Trypanosoma cruzi Detection in Colombian Patients with a Diagnosis of Esophageal Achalasia.

Santiago Panesso-Gómez,John M González,Paula Pavia,Paola Lasso,Concepción J Puerta,Iván Enrique Rodríguez-Mantilla,Luis A Orozco,Belén Mendoza De Molano,Adriana Cuellar

doi:10.4269/ajtmh.17-0417

Abstract

.Achalasia is a motility disorder of the esophagus that might be secondary to a chronic Trypanosoma cruzi infection. Several studies have investigated esophageal achalasia in patients with Chagas disease (CD) in Latin America, but no related studies have been performed in Colombia. The goals of the present study were to determine the presence of anti-T. cruzi antibodies in patients with esophageal achalasia who visited a referral hospital in Bogotá, Colombia, and to detect the presence of the parasite and its discrete typing units (DTUs). This cross-sectional study was conducted in adult patients (18–65 years old) who were previously diagnosed with esophageal achalasia and from whom blood was drawn to assess antibodies against T. cruzi using four different serological tests. Trypanosoma cruzi DNA was detected by conventional polymerase chain reaction (cPCR) and quantitative polymerase chain reaction (qPCR). In total, 38 patients, with an average age of 46.6 years (standard deviation of ±16.2) and comprising 16 men and 22 women, were enrolled. Five (13.15%) patients were found to be positive for anti-T. cruzi antibodies by indirect immunofluorescence assay (IFA), and two patients who were negative according to IFA were reactive by both enzyme-linked immunosorbent assay and immunoblot (5.3%). Parasite DNA was detected in two of these seven patients by cPCR and in one of these by qPCR. The parasite DTU obtained was TcI. In summary, this study identified T. cruzi in Colombian patients with esophageal achalasia, indicating that digestive compromise could also be present in patients with chronic CD.

Highlights

Chagas disease (CD), which is caused by the intracellular protozoan Trypanosoma cruzi, is a major endemic parasitic infection in Latin America
Studies of patients with chronic CD have focused on cardiomyopathy, which is the most common complication observed during chronic infection because of its high mortality and socioeconomic impact.[33]
Several studies from Brazil[9,10] and from immigrant populations in Spain and Italy[11,12,13] have examined the gastrointestinal complications of chronic T. cruzi infection. Most of these studies were conducted in patients who had been previously diagnosed with CD and were later examined for symptoms or signs of digestive compromise

Summary

Introduction

Chagas disease (CD), which is caused by the intracellular protozoan Trypanosoma cruzi, is a major endemic parasitic infection in Latin America. In Colombia, it is estimated that 437,960 individuals are infected and that nearly 11% of the population is at risk of contracting the disease. A recent study indicated that only 1.2% of this population has screening coverage.[1] the vector transmission of the parasite is confined to the Latin American continent and certain regions of North America, human migration has spread congenital and transfusion infections to Europe and Asia. Certain studies have attempted to associate a parasite’s DTU with tissue tropism and clinical presentation, these associations are not completely understood.[5]

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