Molecular Identification of<i>Trypanosoma cruzi</i>Discrete Typing Units in End‐Stage Chronic Chagas Heart Disease and Reactivation after Heart Transplantation

Burgos, Juan Miguel; Díez, Mirta; Vigliano, Carlos; Bisio, Margarita; Risso, Marikena Guadalupe; Duffy, Tomás; Cura, Carolina; Brusses, Betina; Favaloro, Liliana; Leguizamón, María Susana; Lucero, Raúl Horacio; Laguens, Rubén P.; Levìn, Mariano J.; Favaloro, Roberto; Schijman, Alejandro G.

doi:10.1086/655680

Cited by 178 publications

(191 citation statements)

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“…Unlike that generally occurs in Brazil, TcI is the main agent of chronic Chagas disease in some American countries (e.g., Venezuela and Colombia), where the patients can develop severe and fatal cardiomyopathy (usually without digestive megasyndromes), as well as meningoencephalitis in immunocompromised individuals [6][7][8][43][44][45][46][47][48][49][50] . Such discrepancy deserves further investigations, but many factors should be considered for attempting to explain it, as the genetic diversity of both parasites and human beings, and the epidemiological conditions that favor the selection of T. cruzi genotypes by local vectors and hosts [51][52][53] .…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, the sequencing analysis of the TcI isolate (CT-IOC 541) showed that it is genetically closer to Sylvio X10, a stock identified as TcId 60 , a sub-group related to sylvatic cycles, which was also found by Câmara et al 38 in Northeastern Brazil. It is worth mentioning that TcId (or TcI sylvatic) was identified in the heart and brain of patients with severe Chagas disease outside Brazil 46,49 . In the present study, the isolate CT-IOC 541 and the Colombian strain showed the same banding pattern at the ME-1 locus, which was distinct from that of the Dm28c stock (Figure 4), a finding that corroborates the variability within TcI.…”

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confidence: 99%

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Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil)

Oliveira¹,

Santos²,

Galdino³

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil)

Oliveira¹,

Santos²,

Galdino³

et al. 2017

Rev. Soc. Bras. Med. Trop.

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“…Patients were confirmed as infected, using direct parasitological tests (thick blood smears), serological tests (trypomastigote excreted-secreted antigen [ [4]. T. cruzi genotyping was performed as previously reported [5,6]. Finally, in all qPCR-positive samples, amplification and analysis by Microsat (a program for microsatellite analysis) was performed using 7 microsatellite markers [7].…”

Section: Methodsmentioning

confidence: 99%

High-Resolution Molecular Typing ofTrypanosoma cruziin 2 Large Outbreaks of Acute Chagas Disease in Colombia

et al. 2016

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Oral transmission of Trypanosoma cruzi has gained relevance because of its association with high morbidity and lethality rates. This transmission route is responsible for maintaining the infection of the parasite in sylvatic cycles, and human cases have been associated mainly with the consumption of food contaminated with triatomine feces or didelphid secretions. Several ecological changes allow the intrusion of sylvatic reservoirs and triatomines to the domestic environments with subsequent food contamination. Here, high-resolution molecular tools were used to detect and genotype T. cruzi across humans, reservoirs, and insect vectors in 2 acute outbreaks of presumptive oral transmission in eastern Colombia.Keywords. Chagas disease; oral transmission; outbreaks; triatomines; Trypanosoma cruzi; opossums; canines; food.Oral transmission of Trypanosoma cruzi is considered ancient, allowing the circulation and maintenance of the parasite in the sylvatic cycle of transmission. T. cruzi has been classified into 6 discrete typing units (DTUs), TcI-TcVI, and, within TcI, into 2 genotypes (domestic TcI [TcI Dom ] and sylvatic TcI). In humans, this mechanism has been described in >1000 cases corresponding to 138 outbreaks, with a fatality rate of 8%-35% across Latin America [1,2]. In Colombia, between 1992 and 2009, 11 outbreaks were reported, with a lethality rate of 16.0% [3]. In 2014, 2 outbreaks occurred in the Colombian Orinoco region.The aim of this study was to determine the possible sources of oral transmission, by using molecular tools, during the outbreaks that occurred in the municipalities of Restrepo, Meta Department, and Paz de Ariporo, Casanare Department. METHODSA total of 70 patients with suspected T. cruzi oral infection, along with 39 samples from reservoir organisms (opossums and canines) and 23 samples from triatomines (Panstrongylus geniculatus, Rhodnius pictipes, and Rhodnius prolixus) during the 2 outbreaks were included. Patients were confirmed as infected, using direct parasitological tests (thick blood smears), serological tests (trypomastigote excreted-secreted antigen [TESA] [5,6]. Finally, in all qPCR-positive samples, amplification and analysis by Microsat (a program for microsatellite analysis) was performed using 7 microsatellite markers [7]. RESULTS Restrepo OutbreakThis outbreak occurred in a family comprising 4 adults and 1 child, who visited Restrepo, including a farm, which contains forests and savannas, as well as some restaurants located along the road in Cumaral municipality, between February 13 and 16, 2014. The family returned to Bogota (the capital of Colombia) afterward, where the 4 adults were hospitalized for fever and edema. Thick blood smears were positive in 2 of 4 symptomatic patients. Results of conventional serological analyses, TESA blots, and molecular tests were positive for the 4 symptomatic patients. The median parasite load was 6.2 equivalent parasites/mL. The child was asymptomatic and had negative results of all diagnostic tests (Supplementary Table 1).The fi...

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“…Using molecular tools, this has now been shown to be the case in mixed infections where the most prevalent genotype in the bloodstream is different to that in cardiac tissue [164,166]. This can complicate treatment involving heart transplantation, where chemotherapy is used to counter reactivation of the parasite following postsurgical immunosuppressive therapy, since in mixed infections parasite reactivation can occur at different times [166].…”

Section: Polyparasitismmentioning

confidence: 99%

The molecular epidemiology of parasite infections: Tools and applications

Lymbery

Thompson

2012

Molecular and Biochemical Parasitology

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Molecular epidemiology, broadly defined, is the application of molecular genetic techniques to the dynamics of disease in a population. In this review, we briefly describe molecular and analytical tools available for molecular epidemiological studies and then provide an overview of how they can be applied to better understand parasitic disease. A range of new molecular tools have been developed in recent years, allowing for the direct examination of parasites from clinical or environmental samples, and providing access to relatively cheap, rapid, high throughput molecular assays. At the same time, new analytical approaches, in particular those derived from coalescent theory, have been developed to provide more robust estimates of evolutionary processes and demographic parameters from multilocus, genotypic data. To date, the primary application of molecular epidemiology has been to provide specific and sensitive identification of parasites and to resolve taxonomic issues, particularly at the species level and below. Population genetic studies have also been used to determine the extent of genetic diversity among populations of parasites and the degree to which this diversity is associated with different host cycles or epidemiologically important phenotypes. Many of these studies have also shed new light on transmission cycles of parasites, particularly the extent to which zoonotic transmission occurs, and on the prevalence and importance of mixed infections with different parasite species or intraspecific variants (polyparasitism). A major challenge, and one which is now being addressed by an increasing number of studies, is to find and utilise genetic markers for complex traits of epidemiological significance, such as drug resistance, zoonotic potential and virulence.

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Molecular Identification ofTrypanosoma cruziDiscrete Typing Units in End‐Stage Chronic Chagas Heart Disease and Reactivation after Heart Transplantation

Abstract: Multiple DTUs coexist in patients with Chagas disease. The frequent finding of T. cruzi I associated with cardiac damage was astounding, revealing its pathogenic role in cChHD at the southern cone.

Cited by 178 publications

References 35 publications

Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil)

Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil)

High-Resolution Molecular Typing ofTrypanosoma cruziin 2 Large Outbreaks of Acute Chagas Disease in Colombia

The molecular epidemiology of parasite infections: Tools and applications

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