Chagas Disease and Leishmaniasis, Sympatric Zoonoses Present in Human from Rural Communities of Venezuela.

PURPOSE: Trypanosoma cruzi and Leishmania spp. coexist in several endemic areas, and there are few studies of Chagas disease and leishmaniasis coinfection worldwide; for this reason, the objective of this work was to determine the Chagas disease and leishmaniasis coinfection in several rural communities co-endemic for these diseases. METHODS: A total of 1107 human samples from six co-endemic rural communities of Cojedes state, Venezuela, were analyzed. Serum samples were evaluated by ELISA, indirect hemagglutination, and indirect immunofluorescence for Chagas disease diagnosis, and individuals were evaluated for leishmaniasis by leishmanin skin test (LST). Approximately, 30% of the individuals were also analyzed by PCR (blood clot samples) for T. cruzi and for Leishmania spp. RESULTS: The 14.7% of the individuals were positive to Trypanosoma cruzi infection by serology, and 25.8% were positive to Leishmania spp. current or past infection by LST. Among the group with PCR results, 7.8% were positive for T. cruzi, and 9.4% for Leishmania spp. The coinfection T. cruzi/Leishmania spp. was 6.5%. The T. cruzi DTUs of the positive blood clot samples were TcI, revealed using the molecular markers: (i) intergenic region of the miniexon, (ii) D7 divergent domain of the 24Sα rDNA, (iii) size-variable domain of the 18S rDNA, and (iv) hsp60-PCR-RFLP (EcoRV). The Leishmania species identified were L. (Leishmania) mexicana and L. (Viannia) braziliensis. CONCLUSION: A high prevalence was found for T. cruzi and Leishmania spp. single and coinfections in almost all communities studied, being these results of relevance for the implementation of control programs in co-endemic areas.

Ecopathogenic complexes of American trypanosomiasis in endemic areas of Venezuela: Diagnosis and variability of Trypanosoma cruzi.

BACKGROUND & OBJECTIVES: Trypanosoma cruzi, the causative agent of American trypanosomiasis, has been reported in 180 mammalian species and 154 triatomines species of Neotropic. This is a clonal parasite with variable biological behaviour, associated with the genetics of the parasite and its hosts. To know the eco-pathogenic complex of this zoonosis, it was proposed to characterize T. cruzi isolates obtained from triatomines and domestic, peridomestic and wild mammals of the eastern and central-western regions of Venezuela. METHODS: The positivity to T. cruzi was established and the isolates were genetically characterized by PCR amplification of the mini-exon gene, the DNA coding for 24Sa and 18S rRNA, and polymorphic sequences-RFLPs. The sampling sites were georeferenced using the MapSource Software and ArcGis 9.3 programs to generate distribution maps of the isolates. RESULTS: Of the 460 hosts (205 triatomines and 255 mammals), 49% were positive for the parasite. On the other hand, 38 isolates obtained from the triatomines and 23 isolates obtained from mammals were evaluated. The TcI genotype predominated in most of the isolates; however, in those obtained from triatomines the presence of the TcIII genotype in single infections and TcI + TcIII or TcI + TcIV in mixed infections was also evidenced. INTERPRETATION & CONCLUSION: There is a possibility that the triatomines act as biological syringes for these genotypes associated exclusively to them. The heterogeneity in T. cruzi isolates demonstrated the complexity of parasitosis in these regions, presenting its control and prevention as a challenge.

Molecular diagnosis of Trypanosoma cruzi/Leishmania spp. coinfection in domestic, peridomestic and wild mammals of Venezuelan co-endemic areas.

American trypanosomiasis and leishmaniases are diseases caused by protozoans of the Trypanosomatidae family. In Venezuela, although several endemic foci of both diseases coincide, there are no reports of coinfection in mammals. The molecular diagnosis of the coinfection T. cruzi-Leishmania spp. was done in 527 blood samples collected on filter paper of several species of mammals (Canis familiaris, Equus asinus, Didelphis marsupialis, Equus mulus, Rattus rattus, Equus caballus, Artibeus fraterculus, Felis catus, Sus scrofa, Bos taurus, Capra hircus and Sciurus granatensis) from the states Cojedes, Aragua, Anzoátegui, Guárico, Miranda and Capital District. The T. cruzi infection was determined through PCR amplification of DNA of kinetoplast minicircles (kDNA) and satellite DNA (sDNA). The Leishmania spp. infection was detected by Leishmania nested PCR (Ln-PCR), and ribosomal DNA internal transcribed spacer 1 PCR (ITS1-PCR). The percentage of infection by T. cruzi was 23.5%, by Leishmania spp. 12.9% and coinfection was 5.7%. D. marsupialis was the species with the highest percentage of infection for each parasitosis (T. cruzi 34.3%, Leishmania spp. 20.0%) and coinfection (14.3%). Anzoátegui was the state with the highest percentage of infection for each parasitosis (T. cruzi 64.9%, Leishmania spp. 64.9%) and coinfection (43.2%). Infections were determined in species not reported as natural reservoirs of T. cruzi (E. asinus and E. mulus) and of Leishmania spp. (E. mulus and S. scrofa). Coinfection was a frequent phenomenon in mammals in several co-endemic zones evaluated.

Estandarización de la técnica de PCR para la detección de ADN de Leishmanía sp. en muestras de sangre de caninos / Standardization of the PCR technique for detection of Leishmania sp. DNA in canine blood samples

La leishmaniasis es una enfermedad con diversidad clínica y epidemiológica, producida por varias especies de protozoarios parásitos del género Leishmania. Estos parásitos infectan una amplia variedad de hospedadores mamíferos y son transmitidos por insectos del género Lutzomyia, en nuestro país. Los caninos han sido implicados como posibles reservorios del parásito. Para el diagnóstico de leishmaniasis se utilizan técnicas parasitológicas que generalmente tienen baja sensibilidad e inmunológicas, con pobre especificidad. Debido a las limitaciones en el diagnóstico, y lo difícil de la obtención, transporte y almacenamiento de las muestras, en este trabajo se planteó estandarizar de una técnica de PCR anidada (Leishmania nested PCR, Ln-PCR) para la detección de ADN de Leishmania sp. en muestras de sangre de caninos colectadas en papel de filtro. Para ello se titularon las concentraciones de reactivos de la PCR para la amplificación del ADN del parásito y se determinó la sensibilidad analítica y la especificidad de la técnica. Se evaluaron 36 muestras de sangre de caninos (6 infectados y 30 no infectados). Las condiciones óptimas de reacción fueron 0,2 mM de dNTPs, 0,4 µM de cada cebador y 1 U de Taq polimerasa. La sensibilidad analítica de Ln-PCR fue de 10 fg y la especificidad fue de 100% en la detección de ADN de Leishmania sp., ya que no se observó amplificación con ADN de otros parásitos, ni con ADN humano, ni de perro. De las muestras de caninos evaluadas los seis controles infectados todos amplificaron por la PCR, mientras que los 30 no infectados, en ninguno se observó amplificación. La extracción de ADN de muestras de sangre colectadas en papel de filtro fue eficiente para la amplificación por la PCR, técnica que puede ser muy útil para el diagnóstico de leishmaniasis en animales y su implicación como posibles reservorios.

Leishmaniasis is a disease with clinical and epidemiological diversity, caused by several species of protozoan parasites of the genus Leishmania. These parasites infect a wide variety of mammalian hosts, and are transmitted by insects of the genus Lutzomyia in our country. Canines have been implicated as potential reservoirs of the parasite. For the diagnosis of leishmaniasis, parasitological techniques generally with low sensitivity and immunological techniques, with poor specificity, are used. Because of limitations in the diagnosis, and the difficulty to obtain, transport, and store samples, the aim of this research was to standardize a Leishmania nested PCR test (Ln-PCR), for the detection of Leishmania sp. DNA in blood samples from dogs collected in filter paper. For that purpose, concentrations of the PCR reagent for DNA parasite amplification were titrated and the analytical sensitivity and specificity of the technique were determined. A total of 36 canine blood samples (6 infected and 30 uninfected) were evaluated.  The optimal reaction conditions were: 0.2 mM dNTPs; 0.4 µM of each primer; and 1 U of Taq polymerase. The analytical sensitivity of the Ln-PCR was 10 fg and the specificity was 100% in detecting Leishmania sp. DNA, since no amplification was observed with DNA from other parasites, human DNA or canine DNA. The six samples from infected canines evaluated amplified Leishmania sp. DNA by PCR, whereas in none of the 30 samples from uninfected canines the amplification was observed. The DNA extraction from blood samples collected in filter paper was efficient for the PCR amplification, a technique that can be very useful for the diagnosis of leishmaniasis in animals and their involvement as potential reservoirs.

Leishmaniasis.

dogs.

diagnosis.

PCR.

Genetic variability of Trypanosoma cruzi TcI isolates from rural and urban areas of Venezuela.

BACKGROUND & OBJECTIVES: Several studies have demonstrated genetic heterogeneity in populations of Trypanosoma cruzi that allowed the identification of six different discrete typing units (DTU) classified as TcI, TcII, TcIII, TcIV, TcV and TcVI. Furthermore, some characterization studies have described genetic variability within TcI isolates from endemic regions. The objective of the present study was to analyze Venezuelan T. cruzi isolates, obtained from triatomine-vectors, mammal-hosts including infected humans, detected in both rural and urban areas from diverse geographic origins. METHODS: Molecular characterization of 44 Venezuelan T. cruzi isolates, obtained from triatomine-vectors, mammalian hosts and human patients from both rural and urban areas of different geographic origins, were carried out. Samples were analyzed by PCR amplification of the intergenic region of the mini-exon gene, 24Sα rDNA and 18S rDNA, followed by sequencing of the amplification products. RESULTS: The TcI amplification pattern was found in 42 out of 44 (95.5%) isolates; a TcIII strain and one possible TcIV were also found. The sequence analysis of the TcI Venezuelan isolates showed genetic variability among them. Urban isolates formed a homogeneous group, with differences in their sequences, when compared to rural isolates. INTERPRETATION & CONCLUSION: The results showed genetic heterogeneity in Venezuelan TcI strains, probably in response to different environmental conditions.

[Standardization of a direct agglutination test for the immunodiagnosis of Chagas disease]. / Estandarización de la técnica de aglutinación directa para el inmunodiagnóstico de la enfermedad de Chagas.

INTRODUCTION: Chagas' disease is caused by the parasite Trypanosoma cruzi and its immunological diagnosis is mainly based on the detection of antibodies against T. cruzi using tests such as the ELISA, the indirect fluorescence antibody test (IFAT) and the indirect hemagglutination test (IHAT). The main disadvantage of the IHAT is the need to prepare sheep erythrocytes, whose availability is limited and they have a short duration once prepared. However, there are alternative tests, such as the direct agglutination test (DAT). OBJECTIVE: To standardize the direct agglutination test for the diagnosis of Chagas disease. MATERIALS AND METHODS: Trypanosoma cruzi epimastigotes were prepared using two protocols, with and without trypsin treatment. The parasites were stained and optimal conditions for parasitic concentration and serum dilutions were determined. We evaluated the technique using sera from patients with Chagas disease, from healthy individuals and from individuals with other parasitic diseases. RESULTS: The optimal parasitic concentration was 500 x 10(6) parasites/ml using stained parasites without trypsin treatment. The optimal serum dilutions were 1/25, 1/50 y 1/100 and the cut-off point was the 1/50 dilution. The diagnostic indices for the standardized technique were as follows: Sensitivity, 94.3% (95% CI: 79.5-99.0) and specificity, 96.3% (95% CI: 88.8-99.0), with positive and negative predictive values of 91.7% (95% CI: 76.4-97.8) and 97.5% (95% CI: 90.4-99.6), respectively. Cross-reaction was observed only in three sera from individuals with visceral leishmaniasis. The results were compared with those obtained by IHA, ELISA, and IFA, and the concordance rate was 96% and the kappa index, 0.90 (95% CI: 0.81-0.99). CONCLUSION: The standardized direct agglutination test could be useful for immunodiagnosis of Chagas disease.

Estandarización de la técnica de aglutinación directa para el inmunodiagnóstico de la enfermedad de Chagas / Standardization of a direct agglutination test for the immunodiagnosis of Chagas disease

Introducción. La enfermedad de Chagas es causada por el parásito Trypanosoma cruzi y su diagnóstico inmunológico se basa principalmente en la detección de anticuerpos contra T. cruzi mediante pruebas tales como ELISA, inmunofluorescencia indirecta (IFI) y hemaglutinación indirecta (HAI). Esta última tiene el inconveniente de requerir la preparación de eritrocitos de carnero, difíciles de obtener y de poca duración. Sin embargo, existen pruebas alternativas, como la técnica de aglutinación directa. Objetivo. Estandarizar la técnica de aglutinación directa para el diagnóstico de la enfermedad de Chagas. Materiales y métodos. Se prepararon parásitos epimastigotes de T. cruzi mediante dos protocolos, con tratamiento con tripsina y sin él. Los parásitos se colorearon, y se determinaron las condiciones óptimas de concentración parasitaria y diluciones de suero. Se utilizaron sueros de pacientes con enfermedad de Chagas, de individuos sanos y con otras parasitosis. Resultados. La concentración parasitaria óptima fue de 500 x10 6 parásitos/ml, utilizando parásitos coloreados y sin tratamiento con tripsina. Las diluciones de suero óptimas fueron de 1/25, 1/50 y1/100, y el punto de corte, la dilución de 1/50. La técnica estandarizada mostró índices diagnósticos de sensibilidad de 94,3 % (IC 95% 79,5-99,0) y de especificidad de 96,3 % (IC 95% 88,8-99,0); se encontró reacción cruzada en tres sueros de individuos con leishmaniasis visceral, con valores pronósticos positivo y negativo de 91,7 % (IC 95% 76,4-97,8) y de 97,5 % (IC 95% 90,4-99,6), respectivamente. Se compararon los resultados con los obtenidos por HAI, ELISA e IFI y la concordancia fue de 96 % con un índice kappa de 0,90 (IC 95% 0,81-0,99). Conclusión. La técnica de aglutinación directa estandarizada podría ser útil para el inmunodiagnóstico de la enfermedad de Chagas.

Introduction: Chagas´ disease is caused by the parasite Trypanosoma cruzi and its immunological diagnosis is mainly based on the detection of antibodies against T. cruzi using tests such as the ELISA, the indirect fluorescence antibody test (IFAT) and the indirect hemagglutination test (IHAT). The main disadvantage of the IHAT is the need to prepare sheep erythrocytes, whose availability is limited and they have a short duration once prepared. However, there are alternative tests, such as the direct agglutination test (DAT). Objective: To standardize the direct agglutination test for the diagnosis of Chagas disease. Materials and methods: Trypanosoma cruzi epimastigotes were prepared using two protocols, with and without trypsin treatment. The parasites were stained and optimal conditions for parasitic concentration and serum dilutions were determined. We evaluated the technique using sera from patients with Chagas disease, from healthy individuals and from individuals with other parasitic diseases. Results: The optimal parasitic concentration was 500 x 10 6 parasites/ml using stained parasites without trypsin treatment. The optimal serum dilutions were 1/25, 1/50 y 1/100 and the cut-off point was the 1/50 dilution. The diagnostic indices for the standardized technique were as follows: Sensitivity, 94.3% (95% CI: 79.5-99.0) and specificity, 96.3% (95% CI: 88.8-99.0), with positive and negative predictive values ?? of 91.7% (95% CI: 76.4-97.8) and 97.5% (95% CI: 90.4-99.6), respectively. Cross-reaction was observed only in three sera from individuals with visceral leishmaniasis. The results were compared with those obtained by IHA, ELISA, and IFA, and the concordance rate was 96% and the kappa index, 0.90 (95% CI: 0.81-0.99). Conclusion: The standardized direct agglutination test could be useful for immunodiagnosis of Chagas disease.

TSOL18/HP6-Tsol, an immunogenic Taenia solium oncospheral adhesion protein and potential protective antigen.

In this study, we employed Taenia solium mRNA extracted from a tapeworm of Venezuelan origin to clone express and test the recombinant protein of the T. solium homologue of the 18-kDa oncospheral adhesion molecule of Taenia saginata (HP6-Tsag/TSA18). We first confirm the conserved nature of the sequence of the T. solium homologue (TSOL18/HP6-Tsol) and demonstrate that the recombinant protein, which, as with its T. saginata homologue, is characterised by a fibronectin type III homology region, functions as an adhesion molecule. This emphasises the possible importance of TSOL18/HP6-Tsol in tissue invasion, thus providing a rational explanation for its efficacy as a vaccine. As protection against Taenia spp., oncospheres is antibody mediated, logically, therefore, TSOL18/HP6-Tsol may also serve as a diagnostic antigen, as is indeed the case for recombinant HP6-Tsag/TSA18.

Molecular epidemiology of cutaneous leishmaniasis in Venezuela.

This paper discusses the utility of a set of primers (3J1, 3J2) designed from a repetitive nuclear deoxyribonucleic acid sequence for the diagnosis of Leishmania braziliensis infection in samples obtained from humans, insect vectors and mammalian reservoir hosts from different endemic areas in Venezuela. A high incidence of Leishmania (Viannia) braziliensis infection was found in the endemic areas studied. The sensitivity and specificity of the primers used were adequate for the identification of the natural vectors and reservoir hosts of L. (V.) braziliensis. The polymerase chain reaction was more sensitive than culture and stained smear examination in the diagnosis of cutaneous leishmaniasis, detecting 80% of cases compared to 42% and 72%, respectively.