Clinical Outcomes of Thirteen Patients with Acute Chagas Disease Acquired through Oral Transmission from Two Urban Outbreaks in Northeastern Brazil

Chagas disease is caused by a parasitic protozoan transmitted to humans by the contaminated feces of blood-feeding assassin bugs from the Triatominae subfamily. It may also be transmitted from mother to baby during pregnancy, by breastfeeding, blood transfusion or organ transplant. In rare cases, the disease can also be caused by accidental ingestion of contaminated food (sugar cane or açaí juice, drinking water, etc.). Acute Chagas disease often presents itself as a mononucleosis-like syndrome, with symptoms including fever, lymph node enlargement and muscle pain. The mortality rate of acute Chagas disease is high, mainly due to heart failure as a consequence of cardiac fiber lesions. There are few studies describing clinical outcomes and the disease progression of patients who receive therapeutic treatment, especially with regard to cardiac exam findings. In this report, the authors describe clinical findings from two micro-outbreaks occurring in impoverished towns in northeastern Brazil. Prior to receiving treatment, patient mortality rate was 28.6% in one of the outbreaks, and one pregnant woman experienced a spontaneous abortion due to the disease in the other outbreak. Most patients complained of fever, dyspnea, myalgia and periorbital edema. After receiving a two-month course of treatment, clinical symptoms improved and the number of abnormalities in cardiac exams decreased

Serological test results from 13 patients with acute Chagas disease in two urban outbreaks Bahia, Brazil, 2006.

<p>n/a: not available.</p><p>cases 1–5: samples collected on May 5, 10 and 15, 2006 (almost 30 days after exposure); cases 6,7: no samples collected (patients died before Chagas disease was confirmed) <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Dias2" target="_blank">[8]</a>.</p><p>cases 8–13: samples collected on October, 8, 2006 (almost 60 days after exposure). Parasitological tests (thick smear or blood culture): samples processed by FIOCRUZ/Bahia and Couto Maia Hospital, Bahia, Brazil); IFAT (Indirect immunofluorescence antibody test): samples processed by LACEN-Bahia, Brazil and FUNED- Minas Gerais, Brazil; ELISA (IgM): samples processed by FUNED- Minas Gerais, Brazil; Elisa with recombinant antigens <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Houghton1" target="_blank">[20]</a>: samples processed by Edgard Santos University Hospital, Federal University of Bahia, Brazil.</p

Frequencies of signs and symptoms of thirteen patients with acute Chagas disease from Macaúbas and Ibipitanga, Bahia-Brazil.

<p>Frequencies of signs and symptoms of thirteen patients with acute Chagas disease from Macaúbas and Ibipitanga, Bahia-Brazil.</p

Clinical outcome, electrocardiogram (EKG) and Two-dimensional Doppler Echocardiography (ECHO) of thirteen patients with acute Chagas disease from Macaúbas and Ibipitanga, Bahia, Brazil, after benznidazole treatment.

<p>Patient #6 and 7 died before evaluation.</p>¥<p>performed 180 days after the end of benzonidazol treatment.</p><p>*MR = Mitral Regurgitation; PE_F = Pericardic Effusion; SD = Septum Dyskinesis; DDLV = diastolic Disfunction of Left Ventricule, RBBB = right bundle branch block, DVR = Disturbance of Ventricular Repolarization, AFib = Atrial Fibrillation, SB = Sinus Bradcardia, TI = Tricuspid Regurgitation.</p><p>EKG according the AHA/ACCF/HRS 2009 Recommendations for the Standardization and Interpretation of the Electrocardiogram <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Surawicz1" target="_blank">[21]</a> and Guidelines of the Brazilian Society of Cardiology 2009 <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Pastore1" target="_blank">[22]</a>.</p><p>ECHO according the ACC/AHA 2006 practice guidelines <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Bonow1" target="_blank">[23]</a> and ASE committee recommendations <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Lang1" target="_blank">[24]</a>.</p

Occurrence of infection with Toxoplasma gondii and factors associated with transmission in broiler chickens and laying hens in different raising systems

Toxoplasmosis is a zoonotic disease caused by the protozoan Toxoplasma gondii. The aim of the present study was to determine the occurrence and identify the risk factors associated with transmission of T. gondii to chickens raised in different systems (free-ranged and confined) to produce eggs or meat. The 810 animals were allocated in two experimental groups according to the production system purpose: 460 broiler chickens (Group 1) and 350 layer chickens (Group 2). In order to analyze the possible factors involved in T. gondii infection in the chickens, an epidemiological questionnaire was developed for all properties.The serological detection of anti-Toxoplasma gondii antibodies was performed by Indirect Immunofluorescence (IFAT) and by Enzime Linked Imunossorbent Assay (ELISA). Since the agreement index (kappa) between these two serological techniques was considered high, 21.2% of the 810 animals were considered reactive. In Group 1, 12.2% (56/460) were positive, while in the Group 2 the positivity rate was 33.1% (116/350). The production system may be influencing the seropositivity of the animals in both groups. However, only in Group 2 it was possible to notice a statistically significant relationship between the breeding system and the frequency of positive sera. This result indicates that, at least for laying hens, the production system is directly involved in T. gondii infection. The contact with cats in Group 1 did not influence the distribution of seroreactive animals, but in Group 2 a significant relationship was observed. The occurrence of anti-T. gondii antibodies was high in both groups (broiler and posture chickens). Free-ranged chickens raised for egg production proved to be the most exposed group to the T. gondii infection. This can be related to the fact that these animals stay for longer periods in the farms, in direct contact with possibly contaminated soil by the presence of domestic cats