Molecular Identification of Trypanosoma cruzi Discrete Typing Units in End-Stage Chronic Chagas Heart Disease and Reactivation after Heart Transplantation

被引：159

作者：

Burgos, Juan Miguel ^{[1
]}

Diez, Mirta ^{[2
]}

Vigliano, Carlos ^{[2
]}

Bisio, Margarita ^{[1
]}

Risso, Marikena ^{[3
]}

Duffy, Tomas ^{[1
]}

Cura, Carolina ^{[1
]}

Brusses, Betina ^{[4
]}

Favaloro, Liliana ^{[2
]}

Leguizamon, Maria Susana ^{[3
]}

Lucero, Raul Horacio ^{[4
]}

Laguens, Ruben ^{[2
]}

Levin, Mariano Jorge ^{[1
]}

Favaloro, Roberto ^{[2
]}

Schijman, Alejandro Gabriel ^{[1
]}

机构：

[1] Univ Buenos Aires, Inst Ingn Genet & Biol Mol, Lab Biol Mol Enfermedad Chagas, Buenos Aires, DF, Argentina

[2] Univ Buenos Aires, Hosp Univ Fdn Favaloro, Buenos Aires, DF, Argentina

[3] Univ Buenos Aires, Fac Med, Dept Microbiol Parasitol & Inmunol, Buenos Aires, DF, Argentina

[4] Reg Univ Nacl Nordeste, Inst Med, Mol Biol Lab, Resistencia, Chaco, Argentina

来源：

CLINICAL INFECTIOUS DISEASES | 2010年 / 51卷 / 05期

关键词：

TIME PCR STRATEGY; PARASITE PERSISTENCE; GENETIC EXCHANGE; LINEAGES; POPULATIONS; EPIDEMIOLOGY; NOMENCLATURE; DIAGNOSIS; REVISION; LESIONS;

D O I：

10.1086/655680

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. One hundred years after the discovery of Chagas disease, it remains a major neglected tropical disease. Chronic Chagas heart disease (cChHD) is the most severe manifestation. Heart transplantation is the proper treatment for end-stage heart failure, although reactivation of disease may result after receipt of immunosuppressive therapy. T. cruzi strains cluster into 6 discrete typing units (DTUs; I-VI) associated with different geographical distribution, transmission cycles and varying disease symptoms. In the southern cone of South America, T. cruzi II, V, and VI populations appear to be associated with Chagas disease and T. cruzi I with sylvatic cycles. Methods. Molecular characterization of DTUs, T. cruzi I genotypes (on the basis of spliced-leader gene polymorphisms), and minicircle signatures was conducted using cardiac explant specimens and blood samples obtained from a cohort of 16 Argentinean patients with cChHD who underwent heart transplantation and from lesion samples obtained from 6 of these patients who presented with clinical reactivation of Chagas disease. Results. Parasite persistence was associated with myocarditis progression, revealing T. cruzi I (genotype Id) in 3 explant samples and T. cruzi II, V, or VI in 5 explant samples. Post-heart transplantation follow-up examination of bloodstream DTUs identified T. cruzi I in 5 patients (genotypes Ia or Id) and T. cruzi II, V, or VI in 7 patients. T. cruzi I, V, and VI were detected in skin chagoma specimens, and T. cruzi V and VI were detected in samples obtained from patients with myocarditis reactivations. Multiple DTUs or genotypes at diverse body sites and polymorphic minicircle signatures at different cardiac regions revealed parasite histotropism. T. cruzi I infections clustered in northern Argentina (latitude, 23 degrees S-27 degrees S), whereas T. cruzi II, V, or VI DTUs were more ubiquitous. Conclusions. Multiple DTUs coexist in patients with Chagas disease. The frequent finding of T. cruzi I associated with cardiac damage was astounding, revealing its pathogenic role in cChHD at the southern cone.

引用

页码：485 / 495

页数：11

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