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Difusion De La Enfermedad De Chagas En America Del Sur

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Difusion De La Enfermedad De Chagas En America Del Sur [Escriba aquí] DIFUSION DE LA ENFERMEDAD DE CHAGAS EN AMERICA DEL SUR CURTO, Susana Isabel 1; LING, Claudia Marcela 2; CHUIT Roberto 2 1 CONICET. Instituto de Investigaciones Epidemiológicas (IIE) de la Academia Nacional de Medicina-Buenos Aires. 2 Instituto de Investigaciones Epidemiológicas (IIE) de la Academia Nacional de Medicina-Buenos Aires [email protected] Resumen Se analizan los siguientes ítems: a) Origen y evolución de los parásitos, sus vectores y hospederos, ciclos de transmisión y formas de transmisión posibles en diferentes épocas, b) procesos de domiciliación de los triatominos y animales que pudieron formar parte del ciclo de T. cruzi en la antigüedad, c) Referencias sobre los insectos vectores y la enfermedad en los relatos de exploradores y viajeros de las etapas coloniales y modernas y d) posibles rutas de difusión de especies domiciliadas. Se usó una extensa bibliografía proveniente de la antropología, la biología, la entomología y la geografía. Se concluye que la relación entre el tripanosoma y el hombre tiene larga data. Muestras de tejido 9000 años de antigüedad sugieren que el ciclo selvático de la enfermedad (infectados por animales) se habría establecido probablemente con los primeros miembros de la cultura Chinchorro que poblaron un área de la costa peruana y que las rutas de difusión siguieron diferentes direcciones asociadas a la coevolución de parásitos y hospederos. También fueron reconocidos como una plaga domestica desde el s. XVI por los misioneros y viajeros quienes denuncian su presencia en todo el continente. Palabras clave: Paleoepidemiología - Paleoparasitología – enfermedades prehistóricas – Geografia de las enfermedades – enfermedad milenaria CHAGAS´ DISEASE DIFFUSION IN AMERICA DEL SUR Abstract The following items are discussed: a) origin and evolution of parasites, their vectors and hosts, transmission cycles and possible forms of transmission at different times, b) process of domiciliation of the triatomines and animals that could be part of the cycle of T. cruzi in antiquity, c) references about insects and disease in the stories of explorers and travelers of the colonial and modern stages and d) possible routes of dissemination of domiciled species. We used an extensive bibliography of anthropology, biology, entomology, and geography. It is concluded that the relationship between the trypanosome and man has long-standing. Samples of tissue 9000 years ago suggest that the sylvatic cycle of disease (infected animals) probably would have been with the first members of the Chinchorro that settled in an area of the Peruvian coast and routes of dissemination followed different routes associated to the coevolution of parasites and hosts. They were also recognized as a plague domestic from century XVI by the missionaries and travelers who denounce their presence across the continent. Key Words: Paleoepidemiology – Paleoparasitology – Prehistoric diseases - Geography of diseases - Millennial disease INTRODUCCIÓN La enfermedad de Chagas o Trypanosomiasis americana es una parasitosis producida por el protozoo Tripanosoma cruzi (del griego τρύπανον = trýpanon = taladro y σῶμα = soma = cuerpo, denominación que hace referencia a la manera en que penetra). El parásito vive en la sangre en los tejidos del hombre, en otros mamíferos y en el intestino de insectos hematófagos de la familia Reduviidae, subfamilia Triatominae conocidos vulgarmente en Argentina, Chile, Uruguay y Bolivia como vinchucas (del quechua wikchukuy "arrojarse") (Lenz, 1910). La forma aguda, 1 [Escriba aquí] generalmente asociada con la primera infección y que se observa especialmente en los niños, frecuentemente es inaparente por lo cual no es diagnosticada. Si presenta un cuadro clínico agudo, se caracteriza por fiebre, parasitemia, edema localizado y/o generalizado, adenopatías linfáticas localizadas y/o generalizadas, miocarditis y encefalitis. La forma crónica se manifiesta por cardiopatía de diferente evolución, trastornos neurológicos o dilatación masiva de órganos (megacolon y megaesófago). La enfermedad en el humano, el parásito que la causa y el vector transmisor fueron descritos por Carlos Chagas en 1909 (Chagas, 1909); se estima que la convivencia entre ellos en el continente americano haya ocurrido desde mucho antes y que, en su origen, fue una enzootia restringida a los animales silvestres que se transformó en una zoonosis cuando los hombres, animales domésticos y sinantrópicos se integraron en una cadena de transmisión a partir de la colonización de áreas silvestres (Walsh et al, 1993; Walter, 2003). Han sido descriptas como vías de transmisión del T.cruzi la transmisión vectorial (cuando los insectos vectores se alimentan depositan sus heces casi en simultáneo), la transmisión trasplacentaria o congénita (cuando el parásito logra atravesar la placenta de la madre seropositiva e infecta al hijo durante el embarazo o el parto). la transmisión oral de tripomastigotos (por alimentos contaminados por parásitos) y la transmisión a través de transfusiones de sangre y por el trasplante de órganos. Tradicionalmente se consideraba que la infección humana por T cruzi se había originado en los grupos andinos del altiplano boliviano hace unos 6.000 años relacionada con la domesticación de los cuis y su cría con los que se habrían introducido los triatominos en la vivienda y de allí se habría difundido hacia otras regiones de Sudamérica. Este documento revisa, mediante una exhaustiva búsqueda bibliográfica asociando la paleoepidemiología de la enfermedad y y la relación entre el parásito, reservorio y el hombre con el objeto de analizar la historia y evolución de sus interacciones desde la prehistoria para profundizar el conocimiento que permita modificar la visión tradicional, y explicar las condiciones actuales de la endemia. En este objetivo fueron considerados los siguientes ítems: 1. Origen y evolución de los parásitos, sus vectores y hospederos. 2. Ciclos de transmisión y formas de transmisión posibles en diferentes épocas. Procesos de domiciliación de los triatominos y animales que pudieron formar parte del ciclo de T. cruzi en la antigüedad. 3. Referencias sobre los insectos vectores y la enfermedad en los relatos de exploradores y viajeros de las etapas coloniales y modernas. 4. Posibles rutas de difusión de especies domiciliadas. ORIGEN Y EVOLUCIÓN DE LOS PARÁSITOS, VECTORES Y HOSPEDEROS El parásito que produce esta enfermedad, el Tripanosoma cruzi, utiliza dos huéspedes para completar su ciclo de vida, uno vertebrado y otro invertebrado; tienen una distribución africana y otra americana diferencianse por la patología que generan: los africanos causan la enfermedad del sueño y los americanos producen la enfermedad de Chagas. Pertenecen a subgéneros diferentes con aspectos biológicos particulares; los americanos son parásitos intracelulares del hospedero 2 [Escriba aquí] vertebrado depositados in situ con las heces del vector que defeca después de la ingesta sanguínea y los africanos viven y se replican en la sangre y se inoculan mediante el piquete del vector. Esta diferenciación podría haber ocurrido hace 475 millones de años cuando la división del supercontinente Pangea separó a la familia Trypanosomatidae y el ancestro de T. Cruzi se separó del ancestro de los salivarios (T. gambiense, T. rangeli, T. rhodesiense, T. brucei) para pasar a ser estercolarios. T cruzi habría surgido entre 280 a 150 millones de años atrás en América y, entre 88 y 37 millones de años atrás se habrían separado las subpoblaciones de T. Cruzi I y T. Cruzi II como genotipos. Miles et al, (2003) ha asociado el grupo T. cruzi I al ciclo de transmisión selvático que predomina al norte de la cuenca amazónica mientras que, el grupo T. cruzi II, lo asocia a los humanos y al ciclo doméstico y predomina en los países del sur. Sin embargo, Fernandes et al, (1998) y Añez et al (2004) mostraron que los dos grupos están circulando en ambos ambientes. Briones et al (1999) y Stevens y Gibson (1999) sostienen que T. Cruzi I sería autóctono de América del Sur y habría coevolucionado con primates y roedores en cambio, T. Cruzi II, habría ingresado desde América del Norte hace cinco millones de años con el gran intercambio de mamíferos ocurrido a través de las pequeñas islas que dieron origen al istmo de Panamá. CICLOS Y FORMAS DE TRANSMISIÓN POSIBLES EN DIFERENTES ÉPOCAS La mayoría de las 110 especies de triatominos clasificados son de hábitos estrictamente silvestres y viven asociadas a aves, edentados, lagartos y mamíferos. Debido a los enemigos naturales y a los cambios estacionales de las poblaciones que constituyen su fuente alimentaria sus poblaciones son poco numerosas. Como enzootia silvestre se extiende desde los 42ºN (Carolina del Norte y Maryland, EEUU) hasta los 49ºS (sur de la Argentina y Chile) incluyendo las islas del Caribe (Dias, 2000). Sus principales reservorios silvestres que se encontraron infectados fueron armadillos (Dasypus), opossum (Didelphis sp.) murciélagos, mapaches, ardillas, edentados y primates. Estos focos silvestres no incluyen al hombre. Varias especies de triatominos invaden frecuentemente los gallineros, corrales y conejeras conformando ciclos peridomiciliarios con hospederos como cabras, conejos y ratas. Las aves, son huéspedes para los triatominos pero no para el parásito ya que este no puede desarrollarse en su sangre. Las culturas andinas domesticaron a los cuis hace 8000 años, según análisis genéticos, en las actuales regiones de Bolivia y Perú (Spotorno et al. 2004), ± 7000 años según Oswaldo Ramírez
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