Abstract
BackgroundOutbreaks of acute Chagas disease associated with oral transmission are easily detected nowadays with trained health personnel in areas of low endemicity, or in which the vector transmission has been interrupted. Given the biological and genetic diversity of Trypanosoma cruzi, the high morbidity, mortality, and the observed therapeutic failure, new characteristics of these outbreaks need to be addressed at different levels, both in Trypanosoma cruzi as in patient response. The aim of this work was to evaluate the patient’s features involved in six outbreaks of acute Chagas disease which occurred in Santander, Colombia, and the characteristics of Trypanosoma cruzi clones isolated from these patients, to establish the potential relationship between the etiologic agent features with host behavior.MethodsThe clinical, pathological and epidemiological aspects of outbreaks were analyzed. In addition, Trypanosoma cruzi clones were biologically characterized both in vitro and in vivo, and the susceptibility to the classical trypanocidal drugs nifurtimox and benznidazole was evaluated. Trypanosoma cruzi clones were genotyped by means of mini-exon intergenic spacer and cytochrome b genes sequencing.ResultsAll clones were DTU I, and based on the mini-exon intergenic spacer, belong to two genotypes: G2 related with sub-urban, and G11 with rural outbreaks. Girón outbreak clones with higher susceptibility to drugs presented G2 genotype and C/T transition in Cyt b. The outbreaks affected mainly young population (±25.9 years), and the mortality rate was 10 %. The cardiac tissue showed intense inflammatory infiltrate, myocardial necrosis and abundant amastigote nests. However, although the gastrointestinal tissue was congestive, no inflammation or parasites were observed.ConclusionsAlthough all clones belong to DTU I, two intra-DTU genotypes were found with the sequencing of the mini-exon intergenic spacer, however there is no strict correlation between genetic groups, the cycles of the parasite or the clinical forms of the disease. Trypanosoma cruzi clones from Girón with higher sensitivity to nifurtimox presented a particular G2 genotype and C/T transition in Cyt b. When the diagnosis was early, the patients responded well to antichagasic treatment, which highlights the importance of diagnosis and treatment early to prevent fatal outcomes associated with these acute episodes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-015-1218-2) contains supplementary material, which is available to authorized users.
Highlights
Outbreaks of acute Chagas disease associated with oral transmission are detected nowadays with trained health personnel in areas of low endemicity, or in which the vector transmission has been interrupted
In Colombia, similar to what happened in northeast Brazil and Venezuela, these factors would be related to the increased outbreak reports of acute Chagas disease (CD) probably associated with oral transmission by food contamination [29, 32]
It is the third department of Colombia with triatomine house infestation [39], most of the outbreaks occurred in towns of low endemicity in which there are no reports of domiciliated triatomines
Summary
Outbreaks of acute Chagas disease associated with oral transmission are detected nowadays with trained health personnel in areas of low endemicity, or in which the vector transmission has been interrupted. The aim of this work was to evaluate the patient’s features involved in six outbreaks of acute Chagas disease which occurred in Santander, Colombia, and the characteristics of Trypanosoma cruzi clones isolated from these patients, to establish the potential relationship between the etiologic agent features with host behavior. Chagas disease (CD) caused by Trypanosoma cruzi affects about 8 million people in Latin America [1]. CD has two clinical phases: acute phase is usually asymptomatic, and chronic phase in which about 10-30 % of infected patients develop symptoms [3], and 70 % could remain asymptomatic, (indeterminate form) [3]. The digestive forms of CD occur almost exclusively in Argentina, Brazil, Chile and Bolivia, they have been reported in Mexico, and Colombia [3,4,5]
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