Chagas

Chagas disease persists as a global public health problem due to the high morbidity and mortality burden. Despite the possibility of a cure and advances in transmission control, epidemiological transformations, such as urbanisation and globalisation, and the emerging importance of oral and vertical transmission mean that Chagas disease should be considered an emerging disease, with new cases occurring worldwide. Important barriers to diagnosis, treatment, and care remain, resulting in repressed numbers of reported cases, which in turn leads to inadequate public policies. The validation of new diagnostic tools and treatment options is needed, as existing tools pose serious limitations to access to health care. Integrated models of surveillance, with community and intersectional participation, embedded in the concept of One Health, are essential for control. In addition, mitigation strategies for the main social determinants of health, including difficulties imposed by migration, are important to improve access to comprehensive health care in a globalised scenario.

Feeding on the blood of vertebrates is a risky task for haematophagous insects and it can be reasonably assumed that it should also be costly in terms of energetic expenditure. Blood circulates inside vessels and it must be pumped through narrow tubular stylets to be ingested. We analysed the respiratory pattern and the energetic cost of taking a blood meal inRhodnius prolixususing flow-through and stop-flow respirometry, for measuring carbon dioxide emission, oxygen consumption and water loss before and during feeding. We observed an increase of up to 17-fold in the metabolic rate during feeding and a change in the respiratory pattern, which switched from discontinuous cyclic during resting, to continuous when the insects started to feed, remaining this condition unchanged for several hours. The energetic cost of taking a meal was significantly higher when bugs fed on a living host, compared to feeding on an artificial feeder. No differences were observed between feeding on blood o...

La película “Casas de Fuego” de Juan Bautista Stagnaro es un recurso difundido en la enseñanza del Chagas en distintos niveles. A más de 25 años de su estreno, nuestro interés en revisitar el uso didáctico del largometraje se originó en una investigación sobre la formación de grado en Chagas en carreras biomédicas de la Universidad Nacional de Río Cuarto (Córdoba, Argentina). En dicho estudio, hallamos referencias espontáneas a “Casas de Fuego” tanto en entrevistas con estudiantes, como en clases observadas. A partir de este resultado “emergente”  realizamos una nueva mirada sobre las  potencialidades y limitaciones de la película para abordar y comprender el Chagas en la actualidad. En este artículo presentamos resultados del análisis y algunas reflexiones como aporte para actualizar y complementar la utilización de “Casas de Fuego” en las aulas.

Feeding on the blood of vertebrates is a risky task for haematophagous insects and it can be reasonably assumed that it should also be costly in terms of energetic expenditure. Blood circulates inside vessels and it must be pumped through narrow tubular stylets to be ingested. We analysed the respiratory pattern and the energetic cost of taking a blood meal inRhodnius prolixususing flow-through and stop-flow respirometry, for measuring carbon dioxide emission, oxygen consumption and water loss before and during feeding. We observed an increase of up to 17-fold in the metabolic rate during feeding and a change in the respiratory pattern, which switched from discontinuous cyclic during resting, to continuous when the insects started to feed, remaining this condition unchanged for several hours. The energetic cost of taking a meal was significantly higher when bugs fed on a living host, compared to feeding on an artificial feeder. No differences were observed between feeding on blood o...

The present study addresses the National Chagas Disease Control Program, a public policy implemented by the Brazilian Ministry of Health (MS), which is the main program to combat and control this disease in the country. Chagas disease (CD), also known as American Trypanosomiasis, appears on the list of diseases classified as neglected (NDs) by the World Health Organization (WHO) and is characterized by a set of endemic diseases caused by infectious-parasitic agents (viruses, bacteria, protozoa and helminths) that cause physical, cognitive, socioeconomic damage and a significant burden of morbidity. The estimate made by the MS indicates that approximately 1.9 to 4.6 million people in the country are infected by the protozoan Trypanosoma cruzi (T. cruzi), whose vector is triatomines (insects), popularly known as kissing bugs, responsible due to the transmission of CD, and approximately 4.000 people have died in the last 10 years, with the basic cause being CD directly transmitted by barbers, ingestion of contaminated food or other forms of transmission. Low socioeconomic conditions, lack of migratory control, and disorderly population concentration in urban areas are social and conditional factors that determine the proliferation and contagion of T. cruzi in humans. This study aims to analyze the National Chagas Disease Control Program and verify its implementation and effectiveness as a public health policy in the state of Rio de Janeiro. The methodology used is exploratory and descriptive bibliographic review. The study also addresses the relationship between poverty and CD, highlighting the importance of understanding the causes and impacts of the disease in the context of poverty to develop effective prevention and treatment strategies.

Keywords: Public Policies; Chagas disease; PNCDCh; poverty; Rio de Janeiro.

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people (travellers, migrants, blood or organ recipients, newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjects screened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees). No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women, three were infected (resulting in abortion in one case). In 2005 a ...

Background: Transnational immigrants are particularly impacted by neglected diseases, which take a heavy biological, social, and emotional toll in these marginalized communities. Chagas disease has transformed from an exclusively rural to an increasingly urban phenomenon encompassing non-endemic areas in Latin America. Methods: Through semi-structured interviews, we investigated representations of Chagas disease in Bolivian immigrants in São Paulo, Brazil. Between August and September 2015, 27 adult migrants were interviewed, 11 of them with Chagas disease. We explored problems of access to health services and essential knowledge about the disease, as well as related conceptions and health practices. Results: Participants constructed social representations of Chagas through interactions with family and social networks, drawing on earlier experiences in Bolivia. Diagnosis often provoked fear, and participants faced barriers to care based on language differences and uncertainties about the disease and treatment options. Healthcare personnel played an important role in alleviating concerns and facilitating access to information. Discussion: The complex intersection of migration and neglected diseases creates challenges for local and national health programs, requiring innovative responses incorporating the perspectives and needs of the often vulnerable affected communities.

El objetivo del trabajo fue comparar el grado de compromiso cardíaco entre dos poblaciones de chagásicos, con residencia permanente en área endémica y con exposición ocasional al parásito y con contagio por vía no vectorial (transfusional, connatal, y otras). Los resultados mostraron que los infectados ocasionales presentan menor presencia de cardiopatía; y cuando presentan cardiopatía, tienen menor prevalencia de miocardiopatía dilatada que los infectados con residencia permanente en el área endémica. También se plantea el rol del parásito, la cantidad de infecciones, los mecanismos inmuno-patogénicos desarrollados, la calidad de vida y el tipo de tareas laborales en la diferente evolución de estos pacientes.

Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is known about the role of rare genetic variants in inflammatory cardiomyopathy. Chronic Chagas disease cardiomyopathy (CCC) is an inflammatory cardiomyopathy prevalent in Latin America, developing in 30% of the 6 million patients chronically infected by the protozoan Trypanosoma cruzi, while 60% remain free of heart disease (asymptomatic (ASY)). The cytokine interferon-γ and mitochondrial dysfunction are known to play a major pathogenetic role. Chagas disease provides a unique model to probe for genetic variants involved in inflammatory cardiomyopathy. Methods We used whole exome sequencing to study nuclear families containing multiple cases of Chagas disease. We searched for rare pathogenic variants shared by all family members with CCC but absent in infected ASY siblings and in unrelated ASY. Results We identified heterozygous, pathogenic variants linked to CCC in all tested families on 22 d...

a vía congénita es una de las principales formas de transmisión de la enfermedad de Chagas: afecta desde un 0,7 a un 17% de los niños nacidos de madres infectadas por Trypanosoma cruzi OBJETIVOS: Calcular la cantidad de infectados por T. cruzi entre niños nacidos de madres diagnosticadas con Chagas durante 2010 y sus hermanos. MÉTODOS: Se realizó un estudio transversal. Se definió como caso índice a toda mujer embarazada residente en el departamento chaqueño de San Fernando con diagnóstico de enfermedad de Chagas en 2010. Se efectuaron visitas en el domicilio de las mujeres y se extrajeron muestras a sus hijos, que fueron procesadas por la red pública de laboratorios mediante Hemaglutinación indirecta (HAI ) y Ensayo por inmunoabsorción ligado a enzimas (ELISA), definiendo las discordancias con Inmunofluorescencia indirrecta (IFI). RESULTADOS: Se localizó a 71 madres que cumplían la definición de caso. Entre las encuestadas, 65 (92,9%) conocían su diagnóstico de infección por T. cru...

Juvenile hormones (JHs) are sesquiterpenoids synthesized by the corpora allata (CA). They play critical roles during insect development and reproduction. The first JH was described in 1934 as a “metamorphosis inhibitory hormone” in Rhodnius prolixus by Sir Vincent B. Wigglesworth. Remarkably, in spite of the importance of R. prolixus as vectors of Chagas disease and model organisms in insect physiology, the original JH that Wigglesworth described for the kissing-bug R. prolixus remained unidentified. We employed liquid chromatography mass spectrometry to search for the JH homologs present in the hemolymph of fourth instar nymphs of R. prolixus. Wigglesworth’s original JH is the JH III skipped bisepoxide (JHSB3), a homolog identified in other heteropteran species. Changes in the titer of JHSB3 were studied during the 10-day long molting cycle of 4th instar nymph, between a blood meal and the ecdysis to 5th instar. In addition we measured the changes of mRNA levels in the CA for the 1...

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people (travellers, migrants, blood or organ recipients, newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjects screened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees). No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women, three were infected (resulting in abortion in one case). In 2005 a ...

Resumo As Ouvidorias Públicas representam um avanço na Administração Pública brasileira no campo da gestão democrática. Nessa perspectiva, este artigo objetiva analisar a atuação da Ouvidoria-geral do SUS. Portanto, como a Ouvidoria-geral do Sistema Único de Saúde atua no âmbito das políticas de saúde? Para responder tal pergunta, foi realizada pesquisa documental utilizando relatórios gerenciais da Ouvidoria-Geral do SUS do Ministério da Saúde, produzidos entre 2010 e 2017. Para classificar a informação, utilizou-se como categorias de análise a participação, o controle social e a avaliação. Observou-se que a participação dos cidadãos-usuários do sistema de saúde via ouvidoria vem aumentando e consolidando-se. A Ouvidoria-Geral do Sistema Único de Saúde disponibiliza uma série de canais para a participação da cidadania, incluindo telefone e internet, que são atualmente as formas de participação mais acessadas. Instrumentos como Carta SUS, Lei de Acesso a Informação e manifestações d...

La enfermedad de Chagas es una infección parasitaria compleja y de alta mortalidad. La Organización Mundial de la Salud señala que las estadísticas no reflejan la verdadera magnitud del problema. La Coordinación Zonal 7 de Salud, no cuenta con epidemiología establecida, lo que justifica la realización de este trabajo. Los objetivos de la presente investigación es identificar anticuerpos Trypanosoma cruzi mediante técnica serológica ELISA; realizar prueba confirmatoria mediante hemaglutinación indirecta; determinar variables epidemiológicas y factores de riesgo que inciden en la presencia de la enfermedad de Chagas en pacientes con diagnóstico definitivo; reportar a los pacientes al Ministerio de Salud Pública para su posterior tratamiento. Se trata de un estudio cualitativo, longitudinal exploratorio, se tomó un universo de 1371 habitantes y se valoró a 200 de ellos. En los resultados el 17% de los pacientes resultó positivo para los dos estudios, de los grupos etarios más afectados...