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苯硝唑治疗慢性感染克氏锥虫的儿童:患者的血清学和分子随访以及离散型单位的鉴定。

Benznidazole treatment in chronic children infected with Trypanosoma cruzi: serological and molecular follow-up of patients and identification of Discrete Typing Units.

机构信息

Unidad de Epidemiología Molecular, Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina; Instituto de Patología Experimental - CONICET, Universidad Nacional de Salta, Argentina.

出版信息

Acta Trop. 2013 Oct;128(1):130-6. doi: 10.1016/j.actatropica.2013.07.003. Epub 2013 Jul 20.

Abstract

A total of 221 children from two rural settlements in Northeast Argentina were examined for T. cruzi infection. Blood samples were taken for serology tests and PCR assays. In addition, T. cruzi Discrete Typing Units (DTUs) were determined by hybridization with specific DNA probes of the minicircle hypervariable regions (mHVR). Serological results indicated that 26% (57/215) were reactive against T. cruzi antigens. PCR analyses were performed on seropositive samples showing presence of parasite DNA in 31 out of 53 samples (58.5%). All seropositive children underwent specific chemotherapy with Benznidazole (5mg/kg/day) for a period of two months and were monitored two and five years after treatment. Overall the treatment was well tolerated and low side effects were observed. Serological conversion was observed at two years post -treatment in one child form Pampa Ávila and at five years in two children from Tres Estacas. However, at the end of the follow-up period, T. cruzi DNA could not be detected by PCR in samples from treated children, except in two cases. In addition, the results of hybridizations with specific DNA probes showed that DTU TcV was detected in 68% (21/31), TcVI in 7% (2/31) and TcV/VI in 3% (1/31) of the samples. Altogether, results of the follow-up of treated children showed a low rate of seroconversion; however trend toward seroconversion was evident at five years post-treatment. On the other hand, detection of T. cruzi DNA by PCR significantly decreased after Benznidazole treatment. The existence of data regarding serological and molecular follow-ups from controlled studies in the Chaco Region will be important for future treatment efforts against T. cruzi infection in this region. The results obtained in the present study represent a contribution in this regard.

摘要

共有 221 名来自阿根廷东北部两个农村定居点的儿童接受了 T. cruzi 感染检查。采集血样进行血清学检测和 PCR 检测。此外,还通过与小环高变区(mHVR)特异性 DNA 探针杂交确定 T. cruzi 离散型单位(DTU)。血清学结果表明,26%(57/215)对 T. cruzi 抗原呈反应性。对血清阳性样本进行 PCR 分析,结果显示 53 个样本中有 31 个(58.5%)存在寄生虫 DNA。所有血清阳性儿童均接受贝那唑嗪(5mg/kg/天)特异性化疗 2 个月,并在治疗后 2 年和 5 年进行监测。总体而言,治疗耐受性良好,观察到低副作用。在 Pampa Ávila 的一名儿童和 Tres Estacas 的两名儿童中,治疗后两年观察到血清学转换,在治疗后五年观察到另一名儿童的血清学转换。然而,在随访结束时,除了 2 例之外,PCR 无法从接受治疗的儿童样本中检测到 T. cruzi DNA。此外,特异性 DNA 探针杂交的结果表明,在 31 个样本中检测到 DTU TcV 占 68%(21/31),TcVI 占 7%(2/31),TcV/VI 占 3%(1/31)。总的来说,治疗后儿童的随访结果显示血清转化率较低;然而,治疗后五年血清转化率明显上升。另一方面,贝那唑嗪治疗后,PCR 检测 T. cruzi DNA 的检出率显著下降。在查科地区开展对照研究的血清学和分子随访数据的存在,对未来在该地区开展针对 T. cruzi 感染的治疗工作将非常重要。本研究的结果为此做出了贡献。

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