Eco-epidemiologic profile of an area of a Chagas disease outbreak: the risk of oral transmissions in the Brazilian northeast

Abstract Chagas disease is a neglected tropical disease strongly associated with low socioeconomic status, affecting nearly 8 million people – mainly Latin Americans. The current infection risk is based on acute case reports, most of which are typically associated with oral transmissions. In the semi-arid region of Northeastern Brazil, serious outbreaks of this transmission type have surged in the last years. One of those occurred in the city of Marcelino Vieira (2016), in the state of Rio Grande do Norte. Rural residents of four municipalities surrounding Marcelino Vieira ingested sugar cane juice – which was probably ground with Trypanosoma cruzi infected insects. The structure of domiciliary unities (DUs) in the rural area of Marcelino Vieira was investigated to better understand the factors related to the outbreaks in this region – which was combined with entomological indicators. We found triatomines (mainly Triatoma brasiliensis) in 54% (36/67) of DUs and all rocky outcrops inspected (n = 7). Overall, 26% (119/458) of examined T. brasiliensis were infected by T. cruzi in artificial ecotopes, with almost the same prevalence in the sylvatic environment (23%; 35/154). The local variation in T. cruzi prevalence (variating from 0%-100%) was highly correlated with the presence of some ecotopes where the insects were found; and we identified those linked to high natural triatomine infection prevalence by T. cruzi (mainly wood/tile/brick piles). Ninety-five percent of people interviewed recognized the triatomines and knew the classic route (vector-borne) of transmission of disease. However, only 7.5% admitted knowledge that Chagas disease can also be acquired orally – which poses a risk this transmission route currently recognized. Here, we highlight the physical proximity between humans and infected vector populations as an additional risk factor to oral/vector contaminations, providing recommendations to avoid further outbreaks.

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A systematic review of historical and current trends in Chagas disease

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211033715 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110337

Author(s):

Diego-Abelardo Álvarez-Hernández ◽

Rodolfo García-Rodríguez-Arana ◽

Alejandro Ortiz-Hernández ◽

Mariana Álvarez-Sánchez ◽

Meng Wu ◽

...

Keyword(s):

Systematic Review ◽

Chagas Disease ◽

Case Reports ◽

Clinical Manifestations ◽

Human Case ◽

Acute Stage ◽

Diagnostic Tools ◽

Chronic Stage ◽

Pubmed Database ◽

Trypanocidal Drugs

Introduction: Chagas disease (CD) is caused by Trypanosoma cruzi. When acquired, the disease develops in stages. For diagnosis, laboratory confirmation is required, and an extensive assessment of the patient’s health should be performed. Treatment consists of the administration of trypanocidal drugs, which may cause severe adverse effects. The objective of our systematic review was to analyze data contained in the CD published case reports to understand the challenges that patients and clinicians face worldwide. Materials and methods: We performed a systematic review following the PRISMA guidance. PubMed database was explored using the terms ‘American trypanosomiasis’ or ‘Chagas disease’. Results were limited to human case reports written in English or Spanish. A total of 258 reports (322 patients) were included in the analysis. Metadata was obtained from each article. Following this, it was analyzed to obtain descriptive measures. Results: From the sample, 56.2% were males and 43.8% were females. Most cases were from endemic countries (85.4%). The most common clinical manifestations were fever during the acute stage (70.0%), dyspnea during the chronic stage in its cardiac form (53.7%), and constipation during the chronic stage in its digestive form (73.7%). Most patients were diagnosed in the chronic stage (72.0%). Treatment was administered in 56.2% of cases. The mortality rate for the acute stage cases was 24.4%, while for the chronic stage this was 28.4%. Discussion: CD is a parasitic disease endemic to Latin America, with increasing importance due to human and vector migration. In this review, we report reasons for delays in diagnosis and treatment, and trends in medical practices. Community awareness must be increased to improve CD’s diagnoses; health professionals should be appropriately trained to detect and treat infected individuals. Furthermore, public health policies are needed to increase the availability of screening and diagnostic tools, trypanocidal drugs, and, eventually, vaccines.

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The epidemiologic profile and prevalence of cardiopathy in Trypanosoma cruzi infected blood donor candidates, Londrina, Paraná, Brazil

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652005000600003 ◽

2005 ◽

Vol 47 (6) ◽

pp. 321-326 ◽

Cited By ~ 6

Author(s):

Divina Seila de Oliveira-Marques ◽

Ana Maria Bonametti ◽

Tiemi Matsuo ◽

Francisco Gregori Junior

Keyword(s):

Trypanosoma Cruzi ◽

Chagas Disease ◽

Blood Donor ◽

Rural Areas ◽

Family Income ◽

State University ◽

Cardiac Symptoms ◽

Significant Difference ◽

Epidemiologic Profile ◽

The City

To describe the epidemiologic profile and prevalence of cardiopathy in 163 Trypanosoma cruzi serum positive blood donor candidates, a descriptive study was carried out between August, 1996 and November, 1997 at the Londrina State University Chagas Disease Outpatient Clinic. The profile found was: young, average age 42.95 ± 8.62 years; male (65%); Caucasian (84%); low level of schooling; low family income; agricultural worker (26%); born in the state of Paraná (67%); from rural areas (85%); migrated to the city (85%); and the vector as the main mechanism of transmission. During the clinical characterization a chronic cardiac form was found in 38% of the patients and classified as cardiac suggestive form in 21% and little suggestive of Chagas disease in 17%. No significant difference was found among age group distribution, sex and the presence of cardiac symptoms in patients with or without cardiopathy. This study emphasizes the importance of expanding medical services to areas with a greater prevalence of infected individuals, in a hierarchical manner and aiming at decentralization.

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Slaying little dragons: the impact of the Guinea Worm Eradication Program on dracunculiasis disability averted from 1990 to 2016

Gates Open Research ◽

10.12688/gatesopenres.12827.1 ◽

2018 ◽

Vol 2 ◽

pp. 30 ◽

Cited By ~ 2

Author(s):

Elizabeth A. Cromwell ◽

Sharon Roy ◽

Dieudonne P. Sankara ◽

Adam Weiss ◽

Jeffrey Stanaway ◽

...

Keyword(s):

Clinical Symptoms ◽

Case Reports ◽

Annual Number ◽

Infection Prevalence ◽

Eradication Program ◽

Guinea Worm ◽

Disability Weights ◽

Life Years ◽

Disease Study ◽

The Impact

Background:The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD.Methods:The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs.Results:The total DALYs attributed to GWD across all endemic countries (n=21) in 1990 was 50,725 (95% UI: 35,265–69,197) and decreased to 0.9 (95% UI: 0.5–1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016.Conclusions:Using 1990 estimates of burden propagated forward, this analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years.

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Prevalence of Chagas disease in blood donors at the Uberaba Regional Blood Center, Brazil, from 1995 to 2009

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000600013 ◽

2012 ◽

Vol 45 (6) ◽

pp. 723-726 ◽

Cited By ~ 7

Author(s):

Laryssa Manso de Lima ◽

Nathália Passos Alves ◽

Valdirene de Fátima Barbosa ◽

Gustavo Alves Pimenta ◽

Helio Moraes-Souza ◽

...

Keyword(s):

Chagas Disease ◽

Blood Donors ◽

Retrospective Studies ◽

Chi Square ◽

Significant Drop ◽

Blood Center ◽

Epidemiologic Profile ◽

Chi Square Test ◽

Consistent Increase

INTRODUCTION: A retrospective study was conducted to assess the occurrence of blood donations that were ineligible due to Chagas disease infection from 1995 to 2009 at the Uberaba Regional Blood Center (HRU), Brazil, verify the tendency of this ineligibility, and describe the epidemiologic profile of the donors. METHODS: Retrospective studies of serological ineligibility due to Chagas disease, statistical analysis by means of the chi-square test and odds ratio, study of the tendencies using a dispersion graph and the linear correlation coefficient (r) were performed. RESULTS: In the period under study, a 0.2% serum prevalence of ineligibility due to Chagas disease was found, with a significant drop in ineligible donations from 2001 to 2009. Among the serum positive-donors, there was a significant predominance among those aged 30 years or above and non-single individuals. CONCLUSIONS: The results show a rate of occurrence that is lower than that described in literature, as well as a progressive drop during the 15 years under assessment. Such results are a consequence of systematic combat of the vector since the 70s and the progressive and consistent increase of returning donors, resulting in a drop of the contamination risk factor by means of blood transfusion and in the improvement of the quality of hemotherapy practices in the HRU.

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Flight dispersal of the Chagas disease vectors Triatoma brasiliensis and Triatoma pseudomaculata in northeastern Brazil

Acta Tropica ◽

10.1016/j.actatropica.2006.12.007 ◽

2007 ◽

Vol 101 (2) ◽

pp. 115-119 ◽

Cited By ~ 44

Author(s):

Ana L. Carbajal de la Fuente ◽

Sebastian A. Minoli ◽

Catarina M. Lopes ◽

François Noireau ◽

Claudio R. Lazzari ◽

...

Keyword(s):

Chagas Disease ◽

Northeastern Brazil ◽

Disease Vectors ◽

Chagas Disease Vectors

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Trypanosoma cruzi infection enhances polyreactive antibody response in an acute case of human Chagas' disease

Clinical & Experimental Immunology ◽

10.1111/j.1365-2249.1993.tb06501.x ◽

2008 ◽

Vol 93 (1) ◽

pp. 85-92 ◽

Cited By ~ 27

Author(s):

M. R. GRAUERT ◽

M. HOUDAYER ◽

M. HONTEBEYRIE-JOSKOWCIZ

Keyword(s):

Trypanosoma Cruzi ◽

Antibody Response ◽

Chagas Disease ◽

Acute Case ◽

Cruzi Infection

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Trypanosoma cruzi Infection Prevalence and Bloodmeal Analysis in Triatomine Vectors of Chagas Disease From Rural Peridomestic Locations in Texas, 2013–2014

Journal of Medical Entomology ◽

10.1093/jme/tjw040 ◽

2016 ◽

Vol 53 (4) ◽

pp. 911-918 ◽

Cited By ~ 28

Author(s):

Rodion Gorchakov ◽

Lillian P. Trosclair ◽

Edward J. Wozniak ◽

Patricia T. Feria ◽

Melissa N. Garcia ◽

...

Keyword(s):

Trypanosoma Cruzi ◽

Chagas Disease ◽

Disease Surveillance ◽

Public Awareness ◽

Parasite Burden ◽

Etiologic Agent ◽

Infection Prevalence ◽

Transmission Cycle ◽

High Infection ◽

History Of

Abstract Protozoan pathogen Trypanosoma cruzi (Chagas, 1909) is the etiologic agent of Chagas disease, which affects millions of people in Latin America. Recently, the disease has been gaining attention in Texas and the southern United States. Transmission cycle of the parasite involves alternating infection between insect vectors and vertebrate hosts (including humans, wildlife, and domestic animals). To evaluate vector T. cruzi parasite burden and feeding patterns, we tested triatomine vectors from 23 central, southern, and northeastern counties of Texas. Out of the 68 submitted specimens, the majority were genetically identified as Triatoma gerstaeckeri (Stal, 1859), with a few samples of Triatoma sanguisuga (LeConte, 1855), Triatoma lecticularia (Stal, 1859), Triatoma rubida (Uhler, 1894), and Triatoma protracta woodi (Usinger, 1939). We found almost two-thirds of the submitted insects were polymerase chain reaction-positive for T. cruzi. Bloodmeal sources were determined for most of the insects, and 16 different species of mammals were identified as hosts. The most prevalent type of bloodmeal was human, with over half of these insects found to be positive for T. cruzi. High infection rate of the triatomine vectors combined with high incidence of feeding on humans highlight the importance of Chagas disease surveillance in Texas. With our previous findings of autochthonous transmission of Chagas disease, urgent measures are needed to increase public awareness, vector control in and around homes, and Chagas screening of residents who present with a history of a triatomine exposure.

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Clinical, Cardiological and Serologic Follow-Up of Chagas Disease in Children and Adolescents from the Amazon Region, Brazil: Longitudinal Study

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5030139 ◽

2020 ◽

Vol 5 (3) ◽

pp. 139

Author(s):

Ana Neves Pinto ◽

Vera Valente ◽

Sebastião Valente ◽

Tamires Motta ◽

Ana Ventura

Keyword(s):

Children And Adolescents ◽

Chagas Disease ◽

Acute Phase ◽

Cardiac Involvement ◽

Cardiac Injury ◽

Antibody Test ◽

Amazon Region ◽

Cardiac Complications ◽

Epidemiologic Profile

Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is still unknown. The authors aim to describe the clinical and epidemiologic profile of children and adolescents with CD, as well as treatment and cardiac involvement during the follow-up. Methods: A descriptive cohort study was conducted from 1998 to 2013 among children and adolescents up to 18 years-old with confirmed diagnosis of CD. All participants met the criteria of CD in the acute phase. Results: A total of 126 outpatients were included and received treatment and follow-up examinations during a medium period of 10.9 years/person. Most of them (68.3%) had their diagnosis established during oral transmission outbreaks. The diagnostic method with the most positive results rate (80.9%) was the IgM class anti-T. cruzi antibody test as an acute phase marker, followed by the thick blood smears (60.8%). Acute myopericarditis was demonstrated in 18.2% of the patients, most of them with favorable evolution, though 2.4% (3/126) persisted with cardiac injury observed at the end point of the follow-up. Conclusions: Antibodies against T. cruzi persisted in 54.8% of sera from the patients without prognostic correlation with cardiac involvement. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility.

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CLINICAL AND EPIDEMIOLOGICAL PROFILE OF ELDERLY PATIENTS WITH CHAGAS DISEASE FOLLOWED BETWEEN 2005-2013 BY PHARMACEUTICAL CARE SERVICE IN CEARÁ STATE, NORTHEASTERN BRAZIL

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652015000200008 ◽

2015 ◽

Vol 57 (2) ◽

pp. 145-152 ◽

Cited By ~ 9

Author(s):

Laíse dos Santos PEREIRA ◽

Erlane Chaves FREITAS ◽

Arduína Sofia Ortet de Barros Vasconcelos FIDALGO ◽

Mônica Coelho ANDRADE ◽

Darlan da Silva CÂNDIDO ◽

...

Keyword(s):

Pharmaceutical Care ◽

Chagas Disease ◽

Family Income ◽

Care Service ◽

The Elderly ◽

University Hospital ◽

Northeastern Brazil ◽

Bundle Branch Block ◽

Epidemiological Profile ◽

Pharmaceutical Care Service

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

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