Julio César Mantilla

Evidence of Trypanosoma cruzi II infection in Colombian chagasic patients

Trypanosoma cruzi is genetically classified into at least two major lineages named T. cruzi I (also named Tc I) and T. cruzi II (also named Tc IIb). T. cruzi II is associated with Chagas’ disease in the southern cone of South America, while T. cruzi I is the only one so far identified in chagasic patients of Central America and in the northern part of South America. Herein we identified T. cruzi IIb directly in 9.9% of blood of chronic chagasic patients of Colombia. This finding establishes that in this region, the two T. cruzi lineages are associated with the pathology of Chagas’ disease and have implications in the morbidity and epidemiology of the disease.

Mixed infection of Trypanosoma cruzi I and II in a Colombian cardiomyopathic patient

The Trypanosoma cruzi taxon is composed of 2 major lineages, T cruzi I and T cruzi II. The clinical symptoms of Chagas disease are highly variable, and their geographic distribution is correlated with the distribution of the parasite lineages. In Colombia and northern South America, T cruzi I lineage is associated with chagasic cardiomyopathy. Alternatively, in the countries south cone of South America, there is a predominance of T cruzi II, which is associated with cardiomyopathy and digestive diseases. We report for the first time a mixed infection consisting of both T cruzi I and T cruzi II detected in the esophagus and in the heart, respectively, of a cardiomyopathic patient from an endemic area in Santander, Colombia. This finding has epidemiological relevance related to the association of T cruzi II with the clinical manifestations of Chagas disease and its frequency in Colombia and countries in northern South America.

Direct analysis of genetic variability in Trypanosoma cruzi populations from tissues of Colombian chagasic patients

The clinical symptoms of Chagas disease are highly variable and are correlated with geographical distribution and parasite genetic group. Trypanosoma cruzi group I is associated with chagasic cardiomyopathy in Colombia and other countries in northern South America. However, in southern South America, T cruzi group II predominates and is associated with cardiomyopathy and digestive forms of the disease. The aim of this work was to determine the correlation between the genetic profiles of T cruzi groups circulating in the biological cycle and those present in tissues from patients with Chagas disease. We genotyped T cruzi in 10 heart tissue samples from patients with cardiomyopathy from a highly endemic area of Colombia. The genotyping was performed using nuclear and mitochondrial genes and low-stringency single-specific primer polymerase chain reaction. As expected, the predominant genetic group was T cruzi group I; however, we also detected T cruzi group II. Microsatellite analyses suggested a predominance of monoclonal populations, and sequence alignments showed similarities with Colombian strains. In addition, kinetoplast DNA signatures obtained by low-stringency single-specific primer polymerase chain reaction allowed us to group strains into the 2 genetic groups. Thus, we conclude that both T cruzi genetic groups are producing severe cases of Chagas disease in Colombia. We did not observe any correlation between low-stringency single-specific primer polymerase chain reaction profiles, histopathologic findings, clinical forms, and severity of Chagas disease.

Chagasic megacolon associated with Trypanosoma cruzi I in a Colombian patient.

Chagasic megacolon has been reported in the southern cone countries of South America and is mainly associated with Trypanosoma cruzi II infection. Herein, we report the first case in Colombia of chagasic megacolon with cardiomyopathy associated with the T. cruzi I lineage. This finding suggests that in Colombia, as well as in other northern countries of South America and throughout Central America, where T. cruzi I is endemic, cardiomyopathy may not be the only clinical form of Chagas disease.

Enfermedad de Chagas: correlación clínico-patológica. Serie de casos del Hospital Universitario de Santander - Departamento de Patología, Universidad Industrial de Santander

La enfermedad de Chagas es un padecimiento que predomina en aquellas regiones del continente americano que combinan condiciones geograficas, climaticas y ecologicas para que el hombre, el Trypanosoma cruzi, sus reservorios y vectores, interactuen de manera ideal. Objetivo presentar nueve casos de enfermedad de Chagas diagnosticados mediante autopsia en el Departamento de Patologia de la Universidad Industrial de Santander entre 2002 y 2009, correlacionar los hallazgos pos-mortem con las manifestaciones clinicas y comparar los datos obtenidos con la informacion referida en la literatura mundial. Materiales y metodos estudio descriptivo, retrospectivo en casos de autopsias realizadas en el Departamento de Patologia de la Universidad Industrial de Santander entre el primero de enero de 2002 y el 30 de junio de 2009. Resultados de un total de 756 autopsias, nueve (1,2%) correspondieron a pacientes con diagnostico confirmado de enfermedad de Chagas: siete hombres y dos mujeres. El rango de edad oscilo entre 14 meses y 56 anos. De los casos analizados cinco correspondieron a la forma aguda, dos a la forma cronica y dos a un proceso de reactivacion. Todos tenian compromiso cardiaco, uno compromiso del colon y uno compromiso encefalico. La causa de muerte se relaciono de manera directa con estas afecciones. Conclusion en zonas endemicas, ante la presencia de manifestaciones cardiacas, es necesario considerar la enfermedad de Chagas con el fin de realizar un diagnostico precoz y oportuno que permita identificar casos y establecer medidas de manejo especifico enfocado de acuerdo con su condicion.