Epidemiological profile of acute Chagas disease in individuals infected by oral transmission in northern Brazil

Abstract INTRODUCTION: Oral infection by Trypanosoma cruzi is currently the most important route of transmission of acute Chagas disease (ACD) in the North region of Brazil, and the reported outbreaks are usually related to ingestion of contaminated food, especially unprocessed açaí pulp. METHODS A retrospective cohort study was performed to analyze the epidemiological profile of individuals with suspected cases of ACD in the municipality of Breves, located in the state of Pará, Brazil. Therefore, notifications of suspected cases of ACD were collected from the Municipal Health Department of Breves from January 2007 to December 2017. RESULTS A total of 265 individuals were registered, and the majority were male (54.7%; 145/265). Age ranged from nine months to 79 years, with a greater number of notifications for individuals aged between 1 and 39 years (71.3%; 189/265). Most of them had a low level of education (74.3%, 197/265), were living in rural and urban areas (58.9%; 156/265 and 37.7%; 100/265, respectively). Infection occurred mainly in the domestic environment (96.2%; 255/265) through oral transmission (98.1%; 260/265). There were a greater number of notifications in November, December and January. CONCLUSIONS These data showed that oral transmission of T. cruzi has become increasingly high in the study region, and health education programs need to be implemented as strategies to ensure good manufacturing practices of unprocessed food.

Comparison of phenol-chloroform and a commercial deoxyribonucleic acid extraction kit for identification of bloodmeal sources from triatomines (Hemiptera: Reduviidae)

Abstract INTRODUCTION: Knowledge of triatomine bloodmeal sources is essential for understanding vector-host interactions in Trypanosoma cruzi transmission cycles. Expensive commercial deoxyribonucleic acid (DNA) extraction kits are widely used for bloodmeal identification. This study assessed the performance of an inexpensive phenol-chloroform DNA extraction protocol for identification of triatomine bloodmeal sources, comparing it with a commercially available kit. METHODS: Both methods were used to obtain DNA from the intestinal contents of Triatoma brasiliensis blood-fed on either Columba sp., Mus musculus, or Gallus gallus. Subsequently, the mitochondrial 12S ribosomal ribonucleic acid (rRNA) gene was amplified by polymerase chain reaction, sequenced, and compared with GenBank data. RESULTS: Twelve (80%) samples extracted with the commercial kit and four (26.7%) with phenol-chloroform were pure (according to the A260/A280 ratio). Samples extracted with phenol-chloroform, except for Columba sp. samples, had higher DNA concentration than those extracted with the commercial kit. Samples extracted using phenol-chloroform and blood-fed on G. gallus had significantly higher DNA concentration than those blood-fed on Columba sp. (p-value <0.001) and M. musculus (p-value <0.001). The 215-base-pair 12S rRNA fragment was amplified from all samples and produced reliable sequences, enabling the identification of the bloodmeal source, most of which showed identity and coverage above 95%. The phenol-chloroform method was much less expensive than the commercial kit but took considerably more time to perform. CONCLUSIONS: Our data showed that both DNA extraction methods produced reliable sequences enabling identification of triatomine bloodmeal sources but differed greatly in cost and time required.

Synanthropic triatomines (hemiptera: reduviidae): infestation, colonization, and natural infection by trypanosomatids in the state of Rio Grande do Norte, Brazil

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.

Characteristics of Triatomine infestation and natural Trypanosoma cruzi infection in the State of Rio Grande do Norte, Brazil

Abstract: INTRODUCTION Natural and artificial ecotope infestation by the kissing bug triatomines and their colonization and infection by Trypanosoma cruzi , the Chagas disease agent, were evaluated in nine municipalities of the State of Rio Grande do Norte, Brazil. METHODS Following identification, triatomine intestinal contents were analyzed by direct microscopic examination, xenoculture, and polymerase chain reaction (PCR) for parasite detection. Trypanosoma cruzi isolates were genotyped using three different markers. RESULTS Of 842 triatomines captured, 65% were Triatoma brasiliensis , 17.8% Triatoma pseudomaculata , 12.5% Panstrongylus lutzi , and 4.7% Rhodnius nasutus . Triatoma brasiliensis and P. lutzi adults were found in the intradomicile. T. brasiliensis, T. pseudomaculata , and R. nasutus nymphs and adults were found in the peridomicile and wild environment. Intradomiciliary and peridomiciliary infestation indexes were 5.6% and 33.7%, respectively. In the peridomicile, chicken coops were the most infested ecotope. The T. cruzi triatomine infection rate was 30.2%, of which PCR detected 29%. P . lutzi (78.1%), T . brasiliensis (24.5%), and T . pseudomaculata (22.7%) were the most infected species. TcII and III genotypes were detected in T. brasiliensis and TcIII in P. lutzi . CONCLUSIONS T. brasiliensis was found in all environments and most ecotopes with high T. cruzi infection rates. High infection rates were also detected in T . pseudomaculata and P. lutzi , suggesting their role in the interchange between the wild and peridomestic transmission cycles. The combination of PCR, microscopic examination, and xenoculture contributed to improving T. cruzi infection evaluation in triatomine bugs. The TcII and TcIII genotypes were predominant in the study area.

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Abstract: INTRODUCTION : This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). METHODS : This cross-sectional study included 186 adults who were evaluated using electrocardiography, echocardiography, chest radiography, and contrast radiography of the esophagus and colon. A clinical-epidemiological questionnaire was also used. RESULTS : The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Heart failure (functional classes I-IV) was detected in 7.5% (14/186) of the participants, and 36.4% (24/66), 30.3% (20/66), 15.2% (10/66), 13.6% (9/66), and 4.5% (3/66) of the patients were at stage A, B1, B2, C, and D, respectively. Dilated cardiomyopathy and electrocardiographic changes were detected in 10.2% (19/186) and 48.1% (91/186) of the participants, respectively. Apical aneurysm was diagnosed in 10.8% (20/186) of the participants, and other changes in the segmental myocardial contractility of the left ventricle were diagnosed in 33.9% (63/186) of the participants. Megaesophagus (groups I-IV) was observed in 7% (13/186) of the participants, megacolon (grades 1-3) was detected in12.9% (24/186) of the participants, and both organs were affected in 29.2% (7/24) of the megacolon cases. CONCLUSIONS : We detected various clinical forms of Chagas disease (including the digestive form). Our findings indicate that clinical symptoms alone may not be sufficient to exclude or confirm cardiac and/or digestive damage, and the number of patients with symptomatic clinical forms may be underestimated.

Seroepidemiology of Trypanosoma cruzi infection in the semiarid rural zone of the State of Rio Grande do Norte, Brazil / Soroepidemiologia da infecção pelo Trypanosoma cruzi na zona rural do semiárido do Estado do Rio Grande do Norte, Brasil

INTRODUCTION: A seroepidemiological survey was carried out to evaluate Trypanosoma cruzi infection in an endemic area of the State of Rio Grande do Norte, Brazil, involving rural residents. METHODS: Sixteen municipalities were randomly selected, 15 from the west mesoregion and one from the central, with an estimated population of 83,852 individuals. A total of 1,950 blood samples were collected in the west mesoregion and 390 in Caicó. Anti-T. cruzi antibodies were detected using the Chagatest® ELISA HAI-hemagglutination kits and indirect immunofluorescence. As sera presented indeterminate results, TESAcruzi® western blot was performed to confirm reactivity. RESULTS: An estimated seroprevalence of 6.5% was determined for the west mesoregion and 3.3% for Caicó. Seropositivity rises progressively with the age of individuals, up to 40 years in Caicó and up to 50 years in the west mesoregion. Only educational level and knowledge regarding the triatomine were associated with seropositivity. No seroreactive individuals under 18 years of age were identified. CONCLUSIONS: Infection by T. cruzi remains high and is concentrated in municipalities in the central western area of the west mesoregion; however, evidence suggests a decline in vector transmission in this mesoregion and in Caicó. Epidemiological variables appear not to influence seropositivity, with the exception of education and knowledge concerning the triatomine, among seroreactive individuals from the west mesoregion.

INTRODUÇÃO: A infecção pelo Trypanosoma cruzi foi avaliada em uma área endêmica do Estado do Rio Grande do Norte, Brasil, por inquérito soroepidemiológico amostral em moradores da zona rural. MÉTODOS: Dezesseis municípios foram sorteados, 15 da mesorregião oeste e um da central, com população estimada em 83.852 indivíduos. Foram coletadas 1.950 amostras de sangue no oeste e 390 em Caicó. A detecção de anticorpos anti-T. cruzi foi realizada usando os kits Chagatest® ELISA, HAI-hemaglutinação e a reação de imunofluorescência indireta. Nos soros com resultados indeterminados foi realizado o western blot TESAcruzi® para confirmação da reatividade. RESULTADOS: A estimativa da soroprevalência revelou 6,5% para a mesorregião oeste e 3,3% em Caicó. A soropositividade eleva-se progressivamente com a idade dos indivíduos até a quinta década de vida em Caicó e na sexta década na mesorregião oeste. Apenas o grau de escolaridade e o conhecimento do triatomíneo evidenciaram associação à soropositividade. Não foram identificados indivíduos sororreativos com idade inferior a 18 anos. CONCLUSÕES: A infecção pelo T. cruzi persiste mais elevada e concentrada em municípios da área central da mesorregião oeste, mas evidências sugerem o declínio da transmissão vetorial nessa mesorregião e em Caicó. As variáveis epidemiológicas parecem não exercer influência na soropositividade, à exceção da escolaridade e conhecimento do triatomíneo entre indivíduos sororreativos da mesorregião oeste.

Effect of medicinal plants on the parasitemia of Trypanosoma cruzi and on the biodistribution of sodium pertechnetate (Na99mTcO4)

Artemisia vulgaris (AV) is an antihelmintic and antimalarial drug; Aloe vera(babosa) acts as antidiabetic, laxative and anti-inflammatory;Benznidazole (BZ) is a trypanocidal of Trypanosoma cruzi (TC). Technetium-99m (99mTc) has been used in nuclear medicine to obtain diagnostic images. This study evaluated the plant effects in TC parasitemia and on the biodistribution of 99mTc in mice. Twenty mice were infected by TC. At the peak of parasitemia, 5 mice received babosa; 5 received AV and 5 received BZ. The parasitemia was determined at 0, 2, 4 and 6 h of drugs administration. Five infected mice without drugs, 5 mice without TC and the group treated withAV, received 99mTc. The radioactivity was calculated. Infected mice that received babosa reduced significantly(p<0.05) the TC parasitemia. The percentage of activity per gram (%ATI/g) decreased significantly on the AVgroup. These results indicate that babosa possibly is an anti-TC drug and AV reduces the %ATI/g probably due toits biological effects.

A Artemisia vulgaris (AV) é uma planta com atividades antihelmíntica e antimalárica. Aloe vera (babosa) tem ação antidiabética, laxante e antiinflamatória. Benzonidazol (BZ) é uma droga tripanosomicida contra o Trypanosoma cruzi (TC), agente da doença de Chagas. Tecnécio-99m(99mTc) tem sido usado na medicina nuclear para obtenção de imagens diagnósticas. Este estudo avaliou o efeito de plantas na parasitemia do TC ena biodistribuição do 99mTc em camundongos. Vinte camundongos foram infectados por TC. No pico da parasitemia, 5 camundongos receberambabosa; 5 receberam AV e 5 receberam BZ. A parasitemia foi determinada durante os tempos 0, 2, 4 e 6 horas após administração das drogas. Cinco camundongos infectados e não tratados, 5 camundongos não infectados e o grupo tratado com AV receberam 99mTc, na forma de pertecnetato de sódio. A radioatividade foi calculada. Os animais infectados que receberam babosa reduziram significativamente (p<0.05) aparasitemia. A porcentagem da radioatividade por grama (%ATI/g) diminuiu significativamente no grupo tratado com AV. Estes resultados indicamque a babosa possivelmente é uma droga anti-TC e a AV reduz a %ATI/g provavelmente devido seus efeitos biológicos e/ou metabólicos.