RESUMO
BACKGROUND: Since the early 1990s, programs to control Chagas disease in South America have focused on eradicating domiciliary Triatoma infestans, the main vector. Seroprevalence studies of the chagasic infection are included as part of the vector control programs; they are essential to assess the impact of vector control measures and to monitor the prevention of vector transmission. OBJECTIVE: To assess the interruption of domiciliary vector transmission of Chagas disease by T. infestans in Paraguay by evaluating the current state of transmission in rural areas. METHODS: A survey of seroprevalence of Chagas disease was carried out in a representative sample group of Paraguayans aged one to five years living in rural areas of Paraguay in 2008. Blood samples collected on filter paper from 12,776 children were tested using an enzyme-linked immunosorbent assay. Children whose serology was positive or undetermined (n = 41) were recalled to donate a whole blood sample for retesting. Their homes were inspected for current triatomine infestation. Blood samples from their respective mothers were also collected and tested to check possible transmission of the disease by a congenital route. FINDINGS: A seroprevalence rate of 0.24% for Trypanosoma cruzi infection was detected in children under five years of age among the country's rural population. Our findings indicate that T. cruzi was transmitted to these children vertically. The total number of infected children, aged one to five years living in these departments, was estimated at 1,691 cases with an annual incidence of congenital transmission of 338 cases per year. MAIN CONCLUSION: We determined the impact of vector control in the transmission of T. cruzi, following uninterrupted vector control measures employed since 1999 in contiguous T. infestans-endemic areas of Paraguay, and this allowed us to estimate the degree of risk of congenital transmission in the country.
Assuntos
Doença de Chagas/epidemiologia , Inquéritos Epidemiológicos , Insetos Vetores/classificação , Triatominae/classificação , Animais , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Humanos , Lactente , Paraguai/epidemiologia , Prevalência , População Rural , Estudos SoroepidemiológicosRESUMO
BACKGROUND Since the early 1990s, programs to control Chagas disease in South America have focused on eradicating domiciliary Triatoma infestans, the main vector. Seroprevalence studies of the chagasic infection are included as part of the vector control programs; they are essential to assess the impact of vector control measures and to monitor the prevention of vector transmission. OBJECTIVE To assess the interruption of domiciliary vector transmission of Chagas disease by T. infestans in Paraguay by evaluating the current state of transmission in rural areas. METHODS A survey of seroprevalence of Chagas disease was carried out in a representative sample group of Paraguayans aged one to five years living in rural areas of Paraguay in 2008. Blood samples collected on filter paper from 12,776 children were tested using an enzyme-linked immunosorbent assay. Children whose serology was positive or undetermined (n = 41) were recalled to donate a whole blood sample for retesting. Their homes were inspected for current triatomine infestation. Blood samples from their respective mothers were also collected and tested to check possible transmission of the disease by a congenital route. FINDINGS A seroprevalence rate of 0.24% for Trypanosoma cruzi infection was detected in children under five years of age among the country’s rural population. Our findings indicate that T. cruzi was transmitted to these children vertically. The total number of infected children, aged one to five years living in these departments, was estimated at 1,691 cases with an annual incidence of congenital transmission of 338 cases per year. MAIN CONCLUSION We determined the impact of vector control in the transmission of T. cruzi, following uninterrupted vector control measures employed since 1999 in contiguous T. infestans-endemic areas of Paraguay, and this allowed us to estimate the degree of risk of congenital transmission in the country.
Assuntos
Humanos , Animais , Criança , Triatominae/parasitologia , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Doença de Chagas/epidemiologia , Insetos Vetores/classificação , Paraguai/epidemiologia , Ensaio de Imunoadsorção Enzimática , Estudos Soroepidemiológicos , Inquéritos EpidemiológicosRESUMO
La coinfección Leishmania/VIH es frecuente y por lo general son casos de leishmaniosis visceral (LV), sin embargo, Leishmania infantum, el agente etiológico, también puede causar formas cutáneas en pacientes VIH-positivos. Los parásitos llegan a la piel por difusión, en una nueva infección o reactivación de una infección latente. Existen técnicas moleculares que confirman el diagnóstico y caracterizan a la especie. En estos pacientes también se presenta como infección oportunista la histoplasmosis, reconocida como marcador de SIDA y causada por Histoplasma capsulatum. En este trabajo describimos un caso de coinfección SIDA, histoplasmosis y LV asociado a lesiones cutáneas. Paciente de sexo masculino, adulto, residente en J.A. Saldívar, VIH positivo (2010), sin tratamiento antirretroviral. En el 2012 es internado en el Instituto de Medicina Tropical (IMT) con fiebre, anemia, hepato-esplenomegalia, frotis de médula ósea y rk39 negativos para Leishmania, recibe tratamiento con Anfotericina B. En el 2013 presenta síndrome febril prolongado y en médula ósea se encuentran amastigotes de Leishmania sp. En el 2014 presenta úlceras en el rostro en las que se observan es porosmicóticos de H. capsulatum y amastigotes de Leishmania sp. Se confirma L. infantum por técnicas de biología molecular. En el caso estudiado concluimos que la presentación dérmica es causada por L. infantum, caracterizada por técnicas moleculares, eH. capsulatum que se presenta en concomitancia debido al estado inmunológico. Cabe resaltar la importancia del diagnóstico diferencial para aplicar el tratamiento correcto y además la manifestación clínica que normalmente no es asociada a esta especie de Leishmania.
Leishmania/HIV coinfection is frequent and generally they are visceral leishmaniasis cases(VL). However, Leishmania infantum, the etiological agent, could also cause cutaneousforms in HIV-positive patients. The parasites reach the skin through diffusion, a newinfection or a reactivation of a latent infection. There are molecular techniques that confirmthe diagnosis and characterize Leishmania species. These patients also present otheropportunistic infections like histoplasmosis, well known as an AIDS marker and caused byHistoplasma capsulatum. In this work, we describe one HIV/histoplasmosis/VL coinfectioncase associated to cutaneous lesions. The patient was a male, adult, coming from the city ofJ.A. Saldívar, HIV positive (since 2010), without antiretroviral treatment. He was hospitalized in 2012 at the Instituto de Medicina Tropical (IMT) with fever, anemia,hepatosplenomegaly, bone marrow smear and rK39 both negative for Leishmania. He wastreated with Amphotericin B. In 2013, he presented a prolonged febrile syndrome andLeishmania amastigotes were observed in the bone marrow. In 2014, the patient presentedulcerations on the face where H. capsulatum fungal spores and Leishmania amastigoteswere observed. L. infantum was confirmed by molecular methods. In the case under studywe can conclude that the dermal manifestation was caused by L. infantuma ccording to thecharacterization by molecular techniques, and simultaneously H. capsulatum was presentdue to his immunological status. It should be emphasized the importance of the differentialdiagnosis in order to apply the right treatment and also the uncommon clinicalmanifestation that is not associated to this Leishmania species.
Assuntos
Humanos , Masculino , Adulto , HIV , Histoplasma , Leishmania infantumRESUMO
El gran Chaco es una eco-región que incluye Argentina, Bolivia y Paraguay; donde la trasmisión vectorial de la enfermedad de Chagas por Triatoma infestans (vector principal), constituye hasta la fecha un problema de salud pública. El Chaco paraguayo ocupa el 25% de esta región, caracterizada por una baja densidad poblacional y localidades dispersas. El objetivo de este estudio fue determinar el rol potencial de la especie Triatoma sordida (vector secundario) en el ciclo doméstico de transmisión de Trypanosoma cruzi. Se aplicaron técnicas moleculares asociadas a indicadores entomológicos y epidemiológicosa 436 ejemplares de T. sordida capturados en 147 viviendas del Chaco Paraguayo. Se detectó infestación y colonización en el intradomicilio y peridomicilio por T. sórdida en 12 (8.2%) y 79 (53.7%) viviendas de las 147 evaluadas, respectivamente. Al menos un ejemplar infectado con T. cruzi fue detectado por PCR en las 12 viviendas con colonización intradomiciliar y en dos de ellas por caracterización molecular se detectó en ninfas el genotipo TC2. Adultos y ninfas en el peridomicilio de 4 viviendas dieron positivo para el genotipo TC1. Se estima un elevado riesgo de transmisión de T. cruzi intradomiciliar del 87%. Estos resultados evidencian capacidad adaptativa de esta especie en el domicilio, y un incremento de su potencial vectorial para transmitir la enfermedad de Chagas en el Chaco Paraguayo.
The Gran Chaco is an eco-region that includes Argentina, Bolivia and Paraguay; where the vectorial transmission of Chagas disease by Triatoma infestans (main vector) is a public health problem up to date. The Paraguayan Chaco occupies 25% of this region, characterized by low population density and dispersed locations. The aim of this study wasto determine the potential role of the specie Triatoma sordida (secondary vector) in the domestic cycle of transmission of Trypanosoma cruzi. Molecular techniques associated with entomological and epidemiological indicators were applied in 436 specimens of T. sordida captured in 147 dwellings of the Paraguayan Chaco. Infestation rate and colonization by T. Sordida was detected in the intradomicile and peridomiciliary in 12 (8.2%) and 79 (53.7%)of the 147 dwellings, respectively. In 12 houses were colonization was observed, at leastone specimen was PCR-T. cruzi positive, and in two of them genotype TC2 of T. cruzi were detected innymphs by molecular characterization. Adults and nymphs in the peridomiciliary of 4 houses were positive for genotype TC1.A high risk of indoor transmission of T. cruzi isestimated in 87%. These results demonstrate adaptive capacity of this specie in the intradomicile, and increased vector potential to transmit Chagas disease in the Paraguayan Chaco.
Assuntos
Humanos , Doença de Chagas , Triatoma , Trypanosoma cruzi , Saúde PúblicaRESUMO
La leishmaniosis es una enfermedad producida por diferentes especies del protozoario Leishmania agrupados en complejos, es transmitida por flebótomos presentando una variedad de síntomas clínicos. La técnica reacción en cadena de la polimerasa (PCR) permite amplificar regiones blanco específicas del género Leishmania y de los complejos Leishmania donovani y Leishmania braziliensis, directamente en muestras biológicas sin cultivos in vitro previo. En este estudio se realizó una evaluación descriptiva, durante el periodo 2001 a 2006, analizando 169 biopsias (piel y mucosas) y 31 aspirados de médula ósea en pacientes con sospecha clínica de leishmaniosis, además se evaluaron 44 muestras de bazo de caninos. Las muestras procedían de distintas zonas endémicas del país. Se detectó género Leishmania en el 71% de las biopsias (piel y mucosas), en 68% en los aspirados de médula ósea y en 82% de los bazos de caninos. Se identificó el complejo L. braziliensis en los pacientes con leishmaniosis cutánea y mucosa y el complejo L. donovani en pacientes con la forma visceral. Estos resultados han demostrado la utilidad de la técnica de PCR para la detección y caracterización de los parásitos de Leishmania en distintas muestras biológicas.