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Active transmission of human chagas disease in Colima Mexico
Coll-Cárdenas, Rafael;Espinoza-Gómez, Francisco;Maldonado-Rodríguez, Arcadio;Reyes-López, Pedro A;Huerta-Viera, Miguel;Rojas-Larios, Fabián;
Memórias do Instituto Oswaldo Cruz , 2004, DOI: 10.1590/S0074-02762004000400004
Abstract: despite efforts to eradicate american trypanosomiasis (at) and chagas disease from the americas, there are still areas of active transmission that can eventually become a source of reinfection in previously controlled regions. mexico could be one of those areas, where there are no formal preventive control programs despite the presence of communities infested by triatominae bugs infected with trypanosoma cruzi. this study explored the prevalence of t. cruzi infection in 405 habitants of 17 communities in the state of colima, on the pacific mexican coast, through a seroepidemiological probabilistic survey. the results revealed a point seroprevalence of 2.4% positive for anti-t. cruzi. in addition, 2 clinical cases of chronic and 2 of acute chagas disease were detected in the explored communities. these findings confirm the risk of active transmission of at in western mexico, especially in rural and suburban communities infested with intra-domestic triatominae, where control programs should be implemented.
Cuticular hydrocarbons of Chagas disease vectors in Mexico
Juárez, M Patricia;Carlson, David A;Salazar Schettino, Paz María;Mijailovsky, Sergio;Rojas, Gloria;
Memórias do Instituto Oswaldo Cruz , 2002, DOI: 10.1590/S0074-02762002000600012
Abstract: capillary gas-liquid chromatography was used to analyse the cuticular hydrocarbons of three triatomine species, triatoma dimidiata, t. barberi and dipetalogaster maxima, domestic vectors of chagas disease in mexico. mixtures of saturated hydrocarbons of straight and methyl-branched chains were characteristic of the three species, but quantitatively different. major methylbranched components mostly corresponded to different saturated isomers of monomethyl, dimethyl and trimethyl branched hydrocarbons ranging from 29 to 39 carbon backbones. sex-dependant, quantitative differences in certain hydrocarbons were apparent in t. dimidiata.
Cuticular hydrocarbons of Chagas disease vectors in Mexico  [cached]
Juárez M Patricia,Carlson David A,Salazar Schettino Paz María,Mijailovsky Sergio
Memórias do Instituto Oswaldo Cruz , 2002,
Abstract: Capillary gas-liquid chromatography was used to analyse the cuticular hydrocarbons of three triatomine species, Triatoma dimidiata, T. barberi and Dipetalogaster maxima, domestic vectors of Chagas disease in Mexico. Mixtures of saturated hydrocarbons of straight and methyl-branched chains were characteristic of the three species, but quantitatively different. Major methylbranched components mostly corresponded to different saturated isomers of monomethyl, dimethyl and trimethyl branched hydrocarbons ranging from 29 to 39 carbon backbones. Sex-dependant, quantitative differences in certain hydrocarbons were apparent in T. dimidiata.
Opportunity Cost for Early Treatment of Chagas Disease in Mexico  [PDF]
Janine M. Ramsey,Miguel Elizondo-Cano,Gilberto Sanchez-González,Adriana Pe?a-Nieves,Alejandro Figueroa-Lara
PLOS Neglected Tropical Diseases , 2014, DOI: 10.1371/journal.pntd.0002776
Abstract: Background Given current neglect for Chagas disease in public health programs in Mexico, future healthcare and economic development policies will need a more robust model to analyze costs and impacts of timely clinical attention of infected populations. Methodology/Principal Findings A Markov decision model was constructed to simulate the natural history of a Chagas disease cohort in Mexico and to project the associated short and long-term clinical outcomes and corresponding costs. The lifetime cost for a timely diagnosed and treated Chagas disease patient is US$ 10,160, while the cost for an undiagnosed individual is US$ 11,877. The cost of a diagnosed and treated case increases 24-fold from early acute to indeterminate stage. The major cost component for lifetime cost was working days lost, between 44% and 75%, depending on the program scenario for timely diagnosis and treatment. Conclusions/Significance In the long term, it is cheaper to diagnose and treat chagasic patients early, instead of doing nothing. This finding by itself argues for the need to shift current policy, in order to prioritize and attend this neglected disease for the benefit of social and economic development, which implies including treatment drugs in the national formularies. Present results are even more relevant, if one considers that timely diagnosis and treatment can arrest clinical progression and enhance a chronic patient's quality of life.
Barriers to Treatment Access for Chagas Disease in Mexico  [PDF]
Jennifer M. Manne ,Callae S. Snively,Janine M. Ramsey,Marco Ocampo Salgado,Till B?rnighausen,Michael R. Reich
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002488
Abstract: Background According to World Health Organization (WHO) prevalence estimates, 1.1 million people in Mexico are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease (CD). However, limited information is available about access to antitrypanosomal treatment. This study assesses the extent of access in Mexico, analyzes the barriers to access, and suggests strategies to overcome them. Methods and Findings Semi-structured in-depth interviews were conducted with 18 key informants and policymakers at the national level in Mexico. Data on CD cases, relevant policy documents and interview data were analyzed using the Flagship Framework for Pharmaceutical Policy Reform policy interventions: regulation, financing, payment, organization, and persuasion. Data showed that 3,013 cases were registered nationally from 2007–2011, representing 0.41% of total expected cases based on Mexico's national prevalence estimate. In four of five years, new registered cases were below national targets by 11–36%. Of 1,329 cases registered nationally in 2010–2011, 834 received treatment, 120 were pending treatment as of January 2012, and the treatment status of 375 was unknown. The analysis revealed that the national program mainly coordinated donation of nifurtimox and that important obstacles to access include the exclusion of antitrypanosomal medicines from the national formulary (regulation), historical exclusion of CD from the social insurance package (organization), absence of national clinical guidelines (organization), and limited provider awareness (persuasion). Conclusions Efforts to treat CD in Mexico indicate an increased commitment to addressing this disease. Access to treatment could be advanced by improving the importation process for antitrypanosomal medicines and adding them to the national formulary, increasing education for healthcare providers, and strengthening clinical guidelines. These recommendations have important implications for other countries in the region with similar problems in access to treatment for CD.
Iniciativa México: Propuesta para el control y vigilancia epidemiológica de la enfermedad de Chagas en México Mexico iniciative: A proposal for the epidemiological control and surveillance of Chagas disease in Mexico  [cached]
Paz María Salazar Schettino,Alejandro Cravioto Q,Roberto Tapia Conver
Boletín chileno de parasitología , 2001,
Abstract: It is showed the programme for the knowledge, control and epidemiological surveillance of Chagas disease in Mexico.
Update on Chagas disease in Venezuela: a review
A?ez, Néstor;Crisante, Gladys;Rojas, Agustina;
Memórias do Instituto Oswaldo Cruz , 2004, DOI: 10.1590/S0074-02762004000800001
Abstract: the present article reviews the status of chagas disease in venezuela based on the detection of trypanosoma cruzi infections both in referred patients with clinical presumptive diagnosis (1988-2002) and in individuals sampled from rural localities representative of the different geographical regions of the country (1995-2002). in the former group from 306 individuals examined, 174 (56.8%) were seropositive to t. cruzi; 73 (42%) in the acute phase with 52 (71%) showing blood circulating parasites, and from these 38% were children under 10 years old. the other 101 (58%) showed chronic infection at different degrees of cardiac complication. in addition, serologic examination of 3835 individuals from rural areas revealed 11.7% seroprevalence. from these, 8.5% (38/448) were children aged from 0 to 10 years old. these figures suggest that chagas disease may be re-emerging in venezuela judging for the active transmission detected during the last decade. the success of the venezuelan anti-chagasic campaign during the last 40 years is evaluated in the frame of the present results. the epidemiological situation is discussed and recommendation to consider chagas disease as a national priority is given.
Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico
Sánchez-Guillén, María del Carmen;López-Colombo, Aurelio;Ordó?ez-Toquero, Guillermo;Gomez-Albino, Isidoro;Ramos-Jimenez, Judith;Torres-Rasgado, Enrique;Salgado-Rosas, Hilda;Romero-Díaz, Mónica;Pulido-Pérez, Patricia;Pérez-Fuentes, Ricardo;
Memórias do Instituto Oswaldo Cruz , 2006, DOI: 10.1590/S0074-02762006000700005
Abstract: in mexico, despite the relatively high seroprevalence of trypanosoma cruzi infection in humans in some areas, reported morbidity of chagas disease is not clear. we determined clinical stage in 71 individuals seropositive to t. cruzi in the state of puebla, mexico, an area endemic for chagas disease with a reported seroprevalence of 7.7%. diagnosis of chagas disease was made by two standardized serological tests (elisa, iha). individuals were stratified according to clinical studies. all patients were submitted to ekg, barium swallow, and barium enema. groups were identified as indeterminate form (if) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade i megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic chagas heart disease who were subdivided as follows: mild (8 patients) - mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients) - left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients) - signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. these data highlight the importance of accurate evaluation of the prevalence and clinical course of chagas disease in endemic and non-endemic areas of mexico.
Estado actual en el tratamiento de la enfermedad de Chagas Update on the treatment of Chagas' disease
Revista médica de Chile , 2011,
Abstract: Efficient drugs against Chagas' disease must have an effect on the amastigote forms or intracellular reproduction elements of Trypanosoma cruzi (T. cruzi). Trypomastigote and epimastigote forms derive from the former and their response to medications is less marked. The only drugs used in humans are nifurtimox (NF) and benznidazole (BNZ). Other useful medications are allopurinol and itraconazole. NF acts producing free radicals and BNZ inhibits the synthesis of macromolecules. There is consensus that Chagas' disease must be treated in all its periods, since T.cruzi DNA is detected by polymerase chain reaction in chronic cases, even when microscopy is negative. The pharmacological treatment modifies the natural evolution of the disease. It also helps to solve a public health problem, considering that there is a high number of subjects with Chagas' disease. Subjects with chronic chagasic cardiomyopathy with terminal heart failure are the only cases without indication for treatment. Due to the digestive and skin secondary effects of the drugs, treated patients must be controlled clinically and with complete blood counts and hepatic proiles before, during and after the therapy. Approximately 30% of patients will experience secondary effects. Children have a better tolerance to the drugs. Congenital or acquired acute, intermediate and chronic cases should be treated.
Chagas disease in Mexico: an analysis of geographical distribution during the past 76 years - A review
Cruz-Reyes, Alejandro;Pickering-López, José Miguel;
Memórias do Instituto Oswaldo Cruz , 2006, DOI: 10.1590/S0074-02762006000400001
Abstract: literature from 1928 through 2004 was compiled from different document sources published in mexico or elsewhere. from these 907 publications, we found 19 different topics of chagas disease study in mexico. the publications were arranged by decade and also by state. this information was used to construct maps describing the distribution of chagas disease according to different criteria: the disease, vectors, reservoirs, and strains. one of the major problems confronting study of this zoonotic disease is the great biodiversity of the vector species; there are 30 different species, with at least 10 playing a major role in human infection. the high variability of climates and biogeographic regions further complicate study and understanding of the dynamics of this disease in each region of the country. we used a desktop genetic algorithm for rule-set prediction procedure to provide ecological models of organism niches, offering improved flexibility for choosing predictive environmental and ecological data. this approach may help to identify regions at risk of disease, plan vector-control programs, and explore parasitic reservoir association. with this collected information, we have constructed a data base: chagmex, available online in html format.
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