Special Issue "Chagas Disease"

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Neglected and Emerging Tropical Diseases".

Deadline for manuscript submissions: closed (20 November 2020) | Viewed by 32387

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Special Issue Editors

Prof. Dr. Jorg Heukelbach
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Guest Editor
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza 60430-140, CE, Brazil
Interests: public health; tropical neglected diseases; epidemiology
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Alberto Novaes Ramos Jr.
E-Mail Website
Co-Guest Editor
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza 60430-140, CE, Brazil
Interests: public health; epidemiology; tropical neglected diseases; infectious diseases
Prof. Dr. Andrea Silvestre de Sousa
E-Mail Website
Co-Guest Editor
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro RJ, Brazil
Interests: clinical research; Chagas disease; cardiology; epidemiology

Special Issue Information

Dear Colleagues,

About 110 years after its discovery, Chagas disease persists as a critical public health problem, having crossed the boundaries of Latin America. It is a neglected tropical disease, as evidenced by the ongoing scientific evidence gaps, the difficulty of incorporating new diagnostic and treatment technologies into the market, and the public health failures to ensure timely access to diagnosis and treatment associated with the development of consistent surveillance and control actions. As a result, there is a high burden of morbidity and mortality, and poor quality of life, poverty, stigma, as well as the fear of death persist for the affected people.

In line with the 72nd World Health Assembly, which approved the designation of 14th April as World Chagas Disease Day, this Special Thematic Issue aims to contribute to greater information dissemination and awareness about Chagas disease. This Special Issue shall focus inter alia on critical-reflective and innovative analyses of the epidemiology of Chagas diseases in endemic and non-endemic areas, Trypanosoma cruzi transmission dynamics, the role of sylvatic and domestic reservoirs, new surveillance and control strategies, advances in the diagnosis and treatment of T. cruzi infection, T. cruzi diversity and the natural history of Chagas disease, the management of clinical complications, predictors of disease progression, and physical and psychosocial rehabilitation. Studies performing economic analyses, successful experiences implemented in the field, and approaches on social and human sciences are also welcome.

Prof. Dr. Jorg Heukelbach
Prof. Dr. Alberto Novaes Ramos Jr.
Prof. Dr. Andrea Silvestre de Sousa
Guest Editors

Manuscript Submission Information

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Keywords

  • Chagas disease
  • American Trypanosomiasis
  • Trypanosoma cruzi infection
  • Neglected tropical disease
  • Public health
  • Epidemiology
  • Prevention and control
  • Surveillance
  • Clinical research
  • Social science

Published Papers (15 papers)

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Editorial

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Editorial
New Contributions to the Elimination of Chagas Disease as a Public Health Problem: Towards the Sustainable Development Goals by 2030
Trop. Med. Infect. Dis. 2021, 6(1), 23; https://doi.org/10.3390/tropicalmed6010023 - 11 Feb 2021
Cited by 1 | Viewed by 2068
Abstract
Despite being described for the first time more than 110 years ago, Chagas disease persists as one of the most neglected tropical diseases [...] Full article
(This article belongs to the Special Issue Chagas Disease)
Editorial
The 14th of April, Past and Present
Trop. Med. Infect. Dis. 2020, 5(2), 100; https://doi.org/10.3390/tropicalmed5020100 - 18 Jun 2020
Cited by 2 | Viewed by 1516
Abstract
In May 2019, the World Health Organization established the “World Chagas Disease Day”, to be celebrated on the 14th of April [...] Full article
(This article belongs to the Special Issue Chagas Disease)

Research

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Article
The Cost of Lost Productivity Due to Premature Chagas Disease-Related Mortality: Lessons from Colombia (2010–2017)
Trop. Med. Infect. Dis. 2021, 6(1), 17; https://doi.org/10.3390/tropicalmed6010017 - 27 Jan 2021
Cited by 6 | Viewed by 1931
Abstract
Background: Economic burden due to premature mortality has a negative impact not only in health systems but also in wider society. The aim of this study was to estimate the potential years of work lost (PYWL) and the productivity costs of premature mortality [...] Read more.
Background: Economic burden due to premature mortality has a negative impact not only in health systems but also in wider society. The aim of this study was to estimate the potential years of work lost (PYWL) and the productivity costs of premature mortality due to Chagas disease in Colombia from 2010 to 2017. Methods: National data on mortality (underlying cause of death) were obtained from the National Administrative Department of Statistics in Colombia between 2010 and 2017, in which Chagas disease was mentioned on the death certificate as an underlying or associated cause of death. Chagas disease as a cause of death corresponded to category B57 (Chagas disease) including all subcategories (B57.0 to B57.5), according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The electronic database contains the number of deaths from all causes by sex and 5-year age group. Economic data, including wages, unemployment rates, labor force participation rates and gross domestic product, were derived from the Bank of the Republic of Colombia. The human capital approach was applied to estimate both the PYWL and present value of lifetime income lost due to premature deaths. A discount rate of 3% was applied and results are presented in 2017 US dollars (USD). Results: There were 1261 deaths in the study, of which, 60% occurred in males. Premature deaths from Chagas resulted in 48,621 PYWL and a cost of USD 29 million in the present value of lifetime income forgone. Conclusion: The productivity costs of premature mortality due to Chagas disease are significant. These results provide an economic measure of the Chagas burden which can help policy makers allocate resources to continue with early detection programs. Full article
(This article belongs to the Special Issue Chagas Disease)
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Article
Clinical, Cardiological and Serologic Follow-Up of Chagas Disease in Children and Adolescents from the Amazon Region, Brazil: Longitudinal Study
Trop. Med. Infect. Dis. 2020, 5(3), 139; https://doi.org/10.3390/tropicalmed5030139 - 31 Aug 2020
Cited by 3 | Viewed by 1762
Abstract
Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is [...] Read more.
Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is still unknown. The authors aim to describe the clinical and epidemiologic profile of children and adolescents with CD, as well as treatment and cardiac involvement during the follow-up. Methods: A descriptive cohort study was conducted from 1998 to 2013 among children and adolescents up to 18 years-old with confirmed diagnosis of CD. All participants met the criteria of CD in the acute phase. Results: A total of 126 outpatients were included and received treatment and follow-up examinations during a medium period of 10.9 years/person. Most of them (68.3%) had their diagnosis established during oral transmission outbreaks. The diagnostic method with the most positive results rate (80.9%) was the IgM class anti-T. cruzi antibody test as an acute phase marker, followed by the thick blood smears (60.8%). Acute myopericarditis was demonstrated in 18.2% of the patients, most of them with favorable evolution, though 2.4% (3/126) persisted with cardiac injury observed at the end point of the follow-up. Conclusions: Antibodies against T. cruzi persisted in 54.8% of sera from the patients without prognostic correlation with cardiac involvement. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility. Full article
(This article belongs to the Special Issue Chagas Disease)
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Article
Benznidazole as Prophylaxis for Chagas Disease Infection Reactivation in Heart Transplant Patients: A Case Series in Brazil
Trop. Med. Infect. Dis. 2020, 5(3), 132; https://doi.org/10.3390/tropicalmed5030132 - 18 Aug 2020
Cited by 4 | Viewed by 1720
Abstract
Background—Patients with Chagas cardiomyopathy (CC) have high mortality, and CC is a common indication for heart transplantation (HTx) in endemic countries. Chagas disease reactivation (CDR) is common after transplantation and is likely to cause adverse outcomes unless detected and treated appropriately. This study [...] Read more.
Background—Patients with Chagas cardiomyopathy (CC) have high mortality, and CC is a common indication for heart transplantation (HTx) in endemic countries. Chagas disease reactivation (CDR) is common after transplantation and is likely to cause adverse outcomes unless detected and treated appropriately. This study reviews our experiences with HTx among patients with CC, and the use of benznidazole (BZ) before transplantation. Methods—During the 18-year period from 1996 through 2014, 70 of 353 patients who underwent HTx (19.8%) had CC, and 53 patients met the inclusion criteria. The effectiveness of prophylactic treatment with BZ (dose of 5 mg/kg/day, two times per day, for at least four weeks and for a maximum of eight weeks) was determined based on the observed reduction in the incidence of CDR during the post-HTx period. Results—Prophylactic therapy was administered to 18/53 patients (34.0%). During the follow-up period, the incidence rate of CDR in our study was 34.0% (18/53). Based on logistic regression analysis, only prophylaxis (OR = 0.12; CI 0.02–0.76; p = 0.025) was considered to protect against CDR. Conclusion—Our study suggests that the use of BZ may reduce the incidence of CDR in patients undergoing HTx and warrants further investigation in a prospective, randomized trial. Full article
(This article belongs to the Special Issue Chagas Disease)
Article
Mandatory Notification of Chronic Chagas Disease: Confronting the Epidemiological Silence in the State of Goiás, Brazil
Trop. Med. Infect. Dis. 2020, 5(2), 92; https://doi.org/10.3390/tropicalmed5020092 - 05 Jun 2020
Cited by 2 | Viewed by 2444
Abstract
Objectives: This paper presents the results of the design and implementation process for the policy of compulsory notification of chronic Chagas disease in the Brazilian state of Goiás (Resolution No. 004/2013-GAB/SES-GO). Methods: The narrative was based on information provided by key actors that [...] Read more.
Objectives: This paper presents the results of the design and implementation process for the policy of compulsory notification of chronic Chagas disease in the Brazilian state of Goiás (Resolution No. 004/2013-GAB/SES-GO). Methods: The narrative was based on information provided by key actors that were part of the different stages of the process, built on contextual axes based on participants’ reflections about the establishment of the most accurate and coherent notification mechanisms. Results: The notification policy addressed the absence of historical data from patients in the state Chagas program, an increase in cases identified through serology, and weaknesses in vector control. Two key challenges involved human resources capacity and dissemination to public agencies and health care workers. Effective training and communication processes were key ingredients for successful implementation. Conclusions: The lack of public health measures aimed at the epidemiological surveillance of chronic Chagas cases constitutes a significant barrier for patients to access appropriate diagnosis, management and follow-up, and hampers the planning of necessary activities within health systems. The implementation of the notification policy in Goiás allows authorities to determine the real magnitude of Chagas disease in the population, so that an appropriate public health response can be mounted to meet the needs of affected people, thereby ending the epidemiological silence of Chagas disease. Full article
(This article belongs to the Special Issue Chagas Disease)
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Article
Funding for Chagas Disease: A 10-Year (2009–2018) Survey
Trop. Med. Infect. Dis. 2020, 5(2), 88; https://doi.org/10.3390/tropicalmed5020088 - 01 Jun 2020
Cited by 8 | Viewed by 2274
Abstract
Chagas disease was discovered in 1909 by the Brazilian scientist Carlos Chagas. After more than 110 years, many outcomes have been achieved in all research fields; however, Chagas disease remains a serious public health problem, mainly in Latin America, being one of the [...] Read more.
Chagas disease was discovered in 1909 by the Brazilian scientist Carlos Chagas. After more than 110 years, many outcomes have been achieved in all research fields; however, Chagas disease remains a serious public health problem, mainly in Latin America, being one of the most neglected tropical diseases in the world. As a neglected disease, it receives very little financial support. Nevertheless, how much is actually spent? With this question in mind, the goal of the present work was to summarize all funding employed by multiple institutions in the Chagas disease field in a 10-year survey. From 2009 to 2018, Chagas disease received only USD 236.31 million, representing 0.67% of the total applied for all neglected diseases in this period. Mostly, the investments are concentrated in basic research (47%) and drug development (42.5%), with the public sector responsible for 74% of all funding, followed by the industry (19%) and philanthropy (7%). Relevantly, NIH (USA) alone accounted for more than half of the total investment. Taking into account that Chagas disease has a great socio-economic impact, it is clear that more investments are needed, especially from endemic countries. Furthermore, coordinated strategies to make better use of resources and incentives for the pharmaceutical industry must be adopted. Full article
(This article belongs to the Special Issue Chagas Disease)
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Article
Elucidating the Mechanism of Trypanosoma cruzi Acquisition by Triatomine Insects: Evidence from a Large Field Survey of Triatoma infestans
Trop. Med. Infect. Dis. 2020, 5(2), 87; https://doi.org/10.3390/tropicalmed5020087 - 01 Jun 2020
Cited by 1 | Viewed by 1886
Abstract
Blood-sucking triatomine bugs transmit the protozoan parasite Trypanosoma cruzi, the etiologic agent of Chagas disease. We measured the prevalence of T. cruzi infection in 58,519 Triatoma infestans captured in residences in and near Arequipa, Peru. Among bugs from infected colonies, T. cruzi [...] Read more.
Blood-sucking triatomine bugs transmit the protozoan parasite Trypanosoma cruzi, the etiologic agent of Chagas disease. We measured the prevalence of T. cruzi infection in 58,519 Triatoma infestans captured in residences in and near Arequipa, Peru. Among bugs from infected colonies, T. cruzi prevalence increased with stage from 12% in second instars to 36% in adults. Regression models demonstrated that the probability of parasite acquisition was roughly the same for each developmental stage. Prevalence increased by 5.9% with each additional stage. We postulate that the probability of acquiring the parasite may be related to the number of feeding events. Transmission of the parasite does not appear to be correlated with the amount of blood ingested during feeding. Similarly, other hypothesized transmission routes such as coprophagy fail to explain the observed pattern of prevalence. Our results could have implications for the feasibility of late-acting control strategies that preferentially kill older insects. Full article
(This article belongs to the Special Issue Chagas Disease)
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Article
Progression Rate from the Indeterminate Form to the Cardiac Form in Patients with Chronic Chagas Disease: Twenty-Two-Year Follow-Up in a Brazilian Urban Cohort
Trop. Med. Infect. Dis. 2020, 5(2), 76; https://doi.org/10.3390/tropicalmed5020076 - 12 May 2020
Cited by 12 | Viewed by 1902
Abstract
Most patients with chronic Chagas disease (CD) present the indeterminate form and are at risk to develop the cardiac form. However, the actual rate of progression to the cardiac form is still unknown. Methods: In total, 550 patients with the indeterminate CD form [...] Read more.
Most patients with chronic Chagas disease (CD) present the indeterminate form and are at risk to develop the cardiac form. However, the actual rate of progression to the cardiac form is still unknown. Methods: In total, 550 patients with the indeterminate CD form were followed by means of annual electrocardiogram at our outpatient clinic. The studied endpoint was progression to cardiac form defined by the appearance of electrocardiographic changes typical of CD. The progression rate was calculated as the cumulative progression rate and the incidence progression rate per 100 patient years. Results: Thirty-seven patients progressed to the CD cardiac form within a mean of 73 ± 48 months of follow-up, which resulted in a 6.9% cumulative progression rate and incidence rate of 1.48 cases/100 patient years. Patients who progressed were older (mean age 47.8 ± 12.2 years), had a higher prevalence of associated heart diseases (p < 0.0001), positive xenodiagnosis (p = 0.007), and were born in the most endemic Brazilian states (p = 0.018). Previous co-morbidities remained the only variable associated with CD progression after multivariate Cox proportional hazards regression analysis (p = 0.002). Conclusion: The progression rate to chronic CD cardiac form is low and inferior to rates previously reported in other studies. Full article
(This article belongs to the Special Issue Chagas Disease)
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Article
Chagas Disease and Healthcare Rights in the Bolivian Immigrant Community of São Paulo, Brazil
Trop. Med. Infect. Dis. 2020, 5(2), 62; https://doi.org/10.3390/tropicalmed5020062 - 17 Apr 2020
Cited by 3 | Viewed by 2561
Abstract
Chagas disease (CD) poses a major public health challenge for the Americas and non endemic regions around the world. This study discusses the legal framework surrounding access to healthcare for CD for Bolivian migrants living in São Paulo, Brazil. While recent guidelines stipulating [...] Read more.
Chagas disease (CD) poses a major public health challenge for the Americas and non endemic regions around the world. This study discusses the legal framework surrounding access to healthcare for CD for Bolivian migrants living in São Paulo, Brazil. While recent guidelines stipulating care for CD exist, there is a lack of legal provisions to ensure they are regularly implemented. Bolivian migrants in SP have specific needs, including language differences and a high level of mobility. Interviews were conducted with ten participants representing public health institutions or organizations working with the Bolivian migrant community. Additionally, a review was conducted of legal, official, and health policy documents pertaining to rights of Bolivian migrants in SP. Although the right to healthcare is constitutionally guaranteed for all, in practice, immigrants, especially those without documentation, encounter barriers to initiating treatment for CD. Providing the primary health care system (SUS) card would not only improve access to healthcare for Bolivian migrants, but also provide a potential pathway toward regularization of status. The approval of clinical protocols and therapeutic guidelines for CD (2018) represents an opportunity to improve care for all Brazilians with CD. Programs with multidisciplinary teams should be developed taking into account the specific social and cultural needs of this population. Full article
(This article belongs to the Special Issue Chagas Disease)

Review

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Review
Trypanosoma cruzi Genome 15 Years Later: What Has Been Accomplished?
Trop. Med. Infect. Dis. 2020, 5(3), 129; https://doi.org/10.3390/tropicalmed5030129 - 06 Aug 2020
Cited by 6 | Viewed by 2195
Abstract
On 15 July 2020 was the 15th anniversary of the Science Magazine issue that reported three trypanosomatid genomes, namely Leishmania major, Trypanosoma brucei, and Trypanosoma cruzi. That publication was a milestone for the research community working with trypanosomatids, even more [...] Read more.
On 15 July 2020 was the 15th anniversary of the Science Magazine issue that reported three trypanosomatid genomes, namely Leishmania major, Trypanosoma brucei, and Trypanosoma cruzi. That publication was a milestone for the research community working with trypanosomatids, even more so, when considering that the first draft of the human genome was published only four years earlier after 15 years of research. Although nowadays, genome sequencing has become commonplace, the work done by researchers before that publication represented a huge challenge and a good example of international cooperation. Research in neglected diseases often faces obstacles, not only because of the unique characteristics of each biological model but also due to the lower funds the research projects receive. In the case of Trypanosoma cruzi the etiologic agent of Chagas disease, the first genome draft published in 2005 was not complete, and even after the implementation of more advanced sequencing strategies, to this date no final chromosomal map is available. However, the first genome draft enabled researchers to pick genes a la carte, produce proteins in vitro for immunological studies, and predict drug targets for the treatment of the disease or to be used in PCR diagnostic protocols. Besides, the analysis of the T. cruzi genome is revealing unique features about its organization and dynamics. In this work, I briefly summarize the actions of Latin American researchers that contributed to the first publication of the T. cruzi genome and discuss some features of the genome that may help to understand the parasite’s robustness and adaptive capabilities. Full article
(This article belongs to the Special Issue Chagas Disease)
Review
Chagas Disease Infection Reactivation after Heart Transplant
Trop. Med. Infect. Dis. 2020, 5(3), 106; https://doi.org/10.3390/tropicalmed5030106 - 29 Jun 2020
Cited by 6 | Viewed by 2546
Abstract
Chagas disease, caused by a Trypanosona cruzi infection, is one of the main causes of heart failure in Latin America. It was originally a health problem endemic to South America, predominantly affecting residents of poor rural areas. With globalization and increasing migratory flows [...] Read more.
Chagas disease, caused by a Trypanosona cruzi infection, is one of the main causes of heart failure in Latin America. It was originally a health problem endemic to South America, predominantly affecting residents of poor rural areas. With globalization and increasing migratory flows from these areas to large cities, the immigration of T. cruzi chronically-infected people to developed, non-endemic countries has occurred. This issue has emerged as an important consideration for heart transplant professionals. Currently, Chagas patients with end-stage heart failure may need a heart transplantation (HTx). This implies that in post-transplant immunosuppression therapy to avoid rejection in the recipient, there is the possibility of T. cruzi infection reactivation, increasing the morbidity and mortality rates. The management of heart transplant recipients due to Chagas disease requires awareness for early recognition and parasitic treatment of T. cruzi infection reactivation. This issue poses challenges for heart transplant professionals, especially regarding the differential diagnosis between rejection and reactivation episodes. The aim of this review is to discuss the complexity of the Chagas disease reactivation phenomenon in patients submitted to HTx for end-stage chagasic cardiomyopathy. Full article
(This article belongs to the Special Issue Chagas Disease)
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Review
New Imaging Parameters to Predict Sudden Cardiac Death in Chagas Disease
Trop. Med. Infect. Dis. 2020, 5(2), 74; https://doi.org/10.3390/tropicalmed5020074 - 08 May 2020
Cited by 2 | Viewed by 2349
Abstract
Chronic Chagas’ cardiomyopathy is the most severe and frequent manifestation of Chagas disease, and has a high social and economic burden. New imaging modalities, such as strain echocardiography, nuclear medicine, computed tomography and cardiac magnetic resonance imaging, may detect the presence of myocardial [...] Read more.
Chronic Chagas’ cardiomyopathy is the most severe and frequent manifestation of Chagas disease, and has a high social and economic burden. New imaging modalities, such as strain echocardiography, nuclear medicine, computed tomography and cardiac magnetic resonance imaging, may detect the presence of myocardial fibrosis, inflammation or sympathetic denervation, three conditions associated with risk of sudden death, providing additional diagnostic and/or prognostic information. Unfortunately, despite its high mortality, there is no clear recommendation for early cardioverter-defibrillator implantation in patients with Chagas heart disease in the current guidelines. Ideally, the risk of sudden cardiac death may be evaluated in earlier stages of the disease using new image methods to allow the implementation of primary preventive strategies. Full article
(This article belongs to the Special Issue Chagas Disease)
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Other

Opinion
Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease
Trop. Med. Infect. Dis. 2020, 5(2), 82; https://doi.org/10.3390/tropicalmed5020082 - 26 May 2020
Cited by 4 | Viewed by 1535
Abstract
Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic [...] Read more.
Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Despite its importance, the actual incidence of cardioembolic ischemic stroke in Chagas disease is not completely known. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC-FIOCRUZ) score aims to propose prophylaxis strategies against cardioembolic ischemic stroke in Chagas disease based on clinical risk–benefit. To date, the IPEC-FIOCRUZ score is considered the best tool to identify patients for stroke prophylaxis in Chagas disease according the Latin American guideline and Brazilian consensus. It can prevent many cardioembolic strokes that would not be predicted, by applying the current recommendations to other cardiopathies. However, the IPEC-FIOCRUZ score still requires external validation to be used in different Chagas disease populations with an appropriate study design. Full article
(This article belongs to the Special Issue Chagas Disease)
Case Report
Effects of Meglumine Antimoniate Treatment on Cytokine Production in a Patient with Mucosal Leishmaniasis and Chagas Diseases Co-Infection
Trop. Med. Infect. Dis. 2020, 5(2), 69; https://doi.org/10.3390/tropicalmed5020069 - 02 May 2020
Cited by 2 | Viewed by 2200
Abstract
The influence of antimoniate treatment on specific anti-protozoan T-cell responses was evaluated in a 48-year-old male patient diagnosed with mucosal leishmaniasis and Chagas disease infection. Before and after treatment, PBMC (peripheral blood mononuclear cells) were cultured in the absence or presence of Leishmania [...] Read more.
The influence of antimoniate treatment on specific anti-protozoan T-cell responses was evaluated in a 48-year-old male patient diagnosed with mucosal leishmaniasis and Chagas disease infection. Before and after treatment, PBMC (peripheral blood mononuclear cells) were cultured in the absence or presence of Leishmania braziliensis or Trypanosoma cruzi live parasites, their soluble antigens, or PHA (phytohaemagglutinin). Cytokines were measured and Treg (T regulatory) cell percentages were quantified. Before treatment, PBMC were able to produce higher amounts of TNF-α, IL-6 (Interleukin-6), and IL-10 (Interleukin-10) but lower amounts of IL-12 (Interleukin-12) in response to culture stimulation. However, after treatment, there was a down-modulation of TNF-α, IL-6, and IL-10 cytokines but an up-modulation in IL-12 production. PBMC had the ability to produce TNF-α only against live parasites or PHA. There was an overall decrease of circulating Treg cells after treatment. In mixed Leishmaniasis and Chagas disease infection, treatment with antimoniate could modulate immune responses toward a more protective profile to both diseases. Full article
(This article belongs to the Special Issue Chagas Disease)
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