Abstract
BackgroundThe 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 FindingsThe 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/SignificanceThese 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”.
Highlights
Trypanosoma cruzi (Chagas 1909), the etiologic agent of Chagas disease [1], is a protozoan parasite included in the Trypanosomatidae family, order Trypanosomatida [2]
Conclusion/Significance: These findings show that cases of Chagas disease in the urban area of Belem may be derived from infected triatomines coming together with the acaı fruits from distant islands
After the interruption of Trypanosoma cruzi transmission by Triatoma infestans, a new epidemiological scenario emerged in Brazil: the oral route
Summary
Trypanosoma cruzi (Chagas 1909), the etiologic agent of Chagas disease [1], is a protozoan parasite included in the Trypanosomatidae family, order Trypanosomatida [2]. This successful parasite species is found from the southern United States to Argentinean Patagonia [3]. Trypanosomiasis due to T. cruzi is characterized as a complex zoonosis, transmitted by approximately 130 species of triatomines from the Reduviidae family (Hemiptera insects that are exclusively hematophagous at all life stages) and able to infect more than 150 species of wild and domestic mammals in 8 orders [4]. The capital of Parastate, reports the highest number of acute Chagas disease (ACD) cases associated with the consumption of acaı juice
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