, Belém, PA, Brazil
| | - Carlos E P Corbett
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Márcia D Laurenti
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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3
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Sandoval Pacheco CM, Araujo Flores GV, Ferreira AF, da Matta VLR, de Castro Gomes CM, Sosa-Ochoa WH, Zúniga C, Silveira FT, Corbett CEP, Laurenti MD. Role of antigen-presenting cells in non-ulcerated skin lesions caused by Leishmania (Leishmania) infantum chagasi. Parasite Immunol 2023; 45:e12971. [PMID: 36695719 DOI: 10.1111/pim.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
In Central America, infection by Leishmania (Leishmania) infantum chagasi causes visceral leishmaniasis and non-ulcerated cutaneous leishmaniasis (NUCL). This work aimed to evaluate the participation of subpopulations of antigen-presenting cells in skin lesions of patients affected by NUCL through double-staining immunohistochemistry using cellular and intracellular markers. Twenty-three skin biopsies from patients affected by NUCL were used. Histological sections stained by HE were used for histopathological study. Immunohistochemical studies were performed using primary antibodies against Langerhans cells, dermal dendritic cells, T lymphocytes, and the cytokines IL-12, IFN-γ, TNF-α, iNOS, and IL-10. The histopathological lesions were characterized by an inflammatory infiltrate, predominantly lymphohistiocytic, of variable intensity, with a diffuse arrangement associated with epithelioid granulomas and discreet parasitism. Double-staining immunohistochemistry showed higher participation of dendritic cells producing the proinflammatory cytokine IL-12 in relation to the other evaluated cytokines. Activation of the cellular immune response was marked by a higher density of CD8 Tc1-lymphocytes followed by CD4 Th1-lymphocytes producing mainly IFN-γ. The data obtained in the present study suggest that antigen-presenting cells play an important role in the in situ immune response through the production of proinflammatory cytokines, directing the cellular immune response preferentially to the Th1 and Tc1 types in NUCL caused by L. (L.) infantum chagasi.
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Affiliation(s)
- Carmen M Sandoval Pacheco
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriela V Araujo Flores
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aurea F Ferreira
- Laboratorio de Investigação Médica, LIM50, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, HCFMUSP, São Paulo, SP, Brazil
| | - Vânia L R da Matta
- Laboratorio de Investigação Médica, LIM50, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, HCFMUSP, São Paulo, SP, Brazil
| | - Claudia M de Castro Gomes
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilfredo H Sosa-Ochoa
- Instituto de Investigaciones en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Fernando T Silveira
- Instituto Evandro Chagas, Belém, PA, Brazil.,Universidade Federal do Pará, Belém, PA, Brazil
| | - Carlos E P Corbett
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Márcia D Laurenti
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Laurenti MD, Sosa-Ochoa W, Araujo Flores GV, Sandoval Pacheco CM, Tomokane TY, Oliveira LMDS, Zúniga C, Silveira FT, Corbett CEP. Evaluation of systemic immunity in atypical cutaneous leishmaniasis caused by Leishmania (L.) infantum chagasi. Parasite Immunol 2021; 44:e12896. [PMID: 34748659 DOI: 10.1111/pim.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
Abstract
In some central-American countries, Leishmania (L.) infantum chagasi infection can cause non-ulcerated or atypical cutaneous leishmaniasis (NUCL) in addition to the classic clinical form, visceral leishmaniasis (VL). Little is known about the host-parasite relationship that can contribute to the determination of one or another clinical form. The present study had the objective to evaluate the humoral and cellular immunity in the sera of individuals affected by NUCL to improve the comprehension of this atypical host-parasite interaction. Based on clinical and laboratory diagnosis, serum of 80 individuals was collected to evaluate the cytokines and immunoglobulins profile of NUCL (n = 47), VL patients (n = 5), and negative controls (n = 28). Cytokines were detected using Cytokine Bead Array (CBA) Human Th1/Th2/Th17 kit according to the manufacturer's instructions; class (IgG and IgM), and subclass of (IgG1 and IgG2) immunoglobulins was evaluated by ELISA using specific antigens. The concentration of TNF-α, IFN-γ, IL-2 and IL-4 cytokines in NUCL, VL and control was present below the detection threshold of CBA kit. IL-6, IL-10 and IL-17A cytokines was lower in NUCL compared to LV patients. Regarding to immunoglobulins, NUCL patients produced 4.0 times more IgG than the control, while VL patients produced 6.6 times more; and IgM level was 1.6 times higher in NUCL and 2.6 times in VL patients compared to the control. Concerning the immunoglobulins subclass, only VL patients showed positive reaction for IgG1, and IgG2 did not show positive reaction among the groups. The results showed a weak cellular and humoral systemic immune response in NUCL patients.
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Affiliation(s)
- Márcia Dalastra Laurenti
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wilfredo Sosa-Ochoa
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Gabriela Venicia Araujo Flores
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carmen Maria Sandoval Pacheco
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Thaise Yumie Tomokane
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luanda Mara da Silva Oliveira
- Laboratório de Dermatologia e Imunodeficiências (LIM-56), Departamento de Dermatologia, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Fernando Tobias Silveira
- Laboratório de Parasitologia, Instituto Evandro Chagas (Ministério da Saúde), Belém, PA, Brasil.,Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brasil
| | - Carlos Eduardo Pereira Corbett
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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5
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Alger J, Buekens P, Cafferata ML, Alvarez Z, Berrueta M, Bock H, Bustillo C, Calderón A, Callejas A, Castillo M, Ciganda A, Fúnes J, García J, García K, Gibbons L, Gilboa SM, Harville EW, Hernández G, López R, López W, Lorenzana I, Tulio Luque M, Maldonado C, Moore CA, Ochoa C, Parham L, Pastrana K, Rico F, Rodríguez H, Stella C, Valencia D, Varela D, Wesson DM, Zúniga C, Tong VT. Microcephaly Outcomes among Zika Virus-Infected Pregnant Women in Honduras. Am J Trop Med Hyg 2021; 104:1737-1740. [PMID: 33724927 PMCID: PMC8103474 DOI: 10.4269/ajtmh.20-1483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/19/2021] [Indexed: 11/07/2022] Open
Abstract
The impact of Zika virus (ZIKV) infection on pregnancies shows regional variation emphasizing the importance of studies in different geographical areas. We conducted a prospective study in Tegucigalpa, Honduras, recruiting 668 pregnant women between July 20, 2016, and December 31, 2016. We performed Trioplex real-time reverse transcriptase-PCR (rRT-PCR) in 357 serum samples taken at the first prenatal visit. The presence of ZIKV was confirmed in seven pregnancies (7/357, 2.0%). Nine babies (1.6%) had microcephaly (head circumference more than two SDs below the mean), including two (0.3%) with severe microcephaly (head circumference [HC] more than three SDs below the mean). The mothers of both babies with severe microcephaly had evidence of ZIKV infection. A positive ZIKV Trioplex rRT-PCR was associated with a 33.3% (95% CI: 4.3-77.7%) risk of HC more than three SDs below the mean.
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Affiliation(s)
- Jackeline Alger
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras;,Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras;,Unidad de Investigación Científica, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | - Pierre Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana;,Address correspondence to Pierre Buekens, W. H. Watkins Professor of Epidemiology School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2001, New Orleans, LA 70112. E-mail:
| | - Maria Luisa Cafferata
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina;,Unidad de Investigación Clínica y Epidemiológica, Montevideo, Uruguay
| | - Zulma Alvarez
- Unidad de Vigilancia de la Salud, Región Sanitaria Metropolitana del Distrito Central (RSMDC), Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Harry Bock
- Dirección General, RSMDC, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carolina Bustillo
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras;,Departamento de Ginecología y Obstetricia, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Alejandra Calderón
- Centro de Salud Alonso Suazo, RSMDC, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Allison Callejas
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Mario Castillo
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Alvaro Ciganda
- Unidad de Investigación Clínica y Epidemiológica, Montevideo, Uruguay
| | - Jenny Fúnes
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras;,Departamento de Pediatría, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Jorge García
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras;,Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Kimberly García
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily W. Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Gustavo Hernández
- Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Raquel López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Wendy López
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras;,Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras
| | - Marco Tulio Luque
- Servicio de Infectología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Carlos Maldonado
- Servicio de Oftalmología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Cynthia A. Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos Ochoa
- Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Leda Parham
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras;,Escuela de Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras
| | - Karla Pastrana
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras;,Departamento de Ginecología y Obstetricia, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Fátima Rico
- Departamento de Pediatría, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;,Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | | | - Candela Stella
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Diana Valencia
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas Varela
- Servicio de Neurología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Dawn M. Wesson
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Concepción Zúniga
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras;,Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Van T. Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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6
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Sandoval C, Araujo G, Sosa W, Avalos S, Silveira F, Corbett C, Zúniga C, Laurenti M. In situ cellular immune response in non-ulcerated skin lesions due to Leishmania (L.) infantum chagasi infection. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200149. [PMID: 33708246 PMCID: PMC7909480 DOI: 10.1590/1678-9199-jvatitd-2020-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background Skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis
(NUCL) caused by L. (L.) infantum chagasi are characterized
by lymphohistiocytic inflammatory infiltrate associated with epithelioid
granuloma and scarce parasitism. However, the in situ
cellular immune response of these patients is unclear. Therefore, the aim of
the present study was to characterize the cellular immune response in the
skin lesions of patients affected by NUCL. Methods Twenty biopsies were processed by immunohistochemistry using primary
antibodies to T lymphocytes (CD4, CD8), NK cells, B lymphocytes,
macrophages, nitric oxide synthase and interferon-gamma. Results Immunohistochemistry revealed higher expression of all cellular types and
molecules (IFN-γ, iNOS) in the dermis of diseased skin compared to the skin
of healthy individuals (p < 0.05). Morphometric analysis performed in the
skin lesions sections showed the predominance of CD8+ T
lymphocytes in the mononuclear infiltrate, followed by macrophages, mostly
iNOS+, a response that could be mediated by IFN-γ. Conclusion Our study improves knowledge of the cellular immune response in
non-ulcerated or atypical cutaneous leishmaniasis caused by L. (L.)
infantum chagasi in Central America and pointed to the pivotal
participation of CD8+ T lymphocytes in the host defense
mechanisms against the parasite in patients with NUCL.
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Affiliation(s)
- Carmen Sandoval
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Gabriela Araujo
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Wilfredo Sosa
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil.,Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Sara Avalos
- Master Program in Infectious and Zoonotic diseases, School of Microbiology, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Fernando Silveira
- Department of Parasitology, Evandro Chagas Institute, Secretariat of Health Surveillance, Ministry of Health, Belém, PA, Brazil.,Institute of Tropical Medicine, Federal University of Pará, Belém, PA, Brazil
| | - Carlos Corbett
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Concepción Zúniga
- Department of Health Surveillance, School Hospital, Tegucigalpa, Honduras
| | - Marcia Laurenti
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
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7
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Araujo Flores GV, Sandoval Pacheco CM, Sosa Ochoa WH, Gomes CMC, Zúniga C, Corbett CP, Laurenti MD. Th17 lymphocytes in atypical cutaneous leishmaniasis caused by Leishmania (L.) infantum chagasi in Central America. Parasite Immunol 2020; 42:e12772. [PMID: 32603482 DOI: 10.1111/pim.12772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Skin lesions in nonulcerated cutaneous leishmaniasis (NUCL) caused by Leishmania (L.) infantum chagasi are characterized by a mononuclear inflammatory infiltrate in the dermis, which is composed mainly of lymphocytes, followed by macrophages, few plasma cells and epithelioid granulomas with mild tissue parasitism. Previous studies have shown that the main population of lymphocytes present in the dermal infiltrate is CD8+ T cells, followed by CD4+ T cells, which are correlated with IFN-γ+ cells. To improve the knowledge of cellular immune responses in NUCL, skin biopsies were submitted to immunohistochemistry using anti-ROR-γt, anti-IL-17, anti-IL-6, anti-TGF-β, and anti-IL-23 antibodies to characterize the involvement of Th17 cells in the skin lesions of patients affected by NUCL. ROR-γt+ , IL-17+ , IL-6+ , TGF-β+ and IL-23+ cells were observed in the dermal inflammatory infiltrate of NUCL skin lesions. A positive correlation between CD4+ T-lymphocytes and ROR-γt+ and IL-17+ cells suggests that some of the CD4+ T-lymphocytes in NUCL could be Th17 lymphocytes. Moreover, a positive correlation between ROR-γt+ cells and TGF-β+ , IL-6+ , IL-17+ and IL-23+ cells could indicate the role of these cytokines in the differentiation and maintenance of Th17 lymphocytes. Our findings improve knowledge of the pathogenesis of this rare and atypical clinical form of leishmaniasis.
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Affiliation(s)
| | | | - Wilfredo Humberto Sosa Ochoa
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo, Brazil.,Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | | | - Concepción Zúniga
- Health Surveillance Department, University School Hospital, Tegucigalpa, Honduras
| | - Carlos P Corbett
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo, Brazil
| | - Marcia Dalastra Laurenti
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo, Brazil
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8
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Sosa-Ochoa W, Zúniga C, Chaves LF, Araujo Flores GV, Sandoval Pacheco CM, Ribeiro da Matta VL, Pereira Corbett CE, Tobias Silveira F, Dalastra Laurenti M. Clinical and Immunological Features of Human Leishmania (L.) infantum-Infection, Novel Insights Honduras, Central America. Pathogens 2020; 9:pathogens9070554. [PMID: 32664223 PMCID: PMC7399949 DOI: 10.3390/pathogens9070554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Leishmania (Leishmania) infantum is the etiological agent of both American visceral leishmaniasis (AVL) and non-ulcerated cutaneous leishmaniasis (NUCL) in Honduras. Although AVL is the most severe clinical form of infection, recent studies have shown that human immune response to parasite infection can result in a clinical-immunological spectrum. The overall prevalence rate of infection and clinical-immunological profiles of the L. (L.) infantum infection in Amapala municipality, South Honduras was determined. We examined 576 individuals with diagnosis based on combined ELISA (IgG/IgM) and DTH assays. We also used genus-specific kDNA PCR and Hsp70 PCR-RFLP for NUCL cases. Clinical evaluation found 82% asymptomatic and 18% symptomatic individuals. All symptomatic cases (n = 104) showing NUCL were positive for parasites. We identified L. (L.) infantum species in 100% of the skin lesion scrapings and in 90% of the blood samples from NUCL cases studied. A total of 320 asymptomatic individuals were exposed (ELISA+ and/or DTH+), providing an overall L. (L.) infantum prevalence of 73.6%. Clinical, parasitological, and immunological evaluations suggest seven infection profiles, three asymptomatic and four symptomatic. This represents the first report on clinical and immunological features of human L. (L.) infantum-infection in Amapala municipality, Honduras.
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Affiliation(s)
- Wilfredo Sosa-Ochoa
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras
| | - Concepción Zúniga
- Department of Health Surveillance, University School Hospital, Tegucigalpa 11101, Honduras;
| | - Luis Fernando Chaves
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Tres Ríos 4-2250, Cartago, Costa Rica;
| | - Gabriela Venicia Araujo Flores
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Carmen Maria Sandoval Pacheco
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Vania Lúcia Ribeiro da Matta
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Carlos Eduardo Pereira Corbett
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Fernando Tobias Silveira
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Belém 66090-000, PA, Brazil;
- Tropical Medicine Institute, Pará Federal University, Belém 66075-110, PA, Brazil
| | - Marcia Dalastra Laurenti
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
- Correspondence:
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9
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Peterson JK, Yoshioka K, Hashimoto K, Caranci A, Gottdenker N, Monroy C, Saldaña A, Rodriguez S, Dorn P, Zúniga C. Chagas Disease Epidemiology in Central America: an Update. Curr Trop Med Rep 2019. [DOI: 10.1007/s40475-019-00176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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10
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Buekens P, Cafferata ML, Alger J, Althabe F, Belizán JM, Bustamante N, Carlier Y, Ciganda A, Del Cid JH, Dumonteil E, Gamboa-León R, García JA, Gibbons L, Graiff O, Maldonado JG, Herrera C, Howard E, Lara LS, López B, Matute ML, Ramírez-Sierra MJ, Robles MC, Sosa-Estani S, Truyens C, Valladares C, Wesson DM, Zúniga C, For The Congenital Chagas Working Group. Congenital Transmission of Trypanosoma cruzi in Argentina, Honduras, and Mexico: An Observational Prospective Study. Am J Trop Med Hyg 2017; 98:478-485. [PMID: 29210352 DOI: 10.4269/ajtmh.17-0516] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Compared with South America, there is a lack of epidemiologic studies about the risk of congenital transmission of Trypanosoma cruzi in Central America and Mexico. It has been suggested that T. cruzi genotypes might differ by region and that congenital transmission might vary according to the parasite's genotype. Our objective was to compare T. cruzi congenital transmission rates in three countries. We performed an observational prospective study in 2011-2014 enrolling women at delivery in one hospital in Argentina, two hospitals in Honduras, and two hospitals in Mexico. Congenital T. cruzi infection was defined as the presence of one or more of the following criteria: presence of parasites in cord blood (direct parasitological microscopic examination) with positive polymerase chain reaction (PCR) in cord blood, presence of parasites in infant's blood at 4-8 weeks (direct parasitological microscopic examination), and persistence of T. cruzi-specific antibodies at 10 months, as measured by at least two tests. Among 28,145 enrolled women, 347 had at least one antibody rapid test positive in cord blood and a positive enzyme-linked immunosorbent assay in maternal blood. PCR in maternal blood was positive in 73.2% of the cases, and genotyping identified a majority of non-TcI in the three countries. We found no (0.0%; 95% confidence interval [CI]: 0.0, 2.0) confirmed congenital case in Honduras. Congenital transmission was 6.6% (95% CI: 3.1, 12.2) in Argentina and 6.3% (95% CI: 0.8, 20.8) in Mexico. Trypanosoma cruzi non-TcI predominated and risks of congenital transmission were similar in Argentina and Mexico.
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Affiliation(s)
- Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - María Luisa Cafferata
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | - Jackeline Alger
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Fernando Althabe
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - José M Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Yves Carlier
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Alvaro Ciganda
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
| | | | - Eric Dumonteil
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Jorge A García
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Olga Graiff
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Jesús Gurubel Maldonado
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, México
| | - Claudia Herrera
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Elizabeth Howard
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Laura Susana Lara
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | | | - María Luisa Matute
- Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - María Jesús Ramírez-Sierra
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, México
| | - María Cecilia Robles
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben," CONICET, ANLIS, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Carine Truyens
- Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Valladares
- Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Dawn M Wesson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Concepción Zúniga
- Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
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11
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Hashimoto K, Zúniga C, Romero E, Morales Z, Maguire JH. Determinants of Health Service Responsiveness in Community-Based Vector Surveillance for Chagas Disease in Guatemala, El Salvador, and Honduras. PLoS Negl Trop Dis 2015; 9:e0003974. [PMID: 26252767 PMCID: PMC4529194 DOI: 10.1371/journal.pntd.0003974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Central American countries face a major challenge in the control of Triatoma dimidiata, a widespread vector of Chagas disease that cannot be eliminated. The key to maintaining the risk of transmission of Trypanosoma cruzi at lowest levels is to sustain surveillance throughout endemic areas. Guatemala, El Salvador, and Honduras integrated community-based vector surveillance into local health systems. Community participation was effective in detection of the vector, but some health services had difficulty sustaining their response to reports of vectors from the population. To date, no research has investigated how best to maintain and reinforce health service responsiveness, especially in resource-limited settings. METHODOLOGY/PRINCIPAL FINDINGS We reviewed surveillance and response records of 12 health centers in Guatemala, El Salvador, and Honduras from 2008 to 2012 and analyzed the data in relation to the volume of reports of vector infestation, local geography, demography, human resources, managerial approach, and results of interviews with health workers. Health service responsiveness was defined as the percentage of households that reported vector infestation for which the local health service provided indoor residual spraying of insecticide or educational advice. Eight potential determinants of responsiveness were evaluated by linear and mixed-effects multi-linear regression. Health service responsiveness (overall 77.4%) was significantly associated with quarterly monitoring by departmental health offices. Other potential determinants of responsiveness were not found to be significant, partly because of short- and long-term strategies, such as temporary adjustments in manpower and redistribution of tasks among local participants in the effort. CONCLUSIONS/SIGNIFICANCE Consistent monitoring within the local health system contributes to sustainability of health service responsiveness in community-based vector surveillance of Chagas disease. Even with limited resources, countries can improve health service responsiveness with thoughtful strategies and management practices in the local health systems.
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Affiliation(s)
- Ken Hashimoto
- Chagas Disease Control Project, Japan International Cooperation Agency, Tegucigalpa, Honduras
| | - Concepción Zúniga
- National Chagas Disease Control Program, Directorate of Health Promotion, Ministry of Health, Tegucigalpa, Honduras
| | - Eduardo Romero
- National Vector-Borne Diseases Control Unit, Directorate of Environmental Health, Ministry of Health, San Salvador, El Salvador
| | - Zoraida Morales
- National Vector-Borne Disease Control Program, Department of Regulation of Healthcare Programs, Ministry of Health, Guatemala City, Guatemala
| | - James H. Maguire
- Brigham and Women´s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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12
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Bustamante Zamora DM, Hernández MM, Torres N, Zúniga C, Sosa W, de Abrego V, Monroy Escobar MC. Information to act: household characteristics are predictors of domestic infestation with the Chagas vector Triatoma dimidiata in Central America. Am J Trop Med Hyg 2015; 93:97-107. [PMID: 25870430 DOI: 10.4269/ajtmh.14-0596] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/05/2015] [Indexed: 11/07/2022] Open
Abstract
The interruption of vectorial transmission of Chagas disease by Triatoma dimidiata in central America is a public health challenge that cannot be resolved by insecticide application alone. In this study, we collected information on previously known household risk factors for infestation in 11 villages and more than 2,000 houses in Guatemala, Honduras, and El Salvador, and we constructed multivariate models and used multimodel inference to evaluate their importance as predictors of infestation in the region. The models had moderate ability to predict infested houses (sensitivity, 0.32-0.54) and excellent ability to predict noninfested houses (specificity higher than 0.90). Predictive ability was improved by including random village effects and presence of signs of infestation (insect feces, eggs, and exuviae) as fixed effects. Multimodel inference results varied depending on factors included, but house wall materials (adobe, bajareque, and palopique) and signs of infestation were among the most important predictive factors. Reduced models were not supported suggesting that all factors contributed to predictions. Previous knowledge and information from this study show that we have evidence to prioritize rural households for improvement to prevent house infestation with Triatoma dimidiata in Central America. House improvement will most likely have other health co-benefits.
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Affiliation(s)
- Dulce María Bustamante Zamora
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
| | - Marianela Menes Hernández
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
| | - Nuria Torres
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
| | - Concepción Zúniga
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
| | - Wilfredo Sosa
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
| | - Vianney de Abrego
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
| | - María Carlota Monroy Escobar
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Universidad de San Carlos, Ciudad de Guatemala, Guatemala; Administración Académica, Universidad de San Salvador, San Salvador, El Salvador; Centro de Investigación y Desarrollo en Salud, Universidad de San Salvador, San Salvador, El Salvador; Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Secretaría de Salud, Tegucigalpa, Honduras
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13
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Hashimoto K, Zúniga C, Nakamura J, Hanada K. Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras. BMC Health Serv Res 2015; 15:116. [PMID: 25889097 PMCID: PMC4383207 DOI: 10.1186/s12913-015-0785-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 03/11/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres. METHODS We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community. RESULTS Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy. CONCLUSIONS We found that Chagas disease vector surveillance can be integrated into the PHC service. Health centres demonstrated capacity to manage vector surveillance and improve performance, children's awareness, vector report-response and seroprevalence, once tasks were simplified to be performed by trained non-specialists and distributed among the stakeholders. Health systems integration requires health workers to perform beyond their usual responsibilities and acquire management skills. Integration of vector control is feasible and can contribute to strengthening the preventive capacity of the PHC service.
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Affiliation(s)
- Ken Hashimoto
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Chagas Disease Control Project 2008-2011, Japan International Cooperation Agency, Tegucigalpa, Honduras.
| | | | - Jiro Nakamura
- Chagas Disease Control Project 2008-2011, Japan International Cooperation Agency, Tegucigalpa, Honduras.
- Project Management Direction, External Cooperation Department, Estrella Inc., Tokyo, Japan.
| | - Kyo Hanada
- Independent consultant, Chiba, Japan.
- Former Senior Advisor, Human Development Department, Japan International Cooperation Agency, Tokyo, Japan.
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Aiga H, Sasagawa E, Hashimoto K, Nakamura J, Zúniga C, Chévez JER, Hernández HMR, Nakagawa J, Tabaru Y. Chagas disease: assessing the existence of a threshold for bug infestation rate. Am J Trop Med Hyg 2012; 86:972-9. [PMID: 22665603 DOI: 10.4269/ajtmh.2012.11-0652] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To examine the existence of a possible threshold for the domestic infestation rate of Triatoma dimidiata, below which transmission becomes unlikely, a census was conducted in 59 Chagas disease endemic communities of El Salvador and Honduras. Entomological and serological tests were conducted targeting 4,083 households and 6,324 children between 6 months and 15 years of age. The overall domestic infestation rate of Triatoma dimidiata and seroprevalence among children were 12.9% and 0.49%, respectively. Communities with a domestic infestation rate at 8% or less consistently showed a seroprevalence of 0%. In communities with a domestic infestation rate above 8%, there was a wide range in seroprevalence. A domestic infestation rate of 8% could serve as the possible threshold below which transmission would become unlikely. The implementation of an 8% threshold for determining needs for universal insecticide spraying would lead to a 21% reduction in spraying-related costs.
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Affiliation(s)
- Hirotsugu Aiga
- Human Development Department, Japan International Cooperation Agency (JICA), Tokyo, Japan.
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15
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Medina MT, Aguilar-Estrada RL, Alvarez A, Durón RM, Martínez L, Dubón S, Estrada AL, Zúniga C, Cartagena D, Thompson A, Ramirez E, Banegas L, Osorio JR, Delgado-Escueta AV, Collins JS, Holden KR. Reduction in rate of epilepsy from neurocysticercosis by community interventions: The Salamá, Honduras Study. Epilepsia 2011; 52:1177-85. [DOI: 10.1111/j.1528-1167.2010.02945.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Zúniga C, Lorca M. SITUACIÓN EPIDEMIOLÓGICA DE LA TOXOPLASMOSIS EN HONDURAS. Rev Patol Trop 2010. [DOI: 10.5216/rpt.v39i3.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Escribà JM, Ponce E, Romero ADD, Viñas PA, Marchiol A, Bassets G, Palma PP, Lima MA, Zúniga C, Ponce C. Treatment and seroconversion in a cohort of children suffering from recent chronic Chagas infection in Yoro, Honduras. Mem Inst Oswaldo Cruz 2010; 104:986-91. [PMID: 20027465 DOI: 10.1590/s0074-02762009000700008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 10/07/2009] [Indexed: 11/21/2022] Open
Abstract
Between 1999-2002, Médécins Sans Frontières-Spain implemented a project seeking to determine the efficacy and safety of benznidazole in the treatment of recent chronic Chagas disease in a cohort of seropositive children in the Yoro Department, Honduras. A total of 24,471 children were screened for Trypanosoma cruzi IgG antibodies through conventional enzyme-linked immunosorbent assays (ELISA) on filter paper. Recombinant ELISA (0.93% seroprevalence) showed 256 initially reactive cases, including 232 confirmed positive cases. Of these, 231 individuals were treated with benznidazole (7.5 mg/kg/day) for 60 days and were followed with a strict weekly medical control and follow-up protocol. At the end of the project, 229 patients were examined by the Honduras Secretariat of Health for post-treatment serological assessments; 88.2% seroconverted after 18 months and 93.9% seroconverted after three years. No differences were found in the seroconversion rates according to age or sex. Most of the side effects of the treatment were minor. These results support the argument that in areas where T. cruzi I is predominant and in areas affected by T. cruzi II, when vector transmission has been interrupted, Chagas disease diagnosis and treatment are feasible, necessary and ethically indisputable.
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19
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Medina MT, Durón RM, Martínez L, Osorio JR, Estrada AL, Zúniga C, Cartagena D, Collins JS, Holden KR. Prevalence, Incidence, and Etiology of Epilepsies in Rural Honduras: The Salama Study. Epilepsia 2005; 46:124-31. [PMID: 15660778 DOI: 10.1111/j.0013-9580.2005.11704.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Determination of epilepsy etiology in population-based studies is difficult because of the high cost of diagnostic tests. However, cost-effectiveness may be proven if preventive public-health strategies can be established from the test results. We report an epilepsy population-based study using clinical and laboratory techniques. METHODS A medical team administered an epilepsy survey to 88% of the residents by census in the rural county of Salamá, Honduras. Ninety of 100 participants identified with active epilepsy underwent a neurologic examination, video-electroencephalography (video-EEG), brain computed tomography (CT) scan, and serum enzyme-linked immunoelectrotransfer blot (EITB) for cysticercosis. Final diagnoses were based on the International League Against Epilepsy classifications for seizures and epilepsy syndromes. Combined epidemiologic, clinical, video-EEG, neuroimaging, and serum EITB assays were used for the diagnosis of epilepsy etiologies. RESULTS Among 6,473 residents surveyed, 151 persons with epilepsy (prevalence rate, 23.3/1,000) were identified, 100 of whom had active epilepsy (15.4/1,000) on the prevalence day. Incidence was determined to be 92.7/100,000. Partial seizures with or without secondary generalization were common (92.2%). Symptomatic epilepsy (62%) was primarily due to neurocysticercosis (37%), perinatal brain damage (8%), post-traumatic (3%), and poststroke (2%). Eight percent were idiopathic, and 30% were cryptogenic (unknown cause). CONCLUSIONS Symptomatic epilepsies primarily explained the high prevalence and incidence of epilepsy in Salamá. Integration of video-EEG and brain CT scan with clinical-epidemiologic evaluation was critical for determination of epilepsy etiology. Establishment of specific programs for continuation of epidemiologic surveillance, education, intervention, and long-term follow-up will benefit the Salamá region.
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Affiliation(s)
- Marco T Medina
- Neurology Training Program, Postgraduate Direction, National Autonomous University of Honduras, Honduras.
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