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1.
Mem. Inst. Oswaldo Cruz ; 116: e200528, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154881

ABSTRACT

Panstrongylus geniculatus (Latreille, 1811) is the triatomine with the largest geographic distribution in Latin America. It has been reported in 18 countries from southern Mexico to northern Argentina, including the Caribbean islands. Although most reports indicate that P. geniculatus has wild habitats, this species has intrusive habits regarding human dwellings mainly located in intermediate deforested areas. It is attracted by artificial light from urban and rural buildings, raising the risk of transmission of Trypanosoma cruzi. Despite the wide body of published information on P. geniculatus, many knowledge gaps exist about its biology and epidemiological potential. For this reason, we analysed the literature for P. geniculatus in Scopus, PubMed, Scielo, Google Scholar and the BibTriv3.0 databases to update existing knowledge and provide better information on its geographic distribution, life cycle, genetic diversity, evidence of intrusion and domiciliation, vector-related circulating discrete taxonomic units, possible role in oral T. cruzi transmission, and the effect of climate change on its biology and epidemiology.


Subject(s)
Humans , Animals , Panstrongylus/genetics , Panstrongylus/parasitology , Triatoma/parasitology , Trypanosoma cruzi/isolation & purification , Chagas Disease/transmission , Insect Vectors/parasitology , Panstrongylus/physiology , Phylogeny , Genetic Variation/genetics , Biology , Genes, Insect , Ecology , Genotype , Geography , Insect Vectors/genetics , Latin America
2.
Mem. Inst. Oswaldo Cruz ; 115: e200214, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1135280

ABSTRACT

BACKGROUND Chagas disease, resulting from Trypanosoma cruzi infections, continues to be a health concern mainly in Latin American countries where the parasite is endemic. The laboratory diagnosis of a chronic infection is determined through serological assays for antibodies against T. cruzi and several tests are available that differ in key components, formats and methodologies. To date, no single test meets the criteria of a gold standard. The situation is further complicated by the difficulties associated with performance comparisons between different immunoassays or methodologies executed at different times and geographical areas. OBJECTIVE To improve the diagnosis of Chagas disease, the WHO coordinated the development of two International Biological Reference Standards for antibodies against anti-T. cruzi: NIBSC 09/186 and NIBSC 09/188 that respectively represent geographical regions with the highest prevalence of TcII and TcI lineages of the parasite. METHODS The principle goal of this study was to verify the behavior of these standards when assayed by several commercially available serological tests that employ different methods to capture and detect human anti-T. cruzi antibodies. FINDINGS AND MAIN CONCLUSIONS The results reinforce the recommendation that these standards be considered for performance evaluations of commercialised immunoassays and should be an integral step in the development of new test components or assay paradigms.


Subject(s)
Humans , Trypanosoma cruzi/isolation & purification , Serologic Tests/standards , Chagas Disease/diagnosis , Reference Standards , Trypanosoma cruzi/immunology , World Health Organization , Immunoassay/methods , Serologic Tests/methods , Antibodies, Protozoan/blood , Chagas Disease/parasitology
3.
Rev. panam. salud pública ; 44: e28, 2020. tab
Article in Spanish | LILACS | ID: biblio-1101769

ABSTRACT

RESUMEN Introducción. La enfermedad de Chagas o tripanosomiasis americana es causada por el protozoo flagelado Trypanosoma cruzi, transmitido principalmente por insectos vectores (denominados popularmente en las diferentes zonas de la Región de las Américas "vinchucas", "pitos", "chinches", "chirimachas" o "kissing bugs"). El parásito es transmitido por vía transplacentaria, transfusiones y, menos frecuentemente, por vía oral o trasplante de órganos. La implementación de políticas públicas y el manejo de la condición clínica requiere ser fortalecido debido a las dificultades diagnósticas y terapéuticas que presenta esta parasitosis sistémica. Para contribuir con ello, la Organización Panamericana de la Salud (OPS) desarrolló una guía para el manejo de la tripanosomiasis americana. Objetivos. Sintetizar las recomendaciones incluidas en la Guía para el diagnóstico y el tratamiento de la enfermedad de Chagas, publicada por la Organización Panamericana de la Salud en 2018, con el fin de presentar el adecuado diagnóstico y tratamiento de la enfermedad de Chagas y abordar aspectos sobre su implementación. Métodos. Se llevó a cabo una síntesis de la guía y sus recomendaciones. Adicionalmente, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en las Américas con el fin de identificar barreras, facilitadores y estrategias de implementación. Resultados. Se presentan 10 recomendaciones aplicables a pacientes adultos y pediátricos con sospecha de enfermedad de Chagas, exposición a T. cruzi y diagnóstico confirmado de enfermedad de Chagas aguda, crónica y congénita. Se identificaron reportes que abordaron aspectos de implementación. Conclusiones. Las recomendaciones buscan proveer estrategias para el diagnóstico y tratamiento oportunos de la enfermedad de Chagas, así como consideraciones para su implementación.(AU)


ABSTRACT Introduction. Chagas disease or American trypanosomiasis is caused by the flagellate protozoan Trypanosoma cruzi, transmitted mainly by insect vectors (popularly known in the different areas of the Region of the Americas as "kissing bugs", "pitos", "chinches", or "chirimachas" or "vinchuchas"). The parasite is transmitted via the placenta and in transfusions, and less frequently, orally or during organ transplantation. Because it was necessary to strengthen the implementation of public policies and the management of clinical conditions, given the diagnostic and therapeutic difficulties that this systemic parasitosis presents, the Pan American Health Organization (PAHO) developed guidance for the management of American trypanosomiasis. Objectives. Synthesize the recommendations included in the Guide for Diagnosis and Treatment of Chagas Disease, published (in Spanish only) by the Pan American Health Organization in 2018, in order to present the proper diagnostic methods and treatment for Chagas disease and to address aspects of its implementation. Methods. A summary was made of the guide and its recommendations. In addition, a systematic search was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and the gray literature for studies carried out in the Americas, in order to identify barriers, facilitators, and implementation strategies. Results. Ten recommendations are made. These are applicable to adult and pediatric patients with suspected Chagas disease, exposure to T. cruzi, or a confirmed diagnosis of acute, chronic, or congenital Chagas disease. Reports that addressed aspects of implementation were identified. Conclusions. The recommendations seek to provide strategies for the timely diagnosis and treatment of Chagas disease, as well as considerations for the implementation of such strategies.(AU)


RESUMO Introdução. A doença de Chagas (ou tripanossomíase americana) é uma infecção causada pelo protozoário flagelado Trypanosoma cruzi, comumente transmitido por insetos vetores (popularmente conhecidos na Região das Américas como "barbeiro", "chupão", "vinchuca", "pito", "chinche", "chirimacha" ou "kissing bug"). O parasita é transmitido por via transplacentária, transfusão de sangue e, menos comumente, por via oral ou transplante de órgãos de doadores infectados. A implementação de políticas públicas e o manejo clínico devem ser reforçados diante das dificuldades de diagnóstico e terapêutica para esta doença parasitária sistêmica. Em apoio a este propósito, a Organização Pan-Americana da Saúde (OPAS) elaborou um guia para o manejo da doença de Chagas. Objetivos. Sintetizar as recomendações contidas no Guía para el diagnóstico y el tratamiento de la enfermedad de Chagas (guia de diagnóstico e tratamento da doença de Chagas, disponível apenas em espanhol), publicado pela Organização Pan-Americana da Saúde em 2018, com o propósito de apresentar o diagnóstico e o tratamento adequados da doença de Chagas e abordar aspectos relativos à implementação. Métodos. Foi realizada uma síntese do guia e das recomendações apresentadas. Foi também conduzida uma busca sistemática nas bases de dados PubMed, LILACS, Health Systems Evidence e Epistemonikos e na literatura cinzenta de estudos realizados na Região das Américas visando identificar barreiras, facilitadores e estratégias de implementação. Resultados. O guia oferece 10 recomendações para pacientes adultos e pediátricos com suspeita de doença de Chagas, exposição ao T. cruzi e diagnóstico confirmado de doença de Chagas aguda, crônica e congênita e discute aspectos relativos à implementação. Conclusões. As recomendações visam fornecer estratégias para o diagnóstico e o tratamento de forma oportuna da doença de Chagas e são feitas considerações para a implementação destas estratégias.(AU)


Subject(s)
Humans , Trypanosoma cruzi/isolation & purification , Chagas Disease/diagnosis , Chagas Disease/therapy , Evidence-Based Medicine , Americas/epidemiology
5.
Arq. bras. cardiol ; 112(3): 240-246, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-989336

ABSTRACT

Abstract Background: In the past two decades, a new epidemiological profile of Chagas' disease (CD) has been registered in the Brazilian Amazon where oral transmission has been indicated as responsible for the increase of acute cases. In the Amazonas state, five outbreaks of acute CD have been registered since 2004. The cardiac manifestations in these cases may be characterized by diffuse myocarditis, with alteration in the electrocardiogram (ECG) and transthoracic echocardiogram (TTE). Objective: To perform a cardiac evaluation in autochthonous patients in the acute phase and at least one year after submitted to treatment for acute CD and evaluate the demographic variables associated with the presence of cardiac alterations. Methods: We evaluated patients diagnosed with acute CD through direct parasitological or serological (IgM) methods from 2007 to 2015. These patients were treated with benznidazole and underwent ECG and TTE before and after treatment. We assumed a confidence interval of 95% (CI 95%, p < 0.05) for all variables analyzed. Results: We observed 63 cases of an acute CD in which oral transmission corresponded to 75%. Cardiac alterations were found in 33% of the cases, with a greater frequency of ventricular repolarization alteration (13%), followed by pericardial effusion (10%) and right bundle branch block and left anterior fascicular block (2%). The follow-up occurred in 48 patients with ECG and 25 with TTE for a mean period of 15.5 ± 4.1 months after treatment. Of these, 8% presented normalization of the cardiac alterations in ECG, 62.5% remained with the normal exams. All of the patients presented normal results in TTE in the post-treatment period. As for the demographic variables, isolated cases presented more cardiac alterations than outbreaks (p = 0.044) as well as cases from Central Amazonas mesoregion (p = 0.020). Conclusions: Although cardiac alterations have not been frequent in most of the studied population, a continuous evaluation of the clinical-epidemiological dynamics of the disease in the region is necessary in order to establish preventive measures.


Resumo Fundamento: Nas últimas duas décadas, um novo perfil epidemiológico da Doença de Chagas (DC) foi registrado na Amazônia brasileira, onde a transmissão oral foi indicada como responsável pelo aumento dos casos agudos. No estado do Amazonas, foram registrados cinco surtos da doença desde 2004. As manifestações cardíacas nesses casos podem ser caracterizadas por miocardite difusa, com alteração nos resultados eletrocardiograma (ECG) e ecocardiografia transtorácica (ETT). Objetivo: avaliar parâmetros cardíacos em pacientes autóctones com DC na fase aguda e em um ano ou mais após tratamento, e avaliar as variáveis demográficas associadas com a presença de alterações cardíacas. Métodos: Avaliamos os pacientes diagnosticados com DC aguda por método direto parasitológico e exame sorológico (IgM) entre 2007 e 2015. Os pacientes foram tratados com benzonidazol e submetidos à ECG e ETT antes e após tratamento. Assumimos um intervalo de confiança de 95% (p < 0,05) para todas as variáveis analisadas. Resultados: Observamos 63 casos de DC aguda em que a transmissão oral ocorreu em 75% dos casos. Alterações cardíacas foram encontradas em 33% dos casos, com maior frequência de repolarização ventricular (13%), seguida de derrame pericárdico (10%), e bloqueio do ramo direito e bloqueio fascicular anterior esquerdo (2%). O acompanhamento foi realizado com 48 pacientes com ECG e 25 com ETT por um período médio de 15,5±4,1 meses após o tratamento. Desses pacientes, observou-se normalização das alterações eletrocardiográficas em 8% dos pacientes, e 62,5% continuaram com os parâmetros normais. Todos os pacientes apresentaram resultados da ETT normais no período pós-tratamento. Quanto às variáveis demográficas, os casos isolados apresentaram mais alterações cardíacas em comparação aos casos de surtos (p=0,044) e os casos identificados na mesorregião do Amazonas Central (p = 0,020). Conclusões: Apesar de as alterações cardíacas não terem sido frequentes na maioria da população do estudo, é necessária uma avaliação contínua da dinâmica clínica-epidemiológica da doença na região para se estabelecer medidas preventivas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Trypanocidal Agents/therapeutic use , Chagas Cardiomyopathy/parasitology , Chagas Disease/drug therapy , Nitroimidazoles/therapeutic use , Trypanosoma cruzi/isolation & purification , Brazil/epidemiology , Echocardiography , Chagas Cardiomyopathy/diagnostic imaging , Follow-Up Studies , Chagas Disease/complications , Chagas Disease/epidemiology , Electrocardiography
6.
Rev. Soc. Bras. Med. Trop ; 52: e20190061, 2019. tab, graf
Article in English | LILACS | ID: biblio-1013319

ABSTRACT

Abstract INTRODUCTION The ecoepidemiological situation in the State of Rio Grande do Norte, Brazil is characterized by frequent invasion and colonization of domiciliary units (DUs) by several triatomine species, with high rates of natural infection by Trypanosoma cruzi. METHODS: We evaluated the possibility of vector transmission of T. cruzi based on records of the occurrence of domiciled triatomines collected by the Secretariat of State for Public Health from 2005 to 2015. During this period, 67.7% (113/167) of municipalities conducted at least one active search and 110 recorded the presence of insects in DUs. These activities were more frequent in municipalities considered to have a high and medium-level risk of T. cruzi transmission. RESULTS Of 51,569 captured triatomines, the most common species were Triatoma brasiliensis (47.2%) and T. pseudomaculata (40.2%). Colonies of T. brasiliensis, T. pseudomaculata, T. petrocchiae, Panstrongylus lutzi, and Rhodnius nasutus were also recorded in the intradomicile and peridomicile. Natural infection by trypanosomatids was detected in 1,153 specimens; the highest rate was found in R. nasutus (3.5%), followed by T. brasiliensis (2.5%) and T. pseudomaculata (2.4%). There have been high levels of colonization over the years; however, not all infested DUs have been sprayed. CONCLUSIONS: This is the first report of intradomicile and peridomicile colonization by P. lutzi. These results demonstrate the risk of new cases of infection by T. cruzi and reinforce the need for continuous entomological surveillance in the State of Rio Grande do Norte.


Subject(s)
Animals , Trypanosoma cruzi/isolation & purification , Triatominae/parasitology , Chagas Disease/transmission , Insect Vectors/parasitology , Brazil , Triatominae/classification , Chagas Disease/prevention & control , Entomology , Spatial Analysis , Insect Vectors/classification
7.
Rev. Soc. Bras. Med. Trop ; 52: e20190146, 2019. tab, graf
Article in English | LILACS | ID: biblio-1013302

ABSTRACT

Abstract INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.


Subject(s)
Humans , Male , Female , Trypanosoma cruzi/isolation & purification , Blood Donors/statistics & numerical data , Chagas Disease/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Enzyme-Linked Immunosorbent Assay , Antibodies, Protozoan/blood , Seroepidemiologic Studies , Mass Screening/statistics & numerical data , Prevalence , Cross-Sectional Studies , Chagas Disease/blood , Chagas Disease/transmission , Sex Distribution , Age Distribution
8.
Rev. Soc. Bras. Med. Trop ; 52: e20180541, 2019. tab
Article in English | LILACS | ID: biblio-1057254

ABSTRACT

Abstract INTRODUCTION Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil. METHODS We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR. RESULTS Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients. CONCLUSIONS: Chagas disease affected mostly women, with the indeterminate chronic form of the disease.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Trypanosoma cruzi/isolation & purification , Chagas Disease/epidemiology , Socioeconomic Factors , Trypanosoma cruzi/genetics , Brazil/epidemiology , Echocardiography , Cross-Sectional Studies , DNA, Protozoan/genetics , Chagas Disease/parasitology , Parasite Load , Real-Time Polymerase Chain Reaction , Middle Aged
9.
Rev. Soc. Bras. Med. Trop ; 52: e20180505, 2019. tab, graf
Article in English | LILACS | ID: biblio-1041570

ABSTRACT

Abstract INTRODUCTION: The microscopic examination of microhematocrit tubes (mHCT) has been proposed as the gold standard for acute and congenital Chagas disease diagnosis. We compared different mHCT methodologies detecting T. cruzi parasites in the blood. METHODS: The rotating method, water mount, and immersion oil methods were compared for their suitability, sensitivity, and specificity. RESULTS: The rotating method was easier, faster, and more sensitive than the others with 100% specificity. CONCLUSIONS: The rotating method is feasible for laboratory technicians with standard training in microscopic techniques and is recommended for the diagnosis of acute Chagas disease in primary health care facilities.


Subject(s)
Humans , Animals , Trypanosoma cruzi/isolation & purification , Centrifugation/methods , Chagas Disease/diagnosis , Parasitemia/diagnosis , Capillary Tubing , Hematocrit/methods , Sensitivity and Specificity , Chagas Disease/parasitology , Chagas Disease/blood , Parasitemia/parasitology , Clinical Laboratory Services
10.
Rev. Soc. Bras. Med. Trop ; 52: e20190063, 2019. tab
Article in English | LILACS | ID: biblio-1041569

ABSTRACT

Abstract INTRODUCTION The present study reports the presence of triatomines in natural, peridomestic, and intradomicile environments in Itacoatiara municipality, state of Amazonas, a non-endemic region for Chagas disease. METHODS Active search was performed inside tree trunks, and palm trees, residences, and peridomiciles localized near the forest area. RESULTS: Twenty adults and ten triatomines nymphs were collected, fifteen of which were from natural forests, thirteen from intradomiciles, and two from peridomicile areas. CONCLUSIONS: The new records of adults and nymphs of triatomines in the intra- and peridomiciles suggest the adoption of prophylactic measures for vector surveillance in the study area.


Subject(s)
Animals , Female , Triatominae/parasitology , Insect Vectors/parasitology , Trypanosoma cruzi/isolation & purification , Brazil , Forests , Triatominae/classification , Population Density , Chagas Disease/transmission , Animal Distribution , Housing , Insect Vectors/classification
11.
Rev. Soc. Bras. Med. Trop ; 51(4): 445-451, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-957436

ABSTRACT

Abstract INTRODUCTION The National Park of Serra das Confusões (NPSC) is a protected area of natural landscape located in Southern Piauí, Brazil, and it is considered as one of the largest and most important protected areas in the Caatinga biome. METHODS The natural occurrences of trypanosomatids from hemocultures on small mammals and cultures from intestinal contents triatomines were detected through molecular diagnoses of blood samples, and phylogenetic relationship analysis of the isolates parasites using the trypanosome barcode (V7V8 SSUrDNA) were realized. RESULTS Only two Galea spixii (8.1%) and six Triatoma brasiliensis (17.6%) were positive by hemoculture, and the isolates parasites were cryopreserved. All the isolates obtained were positioned on the Trypanosoma cruzi DTU TcI branch. CONCLUSIONS Research focused on studying the wild animal fauna in preserved and underexplored environments has made it possible to elucidate indispensable components of different epidemiological chains of diseases with zoonotic potential.


Subject(s)
Animals , Rodentia/parasitology , Trypanosoma cruzi/genetics , Disease Reservoirs/parasitology , Triatominae/parasitology , Animals, Wild/parasitology , Marsupialia/parasitology , Phylogeny , Rodentia/classification , Trypanosoma cruzi/isolation & purification , Brazil , Biodiversity , Parks, Recreational , Genotype , Marsupialia/classification
12.
Rev. Soc. Bras. Med. Trop ; 51(1): 77-79, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-1041443

ABSTRACT

Abstract INTRODUCTION The occurrence of Triatoma sordida in the Brazilian Western Amazon is reported for the first time. METHODS Triatoma sordida specimens were collected from a Gallus gallus nest in a peridomiciliary area of Senador Guiomard municipality in the state of Acre. RESULTS The number of triatomine species in Acre increased from six to seven with this first report of T. sordida in the Brazilian Western Amazon. CONCLUSIONS The occurrence of T. sordida in Acre is of concern since it is among the most captured triatomines in peridomiciliary environments in Brazil, and carries a high potential for vector transmission.


Subject(s)
Animals , Triatoma/parasitology , Trypanosoma cruzi/isolation & purification , Chickens/parasitology , Insect Vectors/parasitology , Triatoma/classification , Brazil , Chagas Disease/transmission , Insect Vectors/classification
13.
Cad. Saúde Pública (Online) ; 34(1): e00006517, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-1039367

ABSTRACT

Resumo: O objetivo do artigo foi confirmar e descrever um surto da doença de Chagas aguda por transmissão oral na mesorregião Oeste Potiguar, Rio Grande do Norte, Brasil. Trata-se de um estudo descritivo do tipo série de casos, tendo como fonte de dados os registros de atendimentos médicos e entrevistas com os casos suspeitos entre 16 de setembro e 19 de novembro de 2015. Realizou-se pesquisa entomológica nas prováveis localidades de infecção dos casos de doença de Chagas aguda. Foram confirmados 18 casos de doença de Chagas aguda em residentes de quatro municípios do Rio Grande do Norte. Os sinais e sintomas mais relatados foram febre e fraqueza (n = 18), seguidos de mialgia (n = 17), prostração, inapetência e edema de membros inferiores (n = 15). A mediana de duração da febre foi de 20 dias (intervalo: 6 a 45 dias). Quinze casos foram confirmados por critério laboratorial e três por vínculo epidemiológico com clínica compatível. Todos os casos confirmados relataram ter consumido caldo de cana da mesma procedência. Foram capturados 110 triatomíneos na fazenda onde ocorreu a moagem da cana consumida. Os insetos estavam no peridomicílio, em amontoados de lenha e próximos ao engenho. A maioria dos exemplares capturados era da espécie Triatoma brasiliensis, e apresentou um índice de infecção natural de 63%. Foi confirmado surto da doença de Chagas de transmissão oral por ingestão de caldo de cana contaminado por triatomíneo infectado, evidenciado pelo vínculo epidemiológico entre os casos investigados e a pesquisa entomológica no local provável de infecção.


Abstract: The aim of this article was to confirm and describe an outbreak of acute Chagas disease involving oral transmission in the western region of Rio Grande do Norte State, Brazil. This was a descriptive case series study in which the data sources were medical records and interviews with suspected cases from September 16 to November 19, 2015. An entomological investigation was conducted in the probable sites of infection for acute Chagas disease cases. Eighteen cases of acute Chagas disease were confirmed in residents of four municipalities (counties) in Rio Grande do Norte State. The most frequently reported signs and symptoms were fever and weakness (n = 18), followed by myalgia (n = 17), prostration, loss of appetite, and edema of the lower limbs (n = 15). Median duration of fever was 20 days (range: 6 to 45 days). Fifteen cases were confirmed by the laboratory criterion and three by epidemiological link with consistent clinical characteristics. All confirmed cases reported having consumed sugar cane juice from the same mill. A total of 110 triatomines were captured on the plantation where the sugar cane had been crushed for juice. The insects were found in the peridomicile, in stacks of firewood and close to the sugar cane mill. The majority of the captured specimens were Triatoma brasiliensis and showed a natural infection rate of 63%. The Chagas disease outbreak was confirmed with oral transmission via ingestion of sugar cane juice contaminated with infected triatomines, as evidenced by the epidemiological link between the investigated cases and the entomological survey in the probable site where the infection occurred.


Resumen: El objetivo de este artículo fue confirmar y describir un brote de la enfermedad de Chagas aguda por transmisión oral en la mesorregión oeste de Rio Grande do Norte, Brasil. Se trata de un estudio descriptivo del tipo serie de casos, contando como fuente de datos los registros de atención médica y entrevistas en los casos sospechosos entre el 16 de septiembre y el 19 de noviembre de 2015. Se realizó una investigación entomológica en las probables localidades de infección de los casos de enfermedad de Chagas aguda. Fueron confirmados 18 casos de enfermedad de Chagas aguda en residentes de cuatro municipios de Rio Grande do Norte. Los signos y síntomas más informados fueron fiebre y debilidad (n = 18), seguidos de mialgia (n = 17), postración, inapetencia y edema de miembros inferiores (n = 15). La media de duración de la fiebre fue de 20 días (intervalo: 6 a 45 días). Quince casos fueron confirmados por criterio de laboratorio y tres por vínculo epidemiológico con clínica compatible. Todos los casos confirmados informaron haber consumido caldo de caña de la misma procedencia. Fueron capturados 110 triatominos en la hacienda donde se produjo la molienda de la caña consumida. Los insectos estaban en el peridomicilio, en montones de leña y cerca del ingenio azucarero. La mayoría de los ejemplares capturados era de la especie Triatoma brasiliensis, y presentó un índice de infección natural de un 63%. Se confirmó un brote de la enfermedad de Chagas de transmisión oral por ingestión de caldo de caña contaminado por triatomino infectado, evidenciado por el vínculo epidemiológico entre los casos investigados y la investigación entomológica en el lugar probable de infección.


Subject(s)
Humans , Animals , Male , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Triatoma/parasitology , Food Contamination/analysis , Disease Outbreaks , Chagas Disease/transmission , Chagas Disease/epidemiology , Insect Vectors/parasitology , Trypanosoma cruzi/isolation & purification , Brazil/epidemiology , Saccharum/parasitology , Entomology
14.
Cad. Saúde Pública (Online) ; 34(2): e00123716, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-952371

ABSTRACT

Apesar do declínio na prevalência da doença de Chagas no Brasil, a Região Nordeste apresenta condições propícias ao seu recrudescimento. O objetivo deste estudo foi analisar a positividade por doença de Chagas entre doadores de sangue do Piauí entre 2004 e 2013. A prevalência de sorologia reagente para doenças de Chagas na triagem de doadores foi de 1%, variando de 0,4% na Regional de Saúde de Uruçuí a 2,4% na Regional de Saúde de São Raimundo Nonato. Dos 220 municípios, 58,6% apresentaram casos. Apenas 34,5% das amostras positivas na triagem foram encaminhadas para testes complementares e entre estes, 84,4% apresentaram resultados negativos. Nossos resultados indicam a possibilidade da manutenção da transmissão vetorial em áreas do Estado do Piauí e a necessidade da implantação de ações que melhorem o índice de realização dos testes complementares referentes aos casos positivos na triagem.


Despite the decline in prevalence of Chagas disease in Brazil, the Northeast region of the country has favorable conditions for its resurgence. The study aimed to analyze positive Chagas disease serology rates among blood donors in Piauí State from 2004 to 2013. Prevalence of positive Chagas disease serology in blood donor screening was 1%, ranging from 0.4% in the Uruçuí Regional Health District to 2.4% in the São Raimundo Nonato Regional Health District. Of the state's 220 municipalities, 58.6% reported cases. Only 34.5% of the positive samples in screening were referred for complementary tests, and 84.4% of these showed negative results. Our findings suggest the possibility of persistent vector-borne transmission in areas of Piauí State and the need for measures to improve complementary testing in positive cases detected by screening.


A pesar del declive en la prevalencia de la enfermedad de Chagas en Brasil, la Región Nordeste presenta condiciones propicias para su recrudecimiento. El objetivo de este estudio fue analizar la positividad por enfermedad de Chagas entre donadores de sangre de Piauí entre 2004 y 2013. La prevalencia de la serología reactiva para la enfermedad de Chagas en la clasificación de donadores fue de un 1%, variando de 0,4% en la Regional de Salud de Uruçuí, a 2,4% en la Regional de Salud de São Raimundo Nonato. De los 220 municipios, un 58,6% presentaron casos. Sólo un 34,5% de las muestras positivas en la clasificación fueron dirigidas a test complementarios y entre estos, un 84,4% presentaron resultados negativos. Nuestros resultados indican la posibilidad del mantenimiento de la transmisión vectorial en áreas del Estado de Piauí y la necesidad de la implantación de acciones que mejoren el índice de realización de los test complementarios referentes a los casos positivos en la clasificación.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Blood Donors , Chagas Disease/blood , Chagas Disease/transmission , Donor Selection , Socioeconomic Factors , Trypanosoma cruzi/isolation & purification , Brazil/epidemiology , Residence Characteristics , Prevalence , Chagas Disease/epidemiology
15.
Rev. Soc. Bras. Med. Trop ; 50(6): 824-828, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-1041433

ABSTRACT

Abstract INTRODUCTION: Chagas disease surveillance requires current knowledge on synanthropic triatomines. We analyzed the occurrence and Trypanosoma cruzi infection rates of triatomine bugs in central Brazil, during 2012-2014. METHODS: Triatomines were collected inside or around houses, and T. cruzi infection was determined by optical microscopy and conventional/quantitative polymerase chain reaction. RESULTS: Of the 2706 triatomines collected, Triatoma sordida was the most frequent species in Goiás State, whereas Panstrongylus megistus predominated in the Federal District. Parasites identified were T. cruzi, T. rangeli, and Blastocrithidia sp. CONCLUSIONS: P. megistus and T. sordida sustained the risk of T. cruzi transmission to humans in central Brazil.


Subject(s)
Animals , Male , Female , Triatominae/parasitology , Insect Vectors/parasitology , Trypanosoma cruzi/isolation & purification , Trypanosoma cruzi/genetics , Brazil , Polymerase Chain Reaction , Triatominae/classification , Population Density , Insect Vectors/classification
16.
Mem. Inst. Oswaldo Cruz ; 112(10): 698-708, Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-894840

ABSTRACT

BACKGROUND The eco-epidemiological status of Chagas disease in the Monte Desert ecoregion of western Argentina is largely unknown. We investigated the environmental and socio-demographic determinants of house infestation with Triatoma infestans, bug abundance, vector infection with Trypanosoma cruzi and host-feeding sources in a well-defined rural area of Lavalle Department in the Mendoza province. METHODS Technical personnel inspected 198 houses for evidence of infestation with T. infestans, and the 76 houses included in the current study were re-inspected. In parallel with the vector survey, an environmental and socio-demographic survey was also conducted. Univariate risk factor analysis for domiciliary infestation was carried out using Firth penalised logistic regression. We fitted generalised linear models for house infestation and bug abundance. Blood meals were tested with a direct ELISA assay, and T. cruzi infection was determined using a hot-start polymerase chain reaction (PCR) targeting the kinetoplast minicircle (kDNA-PCR). FINDINGS The households studied included an aged population living in precarious houses whose main economic activities included goat husbandry. T. infestans was found in 21.2% of 198 houses and in 55.3% of the 76 re-inspected houses. Peridomestic habitats exhibited higher infestation rates and bug abundances than did domiciles, and goat corrals showed high levels of infestation. The main host-feeding sources were goats. Vector infection was present in 10.2% of domiciles and 3.2% of peridomiciles. Generalised linear models showed that peridomestic infestation was positively and significantly associated with the presence of mud walls and the abundance of chickens and goats, and bug abundance increased with the number of all hosts except rabbits. MAIN CONCLUSIONS We highlight the relative importance of specific peridomestic structures (i.e., goat corrals and chicken coops) associated with construction materials and host abundance as sources of persistent bug infestation driving domestic colonisation. Environmental management strategies framed in a community-based programme combined with improved insecticide spraying and sustained vector surveillance are needed to effectively suppress local T. infestans populations.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Triatoma/physiology , Triatoma/parasitology , Trypanosoma cruzi/isolation & purification , Chagas Disease/transmission , Feeding Behavior/physiology , Insect Vectors/physiology , Insect Vectors/parasitology , Argentina , Rural Population , Socioeconomic Factors , Goats , Cats , Chickens , Risk Factors , Population Density , Dogs
17.
Rev. Soc. Bras. Med. Trop ; 50(4): 506-515, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-896996

ABSTRACT

Abstract INTRODUCTION In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. METHODS Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T . cruzi isolates were genotyped using three different genetic markers. RESULTS: Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T . cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. CONCLUSIONS Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.


Subject(s)
Humans , Male , Female , Adult , Aged , Trypanosoma cruzi/isolation & purification , Trypanosoma cruzi/genetics , DNA, Protozoan/genetics , Chagas Disease/diagnosis , Polymerase Chain Reaction , Chronic Disease , Sensitivity and Specificity , Chagas Disease/blood , Blood Culture , Genotype , Middle Aged
18.
Rev. chil. infectol ; 34(1): 69-76, feb. 2017. ilus, graf
Article in Spanish | LILACS | ID: biblio-844448

ABSTRACT

Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.


La reactivación de la infección por Trypanosoma cruzi es un diagnóstico infrecuente pero posible en pacientes con infección por VIH/SIDA y una lesión de tipo tumoral o granulomatosa en el sistema nervioso central. Presentamos el caso clínico de un paciente de 60 años con VIH/SIDA y recuentos bajos de linfocitos CD4, con síntomas cerebelosos y paresia leve, lesiones hipodensas supra e infratentoriales y serología positiva para Toxoplasma gondii y T. cruzi. Se trató empíricamente como una toxoplasmosis cerebral y con terapia antiretroviral, sin respuesta clínica. La enfermedad de Chagas cerebral se confirmó por RPC cuantitativa en el LCR. El paciente falleció a pesar de recibir terapia con nifurtimox. Apoyan la posibilidad de un Chagas cerebral en pacientes con VIH/SIDA, la exposición epidemiológica, la serología positiva y el patrón de distribución de las lesiones en las imágenes. El diagnóstico puede mejorarse con técnicas moleculares cuantitativas en LCR. A pesar de su mal pronóstico, se puede intentar una terapia específica junto al tratamiento antiretroviral.


Subject(s)
Humans , Male , Middle Aged , Trypanosoma cruzi/genetics , Chagas Disease/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , Central Nervous System Protozoal Infections/diagnosis , Trypanosoma cruzi/isolation & purification , Magnetic Resonance Imaging , Cerebrospinal Fluid/parasitology , Polymerase Chain Reaction , AIDS-Related Opportunistic Infections/parasitology , Fatal Outcome , CD4 Lymphocyte Count , Viral Load , Central Nervous System Protozoal Infections/parasitology , Diagnosis, Differential
19.
Rev. bras. parasitol. vet ; 25(4): 504-510, Sept.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-830046

ABSTRACT

Abstract Neighborhood dogs may act as reservoirs for several zoonotic protozoan infections, particularly in urban areas, thus constituting a potential public health threat. Accordingly, the aim of the present study was to evaluate the exposure of neighborhood dogs to four protozoan pathogens in public areas with high levels of human movement in Curitiba, southern Brazil. Blood samples from 26 neighborhood dogs were screened by means of the indirect immunofluorescent antibody test (IFAT) for Leishmania spp., Toxoplasma gondii, Trypanosoma cruzi and Neospora caninum, and a questionnaire was answered by the respective keeper. A total of 8/26 dogs (30.7%) seroreactive to T. gondii, 3/26 (11.5%) to N. caninum and 2/26 (7.7%) to both were identified. All the samples were seronegative for T. cruzi and Leishmania spp. Pathogen seroreactivity was not associated with the daily human movements or other epidemiological variables investigated (p > 0.05). In conclusion, the low seroprevalence for T. gondii and N. caninum indicated low environmental and food risk for animal infection and the seronegativity for Leishmania spp. and T. cruzi may reflect the absence of these pathogens in urban areas of Curitiba. Moreover, neighborhood dogs may be used as environmental sentinels for the presence of protozoan pathogens and their vectors.


Resumo Cães comunitários podem atuar como reservatórios para algumas zoonoses causadas por protozoários, principalmente em áreas urbanas, constituindo potencial ameaça à saúde pública. Portanto, o objetivo do presente estudo foi avaliar a exposição de cães comunitários a quatro protozoários em áreas públicas com alta circulação de pessoas, em Curitiba, Sul do Brasil. Amostras de sangue de 26 cães comunitários foram testadas pela reação de imunofluorescência indireta (RIFI) para Leishmania spp., Toxoplasma gondii, Trypanosoma cruzi e Neospora caninum, e um questionário foi respondido pelo respectivo mantenedor. Um total de 8/26 (30,7%) foram sororreagentes para T. gondii, 3/26 (11,5%) para N. caninum e 2/26 (7,7%) para ambos. Todas as amostras foram soronegativas para T. cruzi e Leishmania spp. Não houve associação entre sororreatividade para os patógenos pesquisados e o tráfego diário de pessoas e outras variáveis epidemiológicas analisadas (p > 0.05). Conclui-se a baixa soroprevalência para T. gondii e T. cruzi indica baixo risco ambiental e alimentar para a infecção dos animais, e a soronegatividade para Leishmania spp. e T. cruzi pode refletir a ausência desses patógenos em áreas urbanas de Curitiba. Além disso, os cães comunitários podem atuar como sentinelas ambientais quanto à presença de protozoários e seus vetores.


Subject(s)
Animals , Toxoplasma/isolation & purification , Trypanosoma cruzi/isolation & purification , Disease Reservoirs/parasitology , Neospora/isolation & purification , Dogs/parasitology , Leishmania/isolation & purification , Toxoplasma/immunology , Trypanosoma cruzi/immunology , Brazil , Antibodies, Protozoan/blood , Seroepidemiologic Studies , Toxoplasmosis, Animal/immunology , Toxoplasmosis, Animal/parasitology , Neospora/immunology , Dogs/blood , Leishmania/immunology
20.
Rev. Soc. Bras. Med. Trop ; 49(2): 190-195, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782108

ABSTRACT

Abstract: INTRODUCTION: Before 2004, the occurrence of acute Chagas disease (ACD) by oral transmission associated with food was scarcely known or investigated. Originally sporadic and circumstantial, ACD occurrences have now become frequent in the Amazon region, with recently related outbreaks spreading to several Brazilian states. These cases are associated with the consumption of açai juice by waste reservoir animals or insect vectors infected with Trypanosoma cruzi in endemic areas. Although guidelines for processing the fruit to minimize contamination through microorganisms and parasites exist, açai-based products must be assessed for quality, for which the demand for appropriate methodologies must be met. METHODS: Dilutions ranging from 5 to 1,000 T. cruzi CL Brener cells were mixed with 2mL of acai juice. Four Extraction of T. cruzi DNA methods were used on the fruit, and the cetyltrimethyl ammonium bromide (CTAB) method was selected according to JRC, 2005. RESULTS: DNA extraction by the CTAB method yielded satisfactory results with regard to purity and concentration for use in PCR. Overall, the methods employed proved that not only extraction efficiency but also high sensitivity in amplification was important. CONCLUSIONS: The method for T. cruzi detection in food is a powerful tool in the epidemiological investigation of outbreaks as it turns epidemiological evidence into supporting data that serve to confirm T. cruzi infection in the foods. It also facilitates food quality control and assessment of good manufacturing practices involving acai-based products.


Subject(s)
Humans , Animals , Trypanosoma cruzi/isolation & purification , Food Contamination , DNA, Protozoan/isolation & purification , Food Parasitology , Chagas Disease/transmission , Euterpe/parasitology , Trypanosoma cruzi/genetics , Polymerase Chain Reaction , Disease Outbreaks , Chagas Disease/epidemiology
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