• Amazonia
• Chiroptera
• Epidemiological surveillance
• Marajó
• Vampire bats
• Zoonosis

• Chiroptera/virology
• Animals
• Brazil/epidemiology
• Rabies virus/immunology
• Rabies virus/isolation & purification
• Rabies virus/classification
• Rabies/epidemiology
• Rabies/veterinary
• Rabies/virology
• Humans
• Zoonoses/epidemiology
• Zoonoses/virology
• Disease Outbreaks
• Antibodies, Viral/blood
• Female
• Male
• Adult
• Middle Aged
• Adolescent

Chagas disease, one of the most important neglected tropical diseases in the countries of Latin America, is considered to be a particularly important public health concern in the Amazon region due to increases in the number of outbreaks of acute Chagas disease and increased local transmission in the last 20 years. However, relative to other countries, in Bolivia there is little information available on its transmission in the Amazon region. The aim of this study was to investigate the infestation of palm trees, the main habitat of Triatominae in the region, in several localities, to evaluate the danger they represent to inhabitants.

Triatominae were collected using live bait traps left overnight in six localities in Pando and Beni Departments, Bolivia. DNA extraction and sequencing were used to establish the Triatominae species (Cytb, 16S and 28S-D2 gene fragments), and the blood meal sources (Cytb fragment). Trypanosoma sp. infection was analyzed by sequencing gene fragments (GPX, GPI, HMCOAR, LAP, PDH and COII) or by mini-exon multiplex PCR.

A total of 325 Rhodnius were captured (97.3% of nymphs) from the 1200 traps placed in 238 palm trees and 32 burrows/ground holes. Sequence analyses on DNA extracted from 114 insects and phylogeny analysis identified two triatomine species: Rhodnius stali (17%) and Rhodnius montenegrensis (equated to Rhodnius robustus II, 83%). These were found in palm trees of the genera Attalea (69%), Astrocaryum (13%), Copernicia (12%), Euterpe (2%) and Acrocomia (1%). The infection rate was around 30% (165 analyzed insects), with 90% of analyzed insects infected by Trypanosoma cruzi (only the TcI discrete typing unit was detected), 3% infected by Trypanosoma rangeli (first time found in Bolivian Triatominae) and 7% infected by mixed T. cruzi (TcI)-T. rangeli. Rhodnius specimens fed on Didelphidae, rodents, gecko and humans.

The results of this study highlight the epidemiological importance of Rhodnius in the Bolivian Amazon region. The huge geographical distribution of Rhodnius and their proximity to the human dwellings, high infection rate and frequent meals on the human population highlight a risk of transmission of Chagas disease in the region.

The online version contains supplementary material available at 10.1186/s13071-022-05423-3.

Chagas disease (CD) still imposes a heavy burden on most Latin American countries. Vector-borne and mother-to-child transmission cause several thousand new infections per year, and at least 5 million people carry Trypanosoma cruzi. Access to diagnosis and medical care, however, is far from universal. Starting in the 1990s, CD-endemic countries and the Pan American Health Organization-World Health Organization (PAHO-WHO) launched a series of multinational initiatives for CD control-surveillance. An overview of the initiatives’ aims, achievements, and challenges reveals some key common themes that we discuss here in the context of the WHO 2030 goals for CD. Transmission of T. cruzi via blood transfusion and organ transplantation is effectively under control. T. cruzi, however, is a zoonotic pathogen with 100+ vector species widely spread across the Americas; interrupting vector-borne transmission seems therefore unfeasible. Stronger surveillance systems are, and will continue to be, needed to monitor and control CD. Prevention of vertical transmission demands boosting current efforts to screen pregnant and childbearing-aged women. Finally, integral patient care is a critical unmet need in most countries. The decades-long experience of the initiatives, in sum, hints at the practical impossibility of interrupting vector-borne T. cruzi transmission in the Americas. The concept of disease control seems to provide a more realistic description of what can in effect be achieved by 2030.

Among the 18 genera of the Triatominae subfamily, three stand out for their diversity and epidemiological importance: Triatoma, Panstrongylus, and Rhodnius. Rhodnius includes 21 species that can transmit Trypanosoma cruzi (the etiological agent of Chagas disease, also known as American trypanosomiasis) and Trypanosoma rangeli. The Rhodnius prolixus complex comprises seven species, including Rhodnius marabaensis, Rhodnius prolixus, and Rhodnius robustus, which occur in the northern region of Brazil. Since both adults and immatures can carry T. cruzi, in this study the five nymphal instars of the three species mentioned were dorsally characterized.

Using microscopy, morphometrics, and geometric morphometrics, the present work measures and describes the morphological characters of the five nymphal instars of R. marabaensis, R. prolixus, and R. robustus.

The study enabled the characterization of all five nymphal instars, as well as the distinction between the three species in each of their instars.

The morphological, morphometrics of the head, thorax, and abdomen and geometric morphometrics studies of the head enabled the specific distinction of these three species in all five instars.

The online version contains supplementary material available at 10.1186/s13071-022-05200-2.

• Chagas disease
• Rhodniini
• Rhodnius
• Triatomines
• Vector

Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi. CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.

• Chagas disease
• Diagnosis
• Treatment
• Heart failure
• Arrhythmia
• Stroke

• Adult
• Antiprotozoal Agents/administration & dosage
• Brazil/epidemiology
• Chagas Disease/complications
• Chagas Disease/drug therapy
• Chagas Disease/epidemiology
• Chagas Disease/parasitology
• Chronic Disease/epidemiology
• Chronic Disease/therapy
• Digestive System Diseases/epidemiology
• Digestive System Diseases/etiology
• Digestive System Diseases/mortality
• Female
• Heart Diseases/epidemiology
• Heart Diseases/etiology
• Heart Diseases/mortality
• Humans
• Male
• Middle Aged
• Nitroimidazoles/administration & dosage
• Retrospective Studies
• Trypanosoma cruzi/drug effects
• Trypanosoma cruzi/physiology

• Animals
• Chagas Disease/parasitology
• Ecosystem
• Insect Vectors/parasitology
• Rhodnius/pathogenicity
• Trypanosoma cruzi/pathogenicity

• MCTI/CNPq/MS-SCTIE – Decit, Brazil
• Instituto Evandro Chagas, Brazil
• CAPES, Brazil

• Brazil
• Chagas disease
• contingent valuation
• vaccine
• willingness to pay

• parasite evolution
• infectious-disease diagnostics

• Chromatography, High Pressure Liquid
• Evolution, Molecular
• Gene Expression Regulation
• Phylogeny
• Proteome
• Proteomics
• Protozoan Proteins/genetics
• Protozoan Proteins/metabolism
• Tandem Mass Spectrometry
• Trypanosoma cruzi/genetics
• Trypanosoma cruzi/metabolism

• Fundação de Amparo à Pesquisa do Estado de São Paulo (São Paulo Research Foundation)

• Benznidazole
• Chagas disease
• Trypanosoma cruzi.
• chemotherapy
• drug design
• synthesis

• molecular neuroscience
• depression

• Animals
• Chagas Disease
• Depressive Disorder, Major
• Humans
• Mice
• Oxidation-Reduction
• Oxidative Stress
• Trypanosoma cruzi

• the Brazilian National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM; #465489/2014-1); FOCEM/Mercosur (Grant 003/2011)

• CD8+ lymphocytes
• Trypanosoma cruzi
• host genetic background
• inbred mice
• intragastric infection
• proinflammatory cytokines

• Animals
• Chagas Disease/genetics
• Chagas Disease/immunology
• Chagas Disease/parasitology
• Chagas Disease/pathology
• Cytokines/immunology
• Female
• Heart/parasitology
• Liver/parasitology
• Liver/pathology
• Mice, Inbred Strains
• Myocardium/pathology
• Parasite Load
• Parasitemia/genetics
• Parasitemia/immunology
• Parasitemia/pathology
• Species Specificity
• Stomach/parasitology
• Stomach/pathology

Our case report describes the youngest clinical acute Chagas disease case and their unusual disease presentation of cardiac failure. In parts of the Brazilian Amazon, cultural practices include weaning infants from breastmilk to solid foods with açaí consumption serving as an intermediary. This practice could place infants at an increased risk of oral Trypanosoma cruzi infection and severe Chagasic cardiac disease.

Oral infection by Trypanosoma cruzi is currently the most important route of transmission of acute Chagas disease (ACD) in the North region of Brazil, and the reported outbreaks are usually related to ingestion of contaminated food, especially unprocessed açaí pulp.

A retrospective cohort study was performed to analyze the epidemiological profile of individuals with suspected cases of ACD in the municipality of Breves, located in the state of Pará, Brazil. Therefore, notifications of suspected cases of ACD were collected from the Municipal Health Department of Breves from January 2007 to December 2017.

A total of 265 individuals were registered, and the majority were male (54.7%; 145/265). Age ranged from nine months to 79 years, with a greater number of notifications for individuals aged between 1 and 39 years (71.3%; 189/265). Most of them had a low level of education (74.3%, 197/265), were living in rural and urban areas (58.9%; 156/265 and 37.7%; 100/265, respectively). Infection occurred mainly in the domestic environment (96.2%; 255/265) through oral transmission (98.1%; 260/265). There were a greater number of notifications in November, December and January.

These data showed that oral transmission of T. cruzi has become increasingly high in the study region, and health education programs need to be implemented as strategies to ensure good manufacturing practices of unprocessed food.

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.

• Chagas disease
• disease progression
• electrocardiogram
• heart disease

Oral transmission of Chagas disease has been increasing in Latin American countries. The present study aimed to investigate changes in hepatic function, coagulation factor levels and parasite load in human acute Chagas disease (ACD) secondary to oral Trypanosoma cruzi transmission. Clinical and epidemiological findings of 102 infected individuals attended in the State of Pará from October 2013 to February 2016 were included. The most common symptoms were fever (98%), asthenia (83.3%), face and limb edema (80.4%), headache (74.5%) and myalgia (72.5%). The hepatic enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of 30 ACD patients were higher compared with controls, and this increase was independent of the treatment with benznidazole. Moreover, ACD individuals had higher plasma levels of activated protein C and lower levels of factor VII of the coagulation cascade. Patients with the highest parasite load had also the most increased transaminase levels. Also, ALT and AST were associated moderately (r = 0.429) and strongly (r = 0.595) with parasite load respectively. In conclusion, the present study raises the possibility that a disturbance in coagulation and hepatic function may be linked to human ACD.

Chagas disease is caused by the haemoflagellate protozoan Trypanosoma cruzi. Currently, T. cruzi recognizes seven discrete typing units (DTUs): TcI to TcVI and Tcbat. The genetic diversity of T. cruzi is suspected to influence the clinical outcome. Acute clinical manifestations, which include myocarditis and meningoencephalitis, are sometimes fatal; occur most frequently in children and in immunocompromised individuals. Acute disease is often overlooked, leading to a poor prognosis.

A 38-year-old man from a subtropical area of the Andes mountains of Ecuador was hospitalized after 3 weeks of evolution with high fever, chills, an enlarged liver, spleen, and lymph nodes, as well as facial edema. ECG changes were also observed. T. cruzi was identified in blood smears, culture and amplification of DNA by PCR. Tests for anti-T. cruzi IgG and IgM and HIV were negative. Molecular typing by restriction fragment length polymorphism (PCR-RFLP) determined the parasite to DTU TcI. In the absence of a timely anti-T. cruzi medication, the patient died.

This is a case of severe pathogenicity and the virulence of a DTU TcI strain in an adult patient. The severe acute Chagas disease was probably overlooked due to limited awareness and its low incidence. Our findings suggest that T. cruzi DTU TcI strains circulating in Ecuador are capable of causing fatal acute disease. Early diagnosis and prompt treatment is of paramount importance to avoid fatalities in acute infections.

• DTU
• Ecuador
• Fatal acute Chagas disease
• TcI
• Trypanosoma cruzi

• Trypanosoma cruzi
• reservoirs
• spatial analysis
• transmission cycle
• trypanosomatids
• wild mammals

• Chagas disease
• Epidemiology
• Ischemic stroke

• Chagas disease
• coagulation
• cytokine
• interleukin-6
• oral transmission
• platelet

• T cell activation
• Trypanosoma cruzi
• immune response
• intragastric infection
• oral cavity