Trypanosoma cruzi clonal diversity and the epidemiology of Chagas' disease

Chagas' disease is caused by the protozoan Trypanosoma cruzi and it has a variable clinical outcome. The basis for this variability relies in part on the complexity of the parasite population consisting of multiple clones displaying distinct biological properties. A major current challenge is to correlate parasite genetic variability with pathogenesis.     

Current status of knowledge on Chagas' disease in the Mexican Republic]

A thorough review of the medical literature is made regarding Chagas' disease in Mexico and elsewhere since 1939, when Trypanosoma cruzi was first reported in this country, until 1991. The location where human cases, non human reservoirs and vectors have been found and are pointed out by means of tables and charts. Comments are made regarding the results reported. The importance of increasing the studies of Chagas' disease in Mexican Republic is stressed.     

Chagas' disease and AIDS

Chagas' disease caused by Trypanosoma cruzi is an opportunistic infection in the setting of HIV/AIDS. Some individuals with HIV and chronic T. cruzi infection may experience a reactivation, which is most commonly manifested by meningoencephalitis. A reactivation myocarditis is the second most common manifestation. These presentations may be difficult to distinguish from toxoplasmosis in individuals with HIV/AIDS. The overlap of HIV and Trypanosoma cruzi infection occurs not only in endemic areas but also in non-endemic areas of North America and Europe where the diagnosis may be even more difficult. The pathological features, diagnosis and the role of cytokines in the pathogenesis of the disease are discussed.     

Chagas' disease in pre-Columbian South America

The quest for the origin and dispersion of Chagas' disease, the second most important vector-borne disease in Latin America, has epidemiological, immunological, and genetical implications. Conjectures based on accounts of chroniclers, reviews of the archaeological literature and the present distribution of triatomine bugs, the vectors of the disease, held that the origin of the adaptation of Triatoma infestans (aspecies of the subfamily Triatominae) to human dwellings occurred in prehistoric times. The autopsy of 35 mummies exhumed in the Chilean desert, dated between 470 B.C. and 600 A.D., revealed the presence of clinical manifestations of Chagas' disease and put earlier speculations on a factual basis.     

Immunosensor for the diagnosis of Chagas' disease

Trypanosoma cruzi proteins from epimastigote membranes, herein referred as antigens, have been used for the construction of an amperometric immunosensor for serological diagnosis of Chagas' disease. The proteins used had a molecular mass ranging from 30 to 100 kDa. The gold electrode was treated with cysteamine and glutaraldehyde prior to antigen immobilization. Antibodies present in the serum of patients with Chagas' disease were captured by the immobilized antigens and the affinity interaction was monitored by chronoamperometry at a potential of -400 mV (versus Ag pseudo-reference electrode) using peroxidase-labeled IgG conjugate and hydrogen peroxide, iodide substrate. The incubation time to allow maximum antigen-antibody and antibody-peroxidase-labeled IgG interactions was 20 min with a reactivity threshold at -0.104 microA.     

Experimental Chagas' disease in dogs.

This paper describes the development of experimental Chagas' disease in 64 out-bred young dogs. Twenty-nine animals were inoculated with the Be-62 and 35 with Be-78 Trypanosoma cruzi strains. Twenty-six were infected with blood trypomastigotes by different inoculation routes and 38 with metacyclic trypomastigotes from the vector via the conjunctival route. Twenty of the 26 dogs infected with blood trypomastigotes were autopsied during the acute phase. Eleven died spontaneously and nine were sacrificed. Six remained alive until they died suddenly (two) or were autopsied. (four). Twelve of the 38 dogs infected with metacyclic trypomastigotes evolved naturally to the chronic phase and remained alive for 24-48 months. The parasitemia, clinical aspects and serology (IgM and IgG) as well as electrocardiogram, hemogram and heart anatomo-histopathologic patterns of acute and chronic cardiac forms of Chagas' disease as seen in human infections, were reproduced. The most important finding is the reproducibility of diffuse fibrosing chronic chagasic cardiopathy in all dogs infected with Be-78 T. cruzi strain autopsied between the 90th and 864th days of infection. Thus, the dog can be considered as a suitable experimental model to study Chagas' disease according to the requisites of the Word Health Organization (1984). Furthermore the animal is easily obtained and easy to handle and maintain in experimental laboratory conditions.     

Experimental Chagas' disease: I. Study of different immunization conditions in the infection course]

In previous works it has been demonstrated that Balb/c albino mice immunized with Trypanosoma rangeli developed cellular and humoral immune response to Tripanosoma cruzi. Moreover, the immunized animals were protected against lethal infection by virulent T. cruzi trypomastigotes. In fact, immunized mice had significantly lower parasitemias and longer survival than controls. To go further in this experimental model, the aim of the present work was to analyze the effect of the number of antigenic stimuli and the conservation of the antigen on the effectiveness of protective effect. For that purpose, three different immunization schedules injecting T. rangeli epimastigotes fixed with glutaraldehide and emulsified with Saponin (SAP) as adjuvant were assayed. Different lots of mice which received only phosphate buffer saline or SAP were used as controls. In another set of experiments the conservation of the antigen during 90 days at 4 degrees C was studied. In all the experiments mice were infected with 100 trypomastigotes of T. cruzi, Tulahuén strain. The parasitemias were analyzed on 13th, 16th and 21st post infection days, and the survival until the 60th day. The results revealed that one dose of antigen was inadequate to give an effective protection. On the other hand, mice immunized with 2 and 3 dose showed a significant decrease of parasitemia with regard to controls (p < 0.001 - p < 0.0001) and the survival were markedly increased. Likewise, the antigen kept during 90th days at 4 degrees C showed similar protective efficacy than fresh antigen. Both of these experimental groups showed significant differences with respect to control animals in parasitemia (p < 0.05 - p > 0.01) and survival (p < 0.01). In conclusion, the results of this work showed that in the experimental conditions assayed, the immunization with T. rangeli trigger and adequate immune response when mice received at least two antigenic stimuli. Likewise, it is interesting to point out the stability of the antigenic preparation during at least 90th days.