Autonomic Dysfunction and Risk Factors Associated with Trypanosoma cruzi Infection among Children in Arequipa, Peru

Natalie M. Bowman University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Vivian Kawai University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Robert H. Gilman University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Cesar Bocangel University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Gerson Galdos-Cardenas University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Lilia Cabrera University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Michael Z. Levy University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Juan Geny Cornejo del Carpio University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Freddy Delgado University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Lauren Rosenthal University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Vivian V. Pinedo-Cancino University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Francis Steurer University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Amy E. Seitz University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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James H. Maguire University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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Caryn Bern University of North Carolina—Chapel Hill, Chapel Hill, North Carolina; The Johns Hopkins Hospital, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Morgan Stanley Children's Hospital of New York, New York, New York; Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland; Harvard University School of Medicine, Boston, Massachusetts

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DOI:
https://doi.org/10.4269/ajtmh.2011.10-0303
Volume/Issue:
Volume 84: Issue 1
Page(s):
85–90
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Chagas disease affects an estimated 8 million people in Latin America. Infected individuals have 20–30% lifetime risk of developing cardiomyopathy, but more subtle changes in autonomic responses may be more frequent. We conducted a matched case-control study of children in Arequipa, Peru, where triatomine infestation and Trypanosoma cruzi infection are emerging problems. We collected data on home environment, history, physical examination, electrocardiogram, and autonomic testing. Signs of triatomine infestation and/or animals sleeping in the child's room and household members with Chagas disease were associated with increased infection risk. Electrocardiogram findings did not differ between cases and controls. However, compared with control children, infected children had blunted autonomic responses by three different measures, the Valsalva maneuver, the cold pressor test, and the orthostatic test. T. cruzi-infected children show autonomic dysfunction, although the prognostic value of this finding is not clear. Sustained vector control programs are essential to decreasing future T. cruzi infections.

Author Notes

*Address correspondence to Natalie Bowman, Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5515, Baltimore, MD 21205. E-mail: nbowman@post.harvard.edu

Financial support: N.M.B. was supported by the Fogarty-Ellison Fellowship in Global Health and Clinical Research, the Centers for Disease Control and Prevention Foundation O. C. Hubert Fellowship, and the National Institutes of Health (NIH) training Grant 5T35-AI-007646-03. M.Z.L. is supported by Grant 1K01AI079162. This work was funded by a grant from the International Society for Infectious Diseases, NIH International Collaborations in Infectious Disease Research Opportunity Grant U19-AI-33061, and NIH Grant 5P50AI074285-02. The funding source had no role in the study design, collection, analysis and interpretation of the data, preparation of the manuscript, or the decision to submit for publication.

Authors' addresses: Natalie M. Bowman, Division of Infectious Diseases, University of North Carolina—Chapel Hill, Chapel Hill, NC; and Department of Internal Medicine, The Johns Hopkins Hospital, Baltimore, MD, E-mail: nbowman@post.harvard.edu. Vivian Kawai and Vivian V. Pinedo-Cancino, Asociación Benéfica PRISMA, Lima, Peru, E-mails: vivian_kawai@yahoo.com and vivi_vane@hotmail.com. Robert H. Gilman, Asociación Benéfica PRISMA, Lima, Peru; and The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mail: rgilman@jhsph.edu. Cesar Bocangel, Juan Geny Cornejo del Carpio, and Freddy Delgado, Arequipa Ministry of Health, Arequipa, Peru, E-mails: c_bocangel@yahoo.com, juanepi50@hotmail.com, and fredeldi@hotmail.com. Gerson Galdos-Cardenas, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Arequipa Ministry of Health, Arequipa, Peru, E-mail: gersongaldos@gmail.com. Lilia Cabrera, Asociación Benéfica PRISMA, Lima, Peru, E-mail: lcabrera@peruresearch.com. Michael Z. Levy, University of Pennsylvania, Philadelphia, PA; and Fogarty International Center, National Institutes of Health, Bethesda, MD, E-mail: mzlevy@mail.med.upenn.edu. Lauren Rosenthal, Morgan Stanley Children's Hospital of New York, New York, NY, E-mail: laurenbrosenthal@yahoo.com. Francis Steurer and Caryn Bern, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: fjs1@cdc.gov and cxb9@cdc.gov. Amy E. Seitz, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, E-mail: Amy.Seitz@nih.hhs.gov. James H. Maguire, Harvard University School of Medicine, Boston, MA, E-mail: jmaguire@partners.org.

Copyright:
©The American Society of Tropical Medicine and Hygiene 2011
Received:
27 May 2010
|
Accepted:
30 Aug 2010
|
Published Online:
05 Jan 2011
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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