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and Venezuela have the domestic, peridomicile and sylvatic cycles, with high prevalence of human infection and prevalence of chronic Chagas' cardiomyopathy (CCC).Group II -Colombia, Costa Rica and Mexico, characterized by domestic and peridomicile cycles with presence of CCC.Group III -El Salvador, Guatemala, Nicaragua and Panama have domestic, peridomicile and sylvatic cycles with poor clinical information. AbstractMuch has been achieved in one century after Carlos Chagas' discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

Infective forms of Trypanosoma cruzi, the parasite that causes Chagas' disease, express on their surface an enzyme denominated trans-sialidase (TS). The present study was designed to evaluate the naturally acquired immune responses to a bacterial recombinant protein representing the catalytic domain of TS in chronically infected chagasic individuals. The cellular immune response was measured by in-vitro T-cell proliferation and by interferon (INF)-gamma, interleukin (IL)-4 and IL-10 production in response to a whole-parasite homogenate and the recombinant protein. The peripheral blood mononuclear cells of 78.6% of 28 chagasic patients responded to the recombinant protein as estimated by T-cell proliferation. With respect to cytokine production, 88% of the cells of the chagasic individuals produced IFN-gamma on stimulation with the recombinant protein. In contrast, IL-4 or IL-10 were minimally produced in response to TS. The cellular immune response was specific because most healthy individuals never exposed to T. cruzi failed to react with this recombinant protein. The plasma of 71.4% or 100% of chagasic patients had IgG antibodies as determined by ELISA or by the presence of TS inhibitory antibodies, respectively. We conclude that the catalytic domain of TS is recognized by IFN-gamma producing type 1 cells and antibodies in a large proportion of patients infected with T. cruzi.

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