Blood culture positivity rate for Trypanosoma cruzi in patients with chronic Chagas disease differs among different clinical forms.

BACKGROUND: The purpose of this research was to compare the clinical and epidemiological characteristics of patients with chronic Chagas disease with and without positive blood cultures for Trypanosoma cruzi. METHODS: This was a retrospective longitudinal study that included 139 patients with chronic Chagas disease who underwent blood culture for T. cruzi. Blood cultures were performed using Novy-MacNeal-Nicolle medium enriched with Schneider's medium. Multivariate Cox proportional hazards regression analysis adjusting for age and sex was performed to identify if positive blood culture for T. cruzi was associated with all-cause mortality. RESULTS: The blood culture positivity rate was 30.9%. Most patients were born in the Northeast and Southeast regions of Brazil. Patients with positive blood cultures were older (52±13 vs 45±13 y; p=0.0009) and more frequently women (72.1% vs. 53.1%; p=0.03) than patients with negative blood cultures. The frequency of patients with cardiac or cardiodigestive forms was higher among patients with positive vs negative blood cultures (74.4% vs 54.1%; p=0.02). A total of 28 patients died during a mean follow-up time of 6.6±4.1 y. A positive blood culture was associated with all-cause mortality (hazard ratio 2.26 [95% confidence interval 1.02 to 5.01], p=0.045). CONCLUSIONS: We found a higher proportion of patients with Chagas heart disease among patients with T. cruzi-positive blood cultures. A positive blood culture was associated with an increased risk of all-cause mortality. Therefore T. cruzi persistence may influence Chagas disease pathogenesis and prognosis.

Association between Trypanosoma cruzi DTU TcII and chronic Chagas disease clinical presentation and outcome in an urban cohort in Brazil.

BACKGROUND: The specific roles of parasite characteristics and immunological factors of the host in Chagas disease progression and prognosis are still under debate. Trypanosoma cruzi genotype may be an important determinant of the clinical chronic Chagas disease form and prognosis. This study aimed to identify the potential association between T. cruzi genotypes and the clinical presentations of chronic Chagas disease. METHODOLOGY/PRINCIPAL FINDINGS: This is a retrospective study using T. cruzi isolated from blood culture samples of 43 patients with chronic Chagas disease. From 43 patients, 42 were born in Brazil, mainly in Southeast and Northeast Brazilian regions, and one patient was born in Bolivia. Their mean age at the time of blood collection was 52.4±13.2 years. The clinical presentation was as follows 51.1% cardiac form, 25.6% indeterminate form, and 23.3% cardiodigestive form. Discrete typing unit (DTU) was determined by multilocus conventional PCR. TcII (n = 40) and TcVI (n = 2) were the DTUs identified. DTU was unidentifiable in one patient. The average follow-up time after blood culture was 5.7±4.4 years. A total of 14 patients (32.5%) died and one patient underwent heart transplantation. The cause of death was sudden cardiac arrest in six patients, heart failure in five patients, not related to Chagas disease in one patient, and ignored in two patients. A total of 8 patients (18.6%) progressed, all of them within the cardiac or cardiodigestive forms. CONCLUSIONS/SIGNIFICANCE: TcII was the main T. cruzi DTU identified in chronic Chagas disease Brazilian patients (92.9%) with either cardiac, indeterminate or cardiodigestive forms, born at Southeast and Northeast regions. Other DTU found in much less frequency was TcVI (4.8%). TcII was also associated to patients that evolved with heart failure or sudden cardiac arrest, the two most common and ominous consequences of the cardiac form of Chagas disease.

Transmissão da doença de Chagas por consumo de carne de caça: revisão sistemática / Chagas disease transmission by consumption of game meat: systematic review

RESUMO: Objetivo: Avaliar a influência do consumo de carne de caça na transmissão da doença de Chagas (DC), assim como as condições em que ela ocorre e a frequência de relatos na literatura. Métodos: Mediante revisão sistemática, foram consultadas as bases PubMed, LILACS, MEDLINE e SciELO, sendo incluídos artigos escritos em português, inglês e espanhol, sem limitação do ano de publicação. Os descritores utilizados foram: oral, transmission, meat, wild animals, hunt, carnivory e Chagas disease, sendo inseridos na análise os artigos que mencionavam o consumo de carne de animais como forma de transmissão humana da DC. Foram utilizados critérios de evidência epidemiológico, clínico e laboratorial. Resultados: Entre os 298 artigos identificados, apenas seis preencheram os critérios de elegibilidade. Foram identificados somente cinco episódios de transmissão oral por consumo de carne ou sangue de animais silvestres, porém em dois deles não foi possível afastar a possibilidade de transmissão vetorial. A maior parte dos relatos preencheu os critérios de evidência epidemiológico, clínico e laboratorial, estabelecidos para sustentar a transmissão. Conclusão: Apesar da transmissão de DC ser incomum, a caça e o consumo de mamíferos silvestres reservatórios devem ser desestimulados nos países endêmicos em função dos riscos inerentes a essas práticas.

ABSTRACT: Objective: To evaluate the influence of game meat consumption in Chagas disease (CD) transmission, the conditions under which it occurs and the frequency of reports in the literature. Methods: Through systematic review, databases PubMed, LILACS, MEDLINE, and SciELO were consulted, and articles written in Portuguese, English, and Spanish were included, with no limitation over publication date. We used the following descriptors: oral, transmission, meat, wild animals, hunt, carnivory, and Chagas disease. Articles that mentioned consumption of animal meat as a form of human transmission of CD were included. We used epidemiological, clinical, and laboratory evidence criteria to confirm cases. Results: Among the 298 articles identified, only six met the eligibility criteria. Only five episodes of oral transmission through wild animal meat or blood consumption were identified. However, in two of them, the possibility of vectorial transmission could not be ruled out. Most reports met the epidemiological, clinical, and laboratory evidence criteria established to support the transmission. Conclusion: Though CD transmission is uncommon, hunting and consumption of wild mammals that serve as Trypanosoma cruzi reservoirs should be discouraged in endemic countries in light of the risks inherent to these practices.

Chagas disease transmission by consumption of game meat: systematic review. / Transmissão da doença de Chagas por consumo de carne de caça: revisão sistemática.

OBJECTIVE:: To evaluate the influence of game meat consumption in Chagas disease (CD) transmission, the conditions under which it occurs and the frequency of reports in the literature. METHODS:: Through systematic review, databases PubMed, LILACS, MEDLINE, and SciELO were consulted, and articles written in Portuguese, English, and Spanish were included, with no limitation over publication date. We used the following descriptors: oral, transmission, meat, wild animals, hunt, carnivory, and Chagas disease. Articles that mentioned consumption of animal meat as a form of human transmission of CD were included. We used epidemiological, clinical, and laboratory evidence criteria to confirm cases. RESULTS:: Among the 298 articles identified, only six met the eligibility criteria. Only five episodes of oral transmission through wild animal meat or blood consumption were identified. However, in two of them, the possibility of vectorial transmission could not be ruled out. Most reports met the epidemiological, clinical, and laboratory evidence criteria established to support the transmission. CONCLUSION:: Though CD transmission is uncommon, hunting and consumption of wild mammals that serve as Trypanosoma cruzi reservoirs should be discouraged in endemic countries in light of the risks inherent to these practices.

Acidentes ofídicos no município de Valença, Rio de Janeiro: possível emergência de envenenamento por cascavel / Snake bites in the Municipality of Valença, Rio de Janeiro, Brazil: possible emergence of envenoming by rattlesnake

O estado do Rio de Janeiro notifica cerca de 500 casos de acidentes por ofídios peçonhentos ao ano. O acidente relacionado com cascavel representa menos de 3por cento do total. O município de Valença, situado na região sul do estado, apresentou um aumento do número de notificações de acidentespor serpentes do gênero Crotalus nos últimos anos. Os dados foram coletados do livro de registro da emergência e dos prontuários médicos dos pacientes atendidos no Hospital da Faculdade deMedicina de Valença no período de janeiro de 2003 a julho de 2010. Neste período ocorreram 97 acidentes por ofídios peçonhentos, 49 por Bothrops (50,5por cento) e 48 por Crotalus (49,5por cento). Após 2005, houve aumento dos acidentes por cascavel, chegando a 70por cento em 2009. Quanto à origem, 81por cento ocorreram em área rural. Predominaram os pacientes do sexo masculino (72por cento) e na faixaetária de 15 a 44 anos. Os acidentes por Bothrops, em sua maioria, foram classificados como leves ou moderados e pelo gênero Crotalus, como moderados ou graves. O número de internações foi maior nos casos de acidentes por Bothrops. Embora não tenhamos registrado nenhum óbito, há orisco de aumento de casos fatais, pois o acidente por cascavel apresenta maior letalidade. Dados recentes demonstram a ocorrência de acidentes por Crotalus durissus em outros municípios do suldo estado, o que nos faz concluir que esta serpente continua a se difundir e serve de alerta à vigilânciaepidemiológica estadual e dos municípios afetados.