title: Autochthonous transmission of Chagas disease in Rio de Janeiro State, Brazil: a clinical and eco-epidemiological study.
abstract: BACKGROUND
  After the control of the main modes of Chagas disease (CD) transmission in most endemic countries, it is important to identify the participation of native sylvatic vectors in CD transmission. Although CD is not considered endemic in Rio de Janeiro State (RJ), Brazil, we identified patients with CD born in RJ and investigated the possible autochthonous transmission in the state.
  
  
  METHODS
  Patients born in RJ and followed in our institution between 1986 and 2011 were retrospectively analyzed. The cases identified as autochthonous transmission were submitted to epidemiological, clinical, serological, parasitological and molecular studies. Sectional field study with serological survey, research of sylvatic reservoirs and vectors was conducted in rural areas where patients were born.
  
  
  RESULTS
  Among 1963 patients, 69 (3.5%) were born in RJ. From these, 15 (21.7%) were considered to have acquired the infection by autochthonous transmission. Cardiac form was the commonest form of presentation (60%). In rural areas in RJ northern region, sylvatic cycles of Trypanosoma cruzi and domestic invasion by Triatoma vitticeps were identified, and CD prevalence among inhabitants was 0.74%.TcI genotype was identified in sylvatic reservoirs and vectors. The genotype (mixed infection TcI/TcVI) could be identified in one of the autochthonous cases.
  
  
  CONCLUSIONS
  The autochthonous vectorial transmission of CD occurs in RJ, probably due to wild cycles of T. cruzi and sylvatic vectors, such as T. vitticeps. Therefore, the health authorities should evaluate if RJ should be included in the original endemic area of CD and CD should be included in the diagnostic work out of cardiomyopathy of patients born in RJ. Moreover, control and educational measures should be put into place in the risk areas.
authors.affiliation: Laboratório de Pesquisa Clínica em Doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. luiz.sangenis@ini.fiocruz.br.
authors.forename: Luiz Henrique Conde
authors.initials: LH
authors.lastname: Sangenis
authors.affiliation: Laboratório de Pesquisa Clínica em Doença de Chagas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. roberto.saraiva@ini.fiocruz.br.
authors.forename: Roberto Magalhães
authors.initials: RM
authors.lastname: Saraiva
authors.affiliation: Laboratório de Imunodiagnóstico, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. ingebourg.georg@ini.fiocruz.br.
authors.forename: Ingebourg
authors.initials: I
authors.lastname: Georg
authors.affiliation: Laboratório de Farmacocinética, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. liane.castro@ini.fiocruz.br.
authors.forename: Liane
authors.initials: L
authors.lastname: de Castro
authors.affiliation: Laboratório de Biologia de Tripanossomatídeos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. brancaya@ioc.fiocruz.br.
authors.forename: Valdirene
authors.initials: V
authors.lastname: dos Santos Lima
authors.affiliation: Laboratório de Biologia de Tripanossomatídeos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. roque@ioc.fiocruz.br.
authors.forename: André Luiz R
authors.initials: AL
authors.lastname: Roque
authors.affiliation: Laboratório de Biologia de Tripanossomatídeos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. samanta@ioc.fiocruz.br.
authors.forename: Samanta Cristina das Chagas
authors.initials: SC
authors.lastname: Xavier
authors.affiliation: Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. lcs@ioc.fiocruz.br.
authors.forename: Laura Cristina
authors.initials: LC
authors.lastname: Santos
authors.affiliation: Laboratório de Ecoepidemiologia da Doença de Chagas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. fabiano.fernandes@ioc.fiocruz.br.
authors.forename: Fabiano A
authors.initials: FA
authors.lastname: Fernandes
authors.affiliation: Laboratório de Ecoepidemiologia da Doença de Chagas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. otiliasarquis@ioc.fiocruz.br.
authors.forename: Otília
authors.initials: O
authors.lastname: Sarquis
authors.affiliation: Laboratório de Ecoepidemiologia da Doença de Chagas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. mmlima@ioc.fiocruz.br.
authors.forename: Marli Maria
authors.initials: MM
authors.lastname: Lima
authors.affiliation: Laboratório de Sistemática e Bioquímica, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. guaratiba@ioc.fiocruz.br.
authors.forename: Filipe Aníbal
authors.initials: FA
authors.lastname: Carvalho-Costa
authors.affiliation: Laboratório de Biologia e Parasitologia de Mamíferos Silvestres Reservatórios, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. mboia@ioc.fiocruz.br.
authors.forename: Márcio Neves
authors.initials: MN
authors.lastname: Bóia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D005260:Female; D005838:Genotype; D006801:Humans; D007303:Insect Vectors / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012189:Retrospective Studies; D014224:Triatoma / Q000469:parasitology; D014349:Trypanosoma cruzi / Q000235:genetics / Q000302:isolation & purification*