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- Title
Distantiae Transmission of Trypanosoma cruzi: A New Epidemiological Feature of Acute Chagas Disease in Brazil.
- Authors
Xavier, Samanta Cristina das Chagas; Roque, André Luiz Rodrigues; Bilac, Daniele; de Araújo, Vitor Antônio Louzada; Neto, Sócrates Fraga da Costa; Lorosa, Elias Seixas; Silva, Luiz Felipe Coutinho Ferreira da; Jansen, Ana Maria
- Abstract
Background: The new epidemiological scenario of orally transmitted Chagas disease that has emerged in Brazil, and mainly in the Amazon region, needs to be addressed with a new and systematic focus. Belém, the capital of Pará state, reports the highest number of acute Chagas disease (ACD) cases associated with the consumption of açaí juice. Methodology/Principal Findings: The wild and domestic enzootic transmission cycles of Trypanosoma cruzi were evaluated in the two locations (Jurunas and Val-de Cães) that report the majority of the autochthonous cases of ACD in Belém city. Moreover, we evaluated the enzootic cycle on the three islands that provide most of the açaí fruit that is consumed in these localities. We employed parasitological and serological tests throughout to evaluate infectivity competence and exposure to T. cruzi. In Val-de-Cães, no wild mammal presented positive parasitological tests, and 56% seroprevalence was observed, with low serological titers. Three of 14 triatomines were found to be infected (TcI). This unexpected epidemiological picture does not explain the high number of autochthonous ACD cases. In Jurunas, the cases of ACD could not be autochthonous because of the absence of any enzootic cycle of T. cruzi. In contrast, in the 3 island areas from which the açaí fruit originates, 66.7% of wild mammals and two dogs displayed positive hemocultures, and 15.6% of triatomines were found to be infected by T. cruzi. Genotyping by mini-exon gene and PCR-RFLP (1f8/Akw21I) targeting revealed that the mammals and triatomines from the islands harbored TcI and Trypanosoma rangeli in single and mixed infections. Conclusion/Significance: These findings show that cases of Chagas disease in the urban area of Belém may be derived from infected triatomines coming together with the açaí fruits from distant islands. We term this new epidemiological feature of Chagas disease as "Distantiae transmission". Author Summary: After the interruption of Trypanosoma cruzi transmission by Triatoma infestans, a new epidemiological scenario emerged in Brazil: the oral route. In the Amazon region, considered as a non-endemic Chagas disease region, T. cruzi is thought to exist as an enzootic parasite of wild animals. Currently, this region comprises approximately 92.3% of human Chagas cases in Brazil, the majority of which are in the Pará state. Its capital, Belém, reports the highest number of acute Chagas disease (ACD) cases (associated with the consumption of açaí juice), despite being an urban environment without the domiciliation of triatomines or an enzootic cycle. Thus, we decided to test the hypothesis that the cases related to the urban area of Belém are derived from infected sylvatic triatomine bugs accidentally transported from the islands that provide the majority of the açaí fruit sold in the metropolitan area. We term this new epidemiological feature "Distantiae transmission," indicating that the ACD cases in the metropolitan region of Belém are related to infected triatomines transported from the islands. In the Amazon region, food contamination by infected triatomines is the result of the unhygienic manipulation of açaí and is supposed to be controlled by an epidemiological and sanitary surveillance program.
- Subjects
BELEM (Brazil); BRAZIL; PARA (Brazil : State); CHAGAS' disease; ACUTE diseases; TRYPANOSOMA cruzi; FOOD contamination; CONENOSES; TRICHOMONIASIS
- Publication
PLoS Neglected Tropical Diseases, 2014, Vol 8, Issue 5, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0002878