OneHealth Research Group, Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad de Las Américas (UDLA), Calle Jose Queri s/n entre Av. Granados y Av. Eloy Alfaro, PO BOX 17-17-9788, Quito, Ecuador.
Instituto de Biomedicina, Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador.
BMC Infect Dis. 2020 Feb 14;20(1):143. doi: 10.1186/s12879-020-4851-0.
Chagas disease is caused by the haemoflagellate protozoan Trypanosoma cruzi. Currently, T. cruzi recognizes seven discrete typing units (DTUs): TcI to TcVI and Tcbat. The genetic diversity of T. cruzi is suspected to influence the clinical outcome. Acute clinical manifestations, which include myocarditis and meningoencephalitis, are sometimes fatal; occur most frequently in children and in immunocompromised individuals. Acute disease is often overlooked, leading to a poor prognosis.
A 38-year-old man from a subtropical area of the Andes mountains of Ecuador was hospitalized after 3 weeks of evolution with high fever, chills, an enlarged liver, spleen, and lymph nodes, as well as facial edema. ECG changes were also observed. T. cruzi was identified in blood smears, culture and amplification of DNA by PCR. Tests for anti-T. cruzi IgG and IgM and HIV were negative. Molecular typing by restriction fragment length polymorphism (PCR-RFLP) determined the parasite to DTU TcI. In the absence of a timely anti-T. cruzi medication, the patient died.
This is a case of severe pathogenicity and the virulence of a DTU TcI strain in an adult patient. The severe acute Chagas disease was probably overlooked due to limited awareness and its low incidence. Our findings suggest that T. cruzi DTU TcI strains circulating in Ecuador are capable of causing fatal acute disease. Early diagnosis and prompt treatment is of paramount importance to avoid fatalities in acute infections.
克氏锥虫病是由血鞭毛原生动物克氏锥虫引起的。目前，克氏锥虫被认为有 7 种离散的分型单元（DTU）：TcI 到 TcVI 和 Tcbat。克氏锥虫的遗传多样性被怀疑会影响临床结果。急性临床表现包括心肌炎和脑膜脑炎，有时是致命的；多见于儿童和免疫功能低下者。急性疾病常被忽视，导致预后不良。
一名来自厄瓜多尔安第斯山脉亚热带地区的 38 岁男子，在出现高热、寒战、肝脾肿大和淋巴结肿大以及面部水肿等症状 3 周后住院。心电图也发生了变化。在血涂片、培养和 PCR 扩增 DNA 中均发现了克氏锥虫。抗克氏锥虫 IgG 和 IgM 以及 HIV 检测均为阴性。通过限制性片段长度多态性（PCR-RFLP）的分子分型确定寄生虫为 DTU TcI。由于没有及时使用抗克氏锥虫药物，患者死亡。
这是一例严重致病性和成人患者中 TcI 型 DTU 毒力的病例。由于认识有限且发病率低，严重的急性克氏锥虫病可能被忽视。我们的研究结果表明，在厄瓜多尔流行的 TcI 型克氏锥虫菌株能够引起致命的急性疾病。早期诊断和及时治疗对于避免急性感染的死亡至关重要。
