Trypanosoma cruzi
is the causative agent of Chagas disease. Nowadays, the transmission in Brazil occurs mainly by oral ingestion of contaminated food that has been associated with more severe clinical manifestations. We report a case of Acute Chagas disease caused by oral transmission in a child from Northern Brazil. In the hospital admission, physical examination showed tachycardia, hepatomegaly, bipalpebral edema and anasarca.
Trypanosoma cruzi
trypomastigotes were found in microscopy during blood cell count. Twenty-three days before hospitalization, the child had ingested the “bacaba palm fruit's wine”. Even with the appropriate diagnosis and starting of treatment, she did not survive. Quantitative analysis of
Trypanosoma cruzi
DNA in a blood sample resulted in 54,053.42 parasite equivalents/mL and the DTU TcIV was identified. The outcome may have been determined by several factors, including the delay to seek a medical service beyond the high parasitemia, detected by qPCR. DTU TcIV could also have influenced the natural history of the disease.
This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of
Trypanosoma cruzi
parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify
T. cruzi
Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient’s biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify
T. cruzi
DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for
T. cruzi
DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as
T. cruzi
TcIV, from Marimarituba’s outbreak, and
T. cruzi
TcI, from Cachoeira do Arua’s outbreak. The molecular identification of
T. cruzi
may increase understanding of the role of this parasite in Chagas disease’s emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.
This study describes difficulties in the monitoring of a child born during an
oral outbreak of Chagas disease, in which there are several indications that the
transmission occurred through the congenital route: 1. the mother was in the
third trimester of pregnancy when she was infected; 2. She presented high
parasitemia at the time of delivery; 3. In both, the mother and her daughter,
T. cruzi
was classified as DTU TcIV. The parasites were not
found in the blood at birth and the infection was detected only three months
later in an asymptomatic infant. As the mother and her child live in a highly
endemic area, vector transmission could not be excluded during this period.
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