Molecular diagnosis and characterization of acute Trypanosoma cruzi infection due to organ transplantation

CURA C; LATTES R; NAGEL C; BARCÁN L; ANDERS M.; SCHIJMAN A.G

Mar del Plata

Congreso; IX Congreso Argentino de Protozoología y Enfermedades Parasitarias; 2011

Sociedad Argentina de Protozoología

Chagas disease, caused by T. cruzi, is a prevalent zoonosis in Latin America, and is transmitted mainly by reduviid insect vectors, blood transfusion or by infected women to offspring. Part of the infectious cycle consists of chronic subclinical parasitemia, causing in the long term organ damage. Amastigotes have been isolated from various organs, thus, transplantation (Tx) plus immunosuppression therapy is another way of disease transmission and reactivation. Herein, we report and characterize four cases of T. cruzi acute infection due to organ Tx from seropositive donors: two hepatic, one pulmonary and one kidney Tx. Two recipients received lungs and liver, respectively, from the same infected donor; and another patient, infected after kidney Tx, also showed central nervous system involvement. Materials and Methods: Peripheral blood or cerebrospinal fluid (CSF) samples were collected for detection of T. cruzi by means of kDNA-PCR. Positive samples were subjected to a PCR algorithm for identification of T. cruzi Discrete Typing Units (DTU), as reported in Burgos et al. (Clin Infect Dis., 2010) and to a real-time PCR strategy to quantify T. cruzi DNA in blood samples as described in Duffy et al. (PLoS Negl Trop Dis., 2009). Minicircle signatures of T. cruzi infecting populations were analyzed using RFLP-PCR. Results: Blood samples from the two organ recipients from the same infected donor (case 1 and 2) were kDNA-PCR positive after 72 and 98 days post-Tx, respectively, and both were infected by DTU Tc V (or Tc V + Tc VI). The comparison between their minicircle signatures revealed nearly identical RFLP profiles, suggesting a common source of infection. The other liver recipient (case 3) exhibited positive kDNA-PCR 36 days post-Tx and was also infected by Tc V (or Tc V + Tc VI). The kidney recipient (case 4) showed kDNA PCR positive results 93 days after Tx and T. cruzi infecting populations belonged to group Tc II/V/VI. It is worth noting that there are two other kidney recipients from the same infected donors of cases 1-2 and 4 who have not had a positive kDNA-PCR result until the present moment. Conclusion: The above mentioned molecular tools allowed diagnosis of acute T. cruzi infection, whose route of transmission could be inferred by fingerprinting of the detected T. cruzi populations, directly in peripheral blood and a CSF sample from transplant recipients. Furthermore, this report reveals the relevance of systematic monitoring of recipients by PCR strategies in order to provide prompt diagnosis and subsequent anti-trypanosomal treatment.