title: Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches.
abstract: Orally transmitted Chagas disease has become a matter of concern due to outbreaks reported in four Latin American countries. Although several mechanisms for orally transmitted Chagas disease transmission have been proposed, food and beverages contaminated with whole infected triatomines or their faeces, which contain metacyclic trypomastigotes of Trypanosoma cruzi, seems to be the primary vehicle. In 2007, the first recognised outbreak of orally transmitted Chagas disease occurred in Venezuela and largest recorded outbreak at that time. Since then, 10 outbreaks (four in Caracas) with 249 cases (73.5% children) and 4% mortality have occurred. The absence of contact with the vector and of traditional cutaneous and Romana's signs, together with a florid spectrum of clinical manifestations during the acute phase, confuse the diagnosis of orally transmitted Chagas disease with other infectious diseases. The simultaneous detection of IgG and IgM by ELISA and the search for parasites in all individuals at risk have been valuable diagnostic tools for detecting acute cases. Follow-up studies regarding the microepidemics primarily affecting children has resulted in 70% infection persistence six years after anti-parasitic treatment. Panstrongylus geniculatus has been the incriminating vector in most cases. As a food-borne disease, this entity requires epidemiological, clinical, diagnostic and therapeutic approaches that differ from those approaches used for traditional direct or cutaneous vector transmission.
authors.affiliation: Sección de Inmunología, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Belkisyolé Alarcón de
authors.initials: BA
authors.lastname: Noya
authors.affiliation: Sección de Inmunología, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Zoraida
authors.initials: Z
authors.lastname: Díaz-Bello
authors.affiliation: Sección de Inmunología, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Colmenares
authors.affiliation: Escuela de Medicina Luís Razetti, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Raiza
authors.initials: R
authors.lastname: Ruiz-Guevara
authors.affiliation: Sección de Inmunología, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Luciano
authors.initials: L
authors.lastname: Mauriello
authors.affiliation: Sección de Inmunología, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Arturo
authors.initials: A
authors.lastname: Muñoz-Calderón
authors.affiliation: Sección de Inmunología, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Oscar
authors.initials: O
authors.lastname: Noya
mesh_terms: D014355:Chagas Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D006801:Humans; D014687:Venezuela / Q000453:epidemiology