• 1.

    Organización Panamericana de la Salud, 2006. Estimación Cuantitativa de la Enfermedad de Chagas en las Americas. Montevideo, Uruguay: Organización Panamericana de la Salud.

    • Search Google Scholar
    • Export Citation
  • 2.

    World Health Organization, 2004. World Health Report: Changing History. Geneva, Switzerland: World Health Organization.

  • 3.

    Maguire JH, 2004. Trypanosoma. Gorbach S, Bartlett J, Blacklow N, eds. Infectious Diseases. Philadelphia, PA: Lippincott, Williams, and Wilkins, 23272334.

    • Search Google Scholar
    • Export Citation
  • 4.

    Rassi A Jr, Rassi SG, Rassi A, 2001. Sudden death in Chagas' disease. Arq Bras Cardiol 76: 7596.

  • 5.

    Carrasco HA, Parada H, Guerrero L, Duque M, Duran D, Molina C, 1994. Prognostic implications of clinical, electrocardiographic and hemodynamic findings in chronic Chagas' disease. Int J Cardiol 43: 2738.

    • Search Google Scholar
    • Export Citation
  • 6.

    Mady C, Cardoso RH, Barretto AC, da Luz PL, Bellotti G, Pileggi F, 1994. Survival and predictors of survival in patients with congestive heart failure due to Chagas' cardiomyopathy. Circulation 90: 30983102.

    • Search Google Scholar
    • Export Citation
  • 7.

    Rassi A Jr, Rassi A, Rassi SG, 2007. Predictors of mortality in chronic Chagas disease: a systematic review of observational studies. Circulation 115: 11011108.

    • Search Google Scholar
    • Export Citation
  • 8.

    Andrade AL, Zicker F, Rassi A, Rassi AG, Oliveira RM, Silva SA, de Andrade SS, Martelli CM, 1998. Early electrocardiographic abnormalities in Trypanosoma cruzi-seropositive children. Am J Trop Med Hyg 59: 530534.

    • Search Google Scholar
    • Export Citation
  • 9.

    Maguire JH, Hoff R, Sherlock I, Guimaraes AC, Sleigh AC, Ramos NB, Mott KE, Weller TH, 1987. Cardiac morbidity and mortality due to Chagas' disease: prospective electrocardiographic study of a Brazilian community. Circulation 75: 11401145.

    • Search Google Scholar
    • Export Citation
  • 10.

    Rangel-Flores H, Sanchez B, Mendoza-Duarte J, Barnabe C, Breniere FS, Ramos C, Espinoza B, 2001. Serologic and parasitologic demonstration of Trypanosoma cruzi infections in an urban area of central Mexico: correlation with electrocardiographic alterations. Am J Trop Med Hyg 65: 887895.

    • Search Google Scholar
    • Export Citation
  • 11.

    Chagas C, Vilella E, 1922. Cardiac form of American trypanosomiasis. Mem Inst Oswaldo Cruz 14: 561.

  • 12.

    Marin-Neto JA, Cunha-Neto E, Maciel BC, Simoes MV, 2007. Pathogenesis of chronic Chagas heart disease. Circulation 115: 11091123.

  • 13.

    Oliveira E, Ribeiro AL, Assis Silva F, Torres RM, Rocha MO, 2002. The Valsalva maneuver in Chagas disease patients without cardiopathy. Int J Cardiol 82: 4954.

    • Search Google Scholar
    • Export Citation
  • 14.

    Ribeiro AL, Ferreira LM, Oliveira E, Cruzeiro PC, Torres RM, Rocha MO, 2004. Active orthostatic stress and respiratory sinus arrhythmia in patients with Chagas' disease with preserved left ventricular global systolic function. Arq Bras Cardiol 83: 3544.

    • Search Google Scholar
    • Export Citation
  • 15.

    Villar JC, Leon H, Morillo CA, 2004. Cardiovascular autonomic function testing in asymptomatic T. cruzi carriers: a sensitive method to identify subclinical Chagas' disease. Int J Cardiol 93: 189195.

    • Search Google Scholar
    • Export Citation
  • 16.

    de Oliveira RB, Troncon LE, Dantas RO, Menghelli UG, 1998. Gastrointestinal manifestations of Chagas' disease. Am J Gastroenterol 93: 884889.

  • 17.

    Marin-Neto JA, Bromberg-Marin G, Pazin-Filho A, Simoes MV, Maciel BC, 1998. Cardiac autonomic impairment and early myocardial damage involving the right ventricle are independent phenomena in Chagas' disease. Int J Cardiol 65: 261269.

    • Search Google Scholar
    • Export Citation
  • 18.

    Davila DF, Donis JH, Torres A, Ferrer JA, 2004. A modified and unifying neurogenic hypothesis can explain the natural history of chronic Chagas heart disease. Int J Cardiol 96: 191195.

    • Search Google Scholar
    • Export Citation
  • 19.

    Marin-Neto JA, 1998. Cardiac dysautonomia and pathogenesis of Chagas' heart disease. Int J Cardiol 66: 129131.

  • 20.

    de Andrade AL, Zicker F, Silva IG, Souza JM, Martelli CM, 1995. Risk factors for Trypanosoma cruzi infection among children in central Brazil: a case-control study in vector control settings. Am J Trop Med Hyg 52: 183187.

    • Search Google Scholar
    • Export Citation
  • 21.

    Grijalva MJ, Escalante L, Paredes RA, Costales JA, Padilla A, Rowland EC, Aguilar HM, Racines J, 2003. Seroprevalence and risk factors for Trypanosoma cruzi infection in the Amazon region of Ecuador. Am J Trop Med Hyg 69: 380385.

    • Search Google Scholar
    • Export Citation
  • 22.

    Gurtler RE, Cohen JE, Cecere MC, Lauricella MA, Chuit R, Segura EL, 1998. Influence of humans and domestic animals on the household prevalence of Trypanosoma cruzi in Triatoma infestans populations in northwest Argentina. Am J Trop Med Hyg 58: 748758.

    • Search Google Scholar
    • Export Citation
  • 23.

    Mott KE, Lehman JS Jr, Hoff R, Morrow RH, Muniz TM, Sherlock I, Draper CC, Pugliese C, Guimaraes AC, 1976. The epidemiology and household distribution of seroreactivity to Trypanosoma cruzi in a rural community in northeast Brazil. Am J Trop Med Hyg 25: 552562.

    • Search Google Scholar
    • Export Citation
  • 24.

    Rizzo NR, Arana BA, Diaz A, Cordon-Rosales C, Klein RE, Powell MR, 2003. Seroprevalence of Trypanosoma cruzi infection among school-age children in the endemic area of Guatemala. Am J Trop Med Hyg 68: 678682.

    • Search Google Scholar
    • Export Citation
  • 25.

    Levy MZ, Bowman N, Kawai V, Waller LA, Cornejo del Carpio J, Cordova E, Gilman RH, Bern C, 2006. Peri-urban infestation by Triatoma infestans carrying Trypanosoma cruzi in Arequipa, Peru. Emerg Infect Dis 12: 13451352.

    • Search Google Scholar
    • Export Citation
  • 26.

    Bowman NM, Kawai V, Levy MZ, Cornejo del Carpio JG, Cabrera L, Delgado F, Malaga F, Cordova Benzaquen E, Pinedo VV, Steurer F, Seitz AE, Gilman RH, Bern C, 2008. Chagas disease transmission in periurban communities of Arequipa, Peru. Clin Infect Dis 46: 18221828.

    • Search Google Scholar
    • Export Citation
  • 27.

    Levy MZ, Kawai V, Bowman NM, Waller LA, Cabrera L, Pinedo-Cancino VV, Seitz AE, Steurer FJ, Cornejo Del Carpio JG, Cordova-Benzaquen E, Maguire JH, Gilman RH, Bern C, 2007. Targeted screening strategies to detect Trypanosoma cruzi infection in children. PLoS Negl Trop Dis 1: e103.

    • Search Google Scholar
    • Export Citation
  • 28.

    Williams JE, 1995. Leishmania and Trypanosoma. Gillespie SH, Hawkey PM, eds. Medical Parasitology: A Practical Approach. Oxford, United Kingdom: Oxford University Press, 151176.

    • Search Google Scholar
    • Export Citation
  • 29.

    WHO Expert Committee, 2002. Control of Chagas Disease. Brasilia, Brazil: World Health Organization, 1109.

  • 30.

    Andrade AL, Zicker F, de Oliveira RM, Almeida Silva S, Luquetti A, Travassos LR, Almeida IC, de Andrade SS, de Andrade JG, Martelli CM, 1996. Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection. Lancet 348: 14071413.

    • Search Google Scholar
    • Export Citation
  • 31.

    Molina RB, Matsubara BB, Hueb JC, Zanati SG, Meira DA, Cassolato JL, Paiva SA, Zornoff LA, 2006. Dysautonomia and ventricular dysfunction in the indeterminate form of Chagas disease. Int J Cardiol 113: 188193.

    • Search Google Scholar
    • Export Citation
  • 32.

    Koberle F, 1968. Chagas' disease and Chagas' syndromes: the pathology of American trypanosomiasis. Adv Parasitol 6: 63116.

  • 33.

    Breniere SF, Bosseno MF, Noireau F, Yacsik N, Liegeard P, Aznar C, Hontebeyrie M, 2002. Integrate study of a Bolivian population infected by Trypanosoma cruzi, the agent of Chagas disease. Mem Inst Oswaldo Cruz 97: 289295.

    • Search Google Scholar
    • Export Citation
  • 34.

    Chippaux JP, Postigo JR, Santalla JA, Schneider D, Brutus L, 2008. Epidemiological evaluation of Chagas disease in a rural area of southern Bolivia. Trans R Soc Trop Med Hyg 102: 578584.

    • Search Google Scholar
    • Export Citation
  • 35.

    Diosque P, Padilla AM, Cimino RO, Cardozo RM, Negrette OS, Marco JD, Zacca R, Meza C, Juarez A, Rojo H, Rey R, Corrales RM, Nasser JR, Basombrio MA, 2004. Chagas disease in rural areas of Chaco Province, Argentina: epidemiologic survey in humans, reservoirs, and vectors. Am J Trop Med Hyg 71: 590593.

    • Search Google Scholar
    • Export Citation
  • 36.

    Gurtler RE, Cecere MC, Lauricella MA, Petersen RM, Chuit R, Segura EL, Cohen JE, 2005. Incidence of Trypanosoma cruzi infection among children following domestic reinfestation after insecticide spraying in rural northwestern Argentina. Am J Trop Med Hyg 73: 95103.

    • Search Google Scholar
    • Export Citation
  • 37.

    Bustamante JM, Rivarola HW, Fernandez AR, Enders JE, Fretes R, Palma JA, Paglini-Oliva PA, 2002. Trypanosoma cruzi reinfections in mice determine the severity of cardiac damage. Int J Parasitol 32: 889896.

    • Search Google Scholar
    • Export Citation
  • 38.

    Bustamante JM, Rivarola HW, Palma JA, Paglini-Oliva PA, 2004. Electrocardiographic characterization in Trypanosoma cruzi reinfected mice. Parasitology 128: 415419.

    • Search Google Scholar
    • Export Citation
  • 39.

    Dias JC, Silveira AC, Schofield CJ, 2002. The impact of Chagas disease control in Latin America: a review. Mem Inst Oswaldo Cruz 97: 603612.

  • 40.

    Verani J, Seitz A, Gilman R, LaFuente C, Galdos-Cardenas G, Kawai V, de LaFuente E, Ferrufino L, Bowman N, Pinedo-Cancino V, Levy M, Steurer F, Todd C, Kirchhoff L, Cabrera L, Verastegui M, Bern C, 2009. Geographic variation in the sensitivity of recombinant antigen-based rapid tests for chronic Trypanosoma cruzi infection. Am J Trop Med Hyg 80: 410415.

    • Search Google Scholar
    • Export Citation
  • 41.

    Gurtler RE, Chuit R, Cecere MC, Castanera MB, Cohen JE, Segura EL, 1998. Household prevalence of seropositivity for Trypanosoma cruzi in three rural villages in northwest Argentina: environmental, demographic, and entomologic associations. Am J Trop Med Hyg 59: 741749.

    • Search Google Scholar
    • Export Citation
  • 42.

    Guzman-Tapia Y, Ramirez-Sierra MJ, Dumonteil E, 2007. Urban infestation by Triatoma dimidiata in the city of Merida, Yucatan, Mexico. Vector Borne Zoonotic Dis 7: 597606.

    • Search Google Scholar
    • Export Citation
  • 43.

    Schofield CJ, Jannin J, Salvatella R, 2006. The future of Chagas disease control. Trends Parasitol 22: 583588.

  • 44.

    Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, Maguire JH, Acquatella H, Morillo C, Kirchhoff LV, Gilman RH, Reyes PA, Salvatella R, Moore AC, 2007. Evaluation and treatment of Chagas disease in the United States: a systematic review. JAMA 298: 21712181.

    • Search Google Scholar
    • Export Citation
  • 45.

    Sosa-Estani S, Segura EL, 2006. Etiological treatment in patients infected by Trypanosoma cruzi: experiences in Argentina. Curr Opin Infect Dis 19: 583587.

    • Search Google Scholar
    • Export Citation
  • 46.

    Monge CC, Leon-Velarde SF (eds), 2003. El Retro Fisiologico de Vivir en los Andes. Lima, Peru: Instituto Frances de Estudios Andinos and Universidad Peruana Cayetano Heredia, 162.

    • Search Google Scholar
    • Export Citation

 

 

 

 

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

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  • 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

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.

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