Probable outbreak of oral transmission of Chagas disease in Turbo, Antioquia
Keywords:
Trypanosoma cruzi, Chagas cardiomyopathy, Triatominae, Panstrongylus, reservoirs, marsupials, Colombia
Abstract
Introduction. Chagas' disease is endemic in 21 countries of South and Central America, including Colombia, where 700,000 to 1.2 million persons are infected and eight millions are at risk. In endemic areas, chronic cases are predominant. However, in recent years, increasing reports of acute oral transmission have appeared.Objective. An outbreak of acute Chagas' disease was verified in the municipality of Turbo (Antioquia), and the most probable cause of transmission was determined in order to establish prevention and control measures.
Materials and methods. A descriptive study was done. A search for information from local health authorities was conducted to uncover all case reports. Laboratory tests, risk factor analysis and search for vectors and reservoirs were undertaken in Turbo.
Results. Of the156 people evaluated, 11 cases of acute Chagas' disease were identified. Ten had significant titers of IgM and IgG antibodies against the Trypanosoma cruzi parasite by IFAT and Elisa tests; one fatal case was linked epidemiologically. In 3 cases, PCR was positive for T. cruzi, two of which displayed Chagas cardiomyopathy, and one with acute fever. Four cases required specialized health care for acute cardiomyopathy. All positive cases had a common source of food. One specimen of the triatomid vector species, Panstrongylus geniculatus, and one reservoir, the woolly opossum Caluromys lanatus, were collected; both were negative to T. cruzi.
Conclusions. An outbreak of acute Chagas' disease occurred in Turbo, Antioquia. The mode of transmission may have occurred by the ingestion of T. cruzi-contaminated food by infected triatomines or opossum feces.
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References
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5. Nattan-Larrier L. Infections à Trypanosomes et voies de penetrations dês virus. Bull Soc Pathol Exot. 1921;14:537-42.
6. Brumpt E. Precis de parasitologíe. Tome 1. Paris: Masson; 1931.
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9. Mazza S, Montana A, Benítez C, Juzin E. Transmisión del Schizotrypanum cruzi al niño por leche de madre con enfermedad de Chagas. MEPRA. 1936;28:41-6.
10. Mayer HF. Infección experimental con Trypanosoma cruzi por vía digestiva. An Inst Med Region (Corrientes). 1961;5:43-8.
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13. Cáceres D, Nicholls RS, Corredor A, Gualdrón L, Slait E, Dib J, et al. Investigación de un brote de síndrome febril con miocarditis aguda en Guamal, Magdalena, 7 a 11 de junio de 1999. Inf Quinc Epidemiol Nac. 1999;4:170-8.
14. Hernández LM, Ramírez A, Cucunubá Z, Zambrano P. Brote de Chagas agudo en Lebrija, Santander, 2008. Revista del Observatorio Salud Pública de Santander. 2009;4:28-36.
15. Ministerio de la Protección Social de Colombia. Primer brote de Chagas agudo en Aguachica, Cesar. Consultado: 30 de octubre de 2010. Disponible en: http://www.minproteccionsocial.gov.co/comunicadosPrensa/Paginas/ConfirmadoprimerbrotedechagasagudaenAguachica,Cesar.aspx
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23. Lent H, Wygodzinsky P. Revision of the Triatominae (Hemiptera, Reduviidae), and their significance as vectors of Chagas disease. Bull Am Mus Nat Hist. 1979;163:123-520.
24. Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz-Guevara R, Mauriello L, Zavala-Jaspe R. et al. Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis. 2010;201:1308-15.
25. Dias JP, Bastos C, Araújo E, Mascarenhas AV, Netto EM, Grassi F, et al. Acute Chagas disease outbreak associated with oral transmission. Rev Soc Bras Med Trop. 2008;41:296-300.
26. Bastos CJ, Aras R, Mota G, Reis F, Dias JP, de Jesus RS, et al. Clinical outcomes of thirteen patients with acute Chagas disease acquired through oral transmission from two urban outbreaks in Northeastern Brazil. PLoS Negl Trop Dis. 2010;4:e711.
27. Nóbrega AA, García MH, Tatto E, Obara MT, Costa E, Sobel J, et al. Oral transmission of Chagas disease by consumption of açaí palm fruit, Brazil. Emerg Infect Dis. 2009;15:653-5.
28. Organización Panamericana de la Salud, Unidad Regional de Prevención y Control de Enfermedades Transmisibles (DPC/CD/CHA), Grupo Técnico Especializado en Inocuidad de Alimentos (DPC/VP/FOS). Informe de la consulta técnica en epidemiología, prevención y manejo de la transmisión de la enfermedad de Chagas como enfermedad transmitida por alimentos (ETA). Rio de Janeiro: OPS; 2006. p. 46.
29. Pinto Dias J. Notas sobre o Trypanosoma cruzi e suas características bio-ecológicas, como agente de enfermidades transmitidas por alimentos. Rev Soc Bras Med Trop. 2006;39:370-5.
30. Pinto PL, Amato Neto V, Nascimento SA, Souza HB, Myamoto A, Moreira AA, et al. Observações sobre a viabilidade do Trypanosoma cruzi no caldo de cana. Rev Inst Med Trop Sao Paulo. 1990;32:325-7.
31. World Health Organ. Control of Chagas disease. Second report of the WHO Expert Committee. World Health Organ Tech Rep Ser. Geneve: WHO; 2002. p. 905. Consultado: 25 de marzo 2010. Disponible en: http://whqlibdoc.who.int/trs/WHO_TRS_905.pdf.
2. Moncayo A. Chagas disease: Current epidemiological trends after the interruption of vectorial and transfusional transmision in the southern cone countries. Mem Inst Oswaldo Cruz. 2003;98:577-91.
3. Galvão C, Carcavallo RU, Rocha DS, Jurberg J. A checklist of the current valid species of the subfamily Triatominae Jeannel, 1919 (Hemiptera, Reduviidae) and their geographical distribution, with nomenclatural and taxonomic notes. Zootaxa. 2003;202:1-36.
4. Storino R, Jörg M. Vías de infección y aspectos clínicos. En: Storino R, Milei J, editores. Enfermedad de Chagas. Buenos Aires: Ed. Mosby-Doyma de Argentina; 1994. p. 185-207.
5. Nattan-Larrier L. Infections à Trypanosomes et voies de penetrations dês virus. Bull Soc Pathol Exot. 1921;14:537-42.
6. Brumpt E. Precis de parasitologíe. Tome 1. Paris: Masson; 1931.
7. Kofoid CA, Donat F. Experimental infection with Trypanosoma cruzi from the intestine of cone-nose bug Triatoma protracta. Proc Soc Exp Biol Med. 1933;30:489-91.
8. Cardoso FA. Sur le mechanisme de la transmission de la maladie de Chagas. Annales de Parasitologíe Humaine. 1933:16:341-9.
9. Mazza S, Montana A, Benítez C, Juzin E. Transmisión del Schizotrypanum cruzi al niño por leche de madre con enfermedad de Chagas. MEPRA. 1936;28:41-6.
10. Mayer HF. Infección experimental con Trypanosoma cruzi por vía digestiva. An Inst Med Region (Corrientes). 1961;5:43-8.
11. Díaz-Ungría C. Transmission of Trypanosoma cruzi in mammals. Ann Parasitol Hum Comp. 1966;41:549-71.
12. Díaz-Ungría C, Zeuss M. Transmisión del Trypanosoma evansi y del Trypanosoma cruzi a partir de heces de animales infectados por vía bucal. Revista Veterinaria Venezolana. 1971;30:187.
13. Cáceres D, Nicholls RS, Corredor A, Gualdrón L, Slait E, Dib J, et al. Investigación de un brote de síndrome febril con miocarditis aguda en Guamal, Magdalena, 7 a 11 de junio de 1999. Inf Quinc Epidemiol Nac. 1999;4:170-8.
14. Hernández LM, Ramírez A, Cucunubá Z, Zambrano P. Brote de Chagas agudo en Lebrija, Santander, 2008. Revista del Observatorio Salud Pública de Santander. 2009;4:28-36.
15. Ministerio de la Protección Social de Colombia. Primer brote de Chagas agudo en Aguachica, Cesar. Consultado: 30 de octubre de 2010. Disponible en: http://www.minproteccionsocial.gov.co/comunicadosPrensa/Paginas/ConfirmadoprimerbrotedechagasagudaenAguachica,Cesar.aspx
16. Voller A, Bartlett A, Bidwell DE. Enzyme immunoassays for parasitic disease. Trans R Soc Trop Med Hyg. 1976;70:98-105.
17. Guhl F, Nicholls S. Manual de procedimientos para el diagnóstico de la enfermedad de Chagas. Bogotá D.C.: Quebecor impresores; 2001. p. 98.
18. Camargo ME. Fluorescent antibody test for the serodiagnosis of American tripanosomiasis. Technical modification employing preserved culture forms of Trypanosoma cruzi in a slide test. Rev Inst Med Trop Sao Paulo. 1966;8:227-34.
19. Sturm NR, Degrave W, Morel C, Simpson L. Sensitive detection and schizodeme classification of T. cruzi cells by amplification of kinetoplastid minicircle DNA sequences: Use in diagnosis of chagas disease. Mol Biochem Parasitol. 1989;33:205-14.
20. Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, et al. Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother. 2003;52:441-9.
21. Prata A. Tripanosomiasis americana. En: Goldsmith R, Heyneman D, editores. Parasitología y medicina tropical. 1ª edición. México, D.F.: El Manual Moderno; 1995. p. 346-48.
22. Feliciangeli D, Hernández M, Suárez B, Martínez C, Bravo A, Bracho J, et al. Comparación de métodos de captura intradoméstica de triatominos vectores de la enfermedad de Chagas en Venezuela. Bol Mal Salud Amb. 2007;47:103-17.
23. Lent H, Wygodzinsky P. Revision of the Triatominae (Hemiptera, Reduviidae), and their significance as vectors of Chagas disease. Bull Am Mus Nat Hist. 1979;163:123-520.
24. Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz-Guevara R, Mauriello L, Zavala-Jaspe R. et al. Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis. 2010;201:1308-15.
25. Dias JP, Bastos C, Araújo E, Mascarenhas AV, Netto EM, Grassi F, et al. Acute Chagas disease outbreak associated with oral transmission. Rev Soc Bras Med Trop. 2008;41:296-300.
26. Bastos CJ, Aras R, Mota G, Reis F, Dias JP, de Jesus RS, et al. Clinical outcomes of thirteen patients with acute Chagas disease acquired through oral transmission from two urban outbreaks in Northeastern Brazil. PLoS Negl Trop Dis. 2010;4:e711.
27. Nóbrega AA, García MH, Tatto E, Obara MT, Costa E, Sobel J, et al. Oral transmission of Chagas disease by consumption of açaí palm fruit, Brazil. Emerg Infect Dis. 2009;15:653-5.
28. Organización Panamericana de la Salud, Unidad Regional de Prevención y Control de Enfermedades Transmisibles (DPC/CD/CHA), Grupo Técnico Especializado en Inocuidad de Alimentos (DPC/VP/FOS). Informe de la consulta técnica en epidemiología, prevención y manejo de la transmisión de la enfermedad de Chagas como enfermedad transmitida por alimentos (ETA). Rio de Janeiro: OPS; 2006. p. 46.
29. Pinto Dias J. Notas sobre o Trypanosoma cruzi e suas características bio-ecológicas, como agente de enfermidades transmitidas por alimentos. Rev Soc Bras Med Trop. 2006;39:370-5.
30. Pinto PL, Amato Neto V, Nascimento SA, Souza HB, Myamoto A, Moreira AA, et al. Observações sobre a viabilidade do Trypanosoma cruzi no caldo de cana. Rev Inst Med Trop Sao Paulo. 1990;32:325-7.
31. World Health Organ. Control of Chagas disease. Second report of the WHO Expert Committee. World Health Organ Tech Rep Ser. Geneve: WHO; 2002. p. 905. Consultado: 25 de marzo 2010. Disponible en: http://whqlibdoc.who.int/trs/WHO_TRS_905.pdf.
How to Cite
1.
Ríos JF, Arboleda M, Montoya AN, Alarcón EP, Parra-Henao GJ. Probable outbreak of oral transmission of Chagas disease in Turbo, Antioquia. biomedica [Internet]. 2011 Mar. 7 [cited 2024 May 17];31(2):185-95. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/302
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