Congenital Chagas disease of second generation in Santiago, Chile. Report of two cases

Congenital Chagas disease (CChD) has been reported in different countries, mostly in Latin America. In 1987 a fatal case of CChD of second generation (CChDSG) was published. Within a period of six months - 1989-1990 - two cases of CChDSG were diagnosed and studied in the city of Santiago. Two premature newborns, sons of two sisters, with moderate liver and spleen enlargement, were found to have positive serology for Chagas disease and xenodiagnoses. The mothers, urban residents all their lives, without antecedents of triatomine bugs contact or blood transfusions, showed positive serology and xenodiagnoses. Their mother (grandmother of the infants), lived 20 years in a Northern rural Chagas disease endemic locality, in a triatomine infested house. Afterwards, she moved to Santiago, where she married and has resided up to now. Serology and xenodiagnoses were also positive. All the Trypanosoma cruzi infected individuals were successfully treated with nifurtimox

Seroepidemiology of human toxoplasmosis in Chile

En este trabajo se revisa, se amplia y se analiza en conjunto una crise serie e encuestas seroepidemiologicas sobre toxoplasmosis efectuadas en Chile entre 1982 y 1994, utilizando la reaccion de hemaglutinacion indirecta (RHAI). El estudio incluyo 76.317 personas aparentemente sanas de diferentes edades (0,57 por cento de la problacion total del pais), procedentes de 309 localidades urbanas y rural-periurbanas...

Rendimiento del xenodiagnóstico, según el número de cajas utilizadas en 1.181 personas con infección chagásica crónica diagnosticada mediante la reacción de hemaglutinación indirecta / Yielding of xenodiagnosis, according to the number of boxes utilized, in 1.181 persons with chronic chagasic infection diagnosed by means of indirect hemagglutination reaction

A study for evaluation of the yielding of xenodiagnosis (XD) in 1,181 persons with a previous positive indierect hemagglutination test (IHAT) for Trypanosoma cruzi infection was carried out. The infections of these people was detected during epidemiological surveys performed in rural-periurban and urban sections of the endemo-enzootic area of Chagas' disease in Chile, which involves the first seven, out of the thirteen political-administrative regions of the country. The sex distribution was 75.0% females and 25.0% males, varying the ages between 2 and 80 years. According to individual and geographical possibilities each person was submitted to 1-8 XD, which consisted in cylindrical wooden boxes containing seven third instar nymphs, laboratory reared, of Triatoma infestans. The boxes, covered with a pieces of tulle fixed with a rubber band were applied on the skin of the posterior side of the arm of the subject to be examined, holdea with a linen bracelet during 25-30 min. After the insects were fed the boxes were maintained in the laboratory at 27-C and 85% relative environmental humidity. Posteriorly, all the nymphs of each box were examined at 30, 60 and 90 days after application. A drop of abdominal content of each of them, homogenized with a drop of saline, was examined at the microscope looking for T. cruzi. XD resulted positive in 503 (42.6%) people. The positiveness of XD showed a trend of increasing according to the number of boxes used, from 11.4% with one to 51.6% with six. Under a practical point of view, the simultaneous application of four XD boxes seems to be advisable. In relation to the IHAT for Chagas' infection, the percentages of XD positivity increased from 39.8% in those people with lower titers (16-128) to 61.7% in those with higher titers (256-1,000)

Enfermedad de Chagas en el Altiplano Chileno: aspectos epidemiológicos, parasitológicos y clínicos / Chagas disease in Chilean altiplane: epidemiological, parasitological, and clinical aspects

Chagas'disease is endemo-enzootic in periurban and rural sections of the first seven (18-30'-34-36' South lat), out of the thirteen political-administrative regions of Chile. Permanent inhabited localities situated at different altitudes over the sea level (OSL) are clasified in: coastal settlement (0-1,499 , OSL), intermediate settlement (1,500-3,000 m OSL) and altiplano settlement (>3,000 m OSL). A total of 1,558 dwellings and their occupants from regions I and II were surveyed in 1982-1984 for different epidemiological Trypanosoma cruzi infection parameters. Hence, 261 dwellings, 189 domestic mammals and 517 people (ages 5-*60 years) from the Altiplano settlement were studied. The results obtained were: 4(1.5% ) and 1(0.8% ) of dwellings infested with Triatoma infestans, according to occupants information and by observation of direct evidences respectively; 8(4.2% ) animals (1 dog, 4 goats and 3 sheep) with a positive hemagglutination test (IHAT) for Chagas' disease; 21 people (4,1% ) with a positive IHAT; 4(19.0% ) and 3(14.3% ), out of the 21 IHAT positive individuals with all types of electrocardiogram (EKG) abnormalities and EKG abnormalities suggestive of a chagasic etiology respectively, whereas 65(13.1% ) and 15(3.0% ), out of the 496 IHAT negative ones presented the same kinds of EKG abnormalities. In comparing the frequence of presumedly chagasic EKG abnormalities in 91, 258 and 21 IHAT positive individuals from the three settlements surveyed, eventhough the figures lack of statistical significance, it is interesting to emphasize the increasing of percentages, paralell to altitutde, observed from 4.4 in the coastal settlement to 6.2 in the intermediate settlement up to 14,3 in the Altiplano, suggesting a possible influence of this factor in the production of EKG abnormalities. A similar situation was observed in 1,155, 1,211 and 496 IHAT negative individuals with the corresponding percentages of 2.1, 1.8 and 3.0

Endemia chagásica familiar detectada a consecuencia de un caso de infección congénita / Household chagasic endemia detected as a consequence of a case of congenital infection

During a study on prevalence of parasitic and viral serological markers in pregnant adolescents, a 17-years-old primipara from Polpaico, village near Santiago, gave birth to a normal male newborn in a Santiago hospital. As both of them presented positive an indirect hemaglutination test (IHAT) for Chagas's disease and the corresponding xenodiagnosis (XD), the infection in the infant was considered to be acquired through the placental route. According to recent epidemiologiacal surveys Polpaico is an endemo-enzootic chagasic rural settlement, where 14.7% of dwellings were infested with Triatoma infestans, while triatominae, persons and domestic mammals were found infected with Trypanosoma cruzi. One month later the adolescent mother, her son and other 11 consanguineous members of the family were visited in their homes in order to submit each of then to a physical examination and to IHAT for Chagas' disease, and XD to those whose IHAT resulted positive. Thus, in 7 (53.8%) the IHAT was positive and in 4(57.1%) out pf these 7 presented positive the XD, results that as a whole yelded a household chagasic endemics

Estudio seroepidemiológico de la hidatidosis y triquinosis humana, mediante la reacción de hemaglutinación indirecta, en la Comuna de San Juan de la Costa: Osorno, X Región, Chile; 1990-1991 / Seroepidemiological study of human hydatidosis and trichinosis, by means of indirect hemagglutination reaction, in San Juan de la Costa County, X Region, Chile: 1990-1991

San Juan de la costa County (40-45' South lat., 73-19' West long) is located in the Osorno province, South of Chile. Its population is 8,486 inhabitants. The basic economic activities are agriculture, cattle raising, timber production and manufacture of wood and coal. According to official reports, the incidence of human hydatidosis and trichinosis in this locality in 1989 were 24 and 59% respectively. In order to contribute to a better knowledge of the epidemiology of human hydatidosis and trichinosis in San Juan de la Costa County, an indirect hemagglutination test (IHAT) for these parasitoses was performed to 511 randomized people. Nine (1.8%) individuals resulted positive for hydatidosis and twenty four (4.7%) were positive for trichinosis. Some considerations on the corresponding phrophylactic meaures are proposed

Resultados de las reacciones serológicas en pacientes con diagnóstico presuntivo de toxoplasmosis / Results of serological reactions in patients with presumptive diagnosis of toxoplasmosis

Eventhough Toxoplasma gondii is an ubiquitous parasite that can affect most of human estructures and organs, not all clinical manifestations suggestive of being produced by it are caused by this protozoon. For these reasons sera samples of patients suspected of having toxoplasmosis are sent to the laboratory for detecting specific antibodies which would facilitate the differential diagnosis. Thus, 716 sera from suspected patients, mainly from the Metropolitan Region of Chile, were sent to the Parasitology Laboratory of Chile University in order to carry out in them, specific serological tests for toxoplasmosis: indirect hemagglutination test (IHAT), Sabin Feldman reaction (SFT) and complement fixation test (CFT). Were considered positive: IHAR and/or SFT with titers * 1 : 16 and CFT with titer * 1 5. The pathologies for demanding these serological tests were: obstetrical probelmas 210 (29,3%), congenital problems 193(27,0%), ophthalmopathies 81(11.3%), adenopathies 77(10.8%), AIDS 67(9.4%), miocardiopathies 46(6.4%) and miscellaneous 42(5.9%). The positivity found in these sera was higher in ophthalmopathies (61.7%), followed by obtetrical problems, miscellaneous problems, miocardiopathies and AIDS (50.7-52.4%), less frequent was the positivity in adenopathies (35.1%) and congenital problems (23.1%). In general, the 43.7% of positivity for toxoplasmosis found in these patients is higher than the 37.0% found in the general population. High titers of IHAT and SFT plus positive CFT was found in 13-fold higher proportion than in the general population

Algunas características epidemiológicas, clínicas y parasitológicas de la enfermedad de Chagas congénita en Chile / Epidemiology clinic and parasitological characteristics of congenital Chagas disease in Chile

La infección chagásica, endemo-enzootia, existe en Chile en sectores rurales y periurbanos de la I a VI Regiones, donde se ha demostrado la existencia de vectores, principalmente el Triatoma infestans, y mamíferos, incluso el hombre, parasitados por el Trypanosoma cruzi. Debido a migraciones, también se ha encontrado individuos infectados por el parásito en centros urbanos de las referidas regiones. Para conocer la prevalencia de la infección humana por T. cruzi en 1982-1987, mediante la reacción de hemaglutinación indirecta (RHAI) para enfermedad de Chagas, se ha examinado a 57.562 habitantes de dichas regiones: 13.515 rurales-periurbanos con RHAI positiva en el 16,9%, y 44.047 urbanos con RHAI positiva en el 1,9%. Entre estos últimos, se incluyeron 14.768 parturientas atendidas en 19 maternidades. La parasitosis puede ser transmitida vía transplacentaria. Con el objeto de conocer mejor el efecto que la infección materna por T. cruzi puede ocasionar sobre el producto de la concepción, se estudió a 1.355 mujeres en edad fértil (646 chagásicas y 709 no chagásicas) y a los productos de los embarazos que tuvieron en 1982-1987. No hubo diferencias significativas en el número ni en la evolución de los embarazos de las madres chagásicas y no chagásicas (peso del niño al nacer, mortinatalidad y abortos). Se estudió desde el momento del parto a 235 hijos de madres chagásicas y 191 de madres no chagásicas, nacidos en maternidades en los que la RHAI fue positiva en el 87,2 y en el 0,0% respectivamente

Algunos aspectos relevantes de la enfermedad de Chagas en Chile / Chaga's disease in Chile

La infección por T. cruzi (enfermedad de Chagas) constituye un problema de salud pública en Chile. tiene carácter endemo-enzoótico en sectores rurales y periféricos de las siete primeras regiones político-administrativas del país. Se registra una poporción significativa de infección por el parásito en habitantes de ciudades ubicadas en las regiones antes mencionadas, debido muy posiblemente a migración rural - urbana. 2.- El T. infestans es el vector domiciliario practicamente único de la parasitosis. Las tasas de infestación domiciliaria, cuyo promedio es de 29,4%, varían entre 9,3% y 65,2%, siendo en general más altas en las regiones III y IV. 3.- La infección promedia por T. cruzi de los T. infestans es de 18,7%, variando entre 6,4% y 47,6% registrándose los porcentajes más latos en las regiones II y III. Las tasas de infección de los triatominos, ocn un promedio de 19,6%, van en aumento según su edad, desde un 5,8% en los estadios II - III hasta un 25,4% en los imagos. Las fuentes de alimentación de los triatomídeos están constituídas principalmente por sangre de mamíferos y aves, alcanzando a un 90,8%, en la de los primeros, correspondiendo al hombre el 68,4%. Como era de esperar, las tasas deinfección por T. cruzi de los triatomas, fueron mayores en aquellos que se alimentaron con sangre de mamíferos. 4.- La infección chagásica humana, diagnosticada por medio de la RHAI correspondiente, fue en general de 16,9%, oscilando entre un 7,0% y un 33,2%, siendo las regiones III y IV las con más altos índices de infección. Las tasas de infección fueron similares para hombres y mujeres con un 17,7% y un 16,3% respectivamente. como es natural, se registró un incrmento progresivo de los valores de dichas tasas desde los grupos de menor edad (5,7%) hasta los grupos de mayores de 60 años (35,8%)...

Linfoma primario del tracto gastrointestinal / Primary lymphoma of the gastrointestinal tract

Se evalúan 29 casos de linfomas primarios gastrointestinales atendidos en el Hospital Nacional Guillermo Almenara Irigoyen (IPSS) Lima-Perú, entre los años 1980 y 1985. De ellos, 15 (51.72%) localizados en el estómago, 11 (37.93%) en el intestino delgado y 3 (10.34%) en el colon. La edad promedio para los linfomas gástricos fue de 53.6 años, para los de intestino delgado 42.7 años y para los de colon la séptima década de la vida. Observamos que no existe un patrón clínico característico y que son síntomas inespecíficos como pérdida de peso marcada (más de 10 Kgrs.), dolor abdominal e hiporexia los que predominan, debiendo, resaltarse que en los linfomas gástricos en un 80% de los casos se presentaron náuseas, vómitos y en un 20% hemorragia digestiva; mientras que en los de intestino delgado el 100% tenía historia de diarrea. La endoscopía de fibra constituye un eficiente método diagnóstico para los primarios de estómago y de colon, 9 y 2 casos respectivamente fueron diagnosticados de este modo, siendo frecuentemente necesario llegar a la laparotomía exploratoria para confirmar el diagnóstico de los que se localizan en el intestino delgado distal. Los linfomas mixtos y linfocítos poco diferenciados difusos fueron los de mayor incidencia y casi la mitad de los pacientes presentaban estadíos avanzados, III y IV, al debut. Hacemos notar que el linfoma gástrico tiene mejor pronóstico que el de las otras dos localizaciones; siendo la quimioterapia o cirugía seguida de quimioterapia, los procedimientos terapéuticos de elección