Nolan Melissa S, Murray Kristy O, Mejia Rojelio, Hotez Peter J, Villar Mondragon Maria Jose, Rodriguez Stanley, Palacios Jose Ricardo, Murcia Contreras William Ernesto, Lynn M Katie, Torres Myriam E, Monroy Escobar Maria Carlota
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
Trop Med Infect Dis. 2021 May 7;6(2):72. doi: 10.3390/tropicalmed6020072.
The eradication of the vector from Central America was heralded as a victory for controlling transmission of , the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children.
中美洲病媒的根除被誉为控制导致恰加斯病的寄生虫——克氏锥虫传播的一项胜利。虽然公共卫生官员认为这一里程碑式的成就将有效消除恰加斯病，但几年内急性病媒传播的病例报告却开始大量出现。这项调查对萨尔瓦多松索纳特州因发烧前来就医的儿童或居住在已知有锥蝽的家庭中的儿童进行了横断面血清学调查。在2018年全年，纳维扎尔科热点聚集地区的儿童中恰加斯病血清阳性率为2.3%。通过多变量回归分析发现，血清学阳性与家中养狗、参与者年龄较大以及家中孩子数量较多显著相关。在所研究的一部分儿童中发现了肠道寄生虫合并感染；60%的儿童至少感染一种肠道寄生虫，15%的儿童有两种或更多种合并感染。合并寄生虫感染与通过定量聚合酶链反应在粪便中检测到的总体较高寄生虫负荷在统计学上相关。最后，与全国平均水平相比，该队列中发育迟缓的负担高出四倍，五分之四的母亲报告存在严重的粮食不安全状况。这项研究强调，多重寄生虫感染很常见，在治疗恰加斯病血清阳性儿童时需要采用基于系统的方法。
