The Challenges of Chagas Disease— Grim Outlook or Glimmer of Hope?

Abstract

The authors discuss the key challenges that undermine the control of Chagas disease and that must be urgently addressed to ensure long-term, sustainable control.

Ergosterol biosynthesis and drug development for Chagas disease

“…This new paradigm suggests, in contrast to long-held views, that eradication of T. cruzi may be a prerequisite to arrest the evolution of Chagas disease and avert its irreversible long-term consequences, and it implies that this condition must be treated primarily as an infectious, not autoimmune, condition (Tarleton 2001, Urbina & Docampo 2003, MarinNeto et al 2007, Tarleton et al 2007, Rassi et al 2009). …”

“…The positive effect of current specific treatments, despite their inability to eradicate the parasite, on clinical evolution has been explained in terms of the parasite persistence hypothesis. That is, a drug-induced reduction of the parasite load in infected tissues reduces the severity of the associated inflammatory processes (Tarleton 2001, Viotti et al 2006, Tarleton et al 2007, Viotti & Vigliano 2007.…”

“…In particular, the Southern Cone initiative has successfully interrupted reservoirto-human and human-to-human propagation of the disease in Uruguay, Chile and Brazil in recent years and has led to a marked reduction of the overall prevalence and the population at risk (Dias et al 2002, Schofield et al 2006. However, many challenges remain before full control or elimination of the disease can be achieved among them, inequality of the control programs in the various endemic areas (Attaran 2006, Schofield et al 2006, Aguilar et al 2007, Guhl 2007, limitations of currently available specific chemotherapy, and insufficient treatment coverage for those currently infected with the aetiological agent, the parasitic protozoan Trypanosoma cruzi (Urbina & Docampo 2003, Pinto Dias 2006, Jannin & Villa 2007, Tarleton et al 2007, Rassi et al 2009). …”

Usefulness of PCR-based assays to assess drug efficacy in Chagas disease chemotherapy: value and limitations

“…Without effective diagnostics, infected individuals cannot be identified and hence treated, and the success of treatment cannot be efficiently assessed. The absence of a true gold standard (i.e., a method to consistently detect the presence of parasites in those T. cruzi-infected individuals) makes it difficult to evaluate the sensitivity of serological tests (Tarleton et al 2007). The development of highly sensitive and specific diagnostic field and laboratory tools to determine active T. cruzi infection is a crucial requirement.…”

ELISA seroprevalence of Trypanosoma cruzi in a cohort of heart disease patients

“…Chagas disease, also known as "American trypanosomiasis", "poverty disease" and "promoter of poverty", is the fourth most important vectortransmitted parasitic disease in Latin America [1], accounting for 662,000 disability-adjusted life years (DALYs) per annum [2]. Since its identification in 1909, this disease had been confined to Latin America until it emerged in the United States and Europe in the last few decades due to the high immigration rate from endemic regions [3][4][5].…”