Saptaparna Dasgupta, Bennett University
A chronic, neglected infectious illness, Chagas Disease (CD) affects many low and middle-income nations. The etiological agent (Trypanosoma cruzi) can also be transferred by blood transfusions, resulting in the spread of the disease from patients with CD to Europe and the United States. Around 7 million people in the globe suffer from Chagas disease (CD), amongst which, asymptomatic, an indeterminate chronic form (ICF) was prevalent. An outpatient CD clinic in Southeastern Brazil was investigated for a nonconcurrent (retrospective) cohort of patients who were hospitalized when showing the ICF in the period from 1998 to 2018. The patients for the research followed up until the year 2019. Specifically, the researchers were interested in the development of cardiac or digestive CDs. In addition, the influence of Benznidazole treatment on illness progression has been investigated in depth.
The causative agent of Chagas disease:
Trypanosoma cruzi, the leading cause of Chagas disease (CD), infects approximately 7 million people worldwide. CD, a vector-borne illness. It is carried by Triatomineae, also known as ‘kissing bugs’, which has been linked to poor building conditions in rural regions of Brazil, particularly in the northern macro-region. The majority of infected individuals have asymptomatic, an intermediate chronic form (ICF). About 40% of patients may develop cardiac or intestinal manifestations over time. Predictors of disease development are still poorly known, and Benznidazole-specific anti-parasitic treatment does not appear to positively influence the disease.
How was the study performed?
The study by Costa et al. 2021 was done at Botucatu Medical School, São Paulo State University’s Tropical Diseases Outpatient Service (UNESP). Between the years 1998 and 2018, a non-concurrent cohort study was undertaken, including individuals with CD who were hospitalized while exhibiting the ICF. Researchers assessed that the study’s power, based on the influence of Benznidazole on CD development. The data for the same was found to be 89.7%, and 96.1%, respectively. Based on the results of two serological testings, the disease was determined to be CD, conducted via ELISA and indirect immunofluorescence. For this study, only the patients who were positive on both tests were included. Further, the data were collected and investigated for the P-values.
Outcome of the study:
Although 430 individuals were diagnosed with ICF at the first medical consultation, the following year, only 51 cases were followed up. The first of either outcome was studied in 10 individuals who had both types. There were 192 individuals in the ICF for the entire follow-up period (53.9%). 99 patients were administered benznidazole, however, 30 of them discontinued therapy within the first 10 days due to adverse effects such as severe pruritus. Benznidazole was administered to the remaining 69 patients, and they were all categorized as “treated with Benznidazole” in the research.
Significance of the study:
However, notwithstanding Brazil’s rapid urbanization, improved housing conditions, and effective public prevention policies implemented over the past two decades, the disease still poses serious health risks for many Brazilians either because of newly acquired oral diseases or because of cardiac and digestive sequelae caused by CD. Some 1 to 2 million CD-affected individuals who attend the ICF are of particular concern. In the study by Costa et al. 2021, systemic arterial hypertension was present in 30% of the individuals and 73.5% of those with the cardiac form of the CD. The protective effect of Benznidazole is evidenced by the Rate Ratio (RR) of 0.33.
Comorbidities play a role in the development of ICF to cardiac CD (such as lung, central nervous system, and coronary syndrome) A majority of the studies showed protection against CD formation with the use of Benznidazole. It was concluded that there was no effect at all on digestive CD. The non-concurrent design limits the investigation. Errors in exposure and result categorization are possible.
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Reference:
- Costa, E. A. P. N. da, Victória, C., & Fortaleza, C. M. C. B. (2021). Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease. PLOS Neglected Tropical Diseases, 15(8), e0009680. https://doi.org/10.1371/journal.pntd.0009680
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Author info:
Saptaparna Dasgupta, currently a B. Tech 3rd year student, pursuing Biotechnology, is a diligent student and determined in terms of her career goals. Being a budding biotechnologist, she is open to all research fields of her course and passionate about knowledge. She is focused and constantly tries to improve her writing skills, also a project enthusiast and is fond of gaining hands-on experience in laboratories. She believes that all hard works and effort pay off eventually and follows this as the motto of her life.
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