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Clinical and Epidemiological Characterization of Acute Chagas Disease in Casanare, Eastern Colombia, 2012–2020

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Clinical and Epidemiological Characterization of Acute Chagas Disease in Casanare, Eastern Colombia, 2012–2020 ORIGINAL RESEARCH published: 23 July 2021 doi: 10.3389/fmed.2021.681635 Clinical and Epidemiological Characterization of Acute Chagas Disease in Casanare, Eastern Colombia, 2012–2020 Claudia Yaneth Rincón-Acevedo 1,2†, Andrea Stella Parada-García 1,2†, Mario Javier Olivera 3, Fernando Torres-Torres 4, Liliana Patricia Zuleta-Dueñas 4, Carolina Hernández 1 and Juan David Ramírez 1* 1 Centro de Investigaciones en Microbiología y Biotecnología-UR, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia, 2 Maestría en Salud Pública, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia, 3 Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia, 4 Secretaría de Salud de Edited by: Casanare, Yopal, Colombia Jean Challacombe, Twist Bioscience, United States Reviewed by: Background: Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is Jeanne Marie Fair, considered a public health problem in Latin America. In Colombia, it affects more than Los Alamos National Laboratory 437,000 inhabitants, mainly in Casanare, an endemic region with eco-epidemiological (DOE), United States Eirini Christaki, characteristics that favor its transmission. The objective of this study was to describe University of Cyprus, Cyprus the clinical and epidemiological characteristics of the cases of acute CD in Casanare, *Correspondence: eastern Colombia, in the period 2012–2020. Juan David Ramírez [email protected] Methods: In the present study, 103 medical records of confirmed cases of acute CD †These authors have contributed were reviewed. The departmental/national incidence and fatality were compared by year; equally to this work and share first the climatological data of mean temperature, relative humidity, and precipitation per year authorship were reviewed and plotted at IDEAM (Colombian Meteorology Institute) concerning the number of cases of acute CD per month, and it was compared with the frequency of Specialty section: This article was submitted to triatomines collected in infested houses by community surveillance. Univariate, bivariate, Infectious Diseases – Surveillance, and multivariate analyses were performed, comparing symptoms and signs according to Prevention and Treatment, a section of the journal transmission routes, complications, and age groups. Frontiers in Medicine Results: The incidence was 3.16 cases per 100,000 inhabitants, and the fatality Received: 17 March 2021 rate was 20% in the study period. The most frequent symptoms included: fever Accepted: 29 June 2021 Published: 23 July 2021 98.1%, myalgia 62.1%, arthralgia 60.2%, and headache 49.5%. There were significant Citation: differences in the frequency of myalgia, abdominal pain, and periorbital edema in oral Rincón-Acevedo CY, transmission. The main complications were pericardial effusion, myocarditis, and heart Parada-García AS, Olivera MJ, Torres-Torres F, Zuleta-Dueñas LP, failure in the group over 18 years of age. In Casanare, TcI Discrete Typing Unit (DTU) has Hernández C and Ramírez JD (2021) mainly been identified in humans, triatomines, and reservoirs such as opossums and Clinical and Epidemiological dogs and TcBat in bats. An increase in the number of acute CD cases was evidenced in Characterization of Acute Chagas Disease in Casanare, Eastern March, a period when precipitation increases due to the beginning of the rainy season. Colombia, 2012–2020. Front. Med. 8:681635. Conclusions: The results corroborate the symptomatic heterogeneity of the acute doi: 10.3389/fmed.2021.681635 phase of CD, which delays treatment, triggering possible clinical complications. In Frontiers in Medicine | www.frontiersin.org 1 July 2021 | Volume 8 | Article 681635 Rincón-Acevedo et al. Acute CD in Casanare, Colombia endemic regions, clinical suspicion, diagnostic capacity, detection, and surveillance programs should be strengthened, including intersectoral public health policies for their prevention and control. Keywords: Trypanosoma cruzi, acute Chagas disease, DTU, outbreaks, Casanare, Colombia BACKGROUND Among the various transmission routes of the disease, the vector and oral routes stand out, the latter associated with acute Chagas disease (CD), caused by the parasite Trypanosoma cruzi, outbreaks with a reported lethality for Latin America between continues to be a significant cause of morbidity, disability, 1 and 35% (14, 15). In some countries of the Southern Cone, and mortality, mainly in Latin America. It is estimated that such as Brazil, Venezuela, Bolivia, Ecuador, Peru, Argentina, it affects 6–7 million people globally, constituting an emerging and French Guyana (16), cases of acute CD due to vector threat for several non-endemic countries (1, 2). The disease transmission and oral outbreaks have been described due to has an acute phase and a chronic phase characterized by contamination of food with feces of wild triatomines or with an unpredictable clinical course, ranging from the absence of secretions from reservoirs. Colombia has also been an important symptoms to severe diseases with cardiovascular, gastrointestinal, scene of acute Chagas outbreaks, which had increased since 1992 or neurological involvement (3). Trypanosoma cruzi presents when the first outbreak was identified. The departments of Norte high genetic variability given that six Discrete Typing Units de Santander, Magdalena, Santander, Putumayo, Arauca, Cesar, (DTUs) have been identified that are distributed throughout Antioquia, Chocó, Atlántico and Casanare have reported various the American continent (TcI-TcVI) and an additional DTU outbreaks and isolated cases (17). Despite the high number of associated mainly with anthropogenic bats called TcBat described oral transmission outbreaks, there are failures in the clinical in Brazil, Colombia, Panama, and Ecuador (4, 5). Additionally, care of patients given the non-specificity of the symptoms, the genetic variability has been detected in TcI DTU, finding clinical and epidemiological ignorance of the disease, which parasites associated with sylvatic transmission cycles and a translates into low suspicion of it and affects the presentation of genotype mainly associated with domestic transmission TcIDom complications and fatality (4). (6). Consequently, the clinical forms and the severity of the In Colombia, it is estimated that more than 437,000 infected manifestations are diverse between regions and individuals, inhabitants and around 5 million are at risk of acquiring CD considering the host’s immune response and a plethora of T. cruzi (18). The department of Casanare in the Colombian Orinoquia virulence factors (7). is endemic for CD and has ecoepidemiological characteristics Clinically, the acute phase of CD can be asymptomatic or that favor the transmission of the disease. According to the present non-specific symptoms that include prolonged fever National Institute of Health (INS) of Colombia, in 2017 40.3% and general malaise, estimating that only 1–2% of cases in of chronic cases and 20% of acute cases in the country were this phase are identified (4, 8); mortality can range between identified in Casanare. The situation in 2018 was similar to 2017, 10 and 80%, which is widely variable depending on the while in 2019, 50.9% of acute CD cases in the country came diagnosis and timely treatment (2). Additionally, in the severe from Casanare (19). This department has reported outbreaks of form of the acute phase, complications such as myocarditis, oral transmission with the lethality of up to 50% and outbreaks heart failure, arrhythmias, atrioventricular blocks, and to a associated with occupational exposure with a significant number lesser extent, meningoencephalitis may occur, situations that of cases (20, 21). Currently, Colombia has a program to interrupt increase mortality (9). When the disease is not diagnosed the domiciliary vector transmission of T. cruzi by Rhodnius or treated in the acute phase, the patient evolves into the prolixus, which means that oral transmission may increase and, chronic phase, with the risk of developing irreversible chronic with this, the presence of acute cases (22, 23). Chagas heart disease characterized by complex ventricular and In Casanare, ten triatomine species (Hemiptera: Reduviidae) atrial arrhythmias, bradyarrhythmias, atrioventricular block, have been reported, where R. prolixus and Triatoma maculata apical aneurysm, ventricular dysfunction, and heart failure(10– stand out, the first with presence in 17 of the 19 municipalities 12) and digestive complications such as megaesophagus and (24, 25). Likewise, abundant populations of sylvatic R. prolixus megacolon (13). have been identified associated with native palms Attalea butyracea and palms introduced in agro-industrial crops such as Elaeis guineensis with high rates of natural infection by T. cruzi Abbreviations: IDEAM, Instituto de Hidrología, Meteorología y Estudios (24).Ahighpresenceof R. prolixus infected with T. cruzi has been Ambientales; SD, Standard deviation; DTU, Discrete Typing Units; T. cruzi, shown in homes in rural areas, which increases in the low rainfall Trypanosoma cruzi; INS, National Institute of Health; R. prolixus, Rhodnius season and decreases in the months of higher rainfall (26, 27). prolixus; SIVIGILA, Public Health Surveillance System; UPGD, Primary Data On the other hand, Casanare is the department of the country Generating Units; IPS, Health Service Provider Institutions; DANE, National with the highest number of acute CD, both isolated cases and Administrative Department
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