title: First report of a family outbreak of Chagas disease in French Guiana and posttreatment follow-up.
abstract: The outbreak of acute Chagas disease due to oral transmission of the parasite is a well-known phenomenon mainly occurring in the Amazon. Such an event is described here for the first time in French Guiana. Eight patients of the same family, presenting epidemiological and clinical histories compatible with recent Trypanosoma cruzi infection of Chagas disease due to the ingestion of palm Oenocarpus bacaba juice were, rather late after the putative date of infection, underwent four parasitological and two serological specific tests for confirmation of the diagnosis. Real-time PCR results were positive for all the patients; strains were isolated by hemoculture from four patients, PCR identification of TcI DTU was made for six patients, while parasites were not detected in any of the patients by direct microscopic examination. The results of two serologic tests were positive. All patients were treated with benznidazole, and two patients were additionally given nifurtimox. A 6-year follow-up was possible for six patients. Real-time PCR was negative for these patients after 1 year, while the antibody rates decreased slowly and serology results were negative only after several years (1-5 years). Our findings confirm the occurrence of an outbreak of Chagas infection in members of the same family, with the oral mode of infection being the most likely hypothesis to explain this group of cases. Our results show the successful treatment of patients infected by TcI and the usefulness of real-time PCR for the emergency diagnosis of recent Chagas disease cases and in posttreatment follow-up.
authors.affiliation: Laboratoire Hospitalier et Universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, EPaT, UFR de Médecine, Université des Antilles et de la Guyane, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
authors.forename: Denis
authors.initials: D
authors.lastname: Blanchet
authors.affiliation: IRD, Institut de Recherche pour le Développement, UMR INTERTRYP (IRD-CIRAD), Interactions hôtes-vecteurs-parasites dans les infections par trypanosomatidae, 911 Av. Agropolis, 34394 Montpellier cédex 5, France. Electronic address: Frederique.Breniere@ird.fr.
authors.forename: Simone Frédérique
authors.initials: SF
authors.lastname: Brenière
authors.affiliation: Laboratorio de Biología Molecular de la Enfermedad de Chagas, LabMECh, INGEBI-CONICET, Buenos Aires, Argentina.
authors.forename: Alejandro G
authors.initials: AG
authors.lastname: Schijman
authors.affiliation: Laboratorio de Biología Molecular de la Enfermedad de Chagas, LabMECh, INGEBI-CONICET, Buenos Aires, Argentina.
authors.forename: Margarita
authors.initials: M
authors.lastname: Bisio
authors.affiliation: Laboratoire Hospitalier et Universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, EPaT, UFR de Médecine, Université des Antilles et de la Guyane, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Simon
authors.affiliation: Laboratoire Hospitalier et Universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, EPaT, UFR de Médecine, Université des Antilles et de la Guyane, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
authors.forename: Vincent
authors.initials: V
authors.lastname: Véron
authors.affiliation: Service d'accueil des urgences, Centre Hospitalier de l'Ouest Guyanais (CHOG), St Laurent du Maroni, French Guiana.
authors.forename: Claire
authors.initials: C
authors.lastname: Mayence
authors.affiliation: Laboratoire Hospitalier et Universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, EPaT, UFR de Médecine, Université des Antilles et de la Guyane, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
authors.forename: Magalie
authors.initials: M
authors.lastname: Demar-Pierre
authors.affiliation: Service de maladie infectieuse et tropicale, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
authors.forename: Félix
authors.initials: F
authors.lastname: Djossou
authors.affiliation: Laboratoire Hospitalier et Universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, EPaT, UFR de Médecine, Université des Antilles et de la Guyane, Centre Hospitalier Andrée Rosemon (CHAR), Cayenne, French Guiana.
authors.forename: Christine
authors.initials: C
authors.lastname: Aznar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D028023:Arecaceae / Q000737:chemistry / Q000469:parasitology*; D014355:Chagas Disease / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000469:parasitology; D002648:Child; D005190:Family; D005260:Female; D005616:French Guiana; D006801:Humans; D008297:Male; D008875:Middle Aged; D009547:Nifurtimox / Q000008:administration & dosage; D009593:Nitroimidazoles / Q000008:administration & dosage; D010936:Plant Extracts / Q000737:chemistry; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000008:administration & dosage*; D014349:Trypanosoma cruzi / Q000145:classification / Q000302:isolation & purification*
chemical_list: D009593:Nitroimidazoles; D010936:Plant Extracts; D014344:Trypanocidal Agents; D009547:Nifurtimox; C009999:benzonidazole
keywords: Chagas disease; French Guiana; Genotyping; Oral transmission; Polymerase chain reaction; Trypanosoma cruzi