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1.
Medicina (B Aires) ; 81(2): 154-158, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33906132

RESUMO

Chagas disease is endemic in Latin America and remains a regional problem despite improvements in environmental health conditions that have helped to control its transmission. To know more about its prevalence in heart disease patients, we carried out a survey in our national (El Salvador) reference hospital. We reviewed the Chagas Lab's records 2013-2015 to find out how many of the patients admitted to the Hospital's Heart Unit were serologically positives for Trypanosoma cruzi infection and which the associated diagnoses were. A total of 1472 patients were tested along the 36-month study period. Out of 557 (37.8%) patients with positive serology for Chagas infection, 97 (17.4%) were eventually admitted to the Heart Unit. Among these 97 Chagas infected patients with heart disease, 40 (41.2%) met the criteria for permanent pacemaker placement, while only 13 of 191 (6.8%) patients with non-chagasic heart disease met these criteria. The frequency of heart atrioventricular block associated with Trypanosoma cruzi infection was higher than frequencies reported in South American studies.


Assuntos
Bloqueio Atrioventricular , Doença de Chagas , Trypanosoma cruzi , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/etiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , El Salvador , Humanos , América Latina
3.
Rev Soc Bras Med Trop ; 54: e0740, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886818

RESUMO

INTRODUCTION: Chagas disease is a health problem that affects approximately 7 million people worldwide, according to the World Health Organization. Vector transmission is one of the most important routes in South and Central American countries. Between 2013 and 2019, municipalities of Sergipe sent 507 triatomines for analysis, unveiling the largest records found in the south in the villages of Poço da Clara, Alagoinhas and Pilões, and the municipality of Tobias Barreto. The high prevalence of infected vectors in these localities motivated this epidemiological study. METHODS: After educational lectures on the vectors and risks of the disease, a structured questionnaire was administered to identify areas and risk factors for transmission of the parasite. The data guided the collection of vectors and blood samples from domestic reservoirs. RESULTS: The studied region is considered endemic for triatomines infected by Trypanosoma cruzi with three species of vectors; the highest prevalence was Panstrongylus lutzi (54.83%), followed by Triatoma pseudomaculata (43.54%), and Triatoma tibiamaculata (1.61%). In the villages in this study, 100% of the vectors were found intradomically. The coexistence of residents with domestic animals was reported by 62.04% (255) of those surveyed. Forty-one small animals that were actively living with humans at home in the localities were evaluated serologically. No infection was observed in the domestic animals. CONCLUSIONS: There are favorable conditions for the domiciliation of triatomines in the evaluated locations, contributing to the risk of vectorial transmission of Chagas disease.


Assuntos
Doença de Chagas , Panstrongylus , Triatoma , Trypanosoma cruzi , Animais , Doença de Chagas/epidemiologia , Humanos , Insetos Vetores
5.
Int J Mol Sci ; 22(4)2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33669428

RESUMO

Chagas disease remains a major social and public health problem in Latin America. Benznidazole (BZN) is the main drug with activity against Trypanosoma cruzi. Due to the high number of adverse drug reactions (ADRs), BZN is underprescribed. The goal of this study was to evaluate the genetic and transcriptional basis of BZN adverse reactions. METHODS: A prospective cohort with 102 Chagas disease patients who underwent BZN treatment was established to identify ADRs and understand their genetic basis. The patients were classified into two groups: those with at least one ADR (n = 73), and those without ADRs (n = 29). Genomic analyses were performed comparing single nucleotide polymorphisms between groups. Transcriptome data were obtained comparing groups before and after treatment, and signaling pathways related to the main ADRs were evaluated. RESULTS: A total of 73 subjects (71.5%) experienced ADRs. Dermatological symptoms were most frequent (45.1%). One region of chromosome 16, at the gene LOC102724084 (rs1518601, rs11861761, and rs34091595), was associated with ADRs (p = 5.652 × 10-8). Transcriptomic data revealed three significantly enriched signaling pathways related to BZN ADRs. CONCLUSIONS: These data suggest that part of adverse BZN reactions might be genetically determined and may facilitate patient risk stratification prior to starting BZN treatment.


Assuntos
Doença de Chagas/tratamento farmacológico , Doença de Chagas/genética , Nitroimidazóis/efeitos adversos , Polimorfismo de Nucleotídeo Único , Transcriptoma , Tripanossomicidas/efeitos adversos , Trypanosoma cruzi/efeitos dos fármacos , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Feminino , Redes Reguladoras de Genes , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Risco , Transdução de Sinais/genética
6.
Artigo em Inglês | MEDLINE | ID: mdl-33681912

RESUMO

INTRODUCTION: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.


Assuntos
Doença de Chagas , Trypanosoma cruzi , Adulto , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Humanos , Masculino , Prevalência , Fatores de Risco , População Rural , Estudos Soroepidemiológicos
7.
Artigo em Inglês | MEDLINE | ID: mdl-33533811

RESUMO

Chagas disease (CD) is caused by the protozoan Trypanosoma cruzi and it is mainly acquired through the vector route, however, blood transfusion and congenital transmission are implicated in the spread of the illness worldwide. The congenital route can occur at any stage of pregnancy and its frequency varies. In the Federal District, in Brazil, the frequency of T. cruzi infection in pregnant women and their offspring has not been updated. Thus, the aim of this study was to estimate the prevalence of T. cruzi infection in pregnant women and the rate of congenital transmission in the Federal District. A cross-sectional study was conducted to estimate the seroprevalence of T. cruzi from 2014 to 2016 in the population of pregnant women attended by the public health service throughout the Federal District and a descriptive cohort for the evaluation of congenital transmission. During the study, prenatal data of 98,895 women were consulted and pregnant women registered in 2016, presenting with positive T. cruzi serology, were part of the descriptive cohort. The estimated prevalence of T. cruzi infection in the three years was 0.19% and the congenital transmission rate was 1/40 (2.5%). Our results have shown that, although the main routes of transmission of CD have been interrupted, there is still a risk of congenital transmission in the Federal District. This present study highlights the need for the continuous implementation of a screening program for pregnant women and timely treatment of infected newborns and children.


Assuntos
Doença de Chagas/epidemiologia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Parasitárias na Gravidez/epidemiologia , Trypanosoma cruzi/isolamento & purificação , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/transmissão , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , Gestantes , Cuidado Pré-Natal , Prevalência , Estudos Soroepidemiológicos
8.
Parasit Vectors ; 14(1): 35, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422133

RESUMO

BACKGROUND: Peri-urban and urban settings have recently gained more prominence in studies on vector-borne transmission of Trypanosoma cruzi due to sustained rural-to-urban migrations and reports of urban infestations with triatomines. Prompted by the finding of Triatoma infestans across the rural-to-urban gradient in Avia Terai, an endemic municipality of the Argentine Chaco, we assessed selected components of domestic transmission risk in order to determine its variation across the gradient. METHODS: A baseline vector survey was conducted between October 2015 and March 2016, following which we used multistage random sampling to select a representative sample of T. infestans at the municipal level. We assessed T. cruzi infection and blood-feeding sources of 561 insects collected from 109 houses using kinetoplast DNA-PCR assays and direct enzyme-linked immunosorbent assays, respectively. We stratified triatomines according to their collection site (domestic or peridomestic), and we further categorized peridomestic sites in ecotopes of low- or high-risk for T. cruzi infection. RESULTS: The overall adjusted prevalence of T. cruzi-infected T. infestans was 1.8% (95% confidence interval [CI] 1.3-2.3) and did not differ between peri-urban (1.7%) and rural (2.2%) environments. No infection was detected in bugs captured in the urban setting; rather, infected triatomines were mainly collected in rural and peri-urban domiciles, occurring in 8% of T. infestans-infested houses. The main blood-feeding sources of domestic and peridomestic triatomines across the gradient were humans and chickens, respectively. The proportion of triatomines that had fed on humans did not differ between peri-urban (62.5%) and rural (65.7%) domiciles, peaking in the few domestic triatomines collected in urban houses and decreasing significantly with an increasing proportion of chicken- and dog- or cat-fed bugs. The relative odds ratio (OR) of having a T. cruzi infection was nearly threefold higher in bugs having a blood meal on humans (OR 3.15), dogs (OR 2.80) or cats (OR: 4.02) in a Firth-penalized multiple logistic model. CONCLUSIONS: Trypanosoma cruzi transmission was likely occurring both in peri-urban and rural houses of Avia Terai. Widespread infestation in a third of urban blocks combined with high levels of human-triatomine contact in the few infested domiciles implies a threat to urban inhabitants. Vector control strategies and surveillance originally conceived for rural areas should be tailored to peri-urban and urban settings in order to achieve sustainable interruption of domestic transmission in the Chaco region.


Assuntos
Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Insetos Vetores/parasitologia , Triatoma , Trypanosoma cruzi , Adulto , Animais , Argentina/epidemiologia , Gatos , Galinhas , Cães , Ensaio de Imunoadsorção Enzimática , Comportamento Alimentar , Feminino , Cabras , Humanos , Masculino , Camundongos , Fatores de Risco , População Rural
9.
Acta Trop ; 215: 105803, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33373585

RESUMO

Chagas disease is a neglected tropical disease strongly associated with low socioeconomic status, affecting nearly 8 million people - mainly Latin Americans. The current infection risk is based on acute case reports, most of which are typically associated with oral transmissions. In the semi-arid region of Northeastern Brazil, serious outbreaks of this transmission type have surged in the last years. One of those occurred in 2016 in the state of Rio Grande do Norte. Rural residents of four municipalities surrounding Marcelino Vieira ingested sugar cane juice - which was probably ground with Trypanosoma cruzi-infected insects. Eighteen cases of Chagas disease were confirmed serologically, with two deaths reported. Socioeconomic information, schooling of residents and the structure of peridomestic and domestic environments in the rural area of Marcelino Vieira, along with entomological indicators, were investigated to understand better the factors related to the outbreaks in this region. We found triatomines (mainly Triatoma brasiliensis) in 35% (24/67) of domiciliary units and all rocky outcrops inspected (n = 7). Overall, 25% (91/357) of examined T. brasiliensis were infected by T. cruzi in artificial ecotopes, with almost the same prevalence in the sylvatic environment (22%; 35/154). Among all ecotopes investigated, wood/tile/brick piles were the ones linked to high insect infestations and triatomine T. cruzi infection prevalence. Ninety-five percent of people interviewed recognized the triatomines and knew the classic route of transmission of disease - triatomine bite-dependent. However, only 7.5% admitted knowledge that Chagas disease can also be acquired orally - which poses a risk this transmission route currently recognized. Here, we highlight the physical proximity between humans and triatomine populations with high T. cruzi infection prevalence as an additional risk factor to oral/vector contaminations. In sum, residents have low income, low level of education, and/or a willful disregard for the routes of Chagas disease transmission (specifically oral transmission), a combination of factors that may have favored the Chagas disease outbreak. We here provide recommendations to avoid further outbreaks.


Assuntos
Doença de Chagas/transmissão , Surtos de Doenças , Animais , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Entomologia , Humanos , Insetos Vetores , Prevalência , Fatores de Risco , Fatores Socioeconômicos
10.
PLoS Negl Trop Dis ; 14(12): e0009015, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33370305

RESUMO

Trypanosoma rangeli is a non-pathogenic protozoan parasite that infects mammals, including humans, in Chagas disease-endemic areas of South and Central America. The parasite is transmitted to a mammalian host when an infected triatomine injects metacyclic trypomastigotes into the host's skin during a bloodmeal. Infected mammals behave as parasite reservoirs for several months and despite intensive research, some major aspects of T. rangeli-vertebrate interactions are still poorly understood. In particular, many questions still remain unanswered, e.g. parasite survival and development inside vertebrates, as no parasite multiplication sites have yet been identified. The present study used an insect bite transmission strategy to investigate whether the vector inoculation spot in the skin behave as a parasite-replication site. Histological data from the skin identified extracellular parasites in the dermis and hypodermis of infected mice in the first 24 hours post-infection, as well as the presence of inflammatory infiltrates in a period of up to 7 days. However, qPCR analyses demonstrated that T. rangeli is eliminated from the skin after 7 days of infection despite being still consistently found on circulating blood and secondary lymphoid tissues for up to 30 days post-infection. Interestingly, significant numbers of parasites were found in the spleen and mesenteric lymph nodes of infected mice during different periods of infection and steady basal numbers of flagellates are maintained in the host's bloodstream, which might behave as a transmission source to insect vectors. The presence of parasites in the spleen was confirmed by fluorescent photomicrography of free and cell-associated T. rangeli forms. Altogether our results suggest that this organ could possibly behave as a T. rangeli maintenance hotspot in vertebrates.


Assuntos
Doença de Chagas/transmissão , Linfonodos/parasitologia , Pele/parasitologia , Baço/parasitologia , Trypanosoma rangeli/isolamento & purificação , Animais , América Central/epidemiologia , Doença de Chagas/epidemiologia , Modelos Animais de Doenças , Interações Hospedeiro-Parasita , Humanos , Mordeduras e Picadas de Insetos/parasitologia , Insetos Vetores/parasitologia , Camundongos , Rhodnius/parasitologia , Sepse/parasitologia , América do Sul/epidemiologia
11.
Rev Soc Bras Med Trop ; 54: e00842020, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33338105

RESUMO

INTRODUCTION: Panstrongylus megistus is the main triatomine involved in the human transmission of Trypanosoma cruzi in Minas Gerais, Brazil. We analyzed the occurrence of triatomines in the Itaúna micro-regions for healthcare. METHODS: Data were collected as part of routine entomological surveillance activities, including the species identity, capture site, developmental stage, and trypanosome infection. RESULTS: In total, 503 specimens from five species were captured (495 P. megistus). Adults were mainly captured by residents inside their homes, whereas nymphs were mostly captured by public health professionals outside. CONCLUSIONS: The epidemiologically important triatomine, P. megistus, continues to persist in our study region.


Assuntos
Doença de Chagas , Panstrongylus , Trypanosoma cruzi , Animais , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Humanos , Insetos Vetores
13.
PLoS Negl Trop Dis ; 14(12): e0008932, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33332357

RESUMO

BACKGROUND: Chagas disease is a neglected zoonosis of growing concern in the southern US, caused by the parasite Trypanosoma cruzi. We genotyped parasites in a large cohort of PCR positive dogs to shed light on parasite transmission cycles and assess potential relationships between parasite diversity and serological test performance. METHODOLOGY/PRINCIPAL FINDINGS: We used a metabarcoding approach based on deep sequencing of T. cruzi mini-exon marker to assess parasite diversity. Phylogenetic analysis of 178 sequences from 40 dogs confirmed the presence of T. cruzi discrete typing unit (DTU) TcI and TcIV, as well as TcII, TcV and TcVI for the first time in US dogs. Infections with multiple DTUs occurred in 38% of the dogs. These data indicate a greater genetic diversity of T. cruzi than previously detected in the US. Comparison of T. cruzi sequence diversity indicated that highly similar T. cruzi strains from these DTUs circulate in hosts and vectors in Louisiana, indicating that they are involved in a shared T. cruzi parasite transmission cycle. However, TcIV and TcV were sampled more frequently in vectors, while TcII and TcVI were sampled more frequently in dogs. CONCLUSIONS/SIGNIFICANCE: These observations point to ecological host-fitting being a dominant mechanism involved in the diversification of T. cruzi-host associations. Dogs with negative, discordant or confirmed positive T. cruzi serology harbored TcI parasites with different mini-exon sequences, which strongly supports the hypothesis that parasite genetic diversity is a key factor affecting serological test performance. Thus, the identification of conserved parasite antigens should be a high priority for the improvement of current serological tests.


Assuntos
Doença de Chagas/veterinária , Éxons/genética , Variação Genética , Trypanosoma cruzi/genética , Animais , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Doença de Chagas/transmissão , Estudos de Coortes , Cães , Genótipo , Humanos , Louisiana/epidemiologia , Filogenia , Testes Sorológicos/veterinária , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/fisiologia , Zoonoses
14.
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
15.
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
16.
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
17.
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
18.
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
19.
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
20.
Rev. chil. infectol ; 37(4): 402-412, ago. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138565

RESUMO

Resumen Introducción: La enfermedad de Chagas en Chile ha aumentado en pesquisa, especialmente en mujeres gestantes y donantes en general, pero sigue desatendida en Latinoamérica. La epidemiología ambiental del vector señala a la Región de Coquimbo de mayor riesgo. Objetivo: Analizar la serie temporal de mortalidad y tasa de incidencia por enfermedad de Chagas a nivel nacional, regional, comunal y según edad. Método: Estudio de base poblacional, serie de tiempo de mortalidad (1997 al 2017) y tasa de incidencia (2011 al 2017), país, región y 15 comunas. Uso de tasas brutas y ajustadas, calculando χ2, T test, ANOVA, valor p < 0,05. Resultados: Mortalidad; El 49,37% (668) de las muertes nacionales (1.353) tenían residencia en la Región de Coquimbo, mayoritariamente hombres y mayores de 60 años con complicaciones cardiacas y digestivas, residentes en Salamanca, Combarbalá e Illapel. Incidencia; De 6.173 casos acumulados, 6% son menores de 20 años, mayor en mujeres (61,4%) con edad promedio 50 años versus 56 años hombres (T test = 29,19 valor p = 0,000), residentes de; Ovalle, Andacollo, Monte Patria e Illapel. Conclusiones: La mitad de las muertes por enfermedad de Chagas residen en la Región de Coquimbo, los casos nuevos son 6% en personas bajo 20 años de edad.


Abstract Background: Chagas disease in Chile has increased in research, especially in pregnant women and donors in general, but remains neglected in Latin America. The environmental epidemiology of the vector points out the Coquimbo region is a greatest risk area. Aim: To analyze the time series of mortality and incidence rate Chagas disease national; regional and communal according to age. Method: Population-based study, time series of mortality (1997 to 2017) and incidence rate (2011 to 2017), country, region and 15 communes. Use of gross and adjusted rates, calculating ch2, T test, ANOVA, p value < 0.05. Results: Mortality; 49.37% (668) of the National deaths (1353) were Coquimbo region's residents, mainly male patients and over 60 years old people with cardiac and digestive complications, residents from Salamanca, Combarbalá and Illapel. Incidence: Of 6.173 accumulated cases, 6% are under 20 years old, higher incidence of women (61.4%) with an average age of 50 years old versus 56 years old men (T test = 29.19 p-value = 0.000), residents from Ovalle, Andacollo, Monte Patria and Illapel. Conclusions: Half of Chagas' disease deaths reside in the Coquimbo region, new cases, under 20 years old, are 6%.


Assuntos
Humanos , Masculino , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Doença de Chagas/epidemiologia , Chile/epidemiologia , Incidência , América Latina
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