Contribuições para a mobilização social, comunicação e educação em saúde sobre a doença de Chagas no YouTube ­ percurso e notas sobre o canal Falamos de Chagas / Contributions to social mobilization, communication and health education on Chagas disease on YouTube ­ route and notes on the channel Falamos de Chagas / Aportes a la movilización social, comunicación y educación en salud sobre la enfermedad de Chagas en YouTube ­ trayectoria y notas en el canal Falamos de Chagas

A doença de Chagas crônica afeta seis milhões de pessoas em regiões endêmicas, com 30 mil novos casos anuais ­ logo, espaços de divulgação científica são muito importantes para ofertar informações de qualidade à população. As iniciativas envolvendo o controle da doença de Chagas não podem se limitar às pesquisas com enfoque biológico. Este estudo objetiva apresentar um panorama sobre o processo de construção do canal Falamos de Chagas, no YouTube, sua importância para a comunicação, a informação, a educação em saúde e a mobilização social, bem como refletir sobre a qualidade de uma subamostra de vídeos do canal. Trata-se de um estudo qualitativo, dividido em duas fases: criação do canal e análise qualitativa dos vídeos sobre a doença disponíveis no YouTube. Observamos que existe potencial nas redes sociais, enquanto recurso de comunicação, contudo é preciso cautela, uma vez que se faz necessária a certificação da qualidade do material

Chronic Chagas disease affects six million people in endemic regions, with 30,000 new infected cases an-nually ­ thus, initiatives involving science diffusion are relevant to offer qualified information to the people. Chagas disease control initiatives cannot be limited to the level of biological focused research. This study aims to present an overview of the construction process of the YouTube channel Falando de Chagas, its importance for communication, information, health education and social mobilization, as well as to reflect on the quality of a subsample of videos present in the channel. Qualitative in nature, the study was divided into two stages: construction of the channel and qualitative analysis of videos about the disease available on YouTube. We observed that there is potential for social networks as communication resources, but caution is needed in their use, since the quality of the material needs certification

La enfermedad de Chagas crónica afecta seis millones de personas en regiones endémicas, con 30.000 nuevos casos anuales ­ los espacios de divulgación científica son muy importantes para ofrecer información a la población. Las iniciativas de control de la enfermedad de Chagas no pueden limitarse al nivel de investigación con enfoque biológico. El estudio tiene como objetivo presentar un panorama del proceso de construcción del canal Falando de Chagas, en YouTube, su importancia para la comunicación, información, educación en salud y movilización social, así como reflexionar sobre la calidad de una submuestra de videos presentes en la canal. De naturaleza cualitativa, el estudio se dividió en dos fases: construcción del canal y análisis cualitativo de videos sobre la enfermedad disponibles en YouTube. Observamos que existe potencial para las redes sociales como recurso de comunicación, sin embargo, se requiere cautela en su uso, ya que se requiere certificar la calidad del material

Bioinformatics and expression analysis of the Xeroderma Pigmentosum complementation group C (XPC) of Trypanosoma evansi in Trypanosoma cruzi cells / Análises de bioinformática e da expressão do gene Xeroderma Pigmentosum complementation group C (XPC) de Trypanosoma evansi em células de Trypanosoma cruzi

Abstract Nucleotide excision repair (NER) acts repairing damages in DNA, such as lesions caused by cisplatin. Xeroderma Pigmentosum complementation group C (XPC) protein is involved in recognition of global genome DNA damages during NER (GG-NER) and it has been studied in different organisms due to its importance in other cellular processes. In this work, we studied NER proteins in Trypanosoma cruzi and Trypanosoma evansi, parasites of humans and animals respectively. We performed three-dimensional models of XPC proteins from T. cruzi and T. evansi and observed few structural differences between these proteins. In our tests, insertion of XPC gene from T. evansi (TevXPC) in T. cruzi resulted in slower cell growth under normal conditions. After cisplatin treatment, T. cruzi overexpressing its own XPC gene (TcXPC) was able to recover cell division rates faster than T. cruzi expressing TevXPC gene. Based on these tests, it is suggested that TevXPC (being an exogenous protein in T. cruzi) interferes negatively in cellular processes where TcXPC (the endogenous protein) is involved. This probably occurred due interaction of TevXPC with some endogenous molecules or proteins from T.cruzi but incapacity of interaction with others. This reinforces the importance of correctly XPC functioning within the cell.

Resumo O reparo por excisão de nucleotídeos (NER) atua reparando danos no DNA, como lesões causadas por cisplatina. A proteína Xeroderma Pigmentosum complementation group C (XPC) está envolvida no reconhecimento de danos pela via de reparação global do genoma pelo NER (GG-NER) e tem sido estudada em diferentes organismos devido à sua importância em outros processos celulares. Neste trabalho, estudamos proteínas do NER em Trypanosoma cruzi e Trypanosoma evansi, parasitos de humanos e animais, respectivamente. Modelos tridimensionais das proteínas XPC de T. cruzi e T. evansi foram feitos e observou-se poucas diferenças estruturais entre estas proteínas. Durante testes, a inserção do gene XPC de T. evansi (TevXPC) em T. cruzi resultou em crescimento celular mais lento em condições normais. Após o tratamento com cisplatina, T. cruzi superexpressando seu próprio gene XPC (TcXPC) foi capaz de recuperar as taxas de divisão celular mais rapidamente do que T. cruzi expressando o gene TevXPC. Com base nesses testes, sugere-se que TevXPC (sendo uma proteína exógena em T. cruzi) interfere negativamente nos processos celulares em que TcXPC (a proteína endógena) está envolvida. Isso provavelmente ocorreu pois TevXPC é capaz de interagir com algumas moléculas ou proteínas endógenas de T.cruzi, mas é incapaz de interagir com outras. Isso reforça a importância do correto funcionamento de XPC dentro da célula.

Bioinformatics and expression analysis of the Xeroderma Pigmentosum complementation group C (XPC) of Trypanosoma evansi in Trypanosoma cruzi cells / Análises de bioinformática e da expressão do gene Xeroderma Pigmentosum complementation group C (XPC) de Trypanosoma evansi em células de Trypanosoma cruzi

Nucleotide excision repair (NER) acts repairing damages in DNA, such as lesions caused by cisplatin. Xeroderma Pigmentosum complementation group C (XPC) protein is involved in recognition of global genome DNA damages during NER (GG-NER) and it has been studied in different organisms due to its importance in other cellular processes. In this work, we studied NER proteins in Trypanosoma cruzi and Trypanosoma evansi, parasites of humans and animals respectively. We performed three-dimensional models of XPC proteins from T. cruzi and T. evansi and observed few structural differences between these proteins. In our tests, insertion of XPC gene from T. evansi (TevXPC) in T. cruzi resulted in slower cell growth under normal conditions. After cisplatin treatment, T. cruzi overexpressing its own XPC gene (TcXPC) was able to recover cell division rates faster than T. cruzi expressing TevXPC gene. Based on these tests, it is suggested that TevXPC (being an exogenous protein in T. cruzi) interferes negatively in cellular processes where TcXPC (the endogenous protein) is involved. This probably occurred due interaction of TevXPC with some endogenous molecules or proteins from T. cruzi but incapacity of interaction with others. This reinforces the importance of correctly XPC functioning within the cell.

O reparo por excisão de nucleotídeos (NER) atua reparando danos no DNA, como lesões causadas por cisplatina. A proteína Xeroderma Pigmentosum complementation group C (XPC) está envolvida no reconhecimento de danos pela via de reparação global do genoma pelo NER (GG-NER) e tem sido estudada em diferentes organismos devido à sua importância em outros processos celulares. Neste trabalho, estudamos proteínas do NER em Trypanosoma cruzi e Trypanosoma evansi, parasitos de humanos e animais, respectivamente. Modelos tridimensionais das proteínas XPC de T. cruzi e T. evansi foram feitos e observou-se poucas diferenças estruturais entre estas proteínas. Durante testes, a inserção do gene XPC de T. evansi (TevXPC) em T. cruzi resultou em crescimento celular mais lento em condições normais. Após o tratamento com cisplatina, T. cruzi superexpressando seu próprio gene XPC (TcXPC) foi capaz de recuperar as taxas de divisão celular mais rapidamente do que T. cruzi expressando o gene TevXPC. Com base nesses testes, sugere-se que TevXPC (sendo uma proteína exógena em T. cruzi) interfere negativamente nos processos celulares em que TcXPC (a proteína endógena) está envolvida. Isso provavelmente ocorreu pois TevXPC é capaz de interagir com algumas moléculas ou proteínas endógenas de T. cruzi, mas é incapaz de interagir com outras. Isso reforça a importância do correto funcionamento de XPC dentro da célula.

Encapsulation of benznidazole in nanostructured lipid carriers and increased trypanocidal activity in a resistant Trypanosoma cruzi strain

Abstract Chagas disease is a neglected parasitic disease caused by Trypanosoma cruzi, whose treatment has remained unsatisfactory for over 50 years, given that it is limited to two drugs. Benznidazole (BZN) is an efficient antichagasic drug used as the first choice, although its poor water-solubility, irregular oral absorption, low efficacy in the chronic phase, and various associated adverse effects are limiting factors for treatment. Incorporating drugs with such characteristics into nanostructured lipid carriers (NLC) is a promising alternative to overcome these limiting obstacles, enhancing drug efficacy and bioavailability while reducing toxicity. Therefore, this study proposed NLC-BZN formulations in different compositions prepared by hot-melt homogenization followed by ultrasound, and the optimized formulation was characterized by FTIR, DRX, DSC, and thermogravimetry. Biological activities included in vitro membrane toxicity (red blood cells), fibroblast cell cytotoxicity, and trypanocidal activity against epimastigotes of the Colombian strain of T. cruzi. The optimized NLC-BZN had a small size (110 nm), negative zeta potential (-18.0 mV), and high encapsulation (1.64% of drug loading), as shown by infrared spectroscopy, X-ray diffraction, and thermal analysis. The NLC-BZN also promoted lower in vitro membrane toxicity (<3% hemolysis), and 50% cytotoxic concentration (CC50) for NLC-BZN in L929 fibroblast cells (110.7 µg/mL) was twice the value as the free BZN (51.3 µg/mL). Our findings showed that the NLC-BZN had higher trypanocidal activity than free BZN against the epimastigotes of the resistant Colombian strain, and this novel NLC-BZN formulation proved to be a promising tool in treating Chagas disease and considered suitable for oral and parenteral administration

Circulación de Leishmania infantum y Trypanosoma cruzi en perros domésticos de áreas urbanas de Sincelejo, región Caribe de Colombia / Silent circulation of Leishmania infantum and Trypanosoma cruzi among urban dogs from Sincelejo city, Caribbean region of Colombia

Introducción. La enfermedad de Chagas y la leishmaniasis tradicionalmente se han considerado zoonosis endémicas de áreas rurales del país. Sin embargo, la aparición de casos de estas enfermedades en áreas urbanas sugiere nuevos ciclos de circulación de estos parásitos. Por esta razón, se ha propuesto a los perros como centinelas de estos agentes zoonóticos, dado su rol como huéspedes accidentales o reservorios. Objetivo. Evaluar la circulación silenciosa de Leishmania spp. y Trypanosoma cruzi en perros de zonas urbanas de la ciudad de Sincelejo, Sucre. Materiales y métodos. Se analizaron 100 muestras de sangre de perros para amplificar la región ITS1 de Leishmania spp. Las muestras positivas se utilizaron para amplificar la región conservada del minicírculo del ADN del cinetoplasto de Leishmania infantum y para el análisis de polimorfismos de longitud de fragmentos de restricción con la endonucleasa HaelII. Por otra parte, se amplificó un fragmento del ADN satelital de T. cruzi. Además, se evaluó la presencia de infecciones por Ehrlichia canis y Anaplasma platys, como potencialmente modificadoras de las manifestaciones clínicas. Resultados. De los 100 perros estudiados, se detectó: Leishmania spp. en 32, T. cruzi en 12, ambos parásitos en 7 y L. infantum en 18. Se encontraron infecciones por anaplasmatáceos en 18, y coinfecciones por bacterias y parásitos en 8 de los perros. En general, 47 de los animales estaban infectados por, al menos, un agente etiológico. Conclusión. Se demuestra la circulación de L. infantum y T. cruzi en zonas urbanas de Sincelejo, así como coinfecciones de estos parásitos junto con parásitos de la familia Anaplasmataceae. El presente estudio demuestra la conveniencia del uso de perros en la vigilancia epidemiológica de estos agentes zoonóticos.

Introduction: Leishmania infantum and Trypanosoma cruzi are considered endemic zoonotic agents in rural areas of the country; however, there is a high risk of urbanization due to anthropogenic processes. For this reason, dogs have been proposed as sentinels of these zoonoses given their role as patients, hosts and/or reservoirs. Objective: To assess the silent circulation of Leishmania spp. and T. cruzi parasites in canines from urban areas of Sincelejo, Sucre. Materials and methods: One hundred canine blood samples were used to amplify the ITS1 region of Leishmania spp. Positive samples were used to amplify the conserved region of the kinetoplast DNA minicircle of L. infantum and for restriction fragment length polymorphism analysis with HaelII endonuclease. In addition, a satellite DNA of T. cruzi was amplified. Also, the presence of Ehrlichia canis and Anaplasma platys was evaluated as infections that can influence clinical symptoms and health of animals. Results: Leishmania spp. was detected in 32% (32/100) and T. cruzi in 12% (12/100) of the animals, and 7% (7/100) of the samples were positive for both parasites. Also, L. infantum and infections with Anaplasmataceae family parasites were both detected in 18 % (18/100) of the samples. In the same way, co-infections with bacteria and parasites were found in 8 % (8/100) of the animals. Overall, 47 % (47/100) of the animals were infected with at least one agent. Conclusion: The circulation of L. infantum and T. cruzi, as well as co-infections of pathogens of the Anaplasmataceae family, is demonstrated in urban areas of Sincelejo. The present study demonstrates the convenience of canines as epidemiological surveillance sentinels of these zoonotic agents.

Reactivación de la enfermedad de Chagas después de trasplante autólogo de progenitores hematopoyéticos. Reporte de caso y revisión de la literatura / Chagas disease reactivation after autologous stem cell transplant. Case report and literature review

Introducción. La enfermedad de Chagas es una parasitosis endémica en Latinoamérica transmitida por triatominos. Está asociada a factores de riesgo como la pobreza y la ruralidad. Después de la infección aguda, un tercio de los pacientes presenta compromiso del corazón, el aparato digestivo o el sistema nervioso central, en tanto que los dos tercios restantes no presentan este tipo de compromiso secundario. La inmunosupresión farmacológica rompe el equilibrio entre el sistema inmunitario y el parásito, lo cual favorece su reactivación. Caso clínico. Se presenta el caso de un hombre de 58 años procedente de un área rural colombiana, con diagnóstico de mieloma múltiple resistente a los fármacos de primera línea de tratamiento, que requirió un nuevo esquema de quimioterapia y consolidación con trasplante autólogo de células madre. Después del trasplante, presentó neutropenia febril. Los estudios microbiológicos iniciales fueron negativos. En el frotis de sangre periférica, se demostraron tripomastigotes y se diagnosticó enfermedad de Chagas aguda posterior al trasplante. Se inició el tratamiento con benznidazol. La evolución del paciente fue satisfactoria. Conclusiones. La serología positiva para Chagas previa a un trasplante obliga a descartar la reactivación de la enfermedad en caso de neutropenia febril. Se requieren más estudios para determinar las herramientas que permitan estimar la probabilidad de reactivación de la enfermedad y decidir sobre la mejor opción de relación entre costo, riesgo y beneficio de la terapia profiláctica.

Introduction: Chagas disease is an endemic parasitic infection in Latin America transmitted by triatomines. It is associated with risk factors such as poverty and rurality. After acute infection, a third of patients will present target organ involvement (heart, digestive tract, central nervous system). The remaining two thirds remain asymptomatic throughout their life. Pharmacological immunosuppression breaks the balance between the immune system and the parasite, favoring its reactivation. Clinical case: We present the case of a 58-year-old man from a Colombian rural area with a diagnosis of multiple myeloma refractory to the first line of treatment who required a new chemotherapy scheme and consolidation with autologous stem cell transplant. During the post-transplant period, he suffered from febrile neutropenia. Initial microbiological studies were negative but the peripheral blood smear evidenced trypomastigotes in blood. With a diagnosis of acute Chagas disease in a post-transplant patient, benznidazole was started. The evolution of the patient was satisfactory. Conclusions: Positive serology prior to transplantation makes it necessary to rule out reactivation of the pathology in the setting of febrile neutropenia. More studies are required to determine tools for estimating the probability of reactivation of the disease and defining the best cost-risk-benefit relation for the prophylactic therapy.

Verificación del desempeño general del método Elecsys® Chagas en la detección de anticuerpos específicos contra Trypanosoma cruzi / Verification of the general performance of the Elecsys® Chagas method in the detection of specific antibodies against Trypanosoma cruzi

Resumen La enfermedad de Chagas es una parasitosis producida por Trypanosoma cruzi, prevalente principalmente en el continente americano, y observada en regiones no endémicas, producto de viajes y migraciones. El objetivo de este estudio fue comparar el desempeño del ensayo Elecsys® Chagas (Roche Diagnostics Alemania) (ECLIA) para el diagnóstico de la infección chagásica crónica con el método estándar y evaluar su posible empleo en reemplazo del método automatizado existente. Se estudiaron 77 muestras de sueros pertenecientes a pacientes con diagnóstico presuntivo de enfermedad de Chagas, procesadas por los distintos métodos disponibles en la Sección Parasitología del Hospital Muñiz: inmunoensayo quimioluminiscente de micropartículas (CMIA) (Abbott), enzimoinmunoanálisis de adsorción (ELISA) (Wiener) y hemaglutinación indirecta (HAI) (Lab. Lemos S.R.L.). Los resultados de los métodos ELISA y HAI fueron comparados con los obtenidos en la prueba ECLIA, y estos a su vez con el método automatizado disponible. De las muestras analizadas, 22 (28,57%) presentaron IgG anti-T. cruzi y 55 (71,43%) resultaron negativas. Con el método ECLIA se logró un 100% en los parámetros de desempeño, con diferencias en los intervalos de confianza. La razón de verosimilitud positiva y la razón de verosimilitud negativa clasificaron al ensayo como excelente y la potencia global del test apoyó esa afirmación. Los métodos inmunológicos automatizados ayudan a la performance diagnóstica en la etapa crónica de la enfermedad de Chagas, permiten minimizar errores, favorecen la velocidad de emisión de los resultados y, debido a su alta sensibilidad y especificidad, en ciertos escenarios podrían proponerse para usar como única técnica.

Abstract Chagas disease is a parasitosis caused by Trypanosoma cruzi, prevalent mainly in the American continent, and observed in non-endemic regions as a result of travel and migration. The objective of this study was to compare the performance of the Elecsys® Chagas (Roche Diagnostics Alemania) (ECLIA) assay for the diagnosis of chronic Chagas infection with the diagnostic standard, and to evaluate its possible use as a replacement for the existing automated method. A total of 77 serum samples belonging to patients with a presumptive diagnosis of Chagas disease were evaluated, processed by the different methods available in the Parasitology Section of Hospital Muñiz: microparticle chemiluminescent immunoassay (CMIA) (Abbott), enzyme-linked immunosorbent assay (ELISA) (Wiener) and indirect hemagglutination (HAI) (Lab. Lemos S.R.L). The results of the ELISA and HAI methods were compared with those obtained in the ECLIA test, and these in turn with the available automated method. Of the samples analysed, 22 (28.57%) presented IgG anti-T. cruzi and 55 (71.43%) were negative. With the ECLIA method, 100% was achieved in the performance parameters, with differences in the confidence intervals. The positive likelihood ratio and the negative likelihood ratio classify the essay as excellent, and the overall power of the test supports this statement. Automated immunological methods help diagnostic performance in the chronic stage of Chagas disease, allow minimising errors, favour the speed of issuance of results, and due to the high sensitivity and specificity, in certain scenarios, they could be proposed for use as single technique.

Resumo A doença de Chagas é uma parasitose causada pelo Trypanosoma cruzi, prevalente principalmente no continente americano, e observada em regiões não endêmicas em decorrência de viagens e migrações. O objetivo deste estudo foi comparar o desempenho do ensaio Elecsys® Chagas (Roche Diagnostics Alemanha) (ECLIA) para o diagnóstico da infecção crônica de Chagas com o método padrão e avaliar seu possível uso em substituição do método automatizado existente. Foram avaliadas 77 amostras de soro pertencentes a pacientes com diagnóstico presuntivo de doença de Chagas, processadas pelos diferentes métodos disponíveis na Seção de Parasitologia do Hospital Muñiz: imunoensaio quimioluminescente de micropartículas (CMIA) (Abbott), ensaio imunoenzimático de adsorção (ELISA) (Wiener) e hemaglutinação indireta (HAI) (Lab. Lemos S.R.L). Os resultados dos métodos ELISA e HAI foram comparados com os obtidos no teste ECLIA, e estes por sua vez com o método automatizado disponível. Das amostras analisadas, 22 (28,57%) apresentaram IgG anti-T. cruzi e 55 (71,43%) foram negativos. Com o método ECLIA, foram obtidos 100% nos parâmetros de desempenho, com diferenças nos intervalos de confiança. A razão de verossimilhança positiva e a razão de verossimilhança negativa classificam o ensaio como excelente, e a potencia geral do teste conformou essa afirmação. Os métodos imunológicos automatizados auxiliam no desempenho diagnóstico na fase crônica da doença de Chagas, permitem minimizar erros, favorecem a rapidez na emissão dos resultados e, devido à alta sensibilidade e especificidade, em determinados cenários, poderiam ser propostos para uso como técnica única.

Revisiting the History of Chagas Disease: "Live to tell"

Abstract In 1907, Carlos Chagas was designated to fight paludism in the Rio das Velhas region along the Central do Brasil railroad. During his field research, Chagas discovered a hematophagous insect ( Panstrongylus megitus ) carrying a new trypanosomatide, which he named Trypanosoma cruzi . On April 14th, 1909, he found the same parasite in the blood of a febrile child, submitting the announcement of his discoveries to the Brasil Médico scientific journal. Here, we discuss the early stages in the establishment of a new human morbid entity during the first decades after its discovery with a definite influence from its discoverer, Carlos Chagas, as well the first collaborators. Moreover, we cover the importance of the Center for the Study and Prophylaxis of Chagas Disease in Bambuí (MG), unraveling the most advanced developments in research within the disease's habitat and the widening perspectives for modern research that have emerged after the 1960s and continue to improve to this day. In this revisitation to the history of Chagas disease, we begin at Manguinhos (RJ ), making our way to Lassance (MG), where the discovery took place. Then, we travel back to Rio de Janeiro in the beginning of the twentieth century and Brazilian republic until the current day, revealing milestone publications that settled Chagas disease both as a source of pride for Brazilian medicine and as a challenge with important aspects that remain to be clarified. Any similarities to our country's politics and economy in the twentieth century are not mere coincidences.

Antígeno nativo y no nativo para determinar la seroprevalencia de Trypanosoma cruzi en mujeres embarazadas en el estado de Morelos, México / Native and non-native antigen to determine the seroprevalence of Trypanosoma cruzi in pregnant women from the state of Morelos, Mexico

INTRODUCCIÓN: La enfermedad de Chagas es una infección parasitaria crónica sistémica, de importancia global, causada por Trypanosoma cruzi. OBJETIVO: Determinar la prevalencia de anticuerpos contra T cruzi en mujeres embarazadas en el estado de Morelos, México. MATERIALES Y MÉTODOS: Se analizaron 1.620 sueros de mujeres embarazadas mediante dos pruebas serológicas: ELISAc (antígeno crudo nativo) y ELISAr (antígeno recombinante, no nativo). Las muestras reactivas se analizaron posteriormente mediante hemaglutinación indirecta (HAI). Se utilizaron dos enfoques de detección, en paralelo (son positivas las muestras reactivas por cualquier método) y en serie (son positivas las muestras confirmadas por HAI). Se evaluaron factores sociodemográficos y de salud asociados a la presencia de anticuerpos contra T. cruzi mediante razones de momios al 95%. RESULTADOS: Se obtuvo una seroprevalencia de 4,87% con el diagnóstico en paralelo y de 0,43% en serie. A partir de los resultados en paralelo las mujeres que fueron atendidas en los hospitales generales de Tetecala y Jojutla tuvieron, respectivamente, 2,2 y 2,0 veces mayor posibilidad de presentar anticuerpos contra T cruzi con respecto a las mujeres que fueron atendidas en el Hospital General de Cuautla. CONCLUSIÓN: La prevalencia de anticuerpos contra T cruzi en mujeres embarazadas en el estado de Morelos fluctuó entre 0,43 y 4,87%, según el antígeno y el abordaje utilizado. Es necesario continuar con la vigilancia de la seroprevalencia de anticuerpos contra T cruzi en mujeres embarazadas en el estado de Morelos, México, con las técnicas de mayor sensibilidad y especificidad disponibles.

BACKGROUND: Chagas disease is a globally important chronic systemic parasitic infection caused by Trypanosoma cruzi. AIM: To determine the prevalence of antibodies against T cruzi in pregnant women from the state of Morelos, México. METHODS: 1,620 sera from pregnant women were analyzed using two serological tests: ELISAc (native crude antigen) and ELISAr (recombinant, non-native antigen). Reactive samples were subsequently analyzed by indirect hemagglutination (IHA). Two detection approaches were used, in parallel (reactive samples by any method are positive) and serial (samples confirmed by IHA are positive). Sociodemographic and health factors associated with the presence of antibodies against T cruzi were evaluated using 95% odds ratios. RESULTS: A seroprevalence of 4.87% was obtained with parallel diagnosis and 0.43% in series. From the parallel results, the women who were attended at the general hospitals of Tetecala and Jojutla had respectively 2.2 and 2.0 times greater chance of presenting antibodies against T cruzi compared to the women who were attended at the General Hospital of Cuautla. CONCLUSION: The prevalence of antibodies against T cruzi in pregnant women from the state of Morelos fluctuated between 0.43 and 4.87%, depending on the antigen and the approach used. It is necessary to continue with the surveillance of the seroprevalence of antibodies against T cruzi in pregnant women from the state of Morelos, Mexico, using the techniques with the highest sensitivity and specificity available.

Análise histopatológica dos efeitos do bioterápico 200dh em camundongos infectados por Trypanosoma Cruzi / Histopathological analysis of the effects of 200dh biotherapeutic in mice infected with Trypanosoma Cruzi

O Trypanosoma cruzi é um protozoário que instaura uma infecção grave em seu hospedeiro vertebrado, podendo causar danos irreversíveis, principalmente em suas células musculares, conhecida como a doença tripanossomíase ou Doença de Chagas. dicação disponível no mercado, que combate esse parasito, não é completamente eficiente e produz danos indesejáveis e irreversíveis, fazendo-se necessário a busca por outros campos da medicina, em termos de medicação, para combater essa doença. Nesse sentido, pesquisas com medicamentos homeopáticos têm se revelado promissoras no combate ao parasito, sobretudo as formas amastigotas, que são mais difíceis de serem exterminadas. Os bioterápicos são os homeopáticos que obtiveram maior sucesso em relação à infecção por T. cruzi, uma vez que esses medicamentos possuem seu princípio ativo retirado do próprio parasito, suas toxinas, parte de membros, realizando uma terapia conhecida como isoterapia ­ cura pelo igual. Resultados encontrados indicam que o bioterápico 200dH atua coagindo o sistema imune a combater o T. cruzi em cobaias contaminadas, fomentando uma resposta imune celular e humoral mais eficiente do que a fisiológica. Acredita-se que esse medicamento atue estimulando as células de defesa, que passarão a responder de forma antígeno- -específico, favorecendo o combate de amastigotas. Esse processo, provavelmente, é iniciado pela estimulação do macrófago, que por sua vez, de acordo com os resultados encontrados, inicia uma cascata inflamatória, com predominância da via Th1, fomentando a produção de IL4, IL-10 e interferon, auxiliando no combate as amastigotas.

The trypanosoma cruzi is a protozoan that causes a serious infeccion in the vertebrate host, being capable of causing irreversible damages mainly in the muscle cells, also known as trypanosomiasis disease or Chagas Disease. The commercially available drug medication which fights this parasite is not completely efficient and causes undesirable and irreversible damages making it necessary to search for other fields of medicine in terms of medication to combat this disease. Therefore research with homeopathic medicines has being promising in the fight against the parasite, especially the amastigote forms, which are more difficult to be exterminated. Biotherapics are the homeopathic ones that have been more successful in relation to T. cruzi infection, since these drugs have their active principle removed from the parasite itself, its toxins, part of its members, performing a therapy known as isotherapy - cure by the same. The results indicates that the 200dH biotherapic acts by coercing the immune system to fight T. cruzi in contaminated guinea pigs, promoting a cellular and humoral imune response more efficient than the physiological one. It is believed that this medicine works by stimulating the defense cells which will respond in an antigen-specific manner favoring the fight against amastigotes. This process is probably initiated by the stimulation of the macrophage which in turn, according to the remains found, initiates an inflammatory cascade with predominance of the Th1 pathway, promoting the production of IL-4e IL-5 and interferon helping to combat amastigotes

Hydroxymethylnitrofurazone (NFOH) decreases parasitaemia, parasitism and tissue lesion caused by infection with the Bolivia Trypanosoma cruzi type I strain in Swiss and C57BL/6 mice

Abstract The chemical hydroxymethylation of the antimicrobial nitrofurazone leads to the prodrug NFOH, also increases the anti-T. cruzi activities (in vitro and in vivo), as well as showed non-genotoxic (Ames and micronucleus assays). In the present study, we assessed the anti-T. cruzi effect of the NFOH In vivo - in acute Swiss and C57Bl/6 experimental Chagas models. The treatment started at 5 days post-infection during 20 consecutive days (orally, once day, 150mg/kg), and the parasitaemia as well as histopathology analysis were performed. In both experimental murine models, NFOH was able to reduce parasitemia blood avoiding parasitic reactivation, during immunosuppression period (dexamethasone 5mg/kg, 14 days), in 100% of the mice, and decrease tissue parasite nests, demonstrating absence of amastigote forms in all organs (100%) analyzed, data similar to benznidazole (BZN). Therefore, the results shown here pointing to the NFOH as promising compound for further preclinical studies, being a high potential drug to effective and safe chemotherapy to Chagas disease.

Seroprevalencia de infección por Trypanosoma cruzi en perros y gatos en la bioregión centro norte de Venezuela / Seroprevalence of Trypanosoma cruzi infection in dogs and cats in the north central bioregion of Venezuela

La enfermedad de Chagas (ECh) es una parasitosis del grupo de enfermedades desatendidas de la OMS. Endémica del continente americano, la transmisión se realiza en ciclos selvático, peridomiciliario y domiciliario. Epidemiológicamente, los caninos y felinos constituyen una fuente importante de infección y son centinelas de la transmisión. El perro es un hospedador común e importante del parásito ya que la presencia y número de caninos infectados en la vivienda del hombre constituyen factores de riesgo de transmisión doméstica de Trypanosoma cruzi. El presente estudio reporta la seroprevalencia de la infección por T. cruzi en la bioregión centro norte de Venezuela (Distrito Capital, Chichiriviche de la Costa del Estado La Guaira y parte del Estado Miranda), en 301 perros y 49 gatos empleando el ensayo inmunoenzimatico (ELISA). La prevalencia global en perros fue del 30,2 % en las tres zonas estudiadas mientras que en gatos fue de 40,8 %. Con relación al sexo de los animales, se encontró una prevalencia general de perros hembras del 27,6 % y para los perros machos del 33,1%. Los gatos machos presentaron una prevalencia mayor que las hembras en todas las localidades. Tanto en perros como en gatos la distribución de seropositividad fue mayor en animales intradomicilio. Se evidenció diferencia en los valores de ELISA-IgG para las poblaciones de perros muestreados en la localidad de Petare comparado con perros presentes en la localidad de Aricagua (perros de caza), (p=0,006). En líneas generales, esta última localidad presentó una media de densidad óptica para la prueba de ELISA-IgG de 0,959 [0,369 - 1,975]. La presencia de perros y gatos infectados es un factor de riesgo actual de infección por T. cruzi para el hombre tanto en el medio rural como en el urbano(AU)

Chagas disease (ChD) is a parasitic infection in the WHO Neglected Diseases group. Endemic to the american continent, transmission takes place in sylvatic, peridomiciliary and domestic cycles. Epidemiologically, canines and felines constitute an important source of infection and are sentinels of transmission. The dog is a common and important host of the parasite, since the presence and number of infected canines in the man's house are risk factors for domestic transmission of Trypanosoma cruzi. This study reports the seroprevalence of T. cruzi infection in the north-central bioregion of Venezuela (Capital District, Chichiriviche de la Costa, La Guaira State, and part of Miranda State), in 301 dogs and 49 cats using the immunoenzymatic assay (ELISA). The overall prevalence in dogs was 30.2 % in the three studied areas, while in cats it was 40.8 %. Regarding the sex of the animals, a general prevalence of 27.6 % for female dogs and 33.1% for male dogs was found. Male cats presented a higher prevalence than females in all localities. In both, dogs and cats, the distribution of seropositivity was greater in indoor animals. There was of a difference in ELISA-IgG values for the populations of dogs sampled in the town of Petare compared to dogs present in the town of Aricagua (hunting dogs), (p=0.006). In general, this last locality presented a mean optical density for the ELISA-IgG test of 0.959 [0.369 - 1.975]. The presence of infected dogs and cats is a current risk factor for T. cruzi infection for man in both of them in the rural and in the urban environment(AU)

Avaliação do potencial antiparasitário de um Alcaloide Indólico isolado do Coral Marinho Tubastraea tagusensis / Evaluation of the Antiparasitic Potential of an Indole Alkaloid isolated from the Marine Coral Tubastraea tagusensis

Diante da falta de uma terapia eficaz e segura para o tratamento da doença de Chagas (DC) e da leishmaniose visceral, a busca por novos fármacos continua imprescindível. O ambiente marinho é uma rica fonte de produtos naturais bioativos, com aplicações contra parasitas, bactérias e outros patógenos que possam afetar humanos e animais. Entre as diversas classes de produtos naturais, os alcaloides têm um importante papel em aplicações terapêuticas. Neste trabalho, colônias de coral Tubastraea tagusensis foram coletadas, e a extração de seus metabolitos secundários foi realizada utilizando o solvente orgânico. Após fracionamento cromatográfico por diferentes técnicas, um alcaloide indolico foi isolado e elucidado estruturalmente por meio de técnicas espectrométricas e espectroscópicas. O alcaloide 6-bromo-2'-de-N-metillaplisinopsina (MR01), demonstrou atividade contra tripomastigotas e amastigota intracelulares de Trypanosoma cruzi, com valores de Concentração Efetiva 50% de 62 µM e 5 µM, respectivamente...(AU)

Considering the lack of effective and safe therapy for the treatment of Chagas disease (CD) and visceral leishmaniasis, the search for new chemotherapies remains indispensable. The marine environment is a well-known source of bioactive products, with applications against parasites, bacteria and other human / animal pathogenic microorganisms. Among different classes of natural products, alkaloids have a rich history of therapeutic applications. In this work, colonies of the coral Tubastraea tagusensis were collected and their secondary metabolites were extracted with ethyl acetate. Using different chromatographic techniques, an indole alkaloid was isolated and elucidated through spectroscopic and spectrometric techniques, resulting in the 6-bromo-2'-de-Nmethylaplisinopsin (MR01). The compound MR01 demonstrated activity against Trypanosoma cruzi, against both trypomastigote and amastigote forms, resulting in 50% Effective Concentration (EC50) values of 62 µM and 5 µM, respectively. The studies with Leishmania infantum amastigotes showed lack of activity. No cytotoxicity was observed for NCTC cells, to the maximal concentration of 200 µM. The mechanism of action was also explored. After incubation with the trypomastigotes, no alteration was observed in the permeability of the plasma membrane. The compound reduced the ATP and induced mitochondrial depolarization with no alterations in the reactive oxygen species levels. The intracellular calcium levels were reduced after treatment with MR01, including the pH alterations of the acidocalcisomes. Using MALDI-TOF/MS, the protein profile of the parasite was altered to a different manner to that observed for the standard drug benznidazole, suggesting a distinct mechanism of action. In silico studies of the pharmacokinetic / pharmacodynamic properties (PKPD) and physicochemical properties using the SwissADME software, suggested a good drug-like. In conclusion, this study showed for the first time the anti-T. cruzi activity of the alkaloid MR01. In addition, considering the potency and selectiveness, our study can suggest this compound to be explored as a new prototype for CD. (AU)

Triagem biológica de inibidores de sirtuína 2 (TcSir2rp1) candidatos a antichagásicos / Biological screening of sirtuin 2 inhibitors (TcSir2rp1) antichagasic candidates

A doença de Chagas é causada pelo Trypanosoma cruzi, e atualmente, acomete entre 6 a 7 milhões de pessoas em todo o mundo. A quimioterapia disponível para seu o tratamento se baseia apenas em dois fármacos, nifurtimox e benznidazol, com mais de 50 anos de descoberto. Estes fármacos apresentam eficácia limitada, pois são pouco efetivos na fase crônica e apresentam alta toxicidade, resultando em efeitos adversos graves. Esse panorama mostra a necessidade de novas abordagens terapêuticas contra essa doença. Nesse sentido, a inibição de vias bioquímicas essencias para o parasita se mostram como uma boa sugestão para identificação de compostos promissores candidatos a novos agentes quimioterápicos. A sirtuína 2 (Sir2) são enzimas reguladoras que participam de mecanismos epigenéticos em tripanossomatídeos, e no T. cruzi possuem um papel fundamental em todos os seus estágios evolutivos, devido a este fato, se apresentam como um alvo promissor na busca por novos fármacos contra a doença de Chagas. Neste sentido propomos a busca de inibidores da Sir2 proteína 1 do T. cruzi (TcSir2rp1) que é geneticamente validada como alvo farmacológico, por meio da estratégia de triagem biológica. Realizou-se a expressão da enzima recombinante por biologia molecular em um sistema de transformação utilizando cepa de Escherichia coli Artic Express (DE3). Foi feita a purificação e a confirmação da obtenção da proteína recombinante se deu por gel SDS-PAGE. Após a obtenção da enzima os parâmetros cinéticos foram determinados por experimentos de fluorimetria. A triagem foi realizada para um conjunto de 82 compostos, previamente sintetizados pelo nosso grupo de pesquisa, como inibidores da TcSir2p1 em dose única de 100 µM. Os ensaios foram realizados em triplicata e em experimentos independentes. Dentre os 82 compostos testados, 20 apresentaram inibições maior que 50% contra a enzima TcSir2rp1, na dose de 100 µM. Dentre estes, se destacaram 3 compostos derivados de chalconas, para os quais foi determinada a potência. O composto 1 foi o que mais potente, apresentando valor de IC50 de 11,65 µM, já os compostos 3 e 5 foram menos potentes (IC50= 38,50 µM e 19,85 µM, respectivamente). Diante dos resultados obtidos, pode-se concluir que a estratégia de triagem biológica é promissora na identificação de inibidores da TcSir2p1 candidatos a agentes anti- T. cruzi

Chagas disease is caused by Trypanosoma cruzi, and currently affects 6 to 7 million people worldwide. The chemotherapy available for its treatment is based on only two drugs, nifurtimox and benznidazole, with more than 50 years of discovery. These drugs have limited efficacy, as they are ineffective in the chronic phase and have high toxicity, resulting in serious adverse effects. This panorama shows the need for new therapeutic approaches against this disease. In this sense, the inhibition of essential biochemical pathways for the parasite proves to be a good suggestion for the identification of promising compounds candidates for new chemotherapeutic agents. Sirtuin 2 (Sir2) are regulatory enzymes that participate in epigenetic mechanisms in trypanosomatids, and in T. cruzi they have a fundamental role in all their evolutionary stages, due to this fact, they present themselves as a promising target in the search for new drugs against Chagas disease. In this sense, we propose the search for inhibitors of Sir2 protein 1 of T. cruzi (TcSir2rp1) which is genetically validated as a pharmacological target, through the biological screening strategy. The expression of the recombinant enzyme was performed by molecular biology in a transformation system using strain of Escherichia coli Artic Express (DE3). Purification was performed and confirmation of obtaining the recombinant protein was performed by SDS-PAGE gel. After obtaining the enzyme, the kinetic parameters were determined by fluorimetry experiments. Screening was performed for a set of 82 compounds, previously synthesized by our research group, as TcSir2p1 inhibitors in a single dose of 100 µM. Assays were performed in triplicate and in independent experiments. Among the 82 compounds tested, 20 showed inhibitions greater than 50% against the enzyme TcSir2rp1, at a dose of 100 µM. Among these, 3 compounds derived from chalcones stood out, for which the potency was determined. Compound 1 was the most potent, with an IC50 value of 11.65 µM, while compounds 3 and 5 were less potent (IC50= 38.50 µM and 19.88 µM, respectively). In view of the results obtained, it can be concluded that the biological screening strategy is promising in the identification of TcSir2p1 inhibitors candidates for anti-T. cruzi agents

Seroprevalence of Chagas disease in Southern Brazilian cardiac patients and their knowledge about the parasitosis and vectors / Soroprevalência da doença de Chagas em pacientes cardíacos do sul do Brasil e seu conhecimento sobre a parasitose e vetores

Abstract Chagas disease (CD) is considered a typical low-income population sickness of the developing countries in Latin America. Given the historical relevance of CD in individuals in southern Rio Grande do Sul (RS) State, Brazil, the aim of this study was to identify the knowledge of the CD and its vectors by cardiac patients, and the prevalence of anti-T cruzi antibodies in these individuals in Pelotas, city located in Rio Grande do Sul (RS) state, Brazil. The subjects with cardiac disease were submitted to a semi-structured questionnaire as well as two serological tests in order to detect anti-T. cruzi IgG antibodies. Of the individuals that born in municipalities showing the highest triatomine infestation rates in recent decades, 81.8% were able to recognize the vector insect (p = 0.0042; OR = 5.9), and 83.3% reported either themselves or someone in their families to have CD (p = 0.043, OR = 5.2). Of the 54 patients submitted to serological analysis, only 01 patient (1.9%) was positive for anti-T. cruzi antibodies, a 55 year old man from the rural area of Canguçu county. This study provides support for the evaluation to be extended to other cardiology centers, given the importance of Chagas disease in Brazil.

Resumo A doença de Chagas (DC) é considerada uma doença típica da população de baixa renda dos países em desenvolvimento da América Latina. Dada a relevância histórica da DC em indivíduos do sul do Estado do Rio Grande do Sul (RS), o objetivo deste estudo foi identificar o conhecimento da doença de Chagas (DC) e seus vetores em pacientes cardíacos, e a prevalência de anticorpos anti-T cruzi nesses indivíduos, em Pelotas, cidade localizada no Rio Grande do Sul (RS), Brasil. Os pacientes cardiopatas foram submetidos a um questionário semiestruturado, e também a dois testes sorológicos para detecção de anticorpos anti-T. cruzi IgG. Dos indivíduos que nasceram em municípios com as maiores taxas de infestação por triatomíneos nas últimas décadas, 81,8% foram capazes de reconhecer o inseto vetor (p = 0,0042; OR = 5,9), e 83,3% relataram que eles próprios ou alguém em suas famílias tem DC (p = 0,043, OR = 5,2). Dos 54 pacientes submetidos à análise sorológica, apenas 01 paciente (1,9%) foi positivo para anticorpos anti-T.cruzi, um homem de 55 anos da área rural do município de Canguçu. Este estudo fornece subsídios para que a avaliação seja estendida a outros centros de cardiologia, devido à importância da doença de Chagas no Brasil.

Evaluación del desempeño de una prueba rápida para el tamizaje de la infección por Trypanosoma cruzi en pacientes con el virus de la inmunodeficiencia humana / Performance evaluation of a rapid test for the screening of Trypanosoma cruzi infection in patients with human immunodeficiency virus

Resumen Un diagnóstico rápido y seguro de la infección por Trypanosoma cruzi permite la administración inmediata de un tratamiento etiológico específico, en los casos clínicamente manifiestos. En el presente trabajo, en 100 sueros de pacientes con diagnóstico presuntivo de infección por T. cruzi, se evaluó el desempeño de la prueba rápida Chagas Ab Rapid SD Bioline (PDR) para el diagnóstico serológico, se la comparó con el estándar diagnóstico (par serológico) y se la valoró para su empleo en la rutina del laboratorio. La PDR reveló un índice de concordancia muy bueno respecto del estándar diagnóstico (Kappa=0,989 [IC95% 0,965-1,000]) y los parámetros de sensibilidad, especificidad, valores predictivos positivos y negativos revelaron un buen desempeño. El índice de Youden informó un buen rendimiento de la prueba (J=0,98 [IC95% 0,93-1,02]); y en el mismo sentido, tanto la razón de verosimilitud positiva (RV (+)= infinito), como la negativa (RV (-)= 0,02 [IC95% 0,00-0,16]), mostraron aumentada la probabilidad que la enfermedad blanco esté presente o ausente, cuando la técnica así lo determinaba. El empleo de una PDR, por su simpleza y buen desempeño (con resultados disponibles el mismo día) produciría una optimización de recursos, podría realizarse en lugares donde el acceso al diagnóstico es limitado y donde su incorporación no requeriría de una infraestructura importante. Por otro lado, en nuestro caso, podría ser utilizada como segunda prueba, para incrementar la especificidad del diagnóstico serológico de la infección por T. cruzi.

Abstract A quick and safe diagnosis of Trypanosoma cruzi infection allows the immediate etiological treatment in clinically manifested cases. In the present work, the performance of the rapid Chagas Ab Rapid SD Bioline (PDR) test for serological diagnosis was evaluated in 100 sera from patients with a presumptive diagnosis of T. cruzi infection, it was compared with the diagnostic standard (serological pair) and this technique was valued to be used within the laboratory routine. The PDR revealed a very good concordance index with respect to the diagnostic standard (Kappa=0.989 [95% CI 0.965-1.000]) and the parameters of sensitivity, specificity, positive and negative predictive values revealed good performance. The Youden index reported good performance of the diagnostic test (J = 0.98 [95% CI 0.93-1.02]); and in the same sense, both the positive likelihood ratio (RV (+) = infinity), and the negative (RV (-) = 0.02 [95% CI 0.00-0.16]) showed an increased probability whether the target disease was present or absent, when the technique so determined. The use of a PDR, due to its simplicity and good performance (with results available on the same day) would produce an optimization of resources, could be carried out in places where access to the diagnosis is limited and where its incorporation would not require an important infrastructure. On the other hand, in our case, it could be used as a second test, to increase the specificity of the serological diagnosis of T. cruzi infection.

Resumo Um diagnóstico rápido e seguro da infecção pelo Trypanosoma cruzi permite a administração imediata de um tratamento etiológico específico nos casos clinicamente manifestos. No presente trabalho, o desempenho do teste rápido Chagas Ab Rapid SD Bioline (PDR) para o diagnóstico sorológico foi avaliado em 100 soros de pacientes com diagnóstico provável de infecção por T. cruzi, foi comparado com o padrão diagnóstico (par sorológico) e essa técnica foi avaliada para ser utilizada na rotina do laboratório. O PDR revelou um índice de concordância muito bom em relação ao padrão diagnóstico (Kappa=0,989 [IC 95% 0,965-1.000]) e os parâmetros de sensibilidade, especificidade, valores preditivos positivos e negativos revelaram bom desempenho. O índice de Youden informou um bom desempenho do teste diagnóstico (J = 0,98 [IC 95% 0,93-1,02]); e, no mesmo sentido, tanto a razão de verossimilhança positiva (RV (+) = infinito), quanto a negativa (RV (-) = 0,02 [IC 95% 0,00-0,16]), mostraram uma probabilidade aumentada de a doença-alvo estar presente ou ausente, quando a técnica assim o determinar. A utilização de um PDR, pela sua simplicidade e por um bom desempenho (com resultados disponíveis no mesmo dia) produziria uma otimização de recursos, podendo ser realizado em locais onde o acesso ao diagnóstico é limitado, e onde a sua incorporação não exigiria um infraestrutura importante. Por outro lado, no nosso caso, poderia ser utilizado como segundo teste, para aumentar a especificidade do diagnóstico sorológico da infecção pelo T. cruzi.

Enfermedad de Chagas en niño residente en zona urbana a 2850 metros sobre el nivel del mar, reporte de caso / Chagas disease in a child living in an urban area at 2850 meters above sea level, case report

Introducción: La enfermedad de Chagas es una afección parasitaria, transmitida por vectores con características eco epidemiológicas causada por el protozoario Trypanosoma cruzi, del 2013 al 2019 el Ecuador reportó 108 casos agudos de los cuales 7 estuvieron en la provincia de Pichincha. Presentamos el caso por sus características eco-epidemiológicas. Caso clínico: un caso agudo de paciente masculino de 14 años, residente en zona no endémica que inició con signo de Romaña, fiebre de tres semanas de evolución con esplenomegalia leve e hipertrofia concéntrica del ventrículo izquierdo. Evolución: el paciente fue tratado con benznidazol 7mg/kg/día vía oral cada 8 horas por dos meses, medidas de soporte y seguimiento multidisciplinario. Conclusión: La zona de detección fue el noreste del distrito metropolitano de Quito, la cual es parte del distrito de salud 17D01, sin reportes previos hasta el año 2016, cuya aparición se podría relacionar con cambios en el ecosistema local y el impacto en la transmisión de enfermedades vectoriales.

Introduction: Chagas disease is a parasitic disease transmitted by vectors with echo-epidemiological characteristics caused by the protozoan Trypanosoma cruzi. From 2013 to 2019, Ecuador reported 108 acute cases, of which 7 were in the province of Pichincha. We present the case due to its ecoepidemiological characteristics. Clinical case: An acute case of a 14-year-old male resident in a nonendemic area that began with Romaña's sign, fever of three weeks of evolution with mild splenomegaly and concentric hypertrophy of the left ventricle. Evolution: The patient was treated with benznidazole 7 mg/kg/day orally every 8 hours for two months, support measures and multidisciplinary follow-up. Conclusion: The detection zone was the northeast of the metropolitan district of Quito, which is part of health district 17D01, without previous reports until 2016, whose appearance could be related to changes in the local ecosystem and the impact on the transmission of vector diseases.

Chagas disease: Performance analysis of immunodiagnostic tests anti-Trypanosoma cruzi in blood donors with inconclusive screening results

ABSTRACT Background: The screening of Trypanosoma cruzi-infected blood donors using two serological techniques frequently leads to conflicting results. This fact prompted us to evaluate the diagnostic performance of four "in-house" immunodiagnostic tests and two commercially available enzyme-linked immunosorbent assays (ELISAs). Material and Methods: One hundred and seventy-nine blood donors, whose screening for Chagas disease was doubtful, underwent three in-house ELISAs, one in-house immunoblotting test (TESA-blot), and two commercial ELISAs (bioMérieux and Wiener) in an attempt to define the presence or absence of infection. Simultaneously, 29 donors with previous positive results from three conventional serological tests and 30 donors with constant negative results were evaluated. Results: The ELISA-Wiener showed the highest rate in sensitivity (98.92%) and the ELISA-bioMérieux, the highest specificity (99.45%), followed by the TESA-blot, which showed superior performance, with lower false-negative (2.18%) and false-positive (1.12%) rates. In series, the combination composed of the TESA-blot and ELISA-bioMérieux showed slightly superior performance, with trifunctional protein deficiency (TFP) = 0.01%. Conclusion: Our study confirms the high sensitivity and specificity of commercial kits. To confirm the presence or absence of T. cruzi infection, the combination of TESA-blot and ELISA-bioMérieux may be suggested as the best alternative. Individually, the TESA-blot performed the closest to the gold standard; however, it is not commercially available.