Emerging and reemerging forms of Trypanosoma cruzi transmission

This review aims to update and discuss the main challenges in controlling emergent and reemergent forms of Trypanosoma cruzi transmission through organ transplantation, blood products and vertical transmission in endemic and non-endemic areas as well as emergent forms of transmission in endemic countries through contaminated food, currently representing the major cause of acute illness in several countries. As a neglected tropical disease potentially controllable with a major impact on morbimortality and socioeconomic aspects, Chagas disease (CD) was approved at the WHO global plan to interrupt four transmission routes by 2030 (vector/blood transfusion/organ transplant/congenital). Implementation of universal or target screening for CD are highly recommended in blood banks of non-endemic regions; in organ transplants donors in endemic/non-endemic areas as well as in women at risk from endemic areas (reproductive age women/pregnant women-respective babies). Moreover, main challenges for surveillance are the application of molecular methods for identification of infected babies, donor transmitted infection and of live parasites in the food. In addition, the systematic recording of acute/non-acute cases and transmission sources is crucial to establish databases for control and surveillance purposes. Remarkably, antiparasitic treatment of infected reproductive age women and infected babies is essential for the elimination of congenital CD by 2030.

Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

Abstract INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.

Tasa de infección y tiempo de defecación de los estadios ninfales de Triatoma dimidiata (Latreille, 1811) después de la infección experimental con Trypanosoma cruzi / Infection rate and time of defecation of the nymphal stages of Triatoma dimidiata (Latreille, 1811) after experimental infection with Trypanosoma cruzi

Resumen Introducción El parásito Trypanosoma cruzi es el agente etiológico de la enfermedad de Chagas. Su transmisión es a través de insectos de la subfamilia Triatominae, donde Triatoma dimidiata es uno de los vectores principales en México y Centro América. La transmisión del parásito depende de factores como la tasa de infección de las distintas especies y el tiempo de defecación después de la alimentación. Objetivo Evaluar la infección con T. cruzi en los cinco estadios de T. dimidiata y determinar el tiempo de defecación postprandial. Material y métodos Treinta individuos de cada estadio de T. dimidiata fueron alimentados con sangre infectada con T. cruzi. Se llevó a cabo una segunda alimentación 20 días posteriores para evaluar la presencia del parásito en las heces y medir el tiempo de defecación postprandial. Resultados El número total de ejemplares infectados con T. cruzi fue de 99 (66 %). No se encontraron diferencias significativas en la tasa de infección por estadio ninfal (p>0.05). El tiempo de defecación fue menor en los individuos del quinto estadio en relación a los otros grupos (p<0.05). Conclusiones Todos los estadios de T. dimidiata se infectaron con T. cruzi, considerando al quinto instar como un mejor vector del parásito en condiciones de laboratorio.

Abstract Introduction Trypanosoma cruzi is the etiologic agent of Chagas disease. Transmission is through insects of the Triatominae subfamily, where Triatoma dimidiata is one of the main vectors in Mexico and Central America. This parasite transmission depends on factors such as the infection rate of the vector and its defecation time after feeding. Aim Evaluate the ability of five nymphal stages of T. dimidiata to cause infection of T. cruzi and determine the posprandial defecation time. Material and methods Thirty individuals of each stage of T. dimidiata were fed with blood infected with T. cruzi. A second feed was carried out after 20 days to evaluate the presence of the parasite in the feces and timing of postprandial defecation. Results The total number of individuals infected with T. cruzi was 99 (66 %). Differences statistically significant were not found among the nymphal stages (p> 0.05). Defecation time was lower in individuals of the fifth stage with difference statistically significant (p <0.05). Conclusions All stages of T. dimidiata were infected with T. cruzi, being the fifth stage the better vector in laboratory conditions.

Efeitos do jejum e da temperatura em laboratório na infectividade de triatomineos por Trypanosoma cruzi / Effects of fasting and laboratory temperature on the infectivity of Triatominae by Trypanosoma cruzi

A tentativa de padronização de alguns parâmetros que envolvem a realização do xenodiagnóstico, levou os autores do presente trabalho a estudarem a influencia do tempo de jejum e da temperatura de criação em laboratório sobre a evolução do T. cruzi em Triatoma infestans, assim como, sobre a própria evolução dos estádios ninfais destes artropodes. Estudaram também, a quantidade de sangue ingerido por tais insetos quando mantidos em diferentes temperaturas e períodos de jejum. Foram utilizados quatro lotes de 50 ovos cada. Os lotes 1 e 2 foram mantidos em temperatura constante (28o.C +/- 2) e umidade relativa do ar de 70-80%; os lotes 3 e 4 ficaram em temperatura ambiente (19-31o.C), variando a umidade livremente de acordo com as condições climáticas. Os lotes de números impares tiveram repastos quinzenais e os lotes de números pares, repastos mensais. Entre o 3o. e o 4o. estádios evolutivos, os barbeiros tomaram repasto contaminado com T. cruzi. Observou-se que a temperatura influiu no tempo de eclosão e desenvolvimento, que foi maior em temperatura ambiente. Quanto ao jejum, verificou se que tem uma importância menos acentuada sobre a evolução dos triatomíneos, porem, influiu decisivamente na mortalidade e na infectividade, pois, quanto maior era o tempo de abstinência de alimento, menor a quantidade de sangue sugado (AU).