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1.
Mem Inst Oswaldo Cruz ; 115: e200110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146244

RESUMO

We aimed to investigate the association of CD14 -260C/T (rs2569190) polymorphism and Chagas cardiomyopathy and the functional characteristics of CD14+ and CD14- monocytes upon infection with Trypanosoma cruzi. We observed an association between the T- genotype (absence of allele -260T) related to low CD14 expression and the dilated cardiomyopathy type of Chagas disease. Furthermore, we observed that CD14- monocytes showed a more activated profile upon in vitro infection with T. cruzi than CD14+ monocytes. Our findings suggest that T- genotype is associated with susceptibility to develop Chagas dilated cardiomyopathy, likely linked to the T. cruzi-induced inflammatory profile of CD14- monocytes.


Assuntos
Cardiomiopatia Dilatada/genética , Cardiomiopatia Chagásica/genética , Receptores de Lipopolissacarídeos/genética , Doença de Chagas , Genótipo , Insuficiência Cardíaca , Humanos , Trypanosoma cruzi , Disfunção Ventricular Esquerda
2.
Mem Inst Oswaldo Cruz ; 115: e200203, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146245

RESUMO

BACKGROUND: Deforestation, driven by anthropogenic change in land use, influences the behaviour and abundance of vector-borne diseases. For various species of Chagas disease vectors, there is evidence that change in land use affects population density and abundance. Triatoma dimidiata is the most important Chagas vector in Guatemala, and at least one million people live in T. dimidiata endemic areas; however, infestation dynamics vary among regions, from high infestation with all life stages to low seasonal infestation by sylvatic adults. OBJECTIVES: The aim of this study was to evaluate how land-use, combined with domiciliary risk factors, influences the infestation dynamics of T. dimidiata for four villages in a dry forest region with a strong deforestation history. METHODS: Land use, measured with drone and satellite images, was classified into four categories (houses, monocultures and pastures, woodland and shrubland, and bare soil). Domiciliary risk factors and infestation were assessed through entomological surveys. Statistical analyses compared infestation indices and the ability of land use and domiciliary risk factors to explain infestation. FINDINGS: Two villages had significantly higher infestation (26 and 30% vs. 5 and 6%), yet all villages had high colonisation (71-100% of infested houses had immature insects), with no significant difference among them. Because of the high level of deforestation across the study area, land use was not related to infestation; however, domiciliary risk factors were. A model based on four weighted domiciliary risk factors (adobe or bajareque walls, intradomicile animals, intradomicile clutter, and dirt floors) explains the infestation risk. MAIN CONCLUSIONS: Because almost all infested houses have reproducing populations in this deforested dry forest region and statistical analysis identified the domiciliary risk factors for infestation, intermediate and long-term control of Chagas disease vectors in this region requires management of these risk factors.


Assuntos
Doença de Chagas/transmissão , Insetos Vetores , Triatoma , Adulto , Animais , Florestas , Guatemala , Habitação , Humanos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33206861

RESUMO

The etiological agent of American trypanosomiasis is the protozoan Trypanosoma cruzi , typically transmitted by triatomines. The aim of this study was to investigate the triatomine fauna and trypanosomiasis infections in Acre State , Western Brazilian Amazon. Insect collection was performed by dissecting palm trees and installing traps. We found that T. cruzi infection rate was 24.5% and Rhodnius pictipes (57.1%) was the most abundant triatomine species. Health education as well as epidemiological and entomological surveillance are necessary to diagnose and prevent new cases of Chagas disease in the region.


Assuntos
Doença de Chagas , Insetos Vetores/parasitologia , Rhodnius/parasitologia , Trypanosoma cruzi , Animais , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão
4.
Rev Soc Bras Med Trop ; 53: e20200504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174962

RESUMO

Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.


Assuntos
Doença de Chagas/complicações , Infecções por Coronavirus/complicações , Hanseníase Dimorfa/complicações , Pneumonia Viral/complicações , Vacina BCG/administração & dosagem , Betacoronavirus , Brasil , Características da Família , Humanos , Pandemias
5.
Rev Soc Bras Med Trop ; 53: e20200225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33111908

RESUMO

INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.


Assuntos
Doença de Chagas , Trypanosoma cruzi , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
6.
BMC Infect Dis ; 20(1): 743, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036559

RESUMO

BACKGROUND: Chagas disease is a zoonotic infection caused by the parasite Trypanosoma cruzi, which affects an estimated 8-11 million people globally. Chagas disease is almost always associated with poverty in rural areas and disproportionately impacts immigrants from Latin America living in the United States. Approximately 20-30% of people who are infected with Chagas disease will develop a chronic form of the infection that can be fatal if left untreated. Chagas disease is vastly underestimated in the United States, often goes undiagnosed and is not well understood by most U.S. healthcare providers. One of the most important ways at reducing barriers to improving diagnostics of Chagas disease in the U.S. is giving healthcare providers the most up-to-date information and access to leading experts. METHODS: An online webinar was conducted for healthcare providers, veterinarians and public health professionals using Chagas disease expert panelists. Pre and post tests were administered to participants (n = 57) to determine the efficacy in raising awareness and to determine key focus areas for improving knowledge. A Wilcoxon rank-sum was used for non-parametric variables equivalent and for questions that assessed knowledge the McNemar's Chi-Square test was used. RESULTS: There were statistically significant learning increases in multiple categories including transmission (p = <.001), clinical presentation (p = 0.016), diagnostics (p = <.001), and treatment (p = <.001). CONCLUSION: Providing easily accessible learning opportunities using validated testing and evaluations should be further developed for rural healthcare providers in the U.S. as well as healthcare providers serving under represented populations such as immigrants. There is a clear lack of knowledge and awareness surrounding Chagas disease in the United States and just by raising awareness and providing education on the topic, lives will be saved.


Assuntos
Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Trypanosoma cruzi , Animais , Doença de Chagas/parasitologia , Educação em Veterinária , Emigrantes e Imigrantes , Feminino , Humanos , Aprendizagem , Masculino , Pobreza , Estados Unidos/epidemiologia , Zoonoses/diagnóstico
7.
Mem Inst Oswaldo Cruz ; 115: e200142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33053076

RESUMO

BACKGROUND: Calpains are present in almost all organisms and comprise a family of calcium-dependent cysteine peptidases implicated in crucial cellular functions. Trypanosoma cruzi, the causative agent of Chagas disease, presents an expansion on this gene family with unexplored biological properties. OBJECTIVES: Here, we searched for calpains in the T. cruzi genome, evaluated the mRNA levels, calpain activity and the protein expression and determined the cellular localisation in all three parasite life cycle forms. METHODS/FINDINGS: Sixty-three calpain sequences were identified in T. cruzi CL Brener genome, with fourteen domain arrangements. The comparison of calpain mRNA abundance by quantitative polymerase chain reaction (qPCR) revealed seven up-regulated sequences in amastigotes and/or bloodstream trypomastigotes and five in epimastigotes. Western Blotting analysis revealed seven different molecules in the three parasite forms, and one amastigote-specific, while no proteolytic activity could be detected. Flow cytometry assays revealed a higher amount of intracellular calpains in amastigotes and/or trypomastigotes in comparison to epimastigotes. Finally, ultrastructural analysis revealed the presence of calpains in the cytoplasm, vesicular and plasma membranes of the three parasite forms, and in the paraflagellar rod in trypomastigotes. CONCLUSION: Calpains are differentially expressed and localised in the T. cruzi life cycle forms. This study adds data on the calpain occurrence and expression pattern in T. cruzi.


Assuntos
Calpaína/genética , Trypanosoma cruzi/genética , Animais , Western Blotting , Calpaína/metabolismo , Doença de Chagas , Estágios do Ciclo de Vida , RNA Mensageiro/genética
8.
Exp Parasitol ; 218: 108012, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33011239

RESUMO

Chagas disease, caused by the protozoan Trypanosoma cruzi, is endemic in almost all countries of Latin America. In Brazil, oral infection is becoming the most important mechanism of transmission of the disease in several regions of the country. The gastrointestinal tract is the gateway for the parasite through this route of infection, however, little is known about the involvement of these organs related to oral route. In this sense, the present study evaluated the impact of oral infection on the digestive tract in mice infected by Berenice-78 (Be-78) T. cruzi strain, in comparison with the intraperitoneal route of infection. In this work, the intraperitoneal route group showed a peak of parasitemia similar to the oral route group, however the mortality rate among the orally infected animals was higher when compared to intraperitoneal route. By analyzing the frequency of blood cell populations, differences were mainly observed in CD4+ T lymphocytes, and not in CD8+, presenting an earlier reduction in the number of CD4+ T cells, which persisted for a longer period, in the animals of the oral group when compared with the intraperitoneal group. Animals infected by oral route presented a higher tissue parasitism and inflammatory infiltrate in stomach, duodenum and colon on the 28th day after infection. Therefore, these data suggest that oral infection has a different profile of parasitological and immune responses compared to intraperitoneal route, being the oral route more virulent and with greater tissue parasitism in organs of the gastrointestinal tract evaluated during the acute phase.


Assuntos
Doença de Chagas/patologia , Trato Gastrointestinal/patologia , Trato Gastrointestinal/parasitologia , Trypanosoma cruzi/patogenicidade , Administração Oral , Análise de Variância , Animais , Doença de Chagas/mortalidade , Doença de Chagas/parasitologia , Colo/parasitologia , Colo/patologia , Duodeno/parasitologia , Duodeno/patologia , Imunofenotipagem , Masculino , Camundongos , Monócitos/patologia , Parasitemia/mortalidade , Parasitemia/parasitologia , Estômago/parasitologia , Estômago/patologia , Taxa de Sobrevida
9.
Washington, D.C.; OPS; 2020-10-22. (OPS/CDE/VT/20-0038).
em Espanhol | PAHO-IRIS | ID: phr-52918

RESUMO

La enfermedad de Chagas o tripanosomiasis americana es una parasitosis sistémica cuya transmisión vectorial se limita a la Región de las Américas. Sin embargo, puede llegar a convertirse en un problema de salud de alcance global a través de sus modalidades de transmisión transfusional y congénita, que se asocian a las migraciones de la población de áreas endémicas de riesgo. Los países endémicos han puesto en marcha numerosas medidas para reducir la prevalencia, la morbilidad, la mortalidad y el riesgo mediante las Iniciativas Subregionales de Prevención, Control y Atención de la Enfermedad de Chagas, con la colaboración de la Secretaría Técnica de la OPS. Sin embargo, aún queda mucho por abordar y por hacer.


Assuntos
Doença de Chagas , Prevenção e Mitigação , Zoonoses , Doenças Transmissíveis
10.
PLoS Negl Trop Dis ; 14(9): e0008712, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32970687

RESUMO

BACKGROUND: Several studies addressed changes on the insect vector behavior due to parasite infection, but little is known for triatomine bugs, vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. We assessed infection rates and metacyclogenesis of T. cruzi (TcVI) in fifth-instar nymphs of Triatoma rubrovaria comparing with the primary vector Triatoma infestans. Also, biological parameters related to feeding-excretion behavior were evaluated aiming to identify which variables are most influenced by T. cruzi infection. METHODOLOGY/PRINCIPAL FINDINGS: Fifth-instar nymphs of T. rubrovaria and T. infestans were fed on mice infected with T. cruzi (TcVI). We compared the presence and the number of parasite evolutive forms in excreta of both triatomine species at 30, 60 and 90 days post-infection (dpi) with traditional statistical analyses. Moreover, both species were analyzed through generalized linear models and multinomial logistic regression hypotheses for seven behavioral parameters related to host-seeking and feeding-excretion. Triatoma rubrovaria and T. infestans had similar overall infection and metacyclogenesis rates of T. cruzi TcVI in laboratory conditions. Regarding vector behavior, we confirmed that the triatomine's tendency is to move away from the bite region after a blood meal, probably to avoid being noticed by the vertebrate host. Interspecific differences were observed on the volume of blood ingested and on the proportion of individuals that excreted after the blood meal, revealing the higher feeding efficiency and dejection rates of T. infestans. The amount of ingested blood and the bite behavior of T. rubrovaria seems to be influenced by TcVI infection. Infected specimens tended to ingest ~25% more blood and to bite more the head of the host. Noteworthy, in two occasions, kleptohematophagy and coprophagy behaviors were also observed in T. rubrovaria. CONCLUSIONS/SIGNIFICANCE: Laboratory infections revealed similar rate of T. cruzi TcVI trypomatigotes in excreta of T. rubrovaria and T. infestans, one of the most epidemiological important vectors of T. cruzi. Therefore, TcVI DTU was able to complete its life cycle in T. rubrovaria under laboratory conditions, and this infection changed the feeding behavior of T. rubrovaria. Considering these results, T. rubrovaria must be kept under constant entomological surveillance in Rio Grande do Sul, Brazil.


Assuntos
Comportamento Alimentar , Insetos Vetores/fisiologia , Insetos Vetores/parasitologia , Triatoma/fisiologia , Triatoma/parasitologia , Trypanosoma cruzi/fisiologia , Animais , Brasil , Doença de Chagas/transmissão , Modelos Animais de Doenças , Interações Hospedeiro-Parasita , Mordeduras e Picadas de Insetos , Modelos Logísticos , Camundongos , Ninfa , Eliminação Renal , Trypanosoma cruzi/patogenicidade
11.
PLoS Negl Trop Dis ; 14(9): e0008667, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32986710

RESUMO

Digestive and cardiodigestive forms of Chagas' disease are observed in 2% to 27% of the patients, depending on their geographic location, Trypanosoma cruzi strain and immunopathological responses. The aim of this work was to evaluate the role of NOD2 innate immune receptor in the pathogenesis of the digestive system in Chagas' disease. Patients with digestive form of the disease showed lower mRNA expression of NOD2, higher expression of RIP2 and α-defensin 6, compared to indeterminate form, detected by Real-time PCR in peripheral blood mononuclear cells. In addition, there was a negative correlation between the expression of NOD2 and the degree of dilation of the esophagus, sigmoid and rectum in those patients. The infection of NOD2-/- mice with T. cruzi strain isolated from the digestive patient induced a decrease in intestinal motility. Histopathological analysis of the colon and jejunum of NOD2-/- and wild type C57BL/6 animals revealed discrete inflammatory foci during the acute phase of infection. Interestingly, during the chronic phase of the infection there was inflammation and hypertrophy of the longitudinal and circular muscular layer more pronounced in the colon and jejunum from NOD2-/- animals, when compared to wild type C57BL/6 mice. Together, our results suggest that NOD2 plays a protective role against the development of digestive form of Chagas' disease.


Assuntos
Doença de Chagas/imunologia , Proteína Adaptadora de Sinalização NOD2/genética , Proteína Adaptadora de Sinalização NOD2/imunologia , Proteína Adaptadora de Sinalização NOD2/metabolismo , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Idoso , Animais , Brasil , Doença de Chagas/patologia , Colo/microbiologia , Colo/patologia , Modelos Animais de Doenças , Feminino , Humanos , Imunidade Inata , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pessoa de Meia-Idade , Proteína Serina-Treonina Quinase 2 de Interação com Receptor/genética , Proteína Serina-Treonina Quinase 2 de Interação com Receptor/metabolismo , Adulto Jovem , alfa-Defensinas/genética , alfa-Defensinas/metabolismo
12.
PLoS Negl Trop Dis ; 14(9): e0008608, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32925918

RESUMO

The receptor Signaling Lymphocyte-Activation Molecule Family 1 (SLAMF1) controls susceptibility to Infection by the lethal Trypanosoma cruzi Y strain. To elucidate whether genetic diversity of the parasite was related with disease susceptibility, we further analyzed the role of SLAMF1 using 6 different Trypanosoma cruzi strains including Y. The interaction of SLAMF1 receptor with T. cruzi was evidenced by fluorescence microscopy, flow cytometry and quantitative PCR. All the strains, except VFRA, showed a decrease in parasite load in infected macrophages in Slamf1-/- compared to BALB/c. In macrophages gene expression NADPH oxidase (NOX2), and reactive oxygen species (ROS) production increased in Slamf1-/- compared to BALB/c in 5 out of 6 strains. However, Slamf1-/-macrophages infected with VFRA strain exhibited a divergent behavior, with higher parasite load, lower NOX2 expression and ROS production compared to BALB/c. Parasitological and immunological studies in vivo with Y strain showed that in the absence of SLAMF1 the immune response protected mice from the otherwise lethal Y infection favoring a proinflammatory response likely involving CD4, CD8, dendritic cells and classically activated macrophages. In the case of VFRA, no major changes were observed in the absence of SLAMF1. Thus, the results suggest that the T. cruzi affects SLAMF1-dependent ROS production, controlling parasite replication in macrophages and affecting survival in mice in a strain-dependent manner. Further studies will focus in the identification of parasite molecules involved in SLAMF1 interaction to explain the immunopathogenesis of the disease.


Assuntos
Macrófagos/parasitologia , Espécies Reativas de Oxigênio/metabolismo , Membro 1 da Família de Moléculas de Sinalização da Ativação Linfocitária/genética , Membro 1 da Família de Moléculas de Sinalização da Ativação Linfocitária/metabolismo , Trypanosoma cruzi/imunologia , Animais , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Linhagem Celular , Doença de Chagas/imunologia , Chlorocebus aethiops , Células Dendríticas/imunologia , Suscetibilidade a Doenças/imunologia , Células HEK293 , Coração/parasitologia , Humanos , Macrófagos/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Knockout , Miocárdio/patologia , NADPH Oxidase 2/genética , NADPH Oxidase 2/metabolismo , Carga Parasitária , Células Vero
13.
Rev Soc Bras Med Trop ; 53: e20200088, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935781

RESUMO

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.


Assuntos
Doença de Chagas , Trypanosoma cruzi , Adolescente , Adulto , Brasil , Doença de Chagas/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Rev Soc Bras Med Trop ; 53: e20200177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935785

RESUMO

INTRODUCTION: Triatomine bugs are hematophagous insects that are extremely important in public health because they are natural vectors of Trypanosoma cruzi, the causative agent of Chagas disease. In this study, we aimed to assess the occurrence of triatomine species and the natural T. cruzi infection in the Guaribas Valley territory, an endemic region for Chagas disease in northeastern Brazil. METHODS: Insects were actively captured from July 2017 to October 2019 in the intra- and peridomiciles of 16 municipalities of the Guaribas Valley territory, in the southeast area of Piauí state. Triatomine species were identified following a taxonomic key, and natural infection was investigated through insects' fresh feces exams. RESULTS: A total of 430 triatomines were collected, including 211 nymphs and 219 adults. Of all collected specimens, 39 (9.1%) were from the intradomiciles and 391 (90.9%) from peridomiciles. Nine species, including two subspecies, could be identified: Triatoma brasiliensis brasiliensis, T. brasiliensis macromelasoma, T. pseudomaculata, T. sordida, T. juazeirensis, T. melanocephala, Panstrongylus lutzi, Rhodnius domesticus, R. nasutus, and R. robustus. T. brasiliensis were the most frequently collected bugs, representing 72% of all the identified insects. None of the examined invertebrates presented flagellate forms of T. cruzi. CONCLUSIONS: This is the first report of T. b. macromelasoma and T. juazeirensis in the Guaribas Valley territory. The persistence of triatomine species in the domiciles in an endemic area for Chagas disease emphasizes the relevance of entomological surveillance and vector control measures in the studied area.


Assuntos
Doença de Chagas , Triatoma , Triatominae , Trypanosoma cruzi , Animais , Brasil , Insetos Vetores
15.
PLoS Negl Trop Dis ; 14(9): e0008370, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956348

RESUMO

Chagas disease (CD) and tuberculosis (TB) are important health problems in Bolivia. Current treatments for both infections require a long period of time, and adverse drug reactions (ADRs) are frequent. This study aims to strengthen the Bolivian pharmacovigilance system, focusing on CD and TB. A situation analysis of pharmacovigilance in the Department of Cochabamba was performed. The use of a new local case report form (CRF) was implemented, together with the CRF established by the Unidad de Medicamentos y Tecnología en Salud (UNIMED), in several healthcare centers. Training and follow-up on drug safety monitoring and ADR reporting was provided to all health professionals involved in CD and TB treatment. A comparative analysis of the reported ADRs using the CRF provided by UNIMED, the new CRF proposal, and medical records, was also performed. Our results showed that out of all patients starting treatment for CD, 37.9% suffered ADRs according to the medical records, and 25.3% of them were classified as moderate/severe (MS). Only 47.4% of MS ADRs were reported to UNIMED. Regarding TB treatment, 9.9% of all patients suffered ADRs, 44% of them were classified as MS, and 75% of MS ADRs were reported to UNIMED. These findings show that the reinforcement of the Bolivian pharmacovigilance system is an ambitious project that should involve a long-term perspective and the engagement of national health workers and other stakeholders at all levels. Continuity and perseverance are essential to achieve a solid ADR reporting system, improving patient safety, drug efficacy and adherence to treatment.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Doença de Chagas/tratamento farmacológico , Farmacovigilância , Tuberculose/tratamento farmacológico , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Bolívia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Humanos , Inquéritos e Questionários
17.
PLoS Negl Trop Dis ; 14(8): e0008445, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32745113

RESUMO

BACKGROUND: In Brazil, acute Chagas disease (ACD) surveillance involves mandatory notification, which allows for population-based epidemiological studies. We conducted a nationwide population-based ecological analysis of the spatiotemporal patterns of ACD notifications in Brazil using secondary surveillance data obtained from the Notifiable Diseases Information System (SINAN) maintained by Brazilian Ministry of Health. METHODOLOGY/PRINCIPAL FINDINGS: In this nationwide population-based ecological all cases of ACD reported in Brazil between 2001 and 2018 were included. Epidemiological characteristics and time trends were analyzed through joinpoint regression models and spatial distribution using microregions as the unit of analysis. A total of 5,184 cases of ACD were recorded during the period under study. The annual incidence rate in Brazil was 0.16 per 100,000 inhabitants/year. Three statistically significant changes in time trends were identified: a rapid increase prior to 2005 (Period 1), a stable drop from 2005 to 2009 (Period 2), followed by another increasing trend after 2009 (Period 3). Higher frequencies were noted in males and females in the North (all three periods) and in females in Northeast (Periods 1 and 2) macroregions, as well as in individuals aged between 20-64 years in the Northeast, and children, adolescents and the elderly in the North macroregion. Vectorial transmission was the main route reported during Period 1, while oral transmission was found to increase significantly in the North during the other periods. Spatiotemporal distribution was heterogeneous in Brazil over time. Despite regional differences, over time cases of ACD decreased significantly nationwide. An increasing trend was noted in the North (especially after 2007), and significant decreases occurred after 2008 among all microregions other than those in the North, especially those in the Northeast and Central-West macroregions. CONCLUSIONS/SIGNIFICANCE: In light of the newly identified epidemiological profile of CD transmission in Brazil, we emphasize the need for strategically integrated entomological and health surveillance actions.


Assuntos
Doença de Chagas/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Estudos Retrospectivos , Análise Espaço-Temporal , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-32844905

RESUMO

This study aimed to describe the spatial distribution and assess entomological indicators of synanthropic triatomines in Piaui State, Northeastern Brazil. We used surveillance data on the detection, identification and assessment of natural infection with trypanosomatids from triatomines in the State from 2014 to 2017. The State was divided into four macroregions. In relation to the dispersion rates of triatomines, they were much lower in the North, when compared to Southwest, Southeast and Central North macroregions. Infestation rates were higher in the Southwest and Southeast and intradomicile infestation rates varied during the study period, reaching high values in all regions. Insects belonging to the species Triatoma brasiliensis complex, Triatoma pseudomaculata, Triatoma sordida, and to the genus Panstrongylus spp. and Rhodnius spp. were collected during this period. T. brasiliensis was collected from all four regions of the State, but more frequently in those located in the Southeast. A similar pattern was observed for T. pseudomaculata. T. sordida was detected in the municipalities in the Southeast and Southwest regions, and less frequently in the Central North municipalities. Rhodnius spp. was detected in the Central North and North regions, and Panstrongylus spp. in the Central North and Southeast regions. The highest trypanosomatid-positivity rate of T. brasiliensis and Panstrongylus spp. was in the Southeast region. A significant proportion of the municipalities of Piaui State presents entomological parameters that indicate a risk of Chagas disease by vector transmission.


Assuntos
Doença de Chagas , Insetos Vetores/parasitologia , Triatoma/parasitologia , Triatominae/classificação , Trypanosoma cruzi/isolamento & purificação , Animais , Brasil , Doença de Chagas/diagnóstico , Doença de Chagas/transmissão , Triatominae/parasitologia
19.
PLoS Negl Trop Dis ; 14(8): e0008411, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32776929

RESUMO

Approximately 150 triatomine species are suspected to be infected with the Chagas parasite, Trypanosoma cruzi, but they differ in the risk they pose to human populations. The largest risk comes from species that have a domestic life cycle and these species have been targeted by indoor residual spraying campaigns, which have been successful in many locations. It is now important to consider residual transmission that may be linked to persistent populations of dominant vectors, or to secondary or minor vectors. The aim of this project was to define the geographical distributions of the community of triatomine species across the Chagas endemic region. Presence-only data with over 12, 000 observations of triatomine vectors were extracted from a public database and target-group background data were generated to account for sampling bias in the presence data. Geostatistical regression was then applied to estimate species distributions and fine-scale distribution maps were generated for thirty triatomine vector species including those found within one or two countries and species that are more widely distributed from northern Argentina to Guatemala, Bolivia to southern Mexico, and Mexico to the southern United States of America. The results for Rhodnius pictipes, Panstrongylus geniculatus, Triatoma dimidiata, Triatoma gerstaeckeri, and Triatoma infestans are presented in detail, including model predictions and uncertainty in these predictions, and the model validation results for each of the 30 species are presented in full. The predictive maps for all species are made publicly available so that they can be used to assess the communities of vectors present within different regions of the endemic zone. The maps are presented alongside key indicators for the capacity of each species to transmit T. cruzi to humans. These indicators include infection prevalence, evidence for human blood meals, and colonisation or invasion of homes. A summary of the published evidence for these indicators shows that the majority of the 30 species mapped by this study have the potential to transmit T. cruzi to humans.


Assuntos
Insetos Vetores , Triatominae/parasitologia , Trypanosoma cruzi , Distribuição Animal , Animais , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Habitação , Humanos , América Latina/epidemiologia , Modelos Teóricos
20.
PLoS Negl Trop Dis ; 14(8): e0008402, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797041

RESUMO

A Trypanosoma cruzi Loopamp kit was recently developed as a ready-to-use diagnostic method requiring minimal laboratory facilities. We evaluated its diagnostic accuracy for detection of acute Chagas disease (CD) in different epidemiological and clinical scenarios. In this retrospective study, a convenience series of clinical samples (venous blood treated with EDTA or different stabilizer agents, heel-prick blood in filter paper or cerebrospinal fluid samples (CSF)) from 30 infants born to seropositive mothers (13 with congenital CD and 17 noninfected), four recipients of organs from CD donors, six orally-infected cases after consumption of contaminated guava juice and six CD patients coinfected with HIV at risk of CD reactivation (N = 46 patients, 46 blood samples and 1 CSF sample) were tested by T. cruzi Loopamp kit (Tc LAMP) and standardized quantitative real-time PCR (qPCR). T. cruzi Loopamp accuracy was estimated using the case definition in the different groups as a reference. Cohen's kappa coefficient (κ) was applied to measure the agreement between Tc LAMP (index test) and qPCR (reference test). Sensitivity and specificity of T. cruzi Loopamp kit in blood samples from the pooled clinical groups was 93% (95% CI: 77-99) and 100% (95% CI: 80-100) respectively. The agreement between Tc LAMP and qPCR was almost perfect (κ = 0.92, 95% CI: 0.62-1.00). The T. cruzi Loopamp kit was sensitive and specific for detection of T. cruzi infection. It was carried out from DNA extracted from peripheral blood samples (via frozen EDTA blood, guanidine hydrochloride-EDTA blood, DNAgard blood and dried blood spots), as well as in CSF specimens infected with TcI or TcII/V/VI parasite populations. The T. cruzi Loopamp kit appears potentially useful for rapid detection of T. cruzi infection in congenital, acute and CD reactivation due to HIV infection.


Assuntos
Doença de Chagas/sangue , Doença de Chagas/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/métodos , Trypanosoma cruzi/isolamento & purificação , Doença de Chagas/líquido cefalorraquidiano , Doença de Chagas/congênito , Coinfecção , DNA de Protozoário/análise , Feminino , Infecções por HIV , Humanos , Lactente , Recém-Nascido , Masculino , Reação em Cadeia da Polimerase em Tempo Real/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Transplantados , Trypanosoma cruzi/fisiologia
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