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      Insect vectors of Chagas disease (Trypanosoma cruzi) in Northeastern Brazil

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          Abstract

          Abstract INTRODUCTION: Chagas disease remains a public health problem in the rural and urban areas of 19 countries in the Americas. METHODS: The aim of the present study was to investigate the Trypanosoma cruzi infection rate of triatomines collected from both intra- and peridomiciliary areas in eleven municipalities of Southeastern Ceará, Brazil, from 2009 to 2015. RESULTS: A total of 32,364 triatomine specimens, including nymphs and adults, were collected, and 31,736 (98.06%) of these were examined. More nymphs were collected than adults, and the greatest number of triatomines (n = 8,548) was collected in 2010, for which the infection rate was 1.3%, with the highest rate of infections observed for specimens from Quixere. The species collected during the study were identified as Triatoma pseudomaculata, Triatoma brasiliensis, Panstrongylus megistus, Panstrongylus lutzi, and Rhodnius nasutus, with T. pseudomaculata being the most abundant (n = 19,962). CONCLUSIONS: These results verify the presence of triatomines in both intra- and peridomiciliary areas, thereby ensuring persistence of the pathogen and consequently, the disease, as the presence of infected vectors in households is an important risk factor. According to these findings, the Chagas Disease Control Program should intensify its efforts in order to prevent the spread of the disease.

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          Chagas disease

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            Chagas Disease Has Now Gone Global

            Chagas disease, caused by the parasite Trypanosoma cruzi, was once thought to be an exotic disease, confined to endemic areas of Latin America and hence of little importance to anyone outside of these endemic regions, including most physicians and scientists. The impact of the lack of physician awareness and lack of scientific attention is undefined, but may contribute to the continued neglect of Chagas disease and the affected populations. Despite historical evidence and growing recognition of the spread of Chagas disease, the prevention and control of this disease outside of Latin America is only now being addressed. Chagas disease was recognized in the United States as early as the 1950s, when the first reports of local vector-borne cases were published [1]. More recently, immigration patterns from endemic countries have changed the epidemiology of this disease in the US. In 1985, Kirchhoff reported three Bolivian immigrants who presented to the US National Institutes of Health with clinical Chagas disease [2], and in 1987 a survey of Central American immigrants in the Washington, D.C., area revealed a 4.9% prevalence of Chagas disease in this population [3]. Shortly after these reports, cases of transfusion-associated Chagas disease were identified in New York City, US, and Manitoba, Canada [4], [5]. In the New York City case, the donor was traced to a Bolivian immigrant and the recipient was a 12-year-old girl with Hodgkin’s disease. Kirchhoff, in an accompanying editorial, raised the alarm as to whether the blood supply was safe [6]; however, it was not until 15 years later that a screening test for Chagas disease was approved by FDA and implemented by the American blood banking industry. To date, this screening has resulted in the recognition of over 1,300 cases of Chagas disease in donors (http://www.aabb.org/programs/biovigilance/Pages/chagas.aspx), the vast majority of which have been asymptomatic representing the indeterminate form of chronic infection. In other parts of the world, immigration alone has contributed to the appearance of Chagas disease in non-endemic countries [7]–[10]. Immigration from endemic regions is widespread; for example, there are Brazilian immigrants in Portugal and Bolivian immigrants in Spain, and currently, there are an estimated 100,000 or more Latin American immigrants living in France. With immigration has come Chagas disease. Chagasic heart disease has been reported in Brazilian immigrants of Japanese origin in Japan [8], and the seroprevalence of Chagas disease among Bolivian women in Barcelona has been determined to be 3.4% [8]. In all parts of the world where people at risk for Chagas disease are found, Chagas disease in immune-suppressed patients has become an important consideration, resulting in organ and tissue safety concerns related to both donors and recipients. In non-endemic areas, screening of donors or recipients may not be performed routinely. Furthermore, individuals with chronic Chagas disease who acquire HIV/AIDS may have a recrudescence of the infection that can go unrecognized or misdiagnosed as Toxoplasma encephalitis. Most of those infected have the indeterminate, asymptomatic form of Chagas disease and are unaware of their infection, but remain potential sources of transmission. Pregnant women unaware of their infection can be sources of congenital transmission. Congenital Chagas disease has now been reported in Europe among infants born to mothers who are Latin American immigrants with undiagnosed Chagas disease [11]–[13]. These observations raise the issue as to whether prescreening of pregnant women for Chagas disease should be recommended for immigrants from Chagas-endemic areas. This issue was recently highlighted in a paper by Verani et al. [14], who conducted a survey of obstetricians and gynecologists in the US, and demonstrated that clinicians had an inadequate understanding of basic information about this disease and no knowledge of the fact that Chagas disease could be transmitted from mother to child. The paper in this issue of PLoS Neglected Tropical Diseases by Roca et al. [15] examined the prevalence of Chagas disease among Latin American immigrants in a primary care setting in Barcelona, which has become a destination of Spanish-speaking immigrants from Chagas-endemic areas. Of the 766 patients tested, 22 individuals were diagnosed with T. cruzi infection (a prevalence of 2.8%); more women were positive than men (54.6% versus 45.5%). Interestingly, 21 patients were from Bolivia, which is a highly endemic area. The prevalence rate among Bolivian immigrants in this study was 16.5%. Many had lived in substandard adobe houses that have been associated with risk for transmission while in Bolivia, and had previous knowledge of Chagas disease in their country of origin. A number of these patients had clinical Chagas disease, including cardiac and gastrointestinal manifestations. Awareness that Chagas disease is now found in places far from endemic areas of Latin America is important because it leads to the development of strategies to prevent potential sources of transmission (e.g., blood transfusion, organ transplantation, or congenital transmission), and to identify individuals who may benefit from anti-parasitic therapy. Increased awareness also enables us to identify patients who may have a diagnosis of ischemic heart disease or cardiomyopathy of unknown etiology or individuals with gastrointestinal disorders of unknown etiology whose illness is actually Chagas disease, improving the ability of physicians to care for these patients appropriately. Indeed, it is evident that the challenges of Chagas disease have become global.
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              Assessing the vulnerability of Brazilian municipalities to the vectorial transmission of Trypanosoma cruzi using multi-criteria decision analysis.

              Despite the dramatic reduction in Trypanosoma cruzi vectorial transmission in Brazil, acute cases of Chagas disease (CD) continue to be recorded. The identification of areas with greater vulnerability to the occurrence of vector-borne CD is essential to prevention, control, and surveillance activities. In the current study, data on the occurrence of domiciliated triatomines in Brazil (non-Amazonian regions) between 2007 and 2011 were analyzed. Municipalities' vulnerability was assessed based on socioeconomic, demographic, entomological, and environmental indicators using multi-criteria decision analysis (MCDA). Overall, 2275 municipalities were positive for at least one of the six triatomine species analyzed (Panstrongylus megistus, Triatoma infestans, Triatoma brasiliensis, Triatoma pseudomaculata, Triatoma rubrovaria, and Triatoma sordida). The municipalities that were most vulnerable to vector-borne CD were mainly in the northeast region and exhibited a higher occurrence of domiciliated triatomines, lower socioeconomic levels, and more extensive anthropized areas. Most of the 39 new vector-borne CD cases confirmed between 2001 and 2012 in non-Amazonian regions occurred within the more vulnerable municipalities. Thus, MCDA can help to identify the states and municipalities that are most vulnerable to the transmission of T. cruzi by domiciliated triatomines, which is critical for directing adequate surveillance, prevention, and control activities. The methodological approach and results presented here can be used to enhance CD surveillance in Brazil. Copyright © 2014 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
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                Journal
                rsbmt
                Revista da Sociedade Brasileira de Medicina Tropical
                Rev. Soc. Bras. Med. Trop.
                Sociedade Brasileira de Medicina Tropical - SBMT (Uberaba, MG, Brazil )
                0037-8682
                1678-9849
                April 2018
                : 51
                : 2
                : 174-182
                Affiliations
                [4] Fortaleza Ceará orgnameUniversidade Federal do Ceará orgdiv1Programa de Pós-Graduação em Ciências Médicas Brazil
                [7] Fortaleza Ceará orgnameUniversidade Federal do Ceará orgdiv1Laboratório de Pesquisa em Doença de Chagas Brazil
                [1] Fortaleza Ceará orgnameUniversidade Federal do Ceará orgdiv1Programa de Pós-Graduação em Ciências Farmacêuticas Brazil
                [3] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Programa de Pós-Graduação em Alergia e Imunopatologia Brazil
                [6] Fortaleza orgnameSecretaria de Saúde do Estado do Ceará orgdiv1Núcleo de Controle Vetorial orgdiv2Programa de Controle de Doença de Chagas Brazil
                [2] Fortaleza Ceará orgnameUniversidade Federal do Ceará orgdiv1Programa de Pós-Graduação em Patologia Brazil
                [5] Lisboa orgnameUniversidade de Lisboa orgdiv1Departamento de Química e Bioquímica orgdiv2Faculdade de Ciências Portugal
                Article
                S0037-86822018000200174
                10.1590/0037-8682-0408-2017
                29768550
                12aa7984-2f91-4da0-a3f7-7dda6cdbb630

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 17 October 2017
                : 07 March 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 9
                Product

                SciELO Brazil


                Infection rate,Chagas disease,Triatomine
                Infection rate, Chagas disease, Triatomine

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