Possible oral transmission of acute Chagas' disease in Brazil

Abstract

In October 1986, 7 to 22 days after a meeting at a farm in Paraíba state, 26 individuals presented with a febrile illness associated with bilateral eyelid and lower limb edema, mild hepatosplenomegaly, lymphadenopathy and, occasionally a skin rash. A 11-year-old boy exhibited atrial premature complexes and a 74-year-old patient developed acute heart failure. In two patients hospitalized in São Paulo city, acute Chagas' disease was diagnosed by the demonstration of circulating Trypanosoma cruzi. At autopsy in a fatal case, acute Chagas' cardiomyopathy was demonstrated. Xenodiagnosis were positive in 9 out of 14 tested patients. A specific IgG immune response was found in all patients and specific IgM antibodies were identified in 20 out of 22 tested patients. A epidemiological survey showed the existence of Triatoma brasiliensis in the outbuildings of this farm, but none in the house where most of the guests stayed. A high rate of infection with Trypanosoma cruzi was found in opossums. These observations together with those related to the food consumed by the patients, lead the authors to suggest that the human infections resulted from oral contamination probably originating from naturally infected marsupials in the area or crushed infected bugs.

2 nd Brazilian Consensus on Chagas Disease, 2015

“…It occurs on around days 4-8 of disease, usually affecting the chest, back, lower limbs, and neck, and sparing the face and palmoplantar regions. It is relatively transient and most often goes unnoticed by the patient, found only on physical examination (91) (169) (170) .…”

Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy

“…This route of transmission is well established and documented (Shikanai-Yasuda et al 1991, Valente et al 1999, Camandaroba et al 2002, MS 2005, Rodríguez-Morales 2007. The most salient characteristic of oral transmission is the fact that several persons are affected simultaneously, pointing to the occurrence of a common source of outbreak through contaminated food.…”

Survival of Trypanosoma cruzi in sugar cane used to prepare juice

“…There are several reports on the outbreak of human Chagas disease in Brazil, probably by oral contamination 8,9,11 . Only a few experimental studies have attempted to demonstrate the likelihood of this route of contamination 7,10 .…”