Health Sciences Graduate Program, Federal University of Maranhão, São Luís, Brazil.
Presidente Dutra University Hospital (HU-UPD), Brazilian Company of Hospital Services (EBSERH), Federal University of Maranhão (UFMA), São Luís, Brazil.
PLoS Negl Trop Dis. 2024 Sep 18;18(9):e0012225. doi: 10.1371/journal.pntd.0012225. eCollection 2024 Sep.
Orally transmitted acute Chagas disease (ACD) primarily affects low-visibility and low-income individuals in tropical and subtropical zones. Managing ACD remains challenging even after more than 100 years of its discovery. Its spread to non-endemic areas has made it a global health issue. The aim of this work is to demonstrate the difficulties encountered in handling a real-life situation.
This report examines an outbreak of 39 cases of ACD due to oral transmission by bacaba juice ingestion that occurred in Pedro do Rosário, Maranhão, Brazil. A clinical and epidemiological investigation, including an entomological search, was conducted. Diagnosis criteria included positive peripheral blood smear (PBS), seroconversion of IgG, and a two-fold increase in IgG titer (laboratory criteria); and clinical findings, epidemiological exposure, and at least one positive IgG test (clinical-epidemiological criteria). In-house conventional polymerase chain reaction (PCR) was performed on 33 samples. All patients were treated with benznidazole. After 4.5 years, IgG levels were reassessed in 26 individuals. The mean age was 33.6 years, with no gender difference. The mean incubation period was 13.8 days, and the mean between symptom onset and treatment was 16.6 days. The most common symptoms were fever and lymphadenopathy (90%). Diagnostic success rates were 66.6% (laboratory criteria), 23% (clinical-epidemiological criteria), and 10.2% (high clinical suspicion despite negative tests). Test positivity rates were 69.7% (PBS), 91.4% (serology), and 100% (PCR). There were no deaths. Serological cure was achieved in 34.6% of cases, and IgG titers decreased in 15.3%.
We encountered several barriers in managing ACD, including population vulnerability, reliance on outdated diagnostic techniques, lack of standardized molecular biology methods, and limited therapeutic options. This report underscores the importance of rapid surveillance and early treatment to prevent fatalities. We recommend the standardization of conventional PCR in diagnostic routines.
经口传播的急性恰加斯病（ACD）主要影响热带和亚热带地区的低可见度和低收入人群。尽管发现该病已有 100 多年，但管理仍具有挑战性。该病传播到非流行地区，已成为全球卫生问题。本工作旨在展示处理实际情况时遇到的困难。
本报告检查了巴西马拉尼昂州佩德罗·多罗萨里奥因摄入bacaba 汁导致的 39 例经口传播 ACD 爆发情况。进行了临床和流行病学调查，包括昆虫学搜索。诊断标准包括外周血涂片阳性（PBS）、IgG 血清转换和 IgG 滴度增加一倍（实验室标准）；临床发现、流行病学暴露和至少一项 IgG 检测阳性（临床流行病学标准）。对 33 个样本进行了内部常规聚合酶链反应（PCR）。所有患者均接受苯并咪唑治疗。4.5 年后，重新评估了 26 名个体的 IgG 水平。平均年龄为 33.6 岁，无性别差异。平均潜伏期为 13.8 天，症状出现与治疗之间的平均时间为 16.6 天。最常见的症状是发热和淋巴结病（90%）。诊断成功率分别为 66.6%（实验室标准）、23%（临床流行病学标准）和 10.2%（尽管检测阴性，但高度临床怀疑）。检测阳性率分别为 69.7%（PBS）、91.4%（血清学）和 100%（PCR）。无死亡病例。34.6%的病例实现了血清学治愈，15.3%的病例 IgG 滴度降低。
我们在管理 ACD 时遇到了几个障碍，包括人口脆弱性、依赖过时的诊断技术、缺乏标准化的分子生物学方法和有限的治疗选择。本报告强调了快速监测和早期治疗以预防死亡的重要性。我们建议在诊断常规中标准化常规 PCR。
