por Trypanosoma cruzi esta aún lejos de haberse resuelto en
latinoamérica. Investigaciones recientes sobre este germen están
fuertemente sesgadas hacia la investigación de ciencias básicas,
principalmente a nivel molecular, dejando de lado importantes
hallazgos clínicos y epidemiológicos. Presentamos aquí
evidencias científicas que demuestran como el Trypanosoma cruzi
afecta diferentes sistemas neurales incluyendo el
autónomo. Las rutas de trasmisión oral y genital relacionadas
con este parásito, así como las reacciones cruzadas y falsos
positivos descritas durante la realización de diferentes tests
serológicos que investigan la posible presencia del Trypanosoma
cruzi, incluyendo los utilizados para investigar el VIH, deben
todas ellas ser tomadas muy en cuenta antes de rotular a los
pacientes con el, casi siempre, fatal diagnóstico de enfermedad
Trypanosoma cruzi infection is far for being solved in Latin
America. Recent research is strongly biased to basic
investigations mostly at molecular levels putting aside
important clinical involvement and epidemiological findings.
Here, we present evidence that Trypansoma cruzi affect neural
systems including the autonomous one. Oral and genital routes of
transmission of this parasite as well as the
cross-reactions and false-positives described with different
serological tests including those used to test HIV must be
checked out before putting the almost always fatal diagnoses of
Trypanosoma cruzi (T. cruzi) infection is still a challenge to
scientists working in basic and/or clinical grounds; some of
these problems, mainly the basic ones, have been addressed by
different groups in different Latin- American countries and
commented in some recent publications as supplements; however,
the basic - clinical gap seems to remain in current
investigations.1,2 In order to help in closing such a gap on
this international health public problem we consider timely to
go further looking for probable clinical, epidemiological and
laboratory advances unaddressed in those previous
scientific communications that may influence patient’s
intervention in clinical practice. We concentrate our efforts in
knowing neural structures involvement because the
neurotropism of this parasite is clearly established.
Material and Methods
Following methodologies described in previous research published
on this topic3 we identified references by searches of Medline/PubMed
from 1966 until December 2006 and of Scielo from 1997 until
December 2006 with the terms “trypanosoma cruzi” “chagas”
“central nervous system” “epidemiology” “spinal cord”
“peripheral nervous system” “neuromuscular junction” “muscle”
“muscle disorders” “neuromuscular diseases and disorders”
“synapticopathies” “pathophysiology” “clinical neurophysiology”
“functional neurology” “clinical neurosciences” “transmission
route” “laboratory.” Articles were also identified through
searches of the authors’ own files. Papers published in
English, Spanish and Portuguese were analyzed. Inclusion and
exclusion criteria were similar to those chosen in a previous
research; however, we consider at this time publications
reporting serological tests using polymerase chain
reaction as well.3
Results and Discussion
In clinical grounds, besides T. cruzi infection-associated
dysautonomy widely recognized and investigated,4 it was
noteworthy to find a good number of acute and chronic disorders
including cerebrovascular disease (CVD), meningitis, cognitive
disorders, peripheral neuropathies, synapticopathies such as
myastenia gravis, myopathies including polymiositis,
pupilopathies and impotence.
We highlight here CVD because it is a very common complication
of T. cruzi infection with a high morbimortality as well as an
increasing trend in social and personal costs.5-7 It should be
remarked that T cruzi infection itself, without a clinically
established disease including cardiopathy, is more than enough
to trigger CVD in humans.6,8,9
Regarding routes of transmission, it was interesting to find
that the parasite colonizes human body by means other than bites
including oral route thru breast feeding and sugar cane
juices.10-12 Genital route seems to be another way of
transmission not well characterized yet in countries where this
problem is endemic.13
On the other hand, T. cruzi generates one of the seventy six
cross reactions described so far while looking for HIV
antibodies14-16 making this germen much more dangerous to humans
than previously thought. Thus, immunosuppressants given as
regular treatments to patients harboring unisolated HIV
viruses17,18 may increase immunosuppression in patients infected
by T. cruzi worsening clinical complications produced by this
parasite as the ones commented above, and would allow to T cruzi
to act more aggressively than usual with devastating
consequences to infected people.
These facts call the attention on what might be the true cause
of possible complications found in seropositive patients to both
T. cruzi and HIV including the deterioration of syncopal
All the aforementioned comments support the continued interest
in researching and publishing supplementary scientific issues on
Chagas disease to complement and up date the knowledge of the
complex disorders produced by T. Cruzi. However, we want to go
further and stress that the “new” routes of infection, the
“infrequent” systemic complications that are very far from being
included in level I of epidemiological evidence
statistically speaking, and the “new” crossed reactions
described in the present report can be, all of them, the first
evidence of a serious health problem that is still far from
being solved in, at least, some Latin-American countries.
We dedicate this manuscript to Eugenio Leon, father of one of us
(FEL-S). He stated ten years before being diagnosed as T. cruzi
carrier at the UIS laboratory of parasitology, in Bucaramanga,
Colombia, that he acquired the parasite after eating
contaminated beef and that never ever he had been bitten by any
possible parasite’s reservoir. Unfortunately he already died of
chagasic myocardiopathy when he was 77 years-old and he took
away with him all of the evidence.
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