Chagas disease: from Latin America to the world

Gascón, Joaquím; Pinazo, Maria-Jesus

doi:10.2147/rip.s57144

Cited by 11 publications

(14 citation statements)

References 79 publications

(82 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chagas disease is a devastating neglected disease that affects several million people worldwide (1). It is caused by the protozoan parasite Trypanosoma cruzi ( T. cruzi ; order: Kinetoplastida; family Trypanosomatidae).…”

Section: Introductionmentioning

confidence: 99%

“…It is caused by the protozoan parasite Trypanosoma cruzi ( T. cruzi ; order: Kinetoplastida; family Trypanosomatidae). The parasite is transmitted by triatomine insect vectors (order Hemiptera; family Reduviidae) endemic to the Americas, and through vector-independent routes such as blood transfusion or mother-to-child (1). The latter are of relevance in endemic and non-endemic regions alike where the disease has been globalized in recent decades due to population movements (2).…”

Section: Introductionmentioning

confidence: 99%

“…It is at the chronic stage, which can last from years to decades, when the onset of symptoms occurs. It is usually then when the infection is diagnosed and treatment is provided, but unfortunately, the drugs' efficacy at this stage is reduced (1). Moreover, BNZ and NFX long dosage regimes have severe toxicity associated, which can lead to treatment discontinuation and failure (3, 4).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, BNZ and NFX long dosage regimes have severe toxicity associated, which can lead to treatment discontinuation and failure (3, 4). Without treatment or upon its failure, about 30% of the chronically infected people will suffer incapacitating heart and/or gut tissue disruptions that can be life-threatening (1). If the damage to the tissues is advanced, diagnosis and treatment might arrive too late to reverse the situation (5).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

In silico Design of an Epitope-Based Vaccine Ensemble for Chagas Disease

et al. 2019

Self Cite

View full text Add to dashboard Cite

Trypanosoma cruzi infection causes Chagas disease, which affects 7 million people worldwide. Two drugs are available to treat it: benznidazole and nifurtimox. Although both are efficacious against the acute stage of the disease, this is usually asymptomatic and goes undiagnosed and untreated. Diagnosis is achieved at the chronic stage, when life-threatening heart and/or gut tissue disruptions occur in ~30% of those chronically infected. By then, the drugs' efficacy is reduced, but not their associated high toxicity. Given current deficiencies in diagnosis and treatment, a vaccine to prevent infection and/or the development of symptoms would be a breakthrough in the management of the disease. Current vaccine candidates are mostly based on the delivery of single antigens or a few different antigens. Nevertheless, due to the high biological complexity of the parasite, targeting as many antigens as possible would be desirable. In this regard, an epitope-based vaccine design could be a well-suited approach. With this aim, we have gone through publicly available databases to identify T. cruzi epitopes from several antigens. By means of a computer-aided strategy, we have prioritized a set of epitopes based on sequence conservation criteria, projected population coverage of Latin American population, and biological features of their antigens of origin. Fruit of this analysis, we provide a selection of CD8+ T cell, CD4+ T cell, and B cell epitopes that have <70% identity to human or human microbiome protein sequences and represent the basis toward the development of an epitope-based vaccine against T. cruzi.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

In silico Design of an Epitope-Based Vaccine Ensemble for Chagas Disease

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…cruzi infection and that 25 million remain at risk of infection. Originally limited to Latin America, CD is now a global health problem as a result of migration flows from traditional endemic zones [ 2 ]. Bolivia has the highest prevalence in the world (6.1%), and the disease is endemic in 60% of the country [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundBolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem.InterventionIn this context, thanks to a Spanish international cooperation collaboration, the Bolivian platform for the comprehensive care of adults with CD was created in 2009. Based on the establishment of a vertical care system under the umbrella of ChNP general guidelines, six centres specialized in CD management were established in different epidemiological contexts. A common database, standardized clinical forms, a and a protocolized attention to adults patients, together with training activities for health professionals were essential for the model success. With the collaboration and knowledge transfer activities between endemic and non-endemic countries, the platform aims to provide care, train health professionals, and create the basis for a future expansion to the National Health System of a proven model of care for adults with CD.ResultsFrom 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained, and more than ten research projects developed. The project helped to increase the number of adults with CD diagnosed and treated, produce evidence-based clinical practice guidelines, and bring about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform’s health care model to adapt and implement it nationwide.ConclusionsThis strategy provides a solution to unmet demands in the care of patients with CD, improving access to diagnosis and treatment. Further scaling up of diagnosis and treatment will be based on the expansion of the model of care to the NHS structures. Its sustainability will be ensured as it will build on existing local resources in Bolivia. Still human trained resources are scarce and the high staff turnover in Bolivia is a limitation of the model. Nevertheless, in a preliminary two-years-experience of scaling up this model, this limitations have been locally solved together with the health local authorities.

show abstract