Fatal evolution of acute Chagas disease in a child from Northern Brazil: factors that determine poor prognosis

Abstract

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.

Reactive oxygen species and nitric oxide imbalances lead to in vivo and in vitro arrhythmogenic phenotype in acute phase of experimental Chagas disease

“…Our work focuses on the acute phase of experimental CD, which does not fully recapitulate the reactivation of the chronic phase of the disease, when structural remodeling of the heart is more prominent [7]. Nevertheless, oral transmission of CD through ingestion of contaminated food is associated with more complicated clinical forms and higher mortality [9], with severe cases reported from both in acute [44] and chronic [45] phases. single cells are plotted individually to highlight the high transient amplitude variation in some cells (black arrow).…”

Oral Trypanosoma cruzi Transmission Resulting in Advanced Chagasic Cardiomyopathy in an 11-Month-Old Male

“…Orally acquired T. cruzi infection from contaminated food products was first described in the 1960s [ 7 ], but a large outbreak stemming from a Venezuelan school [ 4 ] raised attention to the public health importance of this transmission source. Contaminated bacaba palm fruit juice, açaí pulp, and other food/beverage products have been linked to oral transmission outbreaks [ 6 , 8 – 10 ]. In Venezuela and Brazil, oral T. cruzi outbreaks have been increasing over the past decade [ 5 , 6 , 11 ], thought to be linked to increased açaí commercial production in the region [ 12 ].…”

Suspected vertical transmission of Chagas disease caused by DTU TcIV in an infection probably transmitted orally, during anoutbreak in the Brazilian Amazon

“…The serological tests showed showed a positive indirect immunofluorescence (IF) test with titers of anti- T. cruzi IgG and IgM antibodies of 1/320 and 1/160, respectively, a positive indirect hemagglutination test (IHAT) and a non-reagent ELISA. Quantitative PCR (qPCR) for T. cruzi detection was performed with Tcz 3/4 primers, using a previously described methodology 7 . A burden of 53.51 parasites Eq/mL of blood was found.…”

“…T. cruzi was genotyped by two parasite genomic sequences: the D7 divergent domain of the 24Sα rRNA (24Sα rRNA) and a spliced leader intergenic region (SL-IR). To this end, nested and multiplex PCR were performed as previously described 7 . The reference strains used in this study are described in Table 1 .…”