Chagas Cardiomyopathy Manifestations and Trypanosoma cruzi Genotypes Circulating in Chronic Chagasic Patients

Ramírez, Juan David; Guhl, Felipe; Rendón, Lina María; Rosas, Fernando; Marin-Neto, José Antônio; Morillo, Carlos A.

doi:10.1371/journal.pntd.0000899

Cited by 145 publications

(143 citation statements)

References 54 publications

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“…Interestingly, TcIII (formerly known as TcIIc) is associated with terrestrial ecotopes from different reservoirs and vectors 70,71 and is able to coexist with other DTUs in the environment, supporting an overlap between sylvatic and peridomestic transmission cycles of T. cruzi 69 . In Colombia, TcIII has been detected in patients with chronic ChD in whom mixed infection with TcI and TcII was identified 72 . Therefore, previous studies have shown how difficult it is to distinguish the role of each DTU in the disease.…”

Section: Discussionmentioning

confidence: 99%

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Volpato

Sousa

D’Ávila

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Introduction:In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. Methods: Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T. cruzi isolates were genotyped using three different genetic markers. Results: Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T. cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. Conclusions: Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.

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Section: Discussionmentioning

confidence: 99%

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Volpato

Sousa

D’Ávila

et al. 2017

Rev. Soc. Bras. Med. Trop.

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“…Patients were confirmed as infected, using direct parasitological tests (thick blood smears), serological tests (trypomastigote excreted-secreted antigen [ [4]. T. cruzi genotyping was performed as previously reported [5,6]. Finally, in all qPCR-positive samples, amplification and analysis by Microsat (a program for microsatellite analysis) was performed using 7 microsatellite markers [7].…”

Section: Methodsmentioning

confidence: 99%

High-Resolution Molecular Typing ofTrypanosoma cruziin 2 Large Outbreaks of Acute Chagas Disease in Colombia

et al. 2016

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Oral transmission of Trypanosoma cruzi has gained relevance because of its association with high morbidity and lethality rates. This transmission route is responsible for maintaining the infection of the parasite in sylvatic cycles, and human cases have been associated mainly with the consumption of food contaminated with triatomine feces or didelphid secretions. Several ecological changes allow the intrusion of sylvatic reservoirs and triatomines to the domestic environments with subsequent food contamination. Here, high-resolution molecular tools were used to detect and genotype T. cruzi across humans, reservoirs, and insect vectors in 2 acute outbreaks of presumptive oral transmission in eastern Colombia.Keywords. Chagas disease; oral transmission; outbreaks; triatomines; Trypanosoma cruzi; opossums; canines; food.Oral transmission of Trypanosoma cruzi is considered ancient, allowing the circulation and maintenance of the parasite in the sylvatic cycle of transmission. T. cruzi has been classified into 6 discrete typing units (DTUs), TcI-TcVI, and, within TcI, into 2 genotypes (domestic TcI [TcI Dom ] and sylvatic TcI). In humans, this mechanism has been described in >1000 cases corresponding to 138 outbreaks, with a fatality rate of 8%-35% across Latin America [1,2]. In Colombia, between 1992 and 2009, 11 outbreaks were reported, with a lethality rate of 16.0% [3]. In 2014, 2 outbreaks occurred in the Colombian Orinoco region.The aim of this study was to determine the possible sources of oral transmission, by using molecular tools, during the outbreaks that occurred in the municipalities of Restrepo, Meta Department, and Paz de Ariporo, Casanare Department. METHODSA total of 70 patients with suspected T. cruzi oral infection, along with 39 samples from reservoir organisms (opossums and canines) and 23 samples from triatomines (Panstrongylus geniculatus, Rhodnius pictipes, and Rhodnius prolixus) during the 2 outbreaks were included. Patients were confirmed as infected, using direct parasitological tests (thick blood smears), serological tests (trypomastigote excreted-secreted antigen [TESA] [5,6]. Finally, in all qPCR-positive samples, amplification and analysis by Microsat (a program for microsatellite analysis) was performed using 7 microsatellite markers [7]. RESULTS Restrepo OutbreakThis outbreak occurred in a family comprising 4 adults and 1 child, who visited Restrepo, including a farm, which contains forests and savannas, as well as some restaurants located along the road in Cumaral municipality, between February 13 and 16, 2014. The family returned to Bogota (the capital of Colombia) afterward, where the 4 adults were hospitalized for fever and edema. Thick blood smears were positive in 2 of 4 symptomatic patients. Results of conventional serological analyses, TESA blots, and molecular tests were positive for the 4 symptomatic patients. The median parasite load was 6.2 equivalent parasites/mL. The child was asymptomatic and had negative results of all diagnostic tests (Supplementary Table 1).The fi...

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“…TcI is the most widely distributed DTU; it is the principal cause of human chagasic cardiomyopathy in Colombia and Venezuela (Ramírez et al . 2010; Carrasco et al . 2012) and is ubiquitous among sylvatic transmission cycles across the parasite's endemic range (Llewellyn et al .…”

Section: Introductionmentioning

confidence: 99%

Ecological host fitting of Trypanosoma cruzi TcI in Bolivia: mosaic population structure, hybridization and a role for humans in Andean parasite dispersal

et al. 2015

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An improved understanding of how a parasite species exploits its genetic repertoire to colonize novel hosts and environmental niches is crucial to establish the epidemiological risk associated with emergent pathogenic genotypes. Trypanosoma cruzi, a genetically heterogeneous, multi‐host zoonosis, provides an ideal system to examine the sylvatic diversification of parasitic protozoa. In Bolivia, T. cruzi I, the oldest and most widespread genetic lineage, is pervasive across a range of ecological clines. High‐resolution nuclear (26 loci) and mitochondrial (10 loci) genotyping of 199 contemporaneous sylvatic TcI clones was undertaken to provide insights into the biogeographical basis of T. cruzi evolution. Three distinct sylvatic parasite transmission cycles were identified: one highland population among terrestrial rodent and triatomine species, composed of genetically homogenous strains (A r = 2.95; PA/L = 0.61; DAS = 0.151), and two highly diverse, parasite assemblages circulating among predominantly arboreal mammals and vectors in the lowlands (A r = 3.40 and 3.93; PA/L = 1.12 and 0.60; DAS = 0.425 and 0.311, respectively). Very limited gene flow between neighbouring terrestrial highland and arboreal lowland areas (distance ~220 km; FST = 0.42 and 0.35) but strong connectivity between ecologically similar but geographically disparate terrestrial highland ecotopes (distance >465 km; FST = 0.016–0.084) strongly supports ecological host fitting as the predominant mechanism of parasite diversification. Dissimilar heterozygosity estimates (excess in highlands, deficit in lowlands) and mitochondrial introgression among lowland strains may indicate fundamental differences in mating strategies between populations. Finally, accelerated parasite dissemination between densely populated, highland areas, compared to uninhabited lowland foci, likely reflects passive, long‐range anthroponotic dispersal. The impact of humans on the risk of epizootic Chagas disease transmission in Bolivia is discussed.

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Chagas Cardiomyopathy Manifestations and Trypanosoma cruzi Genotypes Circulating in Chronic Chagasic Patients

Cited by 145 publications

References 54 publications

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

High-Resolution Molecular Typing ofTrypanosoma cruziin 2 Large Outbreaks of Acute Chagas Disease in Colombia

Ecological host fitting of Trypanosoma cruzi TcI in Bolivia: mosaic population structure, hybridization and a role for humans in Andean parasite dispersal

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