Christian Olivo Freites1, Hendrik Sy2, Amal Gharamti3, Nelson I Agudelo Higuita4, Carlos Franco-Paredes5, José Antonio Suárez6, Andrés F Henao-Martínez7. 1. Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. 2. Internal Medicine Department, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Internal Medicine Department, Yale-Waterbury Hospital, Yale School of Medicine, New Haven, CT, USA. 4. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 5. Federico Gómez, Hospital Infantil de México, Mexico City, México. 6. Clinical Research Department, Investigador SNI Senacyt Panamá, Instituto Conmemorativo Gorgas de Estudios de La Salud, Panamá City, Republic of Panama. 7. Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, USA. andres.henaomartinez@cuanschutz.edu.
Abstract
PURPOSE OF THE REVIEW: Chagas disease is a neglected anthropozoonosis of global importance with significant cardiovascular-associated mortality. This review focuses on the Trypanosoma cruzi reinfections' role in chronic Chagas cardiomyopathy pathogenesis. We discuss and summarize the available data related to pathology, pathogenesis, diagnosis, and treatment of reinfections. RECENT FINDINGS: Reinfections influence the genetic and regional diversity of T. cruzi, tissue tropism, modulation of the host's immune system response, clinical manifestations, the risk for congenital infections, differences in diagnostics performances, response to antiparasitic therapy, and the natural history of the disease. Animal models suggest that reinfections lead to worse outcomes and increased mortality, while other studies showed an association between reinfections and lower parasitemia levels and subsequent infection protection. In some regions, the human risk of reinfections is 14% at 5 years. Evidence has shown that higher anti-T. cruzi antibodies are correlated with an increased rate of cardiomyopathy and death, suggesting that a higher parasite exposure related to reinfections may lead to worse outcomes. Based on the existing literature, reinfections may play a role in developing and exacerbating chronic Chagas cardiomyopathy and are linked to worse outcomes. Control efforts should be redirected to interventions that address structural poverty for the successful and sustainable prevention of Chagas disease.
PURPOSE OF THE REVIEW: Chagas disease is a neglected anthropozoonosis of global importance with significant cardiovascular-associated mortality. This review focuses on the Trypanosoma cruzi reinfections' role in chronic Chagas cardiomyopathy pathogenesis. We discuss and summarize the available data related to pathology, pathogenesis, diagnosis, and treatment of reinfections. RECENT FINDINGS: Reinfections influence the genetic and regional diversity of T. cruzi, tissue tropism, modulation of the host's immune system response, clinical manifestations, the risk for congenital infections, differences in diagnostics performances, response to antiparasitic therapy, and the natural history of the disease. Animal models suggest that reinfections lead to worse outcomes and increased mortality, while other studies showed an association between reinfections and lower parasitemia levels and subsequent infection protection. In some regions, the human risk of reinfections is 14% at 5 years. Evidence has shown that higher anti-T. cruzi antibodies are correlated with an increased rate of cardiomyopathy and death, suggesting that a higher parasite exposure related to reinfections may lead to worse outcomes. Based on the existing literature, reinfections may play a role in developing and exacerbating chronic Chagas cardiomyopathy and are linked to worse outcomes. Control efforts should be redirected to interventions that address structural poverty for the successful and sustainable prevention of Chagas disease.
Authors: S Huprikar; E Bosserman; G Patel; A Moore; S Pinney; A Anyanwu; D Neofytos; D Ketterer; R Striker; F Silveira; Y Qvarnstrom; F Steurer; B Herwaldt; S Montgomery Journal: Am J Transplant Date: 2013-07-09 Impact factor: 8.086
Authors: Sonia A Kjos; Paula L Marcet; Michael J Yabsley; Uriel Kitron; Karen F Snowden; Kathleen S Logan; John C Barnes; Ellen M Dotson Journal: J Med Entomol Date: 2013-09 Impact factor: 2.278
Authors: Alejandro O Luquetti; Suelene Brito do Nascimento Tavares; Liliane da Rocha Siriano; Rozângela Amaral de Oliveira; Dayse Elizabeth Campos; Cicilio Alves de Morais; Enio Chaves de Oliveira Journal: Mem Inst Oswaldo Cruz Date: 2015-03-14 Impact factor: 2.743