RESUMEN
BACKGROUND: Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age. One such intervention may include population-based deworming, recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas; however, the benefit of deworming has been understudied in early preschool-age children. METHODOLOGY/PRINCIPAL FINDINGS: A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of deworming (500 mg single-dose crushed mebendazole tablet) on growth in one-year-old children in Iquitos, Peru. Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits. Children were randomly allocated to: Group 1: deworming at 12 months and placebo at 18 months; Group 2: placebo at 12 months and deworming at 18 months; Group 3: deworming at both 12 and 18 months; or Group 4: placebo at both 12 and 18 months (i.e. control group). The primary outcome was weight gain at the 24-month visit. An intention-to-treat approach was used. A total of 1760 children were enrolled between September 2011 and June 2012. Follow-up of 1563 children (88.8%) was completed by July 2013. STH infection was of low prevalence and predominantly light intensity in the study population. All groups gained between 1.93 and 2.05 kg on average over 12 months; the average difference in weight gain (kg) compared to placebo was: 0.05 (95% CI: -0.05, 0.17) in Group 1; -0.07 (95%CI: -0.17, 0.04) in Group 2; and 0.04 (95%CI: -0.06, 0.14) in Group 3. There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group. CONCLUSIONS: Overall, with one year of follow-up, no effect of deworming on growth could be detected in this population of preschool-age children. Low baseline STH prevalence and intensity and/or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention. Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01314937).
Asunto(s)
Enfermedades Endémicas , Helmintiasis/tratamiento farmacológico , Suelo/parasitología , Estatura , Peso Corporal , Método Doble Ciego , Heces/parasitología , Femenino , Helmintiasis/epidemiología , Helmintiasis/fisiopatología , Humanos , Lactante , Masculino , Cooperación del Paciente , Factores de TiempoRESUMEN
BACKGROUND: Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, remains an important public health issue in many Central and South American countries, as well as non-endemic areas with high rates of immigration from these countries. Existing treatment options for CD are limited and often unsatisfactory. Moreover the lack of post-treatment tests of cure limits the development of new drugs. To address this issue, we sought to identify serum biomarkers following nifurtimox (Nfx) treatment that could be used as an early test of cure and/or markers of a therapeutic response. METHODS: Human sera from Chagas patients pre- and post-treatment with Nfx (n = 37) were compared to samples from healthy subjects (n = 37) using a range of proteomic and immunologic techniques. Biomarker peaks with the best discriminatory power were further characterized. RESULTS: Using serum samples (n = 111), we validated the presence of five key biomarkers identified in our previous study, namely human apolipoprotein A-I (APOA1) and specific fragments thereof and one fragment of human fibronectin (FN1). In chagasic serum samples all biomarkers except full-length APOA1 were upregulated. These five biomarkers returned to normal in 43% (16/37) of the patients treated with Nfx at three years after treatment. CONCLUSIONS: The normalization of biomarker patterns strongly associated with CD suggests that these markers can be used to identify patients in whom Nfx treatment is successful. We believe that these are the first biomarkers predictive of cure in CD patients.
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Apolipoproteína A-I/sangre , Biomarcadores/sangre , Enfermedad de Chagas/tratamiento farmacológico , Fibronectinas/sangre , Nifurtimox/uso terapéutico , Tripanocidas/uso terapéutico , Adulto , Enfermedad de Chagas/sangre , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Pronóstico , América del Sur , Trypanosoma cruziRESUMEN
An indirect enzyme-linked immunoabsorbent assay (ELISA) for Trypanosoma cruzi was developed using epimastigote secretion/excretion proteins (ESEA antigens) obtained from axenic culture supernatants. A panel of 120 serum samples from subjects with confirmed Chagas disease (n = 50), healthy controls (n = 50), and patients with other parasitic diseases (n = 20) was used to evaluate the new ESEA-based ELISA (ELISA(ESEA)). This new test had excellent sensitivity (98%) and acceptable specificity (88%). Cross-reactivity was observed largely in sera from subjects with Leishmania and Ascaris infections. Using Western blotting and epimastigotes from two distinct T. cruzi isolates, several polypeptide bands with molecular masses ranging from 50 to 220 kDa were detected in pooled chagasic sera. However, the band pattern for each isolate was different. These data suggest that an inexpensive and technically simple ELISA based on ESEA antigens is a promising new tool for the diagnosis of Chagas disease.
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No ideal test exists for Chagas' disease, and better diagnostic strategies are needed. We determined the diagnostic utility of an 85-kDa Trypanosoma cruzi protein in a multiple antigen binding assay (MABA). A standardized MABA test based on concentrated trypomastigote excretory-secretory antigen (TESA) and an 85-kDa purified protein showed 100% sensitivity and specificity. In field conditions, 6/66 individuals tested in a region not thought to be endemic (Rio Brito) were identified as seropositive for T. cruzi infection with our MABA test. In parallel, an enzyme-linked immunosorbent assay based on fixed epimastigotes detected 7/66 positives, which were independently confirmed. These data suggest that the 85-kDa and TESA proteins could be used in the MABA format as a complementary tool for the diagnosis of latent Chagas' disease. High anti-T. cruzi antibody detection rates, poor knowledge of Chagas' disease and its vector, and the demonstration of infected vectors in the study community all suggest a significant risk of reemergence of T. cruzi infection in this region of Venezuela.
Asunto(s)
Antígenos de Protozoos , Enfermedad de Chagas/diagnóstico , Técnicas de Laboratorio Clínico/métodos , Glicoproteínas de Membrana , Proteínas Protozoarias , Trypanosoma cruzi/aislamiento & purificación , Adolescente , Adulto , Anciano , Animales , Antígenos de Protozoos/aislamiento & purificación , Enfermedad de Chagas/parasitología , Niño , Cromatografía de Afinidad , Femenino , Humanos , Inmunoensayo/métodos , Masculino , Glicoproteínas de Membrana/aislamiento & purificación , Persona de Mediana Edad , Proteínas Protozoarias/aislamiento & purificación , Población Rural , Sensibilidad y Especificidad , Trypanosoma cruzi/inmunología , Venezuela , Adulto JovenRESUMEN
Three enzyme immunoassays (EIAs) for diagnosis of Chagas' disease were developed with fixed forms of Trypanosoma cruzi using a panel of 435 sera from the following groups: Venezuelan subjects positive by immunofluorescence (n = 70), Venezuelan healthy controls (n = 85), healthy Canadians (n = 166), and subjects with other parasitic diseases (n = 114). All assays achieved 100% sensitivity and reasonable specificity for amastigotes (97.6%), epimastigotes (98.3%), and trypomastigotes (99.3%). The fixed-trypomastigote assay was stable over 4 months at 4 degrees C and room temperature. These data suggest that a fixed-trypomastigote EIA may be a suitable candidate for blood bank screening.