Higher congenital transmission rate of Trypanosoma cruzi associated with family history of congenital transmission.

INTRODUCTION: Congenital transmission (CT) of Trypanosoma cruzi has led to globalization of Chagas disease and its growing relevance as a public health problem. Although the occurrence of CT has been associated with several factors, its mechanisms are still unknown. This study aimed to analyze the geographical and familiar variables of mothers and their association with CT of Chagas disease in a population living in non-endemic areas of Argentina for the last decades. METHODS: We developed a retrospective cohort study in a sample of 2120 mother-child pairs who attended three reference centers in the cities of Buenos Aires, Santa Fe, and Salta between 2002 and 2015. RESULTS: The highest CT rates were observed in children born to Argentinean mothers (10.7%) and in children born to mothers from Buenos Aires (11.7%). Considering the areas of origin of the mothers, those from areas of null-low risk for vector-borne infection had higher CT rates than those from areas of medium-high risk (11.1% vs 8.2%). We also observed a significant intra-familiar "cluster effect," with CT rates of 35.9% in children with an infected sibling, compared to 8.2% in children without infected siblings (RR=4.4 95% CI 2.3-8.4). CONCLUSIONS: The associations observed suggest a higher CT rate in children born to mothers who acquired the infection congenitally, with familiar antecedents, and from areas without the presence of vectors. These observations are considered new epidemiological evidence about Chagas disease in a contemporary urban population, which may contribute to the study of CT and may also be an interesting finding for healthcare professionals.

Higher congenital transmission rate of Trypanosoma cruzi associated with family history of congenital transmission

Abstract INTRODUCTION: Congenital transmission (CT) of Trypanosoma cruzi has led to globalization of Chagas disease and its growing relevance as a public health problem. Although the occurrence of CT has been associated with several factors, its mechanisms are still unknown. This study aimed to analyze the geographical and familiar variables of mothers and their association with CT of Chagas disease in a population living in non-endemic areas of Argentina for the last decades. METHODS: We developed a retrospective cohort study in a sample of 2120 mother-child pairs who attended three reference centers in the cities of Buenos Aires, Santa Fe, and Salta between 2002 and 2015. RESULTS: The highest CT rates were observed in children born to Argentinean mothers (10.7%) and in children born to mothers from Buenos Aires (11.7%). Considering the areas of origin of the mothers, those from areas of null-low risk for vector-borne infection had higher CT rates than those from areas of medium-high risk (11.1% vs 8.2%). We also observed a significant intra-familiar "cluster effect," with CT rates of 35.9% in children with an infected sibling, compared to 8.2% in children without infected siblings (RR=4.4 95% CI 2.3-8.4). CONCLUSIONS: The associations observed suggest a higher CT rate in children born to mothers who acquired the infection congenitally, with familiar antecedents, and from areas without the presence of vectors. These observations are considered new epidemiological evidence about Chagas disease in a contemporary urban population, which may contribute to the study of CT and may also be an interesting finding for healthcare professionals.

Integrated control of Chagas disease for its elimination as public health problem--a review.

Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions, preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease as a public health problem with a dramatic reduction of burden of the disease.

Integrated control of Chagas disease for its elimination as public health problem - A Review

Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions, preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease as a public health problem with a dramatic reduction of burden of the disease.

Therapy of chagas disease: implications for levels of prevention.

This paper reviews the evidence supporting the use of etiological treatment for Chagas disease that has changed the standard of care for patients with Trypanosoma cruzi infection in the last decades. Implications of this evidence on different levels of prevention as well as gaps in current knowledge are also discussed. In this regard, etiological treatment has shown to be beneficial as an intervention for secondary prevention to successfully cure the infection or to delay, reduce, or prevent the progression to disease, and as primary disease prevention by breaking the chain of transmission. Timely diagnosis during initial stages would allow for the prescription of appropriate therapies mainly in the primary health care system thus improving chances for a better quality of life. Based on current evidence, etiological treatment has to be considered as an essential public health strategy useful to reduce disease burden and to eliminate Chagas disease altogether.

Early diagnosis of congenital Trypanosoma cruzi infection, using shed acute phase antigen, in Ushuaia, Tierra del Fuego, Argentina.

Chagas' disease, or American trypanosomiasis, is caused by the protozoan parasite Trypanasoma cruzi. It is estimated that 15,000 new cases of congenital T. cruzi transmission occur in the Americas each year. The aim of this study was to estimate the rate of congenital T. cruzi infection in infants born to infected women living in Ushuaia, Argentina, as well to assess a serologic test using Shed Acute Phase Antigen (SAPA) for a timely diagnosis of congenital infection. The rate of congenital infection among children in the study was 4.4% (3/68). Our results show that for infants younger than 30 days of age, matched blood samples from mother and infant were capable of identifying congenital transmission of infection using an enzyme-linked immunosorbent assay with SAPA. For infants older than 3 months, congenital infection could be ruled out using the same procedure.

Etiological treatment of young women infected with Trypanosoma cruzi, and prevention of congenital transmission.

The objective was to detect Trypanosoma cruzi infection in 32 children in Salta, Argentina, born to 16 chronically infected young women who were treated with benznidazole. Tests were performed to assess the efficacy of treatment after 14 years. At the end of the follow up, 87.5% of the women were non-reactive to EIA tests, 62.5% to IHA and 43.8% to IFA. 62.5% of the women were non-reactive according to two or three serological tests. No infected children were detected among the newborns of mothers treated before their pregnancy.

Etiological treatment of young women infected with Trypanosoma cruzi, and prevention of congenital transmission / Tratamento etiológico de mulheres jovens infectadas com Trypanosoma cruzi e prevenção da transmissão congênita

The objective was to detect Trypanosoma cruzi infection in 32 children in Salta, Argentina, born to 16 chronically infected young women who were treated with benznidazole. Tests were performed to assess the efficacy of treatment after 14 years. At the end of the follow up, 87.5 percent of the women were non-reactive to EIA tests, 62.5 percent to IHA and 43.8 percent to IFA. 62.5 percent of the women were non-reactive according to two or three serological tests. No infected children were detected among the newborns of mothers treated before their pregnancy.

O objetivo foi detectar a infecção do Trypanosoma cruzi em 32 crianças nacidas de 16 jovens mulheres cronicamente infectadas e tratadas com benzinadol, em Salta, Argentina. Testes foram feitos para avaliar a eficácia após 14 anos do tratamento. Ao final do seguimento 87.5 por cento das mulheres foram não reativas ao EIA, 62.5 por cento ao IHA e 43.8 por cento ao IFA. 62.5 por cento das mulheres foram não reativas de acordo a 3 ou 2 testes serológicos. Nenhuma criança infectada foi detectada entre os recém-nascidos de mães tratadas antes da gravidez.

Therapy, diagnosis and prognosis of chronic Chagas disease: insight gained in Argentina.

The purpose of this review is to describe research findings regarding chronic Chagas disease in Argentina that have changed the standards of care for patients with Trypanosoma cruzi infection. Indirect techniques (serological tests) are still the main tools for the primary diagnosis of infection in the chronic phase, but polymerase chain reaction has been shown to be promising. The prognosis of patients with heart failure or advanced stages of chagasic cardiomyopathy is poor, but a timely diagnosis during the initial stages of the disease would allow for prescription of appropriate therapies to offer a better quality of life. Treatment of T. cruzi infection is beneficial as secondary prevention to successfully cure the infection or to delay, reduce or prevent the progression to disease and as primary disease prevention by breaking the chain of transmission. Current recommendations have placed the bulk of the diagnostic and treatment responsibility on the Primary Health Care System. Overall, the current research priorities with respect to Chagas disease should be targeted towards (i) the production of new drugs that would provide a shorter treatment course with fewer side effects; (ii) the development of new tools to confirm cure after a full course of treatment during the chronic phase and (iii) biomarkers to identify patients with a high risk of developing diseases.

Therapy, diagnosis and prognosis of chronic Chagas disease: insight gained in Argentina

The purpose of this review is to describe research findings regarding chronic Chagas disease in Argentina that have changed the standards of care for patients with Trypanosoma cruzi infection. Indirect techniques (serological tests) are still the main tools for the primary diagnosis of infection in the chronic phase, but polymerase chain reaction has been shown to be promising. The prognosis of patients with heart failure or advanced stages of chagasic cardiomyopathy is poor, but a timely diagnosis during the initial stages of the disease would allow for prescription of appropriate therapies to offer a better quality of life. Treatment of T. cruzi infection is beneficial as secondary prevention to successfully cure the infection or to delay, reduce or prevent the progression to disease and as primary disease prevention by breaking the chain of transmission. Current recommendations have placed the bulk of the diagnostic and treatment responsibility on the Primary Health Care System. Overall, the current research priorities with respect to Chagas disease should be targeted towards (i) the production of new drugs that would provide a shorter treatment course with fewer side effects; (ii) the development of new tools to confirm cure after a full course of treatment during the chronic phase and (iii) biomarkers to identify patients with a high risk of developing diseases.

Etiological treatment in patients infected by Trypanosoma cruzi: experiences in Argentina.

PURPOSE OF REVIEW: The aim of this review is to describe knowledge, mainly of the last 15 years, that changed criteria for specific treatment against Trypanosoma cruzi infection. RECENT FINDINGS: Over the past 15 years, there has been an increase in the use of new methodologies to evaluate the efficacy of antiparasitic treatments. These tools showed that the evaluation period for trypanocidal treatment effectiveness could be shortened. Based on the hypothesis that Chagas' cardiomyopathy may indeed be triggered by persistent parasitic infection, it seems plausible that trypanocidal therapy may delay, reduce or prevent the progression to the disease. SUMMARY: Based on the present knowledge, we can assume that every patient infected with Trypanosoma cruzi in the acute phase and in the early chronic phase (i.e. children under 16 years old) must be treated, and adults could be treated. In this area, research priorities should target obtaining new drugs to allow shorter treatments with fewer adverse reactions and improving new tools to confirm cure when patients are treated during the Chronic Phase.

Vigilancia Participativa y Sostenible del Control de la Transmisión de Trypanosoma cruzi (Chagas) en Redes Sociales

El objetivo de este proyecto es introducir la promoción de Redes Sociales para desarrollar las acciones de vigilancia para el Control de la transmisión de Trypanosoma cruzi (Chagas), la integración del hospital y del sector de trabajadores rurales, a las acciones de vigilncia, en dos Departamentos de Santiago del Estero, Argentina, Sud América.

Leishmaniose cutânea no Norte da Argentina. Fatores de risco identificados num estudo caso-coorte em três municípios de Salta / Cutaneous leishmaniasis in Northern Argetina. Identification of risk factors in a case-cohort study of three municipalities in Salta

Este trabalho tem como objetivo avaliar fatores considerados de risco para adquirir leishmaniose cutânea em Salta, área de maior transmissão da Argentina. Aplicou-se um estudo de caso-coorte com observações entre junho de 1989 e dezembro de 1992. Aos casos e aos controles selecionados se realizou: a) um questionário sócio-demográfico; b) descrição das características da vivenda e peridomicílio; c) um exame físico de pele e mucosa nasal e bucal; d) intradermorreação de Montenegro. A análise multivariada mostrou um risco significativo para fatores extradomiciliares (realizar atividades de vaqueira, dormir no lugar de trabalho, ir caçar) e domiciliares (dormir fora do quarto, presença de três ou mais suínos no quintal da casa e existência de janelas sem fechaduras). Esta associação permitiu pela primeira vez em Salta (Argentina), identificar fatores de risco vinculados com a transmissão de leishmaniose na unidade domiciliária

Diferencias regionales y Síndrome Pulmonar por Hantavirus (enfermedad emergente y tropical en Argentina) / Regional differences and Hantavirus pulmonary syndrome (an emerging and tropical disease in Argentina)

Se describen algunos factores que habrían favorecido a caracterizar la expresión del Síndrome Pulmonar por Hantavirus en Argentina. Estos factores muestran diversos orígenes que van desde los procesos de ocupación del espacio y de producción, la estructura laboral, el patrón de migración humana, la etnia, la dinámica de reservorios y su relación con los tipos de virus, y el comportamiento del hombre. Estos factores se expresan en tres marcos ecológicos asociados a diferentes regiones geográficas de Argentina: 1) Noroeste, 2) Central (Pampa húmeda) y 3) Sur Andina. Este complejo escenario obliga a abordar con la misma complejidad las investigaciones, para identificar determinantes primarios, biologicos, sociales y ambientales, causales de salud o enfermedad en su estrecha interacción y no individualmente. Este abordaje permitirá diseñar estrategias apropiadas para mejorar las condiciones de salud. Las mismas deberían ser diseñadas y transferidas por equipos transdiciplinarios de investigación, donde la participación de la comunidad desde las primeras etapas de desarrollo es esencial para la sustentabilidad de la estrategia.

Tegumentary leishmaniasis in northen Argentina: distribution of infection and disease, in three municipalities of Salta, 1990-1992

O trabalho mostra o padräo epidemiológico da leishmaniose tegumentar em uma area no norte de Salfa, Argentina. A prevalência e incidência foram estimadas atravÚs de um estudo transversal e dois estudos de seguimenlo durante dois anos consecutivos. A Intrademorreaçäo de Montenegro (IDRM) foi aplicada a 7.336 pessoas no estudo de base. A prevalência e incidência entre 1990 e 1992 da infecçäo (IDRM reativa) foi de 38 por cento pessoas e 4,5 por cento pessoas/ano respectivamente. O exame físico realizado em 264 pacientes com IDRM reativa durante 3 anos, revelaram que apenas 130 casos (49,2 por cento) tiveram algum signo evidente de infecçäo (cicatriz ou lesäo), com uma apresentaçäo clinica compatível a leishmaniosis. Nosso trabalho mostrou que após o surto epidêmico em 1985, a transmissäo na area de estudo retornou aos níveis endêmicos em 1992, e também demonstrou a presença da infecçäo assintomática na regiäo

Control de la transmisión de Trypanosoma Cruzi en la República Argentina / Control of Trypanosoma Cruzi transmission in the República Argentina

Históricamente el programa de Control de la enfermedad de Chagas se basó en la utilización de insecticidas para controlar al vector, Triatoma infestans, responsable de la trasnmisión del Trypanosoma cruzi. La reinfestación de las viviendas y estructuras predomiciliarias por Triatoma infestans ocurre poco tiempo después de las campañas de rociado con insecticidas de las viviendas. Basado en el análisis de los datos de terreno en comunidades endémicas la estrategia del programa fue cambiada de un programa vertical a un programa de participación comunitaria para el control y la vigilancia de la transmisión de Chagas. (AU)

Control de la transmisión de Trypanosoma Cruzi en la República Argentina / Control of Trypanosoma Cruzi transmission in the República Argentina

Históricamente el programa de Control de la enfermedad de Chagas se basó en la utilización de insecticidas para controlar al vector, Triatoma infestans, responsable de la trasnmisión del Trypanosoma cruzi. La reinfestación de las viviendas y estructuras predomiciliarias por Triatoma infestans ocurre poco tiempo después de las campañas de rociado con insecticidas de las viviendas. Basado en el análisis de los datos de terreno en comunidades endémicas la estrategia del programa fue cambiada de un programa vertical a un programa de participación comunitaria para el control y la vigilancia de la transmisión de Chagas.

Vigilancia Participativa y Sostenible del Control de la Transmisión de Trypanosoma cruzi (Chagas) en Redes Sociales

El objetivo de este proyecto es introducir la promoción de Redes Sociales para desarrollar las acciones de vigilancia para el Control de la transmisión de Trypanosoma cruzi (Chagas), la integración del hospital y del sector de trabajadores rurales, a las acciones de vigilncia, en dos Departamentos de Santiago del Estero, Argentina, Sud América.

Vigilancia Participativa y Sostenible del Control de la Transmisión de Trypanosoma cruzi (Chagas) en Redes Sociales

El objetivo de este proyecto es introducir la promoción de Redes Sociales para desarrollar las acciones de vigilancia para el Control de la transmisión de Trypanosoma cruzi (Chagas), la integración del hospital y del sector de trabajadores rurales, a las acciones de vigilncia, en dos Departamentos de Santiago del Estero, Argentina, Sud América.