Blanchet Denis, Brenière Simone Frédérique, Schijman Alejandro G, Bisio Margarita, Simon Stéphane, Véron Vincent, Mayence Claire, Demar-Pierre Magalie, Djossou Félix, Aznar Christine
Laboratoire Hospitalier et Universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, EPaT, UFR de Médecine, Université des Antilles et de la Guyane, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
IRD, Institut de Recherche pour le Développement, UMR INTERTRYP (IRD-CIRAD), Interactions hôtes-vecteurs-parasites dans les infections par trypanosomatidae, 911 Av. Agropolis, 34394 Montpellier cédex 5, France.
Infect Genet Evol. 2014 Dec;28:245-50. doi: 10.1016/j.meegid.2014.10.004. Epub 2014 Oct 14.
The outbreak of acute Chagas disease due to oral transmission of the parasite is a well-known phenomenon mainly occurring in the Amazon. Such an event is described here for the first time in French Guiana. Eight patients of the same family, presenting epidemiological and clinical histories compatible with recent Trypanosoma cruzi infection of Chagas disease due to the ingestion of palm Oenocarpus bacaba juice were, rather late after the putative date of infection, underwent four parasitological and two serological specific tests for confirmation of the diagnosis. Real-time PCR results were positive for all the patients; strains were isolated by hemoculture from four patients, PCR identification of TcI DTU was made for six patients, while parasites were not detected in any of the patients by direct microscopic examination. The results of two serologic tests were positive. All patients were treated with benznidazole, and two patients were additionally given nifurtimox. A 6-year follow-up was possible for six patients. Real-time PCR was negative for these patients after 1 year, while the antibody rates decreased slowly and serology results were negative only after several years (1-5 years). Our findings confirm the occurrence of an outbreak of Chagas infection in members of the same family, with the oral mode of infection being the most likely hypothesis to explain this group of cases. Our results show the successful treatment of patients infected by TcI and the usefulness of real-time PCR for the emergency diagnosis of recent Chagas disease cases and in posttreatment follow-up.
由于寄生虫经口传播导致的急性恰加斯病暴发是一种主要发生在亚马逊地区的已知现象。这种事件首次在法属圭亚那被描述。来自同一家庭的8名患者，其流行病学和临床病史与因摄入棕榈酒椰果汁而近期感染克鲁斯锥虫所致恰加斯病相符，在推测的感染日期之后相当晚的时候，接受了四项寄生虫学和两项血清学特异性检测以确诊。所有患者的实时荧光定量聚合酶链反应（PCR）结果均为阳性；通过血液培养从4名患者中分离出菌株，对6名患者进行了TcI基因型鉴定，而通过直接显微镜检查在任何患者中均未检测到寄生虫。两项血清学检测结果均为阳性。所有患者均接受了苯硝唑治疗，另外两名患者还接受了硝呋莫司治疗。对6名患者进行了为期6年的随访。1年后这些患者的实时荧光定量PCR结果为阴性，而抗体率缓慢下降，血清学结果仅在数年（1 - 5年）后才转为阴性。我们的研究结果证实了同一家庭成员中发生了恰加斯感染暴发，经口感染方式是解释这组病例最有可能的假设。我们的结果显示了对TcI感染患者的成功治疗以及实时荧光定量PCR在近期恰加斯病病例紧急诊断和治疗后随访中的作用。
