Home Economics American Trypanosomiasis Chagas Disease, Second Edition: One Hundred Years of Research
First evidence of Trypanosomiasis Americana (Chagas disease) in various countries of Latin America
Thus, slowly the discovery of Chagas disease spread across various countries of Latin America.
In Central America, the first report of human Trypanosomiasis Americana was made by Segovia in El Salvador in 1913.25 Subsequently other Salvadorian researchers reported on new cases: Reina Guerra (1939),26 Castro, Fasquelle, Garcia Montenegro. In 1956, renowned researchers27 described in detail the epidemiological and clinical symptoms of this disease.
In Costa Rica, the disease was originally described in 1922 by Picado (doctoral thesis) and later studied by Von Bullon, Cespedes, Chen, and Zeledon. In Guatemala,28 the disease was first encountered by Reichnow in 1933. Subsequently, the work of De Leon in 1935 highlighted the importance of this disease in this country.29 However, it is important to emphasize the considerable contributions to the understanding of this disease realized by Montenegro, Esteres, Blanco, and Penalver.
In Panama in 1931, the presence of the disease was proven with the report of 19 human cases in the area of the Panama Canal. Later on, other research was carried out by Calero, Johnson, and Rivas.
In Honduras, the disease was not officially reported until the first case came to light in 1960, on which the doctors A. Leon Gomez, A. Flores Fiallo, E. Poujeol, and M. Barilla reported in the Seventh Day of Honduran Medicine which took place in San Pedro Sula.29 In 1961, the same authors communicated seven cases of Chagas’ chronic myocarditis30 and in 1965, Duron, in a postmortem study, encountered numerous pseudocysts of Leishmania in the myocardium of a girl suffering from acute Chagasic myocarditis who died suddenly. Nevertheless, already in 1950, Zepada had observed the existence of a vector in various zones of the country and in 1939 an opossum infected with T. cruzi was discovered.31 In 1968, Fernandez and Lainez reported for the first time the first two cases of the acute form of the disease, with the discovery of T. cruzi in peripheral blood, whose clinical characteristics presented a unilateral conjunctive reaction, temperature above 39°C, palpebral edema, hemifacial edema, and cervical adenitis.
It was in 1949 that the first native case of the disease was described in Nicaragua and as recently as 1969 that Fray Bernadini de Schagen reported on the infestation of homes by vectors described as bloodsucking insects like cockroaches with wings and very poisonous (the Chagas Space Group).
In Mexico, Hoffman published in 1928 a document describing the great abundance and domiciliation of Triatoma dimidiata in Choapas, Veracruz and in 1938, the same author spoke of a case native of the same region that was described by Luis Mazzotti, who, in 1936 identified the first two officially recognized cases originating from Oaxaca as being abundantly infected with triatomine bugs.32 In 1938, Bernal Flandes published on transmitter insects and trypanosomatides in Veracruz, and in 1940 Palomo Eroso described two other new cases in Yutacan. But, it was only in 1972 that the first formal identification of the disease was carried out with reports by Eugenio Palomo and Luis Mazzotti.33
In South America, the first case of Chagas disease reported in Venezuela was by Enrique Tejera, in the state of Zulia,34 10 years after Carlos Chagas discovery. Pioneer studies were carried out in Venezuela, directed by Jose Francisco Torrealba, who, from 1932, initiated studies in the state of Guarico35 and introduced the xenodiagnosis, invented by Emile Brumpt, while in 1941 Pifano36 studied the epidemiology of the disease in the state of Yaracuy. Both authors highlighted its importance as a public health problem and a social one with the maintenance of this zooanthroponosis. In the Institute of Tropical Medicine of the Central University of Venezuela, Maekelt in 1960 had developed a protocol for the preparation of antigen which is still used in the country and Pifano in 1960 published the first figures of national prevalence. As recently as in 1961, the Ministry of Health and Social Welfare allocated budgets, effort, and expertise to fight Chagas Disease, and initiated the Campaign which in 1966 was officially proclaimed as the program to control Chagas disease.37
In Colombia,38 Ignacio Moreno Perez observed in Cali in 1939 for the first time, the pathogenic parasite provoking the disease, according to a report by Hernando Ucros in 1971. In 1947, J. Caicedo and C. Hernandez wrote a report describing the first proven chronic case of the disease in Colombia originating from Fusagasuga in Cundinamarca and in 1961, Marcos Duque began studies on Chagas’ cardiopathy. Ten years later, Hernando Rocha communicated his discoveries on the megaesophagus which is a consequence of the disease.38
The first research on the epidemiology of Chagas disease in Chile39 is attributed to Prof. Juan Noe, who, in 1921, observed for the first time, the presence of T. cruzi in the evidence of many samples of Triatoma infestans, coming from the outskirts of the town of Santiago. Later, in 1931, Dr Miguel Massa, under the authority and direction of Prof. Noe, demonstrated the specificity of the parasite in cardiac fibers in animals used for experimentation. With the creation of the Department of Parasitology of the State Health Office in 1937, began the systematic investigations leading to the demonstration of the first human cases of this disease.39
In Peru, in 1919, E. Escomel described the first human case demonstrating the presence of Trypanosoma in human blood, in a border zone between Brazil and Bolivia where species of the flora and fauna are very abundant. Escomel said that predecessors had described T. infestans in the Vitor and Majes valleys which was suspected of being the cause of certain patients’ clinical symptoms which were, in fact, those of trypanosomiasis; however, the confirmation of the parasite had not been able to be made.40 Roughly 25 years after Escomel’s cited publication, the second human case of Chagas disease was verified in Peru, and at the same time the first epidemiological research was realized.
In Paraguay, in 1924 the first discoveries were made with studies by Lutz, Sousa, Araujo, de Fonseca, and Migone, which showed the first infected bloodsucking insects (the Chagas Space Group). In this way, Gamiro in Uruguay, carried out studies on the infection of these insects in his country.
In Bolivia, in the 16th century, when Bolivia was part of the Spanish Viceroyalty of Peru, a priest, Fray Reginaldo de Lizarraga traveling to inspect the convents of this region, noticed that in the valleys of Cochabamba bloodsucking insects like cockroaches, called “vinchucas” by natives, fell, during the night, from the ceiling of houses of the poor and bit the people while sleeping, particularly in the face and other exposed parts of the body. This was a description of the Triatominae, as was discovered later.41
In 1916, in Sococha, a small town of the Department of Potosi and near the border with Argentina, the Brazilian Artur Neiva, from the group of the Manguinhos Institute of Rio de Janeiro later named as the Oswaldo Cruz Institute, found these Triatominae, similar to the ones called “barbeiros” in Brazil, infected with the parasite T. cruzi.42 Later, in 1929, the Bolivian Felix Veintimillas, claimed that he found Triatominae with T. cruzi in the area of Yungas of La Paz as he reported in 1930.43
The Argentinean Salvador Mazza who studied Chagas disease in the northern region of Argentina, did expeditions to several regions of Bolivia from 1937 to 1943 and found infected triatomine bugs, of the species T. infestans, in 22% of the cases studied in Vitichi, Potosi, 50% in the small village of Mollegrande, Potosi, and found a very thin 2-year-old girl, who died a few days later, with T. cruzi in
smears of her blood.44,45
Rafael Torrico (Fig. 1.11) returned to Bolivia in 1943, after postgraduate studies at the Oswaldo Cruz Institute of Brazil, became Professor of Parasitology at the Medical School in Cochabamba and director of the Central Laboratory of Interamerican Cooperative Public Health Service of the Ministry of Health, where
Figure 1.11 Rafael Torrico, 1943, the father of Chagas disease in Bolivia.
he did several studies on Chagas disease. With M. Dias he published work, in 1943, relating to infected triatomine bugs of the species T. infestans in several towns of the Department of Cochabamba.42
In 1946 he described a 14-year-old girl from Capinota (Fig. 1.12), a rural area of the Department of Cochabamba, as the first case in Bolivia of an acute form of Chagas disease with edema on the eyelid, the site of the bite by a triatomine bugs, identified as T. infestans, and a preauricular lymphadenopathy as described by Romanha in Argentina.46,47
In this area, where the patient lived, Torrico found in 427 insects, of the species T. infestans, 84.9% infected with T. cruzi. However, a Bolivian student in Chile, C.L. Ponce Caballero,48 published in 1946 a study of seven cases of Chagas disease from the town of Colcapirhua, Cochabamba, confirmed, as he claimed by xeno- diagnosis, that did not have any clinical manifestations of the disease according to one of the participants of this study.48 Romanha, in 1947, with students of the University of Chile, including Ponce Caballero, reported 122 cases, confirmed by xenodiagnosis, in several areas of Bolivia.49
At the first Panamerican Meeting of Chagas disease, held in Argentina in 1949, Torrico presented a paper about the knowledge of Chagas disease in Bolivia up to that year. He stated that T. infestans was the principal and the most important vector because of its high infection index, its prevalence, and wide distribution, predominantly in the valleys, where it was an obliged host in most houses. He stated also that guinea pigs (Cavia cobaya), dogs, and cats were the only parasite reservoirs known of T. cruzi in Bolivia, particularly the guinea pigs that are seen in houses inhabited by peasants where they live together. Regarding human morbidity, he
Figure 1.12 First case of Chagas disease in Bolivia, reported in a girl aged 14 in Capinota, Department of Cochabamba, Bolivia.
presented 211 cases collected, most of which were acute ones, either studied by him or published by others, diagnosed by blood examination and mostly by xenodi- agnosis, from many areas of the country.50
Finally, Torrico presented an up-to-date study of the situation of Chagas disease in Bolivia, at the International Congress of Chagas disease in 1959, held in Rio de Janeiro, confirming his observations of the vectors, the reservoirs, and human cases, acute or chronic, which had increased to 342 patients, including cases of Chagasic myocardiopathy, with its classic electrocardiography, studied by J. Rodriguez Rivas.51,52
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