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      FIRST REPORT OF ACUTE CHAGAS DISEASE BY VECTOR TRANSMISSION IN RIO DE JANEIRO STATE, BRAZIL Translated title: Primeiro relato de doença de Chagas aguda por transmissão vetorial no Estado do Rio de Janeiro, Brasil

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          SUMMARY

          Chagas disease (CD) is an endemic anthropozoonosis from Latin America of which the main means of transmission is the contact of skin lesions or mucosa with the feces of triatomine bugs infected by Trypanosoma cruzi. In this article, we describe the first acute CD case acquired by vector transmission in the Rio de Janeiro State and confirmed by parasitological, serological and PCR tests. The patient presented acute cardiomyopathy and pericardial effusion without cardiac tamponade. Together with fever and malaise, a 3 cm wide erythematous, non-pruritic, papule compatible with a "chagoma" was found on his left wrist. This case report draws attention to the possible transmission of CD by non-domiciled native vectors in non-endemic areas. Therefore, acute CD should be included in the diagnostic workout of febrile diseases and acute myopericarditis in Rio de Janeiro.

          RESUMO

          A doença de Chagas é antropozoonose endêmica na América Latina que tem como principal mecanismo de transmissão humana o contato da pele lesada ou da mucosa com as fezes de triatomíneos infectados por Trypanosoma cruzi. Neste artigo descrevemos o primeiro caso de doença de Chagas aguda adquirida no Estado do Rio de Janeiro por transmissão vetorial com confirmação parasitológica, sorológica e pela PCR. O paciente apresentou miocardite aguda e derrame pericárdico de evolução benigna. Juntamente com as manifestações sistêmicas da fase aguda, foi notada pápula eritematosa de três cm de diâmetro compatível com chagoma em punho esquerdo. Este relato de caso chama a atenção para a possibilidade de transmissão da doença de Chagas por vetores nativos não domiciliados e em áreas consideradas indenes. Portanto, a doença de Chagas aguda deve ser incluída entre os diagnósticos diferenciais de doenças febris e miopericardites agudas no Rio de Janeiro.

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          The impact of Chagas disease control in Latin America: a review

          JCP Dias, AC Silveira, CJ Schofield (2002)
          Discovered in 1909, Chagas disease was progressively shown to be widespread throughout Latin America, affecting millions of rural people with a high impact on morbidity and mortality. With no vaccine or specific treatment available for large-scale public health interventions, the main control strategy relies on prevention of transmission, principally by eliminating the domestic insect vectors and control of transmission by blood transfusion. Vector control activities began in the 1940s, initially by means of housing improvement and then through insecticide spraying following successful field trials in Brazil (Bambui Research Centre), with similar results soon reproduced in São Paulo, Argentina, Venezuela and Chile. But national control programmes only began to be implemented after the 1970s, when technical questions were overcome and the scientific demonstration of the high social impact of Chagas disease was used to encourage political determination in favour of national campaigns (mainly in Brazil). Similarly, large-scale screening of infected blood donors in Latin America only began in the 1980s following the emergence of AIDS. By the end of the last century it became clear that continuous control in contiguous endemic areas could lead to the elimination of the most highly domestic vector populations - especially Triatoma infestans and Rhodnius prolixus - as well as substantial reductions of other widespread species such as T. brasiliensis, T. sordida, and T. dimidiata, leading in turn to interruption of disease transmission to rural people. The social impact of Chagas disease control can now be readily demonstrated by the disappearance of acute cases and of new infections in younger age groups, as well as progressive reductions of mortality and morbidity rates in controlled areas. In economic terms, the cost-benefit relationship between intervention (insecticide spraying, serology in blood banks) and the reduction of Chagas disease (in terms of medical and social care and improved productivity) is highly positive. Effective control of Chagas disease is now seen as an attainable goal that depends primarily on maintaining political will, so that the major constraints involve problems associated with the decentralisation of public health services and the progressive political disinterest in Chagas disease. Counterbalancing this are the political and technical cooperation strategies such as the "Southern Cone Initiative" launched in 1991. This international approach, coordinated by PAHO, has been highly successful, already reaching elimination of Chagas disease transmission in Uruguay, Chile, and large parts of Brazil and Argentina. The Southern Cone Initiative also helped to stimulate control campaigns in other countries of the region (Paraguay, Bolivia, Peru) which have also reached tangible regional successes. This model of international activity has been shown to be feasible and effective, with similar initiatives developed since 1997 in the Andean Region and in Central America. At present, Mexico and the Amazon Region remain as the next major challenges. With consolidation of operational programmes in all endemic countries, the future focus will be on epidemiological surveillance and care of those people already infected. In political terms, the control of Chagas disease in Latin America can be considered, so far, as a victory for international scientific cooperation, but will require continuing political commitment for sustained success.
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            Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy.

            A-L Moncayo, Carlos Silveira (2009)
            Chagas disease, named after Carlos Chagas, who first described it in 1909, exists only on the American Continent. It is caused by a parasite, Trypanosoma cruzi, which is transmitted to humans by blood-sucking triatomine bugs and via blood transfusion. Chagas disease has two successive phases: acute and chronic. The acute phase lasts six-eight weeks. Several years after entering the chronic phase, 20-35% of infected individuals, depending on the geographical area, will develop irreversible lesions of the autonomous nervous system in the heart, oesophagus and colon, and of the peripheral nervous system. Data on the prevalence and distribution of Chagas disease improved in quality during the 1980s as a result of the demographically representative cross-sectional studies in countries where accurate information was not previously available. A group of experts met in Brasilia in 1979 and devised standard protocols to carry out countrywide prevalence studies on human T. cruzi infection and triatomine house infestation. Thanks to a coordinated multi-country programme in the Southern Cone countries, the transmission of Chagas disease by vectors and via blood transfusion was interrupted in Uruguay in 1997, in Chile in 1999 and in Brazil in 2006; thus, the incidence of new infections by T. cruzi across the South American continent has decreased by 70%. Similar multi-country initiatives have been launched in the Andean countries and in Central America and rapid progress has been reported towards the goal of interrupting the transmission of Chagas disease, as requested by a 1998 Resolution of the World Health Assembly. The cost-benefit analysis of investment in the vector control programme in Brazil indicates that there are savings of US$17 in medical care and disabilities for each dollar spent on prevention, showing that the programme is a health investment with very high return. Many well-known research institutions in Latin America were key elements of a worldwide network of laboratories that carried out basic and applied research supporting the planning and evaluation of national Chagas disease control programmes. The present article reviews the current epidemiological trends for Chagas disease in Latin America and the future challenges in terms of epidemiology, surveillance and health policy.
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              Geographic Distribution of Chagas Disease Vectors in Brazil Based on Ecological Niche Modeling

              Rodrigo Gurgel-Gonçalves, Cleber Galvão, Jane Costa … (2012)
              Although Brazil was declared free from Chagas disease transmission by the domestic vector Triatoma infestans, human acute cases are still being registered based on transmission by native triatomine species. For a better understanding of transmission risk, the geographic distribution of Brazilian triatomines was analyzed. Sixteen out of 62 Brazilian species that both occur in >20 municipalities and present synanthropic tendencies were modeled based on their ecological niches. Panstrongylus geniculatus and P. megistus showed broad ecological ranges, but most of the species sort out by the biome in which they are distributed: Rhodnius pictipes and R. robustus in the Amazon; R. neglectus, Triatoma sordida, and T. costalimai in the Cerrado; R. nasutus, P. lutzi, T. brasiliensis, T. pseudomaculata, T. melanocephala, and T. petrocchiae in the Caatinga; T. rubrovaria in the southern pampas; T. tibiamaculata and T. vitticeps in the Atlantic Forest. Although most occurrences were recorded in open areas (Cerrado and Caatinga), our results show that all environmental conditions in the country are favorable to one or more of the species analyzed, such that almost nowhere is Chagas transmission risk negligible.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rev Inst Med Trop Sao Paulo
                Journal ID (iso-abbrev): Rev. Inst. Med. Trop. Sao Paulo
                Journal ID (publisher-id): rimtsp
                Title: Revista do Instituto de Medicina Tropical de São Paulo
                Publisher: Instituto de Medicina Tropical
                ISSN (Print): 0036-4665
                ISSN (Electronic): 1678-9946
                Publication date (Print and electronic): Jul-Aug 2015
                Publication date (Print): Jul-Aug 2015
                Volume: 57
                Issue: 4
                Pages: 361-364
                Affiliations
                [1 ]originalLaboratório de Pesquisa Clínica em Doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. normalizedFundação Oswaldo Cruz orgdiv1Instituto Nacional de Infectologia Evandro Chagas orgnameFundação Oswaldo Cruz Rio de Janeiro RJBrazil
                [2 ]originalLaboratório de Pesquisa em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. normalizedFundação Oswaldo Cruz orgdiv1Instituto Nacional de Infectologia Evandro Chagas orgnameFundação Oswaldo Cruz Rio de Janeiro RJBrazil
                [3 ]originalLaboratório de Farmacogenética; Intituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. normalizedFundação Oswaldo Cruz orgdiv1Intituto Nacional de Infectologia Evandro Chagas orgnameFundação Oswaldo Cruz Rio de Janeiro RJBrazil
                [4 ]originalLaboratório de Parasitologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. normalizedFundação Oswaldo Cruz orgdiv1Instituto Nacional de Infectologia Evandro Chagas orgnameFundação Oswaldo Cruz Rio de Janeiro RJBrazil
                [5 ]originalSeção de Imunodiagnóstico, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. normalizedFundação Oswaldo Cruz orgdiv1Instituto Nacional de Infectologia Evandro Chagas orgnameFundação Oswaldo Cruz Rio de Janeiro RJBrazil
                Author notes
                Correspondence to: Luiz Henrique Conde Sangenis, Laboratório de Pesquisa Clínica em Doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas/FIOCRUZ, Av. Brasil 4365, 21040-360 Rio de Janeiro, RJ, Brasil. Phone: 55 21 3865-9648. E-mail: lhcsangenis@ 123456gmail.com
                Article
                DOI: 10.1590/S0036-46652015000400017
                PMC ID: 4616926
                PubMed ID: 26422165
                SO-VID: 539be944-7f1c-4b31-b2be-51b5c5469361
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                Date received : 04 July 2014
                Date accepted : 02 December 2014
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 29, Pages: 4
                Categories
                Subject: Case Report

                Keywords: chagas disease,transmission,triatoma vitticeps,rio de janeiro
                Data availability:
                Keywords: chagas disease, transmission, triatoma vitticeps, rio de janeiro

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