Amazona Peruana
EN FER M ED A D D E
CH A G A S
D IR ES A LO R ETO
CESAR RAMAL ASAYAG, MD, MPH
POST GRADO INFECTOLOGIA Y MED
TROP
HOSPITAL REGIONAL LORETO
AREA ENDEMICAENFERMEDAD DE
CHAGAS
Norte y Oriente:
Panstrongylus,
Rhodnius,
T.
dimidiata, T.
carrioni.
Rufino Cabrera Champe1, Abraham Cceres Lzaro2, Silvia Vega Chirinos2, Carlos lvarez Antonio3,
Csar Ramal Asayag4, Pedro Ladera Ramrez5, Ral Pinedo Vela6, Gladys Chuquipiondo Laulate7.
Abstract
In December 2007, a case of acute Chagas disease in an 8 year old girl well documented case of
the disease in Loreto Department in the Peruvian Amazon indicated that Trypanasoma cruzi was
endemic in the region. Further review demonstrated 9 reported cases since 2003 primarily in
remote indigenous communities. In March 2008, study of family members of the acute case and
a seroprevalence study in residents of the community of San Pedro de Shishita (45 households)
located about 1 hour by fast boat from Pevas was carried out. Trypanosoma cruzi infection of the
index case was confirmed by trypomastigote morphology in thick smears and blood culture of
epimastigotes and observation of amastigotes in histological sections of heart muscle of Balb / c
mice experimentally infected with blood from the index case. Among the 16 family members of
the acute case, none were positive by thick smear (n=14) or xenodiagnosis (n=3). ELISA and
indirect immunoflorescence (IIF) in 104 community members including family members, 1
individual (26 y/o female) had antibodies to T. cruzi (0.96%). Entomological collections were
carried out in and around the household of the acute case; samples of Panstrongylus geniculatus
and Rhodnius pictipes were collected in the bedroom of the acute case, in the peridomestic area
of the house and in nearby households. None of the triatomid bugs collected were infected with
T. cruzi during the investigation which occurred 3 months after the case was detected. In the
same population 6 of 104 (5.76%) were positive for Plasmodium vivax and 3 (2.88%) for
microfilariae. The case had no travel history outside her community indicates active transmission
of T. cruzi within the jungle regions of Peru.
Marzo 2008
CASO DE SHISHITA
31
Iquitos
Iquitos
Positivo
JPC
23
Sta Maria
Sta Maria
Positivo
JRV
53
San Martin
Moyobamba
Positivo
FCM
30
San Regis
Rio Maran
Indeterminad
o
GGS
18
Iquitos
Iquitos
Indeterminad
o
ISR
24
Iquitos
Iquitos
Indeterminad
o
OOT
55
Iquitos
Iquitos
HNV
26
Iquitos
Iquitos
EHP
27
Iquitos
F Punga
VA
22
Iquitos
Pevas
MSF
42
Iquitos
Iquitos
VDM
22
Iquitos
Iquitos
Reactivo:
Wama diagnstica
Procedencia:
Brasil
FCL
26
Iquitos
Iquitos
Positivo
Positivo
Positivo
Positivo
Indeterminad
o
Lote:
Positivo
Positivo
803027 - 810016
Mtodo: Inmunoensayo para detectar anticuerpos IgG en
suero o plasmaq usando antigeno recombinante.
Actividades complementarias
Se realiz, in situ, el examen microscpico por gota
gruesa coloreada con Giemsa
en muestras
correspondientes a 100 pobladores. Se diagnosticaron
06 casos de infeccin por Plasmodium vivax, los
mismos que recibieron tratamiento especfico segn las
recomendaciones de la Estrategia Nacional de
Prevencin y Control de Malaria y otras Enfermedades
Metaxnicas.
Adicionalmente, en 3 lminas de gota gruesa se
encontraron microfilarias. Ninguno fue positivo a la
presencia de Trypanosomas.
CONCLUSIONES
Recomendaciones
REFERENCIAS BIBLIOGRAFICAS
1. Informe Tcnico.
Loreto, Per.