Etiological treatment during early chronic indeterminate Chagas disease incites an activated status on innate and adaptive immunity associated with a type 1-modulated cytokine pattern.

Pro-inflammatory immune response is usually associated with Chagas disease pathogenesis, but is also relevant to treatment effectiveness. Cross-sectional studies have suggested that this activated state may persist for years after therapeutic intervention. However, short-term longitudinal investigation has suggested that the Benznidazole treatment (Bz-treatment) leads to decreased immunological activation. In order to elucidate this issue, we performed a longitudinal study to evaluate the immunological status following Bz-treatment during early indeterminate Chagas disease. Our results demonstrated that Bz-treatment led to higher activation status of circulating monocytes but was negatively associated with the number of IL-12(+)CD14(+) cells. Moreover, Bz-treatment triggered a high frequency of circulating CD3(-)CD16(+)CD56(-) NK cells, in addition to elevated activation status associated with a type 1-modulated cytokine pattern. Bz-treatment induced substantial T and B-cell activation status associated with an overall IL-10 modulated type 1 cytokine profile. In summary, these findings provide new information regarding immune activation status following the etiological treatment of Chagas disease. These results suggest that in addition to the increased number of activated leukocytes in the peripheral blood, Bz-treatment may also involve a qualitative change in their functional capacity that drives their activation state toward a modulated cytokine profile. These changes may account for the benefits of etiological treatment of Chagas disease.

Human chagas disease and migration in the context of globalization: some particular aspects.

Human Chagas disease originated in Latin America, being spread around the world in relation with multiple bioecological, sociocultural, and political factors. The process of the disease production and dispersion is discussed, emphasizing the human migration and correlated aspects, in the context of globalization. Positive and negative consequences concern the future of this trypanosomiasis, mainly in terms of the ecologic and sociopolitical characteristics of the endemic and nonendemic countries.

Tendencias sociales de la enfermedad de Chagas para las próximas décadas / Social tendencies of Chagas disease in the next decades

La existencia de la enfermedad de Chagas humana se considera el resultado de un conjunto complejo de determinantes bioecológicos y sociales. Su cumbre de incidencia se produjo entre los años 1950 y 1970, observándose una tendencia a la disminución en las décadas siguientes. Innumerables elementos socioculturales y políticos están presentes también en la expansión geográfica de la enfermedad, en su prevención y en la atención médica a los infectados. Para las próximas décadas se espera una mayor reducción de la transmisión, especialmente vectorial y transfusional, como producto de las acciones de control y de los cambios en el sistema de producción, en paralelo con la urbanización y con las acciones antrópicas extensivas en las áreas endémicas. Se espera también una reducción en la morbilidad, dependiente de un mejor acceso a los sistemas de salud y de los constantes avances en la medicina. Sin embargo, la enfermedad seguirá siendo muy importante por dos o tres décadas más, dejando como principales desafíos la vigilancia sobre su transmisión y la atención a los individuos ya infectados. Está prevista una disminución en la visibilidad de la enfermedad, con reflejos negativos en la prioridad política de las acciones sobre su atención y control.

Chagas disease is known to be the result of a complex set of bio-ecological and social determinants. The maximum incidence of the disease occurred between 1950 and 1970, with a downward tendency observed in the following decades. Innumerable socio-cultural and political elements take part in the geographic expansion of the disease, the prevention of the disease and in the medical attention given those infected. Over the next decades a major reduction in transmission is expected, especially in the vector and transfusion routes, as a consequence of control-oriented programs and changes in the production system, in conjunction with urbanization processes and extensive anthropic actions in endemic areas. A reduction in morbidity is also expected, owing to better access to the health system and to medical advances. Nevertheless, Chagas disease will continue to have great importance in the next two to three decades, the main challenges being surveillance of disease transmission and the medical attention provided to infected individuals. A reduction in the visibility of the disease, with negative repercussions in the political priority given to medical attention and disease control, is also anticipated.

Programa para el control y la eliminación de la enfermedad de Chagas en Bolivia 1998-2002 / Program for control and erradication of Chagas disease

En Bolivia la situación de la enfermedad de Chagas es de estrema gravedad, de acuerdo con los datos que se presentan en este documento. En este momento, coherente con sus compromisos y su prioridad social, el gobierno y el pueblo de Bolivia han tomado una decisión histórica y definitiva, que es la de implementar efectivamente un programa especial de eliminación de la Enfermedad de Chagas humana de nuestro país, através de un esfuerzo compartido e integrado con los distintos niveles operativos, con las instancias nacionales y regionales de gobierno, con la participación imprescindible de la población responsable y con agencias e instituciones del país y del exterior, lado al lado con los países amigos y vecinos