Home Medizin Die orale Übertragung der Chagas-Krankheit hat schwerwiegende Folgen

Die orale Übertragung der Chagas-Krankheit hat schwerwiegende Folgen

von NFI Redaktion

Thanks to decades of successful vector control strategies, the vector-borne transmission of Chagas disease has significantly decreased in many regions. However, oral transmission of Trypanosoma cruzi through contaminated food and beverages is on the rise. Unlike transmission through vectors, oral transmission of Chagas disease in children and adults leads to high fatality rates.

„Oral transmission of Chagas disease is becoming a recognized route, and it is important to understand that people can die from this type of transmission,“ said Dr. Norman L. Beatty, MD, Assistant Professor of Infectious Diseases and Global Medicine at the University of Florida College of Medicine in Gainesville. He is the lead author of a recent article on this topic.

In regions where the parasite circulates in the environment, people may consume contaminated foods, fruit juices, and possibly wild animal meat. „As we experience changes in our environment and how we consume food, it is crucial to consider how food preparation is carried out in the areas where we live,“ Beatty said. „And as organic farming methods without insecticides become more common, more research is needed in these areas in both Latin America and the United States to understand if oral transmission of T. cruzi occurs.“

In the Amazon basin, foodborne transmission is already the main cause of acute Chagas disease. It has been described in Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, and Venezuela.

Dr. Beatty’s colleagues recently treated a Brazilian patient at a hospital in Florida. „He came to our hospital very ill, with acute myocarditis after consuming contaminated açaí.“ He emphasized that there is widespread awareness of oral transmission in Brazil, but expressed concern that it may not be recognized in other regions of Latin America.

In Mexico and Central American regions, there is little to no information on oral transmission, but it is likely to occur and cases in the region may go unnoticed, Beatty said.

He investigated the issue in Colombia as part of an international collaboration involving the University of Antioquia with the goal of finding ways to contain oral transmission and develop a model that can be used throughout Latin America and the United States. For the Colombia study, they reviewed all cases reported to the Ministry of Health and Social Protection and found that oral transmission occurred more frequently than expected by the research group. „Nevertheless, I imagine that in certain resource limited areas… there are many more cases that go unreported.“

„A myth I would like to dispel is that Chagas disease is not transmitted in the United States,“ Beatty added. He mentioned that there are vectors in at least 30 US states, and in Florida it has been documented that triatomines have invaded homes and bitten residents. Furthermore, 30% of these insects are infected with T. cruzi. Research is currently underway to determine if Florida residents are becoming infected and if they are also at risk of oral transmission of Chagas disease. „In the United States, we know very little about how many people are infected and what the transmission routes are. Much more research is needed.“

Dr. Roberto Chuit, a public health physician and external consultant for the Pan American Health Organization (PAHO), agreed that the route of food contamination, arising from vector-borne parasites, was previously obscured or hidden by the organization’s focus on vector prevalence. It has now gained extreme importance in the Americas as other transmission routes have been controlled, just as it began to gain importance. He emphasized that the public health services and the general public need to be made aware of the severity and potential lethality of outbreaks of oral Chagas disease to prompt immediate responses and containment measures.

The epidemiological approach is essential when diagnosing Chagas disease in groups or families, as according to Chuit, it is usually not isolated cases but outbreaks of 3 to 40 cases. „Under these circumstances, consideration must be given quickly to the possibility that this parasite could be involved,“ he said.

The most common foods involved in oral transmission outbreaks were homemade fruit juices, according to an analysis of 32 outbreaks between 1965 and 2022. However, various vector species were identified, and the reservoirs mainly consisted of dogs, rodents, and large American opossums (Didelphis). The largest oral Chagas outbreak was linked to the consumption of contaminated guava juice in a primary school in Caracas, Venezuela. Non-industrially produced açaí is a common cause of orally acquired Chagas disease in Brazil.

Despite the severity of oral Chagas disease, it is easily treatable. Immediate administration of antiparasitic medications is essential for patient recovery. The use of epidemiological data and awareness of potential risks can help prevent and control outbreaks of oral Chagas disease.

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