medigraphic.com
Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán

2009, Number 3

<< Back Next >>

Rev Biomed 2009; 20 (3)

Trypanosoma cruzi discrete typing units in Chagas disease patients with HIV co-infection

Bisio M, Cura C, Duffy T, Altcheh J, Giganti SÓ, Begher S, Scapellato PG, Burgos JM, Levin MJ, Schreck R, Freilij H, Schijman AG

Language: English
References: 60
Page: 166-178
PDF size: 308.09 Kb.


ABSTRACT

Background. Natural populations of T. cruzi have been classified into six phylogenetic lineages or discrete typing units, T. cruzi I, IIa, IIb, IIc, IId, and IIe, believed to play a role in tissue tropism and disease pathogenesis. The impact of HIV infection in the T. cruzi genetic diversity in coinfected patients is a scarcely explored field of parasitology.
Objective. To characterize parasitic lineages in clinical samples from patients co-infected with T. cruzi and HIV
Materials and Methods. We analyzed blood and lesions samples from 25 patients residing in Argentina, namely 8 infants born to 7 HIV- T. cruzi co-infected mothers, 3 indeterminate adult chagasic patients with HIV co-infection and 7 presenting cerebral Chagas due to AIDS. Molecular diagnosis and monitoring of etiological treatment was carried out by PCR targeted to kinetoplastid (kDNA) and/or satellite sequences. T. cruzi lineages were identified by means of PCR targeted to the intergenic spacer of miniexon gene and 24s ribosomal ARN genes. To characterize the infra-lineage diversity, restriction fragment length polymorphism (RFLP) of KDNA amplicons was carried out.
Results. Out of the 7 co-infected mothers, two transmitted both HIV and T. cruzi to their siblings, four transmitted only T. cruzi. The remaining case was a pregnant woman with cerebral Chagas disease who entered into a coma being treated with benznidazole; she did not transmit congenital Chagas disease nor HIV to her newborn.
Most bloodstream populations belonged to T. cruzi IId, with unique minicircle signatures for each patient´s strain, but identical signatures between strains from mothers and their congenitally infected infants. Mixtures of lineages T. cruzi I and T. cruzi IId were also detected. Differential tissue tropism of T. cruzi IIb and T. cruzi I was found in patients with cerebral chagas. Minicircle signatures showed complex patterns suggestive of polyclonal populations.
Conclusions. The higher proportion of PCR positive samples suggests higher parasite loads that in chagasic population without HIV. The higher prevalence of T. cruzi IId in bloodstream is in agreement with previous findings in this region. The association of rare lineages at sites of encephalytis suggests differential tropism. The direct characterization of parasite lineages in clinical samples allowed identification of a higher prevalence of mixed infections, than previously assumed, from studies based on culture isolates.


REFERENCES

  1. World Health Organization. Reporte del grupo de trabajo científico sobre la enfermedad de Chagas TDR/GTC/06. 2005

  2. Gluckstein D, Ciferri F, Ruskin J. Chagas’ disease: another cause of cerebral mass in the acquired immunodeficiency syndrome. Am J Med 1992; 92:429-32.

  3. Ferreira MS, Nishioka S de A, Silvestre MT, Borges AS, Nunes-Araujo FR, Rocha A. Reactivation of Chagas’ disease in patients with AIDS: report of three new cases and review of the literature. Clin Infect Dis 1997; 25:1397-400.

  4. Sartori AM, Lopes MH, Caramelli B, Duarte MI, Pinto PL, Neto V, et al. Simultaneous occurrence of acute myocarditis and reactivated Chagas’ disease in a patient with AIDS. Clin Infect Dis 1995; 21:1297-9

  5. Sartori AM, Lopes MH, Benvenuti LA, Caramelli B, di Pietro A, Nunes EV, et al. Reactivation of Chagas’ disease in a human immunodeficiency virus-infected patient leading to severe heart disease with a late positive direct microscopic examination of the blood. Am J Trop Med Hyg 1998; 59:784-6.

  6. Sartori AM, Ibrahim KY, Nunes Westphalen EV, Braz LM, Oliveira OC Jr, Gakiya E, et al. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Ann Trop Med Parasitol 2007; 101:31-50.

  7. Corti M. AIDS and Chagas’ disease [Review]. AIDS Patient Care STDs 2000; 14:581-8.

  8. Ferreira MS, Nishioka SA , Rocha A, Silva AM, Ferreira RG, Olivier W, et al. Acute fatal Trypanosoma cruzi meningoencephalitis in a human immunodeficiency virus-positive hemophiliac patient. Am J Trop Med Hyg 1991; 45:723-7.

  9. Rocha A, Ferreira MS, Nishioka SA , Silva AM, Burgarelli MK, Silva M, et al. Trypanosoma cruzi meningoencephalitis and myocarditis in a patient with acquired immunodeficiency syndrome. Rev Inst Med Trop Sao Paulo 1993; 35:205-8.

  10. Rocha A, de Meneses AC, da Silva AM, Ferreira MS, Nishioka SA, Burgarelli MK, et al. Pathology of patients with Chagas´ disease and acquired immunodeficiency syndrome. Am J Trop Med Hyg 1994; 50:261-268.

  11. Pacheco RS, Ferreira MS, Machado MI, Brito CM, Pires MQ, Da-Cruz AM, et al. Chagas´ disease and HIV co-infection: genotypic characterization of the Trypanosoma cruzi strain. Mem I Oswaldo Cruz 1998; 93:165-9.

  12. Cordova E, Boschi A, Ambrosioni J, Cudos C, Corti M. Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992-2007. Int J Infect Dis 2008; 12:587-92

  13. Corti M. Enfermedad de Chagas y síndrome de inmunodeficiencia adquirida. Enf Emerg 2003; 5:13-7.

  14. Anonymous. Recommendations from a satellite meeting. Mem I Oswaldo Cruz 1999; 94 (Suppl 1): 429-32.

  15. Brisse S, Barnabe C, Tibayrenc M. Identification of six Trypanosoma cruzi phylogenetic lineages by random amplified polymorphic DNA and multilocus enzyme electrophoresis. Int J Parasitol 2000; 30:35-44.

  16. Zingales B, Andrade S, Briones M, Campbell D, Chiari E, Fernandes O, et al. A new consensus for Trypanosoma cruzi intraspecific nomenclature: second revision meeting recommends TcI to TcVI. Mem Inst Oswaldo Cruz 2009, in press.

  17. Bosseno MF, Barnabé C, Magallón-Gastélum E, Lozano-Kasten F, Ramsey J, Espinoza B et al. Predominance of Trypanosoma cruzi Lineage I in Mexico. J Clin Microbiol 2002; 40:627-32.

  18. World Health Organization. Control of Chagas disease. Second Report of the WHO Expert Committee. WHO Tech rep ser 2002; 905:1-109.

  19. Monteón-Padilla VM, Vargas-Alarcón G, Vallejo-Allende M, Reyes PA. Specific dilated myocardiopathy. Chronic chagasic cardiopathy at the National Institute of Cardiology Ignacio Chávez. Arch Cardiol Mex 2002; 72 (Suppl 1):S148-52.

  20. Añez, N, Carrasco H, Parada H, Crisante G, Rojas A, Fuenmayor C, et al. Myocardial parasite persistence in chronic chagasic patients. Am J Trop Med Hyg 1999; 60:726-32.

  21. Añez N, Crisante G, da Silva FM, Rojas A, Carrasco H, Umezawa ES, et al. Predominance of lineage I among Trypanosoma cruzi isolates from Venezuelan patients with different clinical profiles of acute Chagas’ disease. Trop Med Int Health 2004; 9:1319-26.

  22. Sousa OE, Samudio F, de Junca C, Calzada JE. Molecular characterization of human Trypanosoma cruzi isolates from endemic areas in Panama. Mem I Oswaldo Cruz 2006; 101:455-7.

  23. Herrera C, Bargues MD, Fajardo A, Montilla M, Triana O, Vallejo GA, et al. Identifying four Trypanosoma cruzi I isolate haplotypes from different geographic regions in Colombia. Infect Genet Evol 2007; 7:535-9.

  24. Falla A, Herrera C, Fajardo A, Montilla M, Vallejo GA, Guhl F. Haplotype identification within Trypanosoma cruzi I in Colombian isolates from several reservoirs, vectors and humans. Acta Trop 2009; 110:15-21.

  25. Llewellyn MS, Miles MA, Carrasco HJ, Lewis MD, Yeo M, Vargas J, et al. Genome-scale multilocus microsatellite typing of Trypanosoma cruzi discrete typing unit I reveals phylogeographic structure and specific genotypes linked to human infection. PLoS Pathog 2009; 5:e1000410.

  26. Virreira M, Truyens C, Alonso-Vega C, Brutus L, Jijena J, Torrico F, et al. Comparison of Trypanosoma cruzi lineages and levels of parasitic DNA in infected mothers and their newborns. Am J Trop Med Hyg 2007; 77:102-6.

  27. Burgos JM, Altcheh J, Bisio M, Duffy T, Valadares HM, Seidenstein ME, et al. Direct molecular profiling of minicircle signatures and lineages of Trypanosoma cruzi bloodstream populations causing congenital Chagas disease. Int J Parasitol 2007; 37:1319-27.

  28. Schijman AG, Vigliano CA, Viotti RJ, Burgos JM, Brandariz S, Lococo BE, et al. Trypanosoma cruzi DNA in cardiac lesions of Argentinean patients with end-stage chronic chagas heart disease. Am J Trop Med Hyg. 2004; 70:210-20.

  29. Burgos JM, Begher S, Silva HM, Bisio M, Duffy T, Levin MJ, et al. Molecular identification of Trypanosoma cruzi I tropism for central nervous system in Chagas reactivation due to AIDS. Am J Trop Med Hyg 2008; 78:294-7.

  30. Piron M, Fisa R, Casamitjana N, López-Chejade P, Puig L, Vergés M, et al. Development of a real-time PCR assay for Trypanosoma cruzi detection in blood samples. Acta Trop 2007; 103:195-200.

  31. Bittencourt AL, Mota E, Ribeiro Filho R, Fernandes LG, de Almeida PR, Sherlock I, et al. Incidence of congenital Chagas disease in Bahia, Brazil. J Trop Pediatr 1985; 31:242-8.

  32. Freilij H, Altcheh J, Storino R. Chagas congénito. In: Storino R, Milei J, editores. Enfermedad de Chagas. Buenos Aires: Mosby-Doyma Argentina; 1994. p. 267-78.

  33. Hermann E, Truyens C, Alonso-Vega C, Rodriguez P, Berthe A, Torrico F, et al. Congenital transmission of Trypanosoma cruzi is associated with maternal enhanced parasitemia and decreased production of interferon gamma in response to parasite antigens. J Infect Dis 2004; 189:1274-81

  34. Moretti E, Basso B, Castro I, Carrizo Paez M, Chaul M, Barbieri G, et al. Chagas’ disease: study of congenital transmission in cases of acute maternal infection. Rev Soc Bras Med Trop 2005; 38:53-5.

  35. Scapellato PG, Bottaro EG, Rodriguez- Brieschke MT. Mother-child transmission of Chagas disease: could co-infection with human immunodeficiency virus increase the risk? Rev Soc Bras Med Trop 2009; 42:107-9.

  36. Freilij H, Altcheh J, Muchinik G. Perinatal immunodeficiency virus infection and congenital Chagas disease. Pediatr Infect Dis J 1995; 14:161-2.

  37. Freilij H, Altcheh J. Congenital Chagas’ disease: diagnostic and clinical aspects. Clin Infect Dis 1995; 21:551-5.

  38. Dolcini G, Ambrosioni J, Andreani G, Pando MA, Martínez Peralta L, Benetucci J. Prevalence of human immunodeficiency virus (HIV)- Trypanosoma cruzi co-infection and injectable-drugs abuse in a Buenos Aires health center. Rev Argent Microbiol 2008; 40:164-6.

  39. Pineda JA, Gallardo JA, Macías J, Delgado J, Regordán C, Morillas F, et al. Prevalence of and factors associated with visceral leishmaniasis in human immunodeficiency virus type 1-infected patients in southern Spain. J Clin Microbiol 1998; 36:2419-22.

  40. Hernández-Becerril N, Mejía AM, Ballinas-Verdugo MA, Garza-Murillo V, Manilla-Toquero E, López R, et al. Blood transfusion and iatrogenic risks in Mexico City. Anti-Trypanosoma cruzi seroprevalence in 43,048 blood donors, evaluation of parasitemia, and electrocardiogram findings in seropositive. Mem I Oswaldo Cruz 2005; 100:111-6.

  41. Amato Neto V, Molinari HE, Siquiera AF, Lucas RS. Analise por meio da fixaçao do complemento do risco de aquisiçao da doença de Chagas a través de hemoterapia, por parte de pacientes politransfundidos. Rev Goiana Med 1975; 21:1.

  42. Sartori AM, Neto JE, Nunes EV, Braz LM, Caiaffa- Filho HH, Oliveira Oda C Jr, et al. Trypanosoma cruzi parasitemia in chronic Chagas disease: comparison between Human Immunodeficiency Virus (HIV)-positive and HIV-negative patients. J Infect Dis 2002; 186:872-5.

  43. Del Castillo M, Mendoza G, Oviedo J, Bianco RP, Anselmo AE, Silva M. AIDS and Chagas disease with central nervous system tumor-like lesion. Am J Med 1990; 88:693-4.

  44. Lazo JE, Meneses AC, Rocha A, Frenkel JK, Marquez JO, Chapadeiro E, et al. Toxoplasmic and chagasic meningoencephalitis in patients with human immunodeficiency virus infection: Anatomopathologic and tomographic differential diagnosis. Rev Soc Bras Med Trop 1998; 3:163-71.

  45. Lury KM, Castillo M. Chagas’ disease involving the brain and spinal cord: MRI findings. AJR Am J Roentgenol 2005; 185:550-2

  46. Burgos JM, Begher SB, Freitas JM, Bisio M, Duffy T, Altcheh J, et al. Molecular diagnosis and typing of Trypanosoma cruzi populations and lineages in cerebral Chagas disease in a patient with AIDS. Am J Trop Med Hyg 2005; 73:1016-8.

  47. Yoo TW, Mlikotic A, Cornford ME, Beck CK. Concurrent cerebral American trypanosomiasis and toxoplasmosis in a patient with AIDS. Clin Infect Dis 2004; 39:30-4.

  48. Nijjar SS, Del Bigio MR. Cerebral trypanosomiasis in an incarcerated man. CMAJ 2007; 176:448.

  49. Valerga M, Bases O, Martín M, Papucci T. Multifocal encephalitis in an AIDS patient. Enferm Infecc Microbiol Clin 2005; 23:569-70.

  50. Montero A, Cohen JE, Martinez DP, Giovannoni AG. Empirical anti-toxoplasma therapy in cerebral AIDS and Chagas disease. Presentation of 2 cases, review of the literature and proposal of an algorithm. Medicina (B Aires) 1998; 58:504-6.

  51. Pimentel PC, Handfas BW, Carmignani M. Trypanosoma cruzi meningoencephalitis in AIDS mimicking cerebral metastases: case report. Arq Neuropsiquiatr 1996; 54:102-6.

  52. De Queiroz AC. Tumor-like lesion of the brain caused by Trypanosoma cruzi. Am J Trop Med Hyg 1973; 22:473-6.

  53. Zago MP, Barrio AB, Cardozo RM, Duffy T, Schijman AG, Basombrío MA. Impairment of infectivity and immunoprotective effect of a LYT1 null mutant of Trypanosoma cruzi. Infect Immun 2008; 76:443-51.

  54. Duffy T, Bisio M, Altcheh J, Burgos JM, Diez M, Levin MJ, et al. Accurate real-time PCR strategy for monitoring bloodstream parasitic loads in chagas disease patients. PLoS Negl Trop Dis 2009; 3:e419.

  55. Perez-Ramirez L, Barnabé C, Sartori AM, Ferreira MS, Tolezano JE, Nunes EV, et al. Clinical analysis and parasite genetic diversity in human immunodeficiency virus/Chagas’ disease coinfections in Brazil. Am J Trop Med Hyg.1999; 61:198-206.

  56. Brisse S, Verhoef J, Tibayrenc M. Characterisation of large and small subunit rRNA and mini-exon genes further supports the distinction of six Trypanosoma cruzi lineages. Int J Parasitol 2001; 31:1218-26.

  57. Di Noia JM, Buscaglia CA, De Marchi CR, Almeida IC, Frasch AC. A Trypanosoma cruzi small surface molecule provides the first immunological evidence that Chagas’ disease is due to a single parasite lineage. J Exp Med 2002; 195:401-13.

  58. Valadares HM, Pimenta JR, de Freitas JM, Duffy T, Bartholomeu DC, Oliveira Rde P, et al. Genetic profiling of Trypanosoma cruzi directly in infected tissues using nested PCR of polymorphic microsatellites. Int J Parasitol 2008; 38:839-50.

  59. Chicharro C, Alvar J. Lower trypanosomatids in HIV/AIDS patients. Ann Trop Med Parasitol 2003; 97 (Suppl 1):75-8.

  60. Alvar J, Aparicio P, Aseffa A, Den Boer M, Cañavate C, Dedet JP, et al. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 2008; 21:334-59.




2020     |     www.medigraphic.com