By Agustin Caceres
At the end of last year, I attended the conference “Lives in the Balance”Doctors Without Borders in New York City. Specialists from all over the world debated the situation of NTDs, particularly TB and Chagas disease: the existing challenges in research and development, the creation of new drugs and the need for better coordination among governments, donors, academia and NGOs.
The surprise for me was hearing National School of Tropical Medicine at Baylor College and president of the Sabin Vaccine Institute, talk about the situation of NTDs in a country that would not come to my mind when I think about Chagas disease: the United States.
According to his research, Texas has an increasing number of cases of Chagas. You might think that these statistics could be due to the high volume of immigrants that reside in the State, but research shows that in many cases, patients infected with the parasite that causes the disease were born and raised in Texas.
Image: A composite risk map for Chagas disease in Texas. Source: University of Texas in Austin
These cases are, like in many other countries, usually neglected. Chagas remains invisible to the public eye, since cases are found mostly in the poorest and most vulnerable populations of Southern Texas and the metropolitan area of Houston, particularly among African Americans.
The situation of Chagas in Texas has drawn the attention of institutions like the three dogs died from acute Chagas cardiomyopathy in one location, an investigation was conducted in the home, garage and grounds of the owner of these pets. A serologic study was conducted on stray dogs, and an ecologic niche model was developed to predict areas where the vector Triatoma gerstaeckeri might be expected.
This study demonstrated the existence of a domestic transmission cycle for an insect species that is typically considered a zoonotic vector. However, according to CDC it is not clear whether this observation represents an isolated case or whether it actually indicates an emerging public health problem.
Some estimate that 300,000 people live with Chagas disease in the United States, and in many cases they do not have access to testing or free treatment. The research conducted in Texas is a good reminder that we must remain vigilant –NTDs are not just a problem of the developing world. These diseases affect the neglected everywhere.
Agustin Caceres is Communications and Outreach Officer at the Inter-American Development Bank (IDB) in Washington DC.
October 25th, 2012
By Angela Herring
Drug discovery is by definition slow and costly. The multiphase process, which begins with basic science research and ends with clinical trials, can consume up to two decades and more than a billion dollars.
Credit: Mary Knox Merrill, Northeastern University
For NTDs such as African sleeping sickness and Chagas disease, the outlook is even grimmer: anti-infective drugs tend to have higher fail rates than other drugs, as parasites quickly develop resistance. And since NTDs predominantly affect low-income populations, the incentive for big pharmaceutical companies to improve on current treatments is low.
But current treatments are ghastly. In some cases, the drugs themselves can be poisonous and have high mortality rates. With one-third of the planet’s population at risk for NTDs, a new paradigm is required.
Northeastern University open-source science model will hasten the drug discovery process. Despite great advances in NTD research over the last decade, the global research effort is largely uncoordinated. Read more: Northeastern University Launches Integrated Global Health Initiative to Tackle NTDs
May 2nd, 2012
By: Charles Ebikeme
On March 5th 2001, a 37 year old woman went into surgery to have a kidney and pancreas transplant from a donor that had already passed away. Once discharged, she returned to the hospital six weeks later to be treated for a sudden onset of fever, of unknown origin. She would die six months later, on the first week of October.
What turned out to be the Chagas disease infection through solid-organ transplantation in the Unites States came after the physician identified the parasites in a peripheral blood smear. Upon identification the physician immediately notified the Center for Disease Control (CDC). Upon further investigation it was discovered that other patients had received infected organs from the same donor- 32 year old woman who had received the liver and a 69 year old woman who received the other kidney. Both organs were found to be infectious. The donor of the infected organs was an immigrant from Central America.
An acute Chagas disease infection with swelling of the right eye (Romañas sign). Source: CDC.
At the time, no protocol or policy was in place for the regular screening of organ donations for T. cruzi,licensed and routinely used to screen organs and blood donation for a wide range of infectious agents (including HIV, hepatitis and West Nile virus).
After the infection was detected, all three women were treated with month of a Bolivian miner’s salary.
Of the three women that were infected, it was only the 69 year old woman that would survive the parasitic infection. The woman who received the kidney and pancreas transplants was the most immunosuppressed of the three patients, and her death was a result of immunosuppression. She died even after completing a full course (4 months) of treatment with nifurtimox. Read more: New routes to Chagas