title: Chagas disease reactivation in a heart transplant patient infected by domestic Trypanosoma cruzi discrete typing unit I (TcIDOM).
abstract: BACKGROUND
  Trypanosoma cruzi, causative agent of Chagas disease, displays high intraspecific genetic diversity: six genetic lineages or discrete typing units (DTUs) are currently recognized, termed TcI through TcVI. Each DTU presents a particular distribution pattern across the Americas, and is loosely associated with different transmission cycles and hosts. Several DTUs are known to circulate in Central America. It has been previously suggested that TcI infection is benign and does not lead to chronic chagasic cardiomyopathy (CCC).
  
  
  RESULTS
  In this study, we genotyped T. cruzi parasites circulating in the blood and from explanted cardiac tissue of an El Salvadorian patient who developed reactivation Chagas disease while on immunosuppressive medications after undergoing heart transplant in the U.S. as treatment for end-stage CCC. Parasite typing was performed through molecular methods (restriction fragment length polymorphism of polymerase reaction chain amplified products, microsatellite typing, maxicircle sequence typing and low-stringency single primer PCR, [LSSP-PCR]) as well as lineage-specific serology. We show that the parasites infecting the patient belong to the TcI DTU exclusively. Our data indicate that the parasites isolated from the patient belong to a genotype frequently associated with human infection throughout the Americas (TcIDOM).
  
  
  CONCLUSIONS
  Our results constitute compelling evidence in support of TcI DTU's ability to cause end-stage CCC and help dispel any residual bias that infection with this lineage is benign, pointing to the need for increased surveillance for dissemination of this genotype in endemic regions, the USA and globally.
authors: Centro de Investigación en Enfermedades Infecciosas, Escuela de Biología, Pontificia Universidad Católica del Ecuador, Avenida 12 de Octubre y Roca, Quito, Ecuador. jacostalesc@puce.edu.ec.
authors: Jaime A
authors: JA
authors: Costales
authors: Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA. ckotton@mgh.harvard.edu.
authors: Camille N
authors: CN
authors: Kotton
authors: Centro de Investigación en Enfermedades Infecciosas, Escuela de Biología, Pontificia Universidad Católica del Ecuador, Avenida 12 de Octubre y Roca, Quito, Ecuador. andrea.zurital.leal@gmail.com.|Present address: Wellcome Trust Centre for Molecular Parasitology, Institute of Infection and Inflammation, College of Medical, Veterinary and Life Science, University of Glasgow, Glasgow, UK. andrea.zurital.leal@gmail.com.
authors: Andrea C
authors: AC
authors: Zurita-Leal
authors: Centro de Investigación en Enfermedades Infecciosas, Escuela de Biología, Pontificia Universidad Católica del Ecuador, Avenida 12 de Octubre y Roca, Quito, Ecuador. josselyn.garciaperez@student.kuleuven.be.|Present address: VIB Autoimmune Genetics Laboratory, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium. josselyn.garciaperez@student.kuleuven.be.
authors: Josselyn
authors: J
authors: Garcia-Perez
authors: Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK. m.s.llewellyn@bangor.ac.uk.|Present address: Molecular Ecology and Fisheries Genetics Laboratory, School of Biological Sciences, University of Wales, Bangor, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK. m.s.llewellyn@bangor.ac.uk.
authors: Martin S
authors: MS
authors: Llewellyn
authors: Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK. louisa.messenger@lshtm.ac.uk.
authors: Louisa A
authors: LA
authors: Messenger
authors: Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK. Tapan.Bhattacharyya@lshtm.ac.uk.
authors: Tapan
authors: T
authors: Bhattacharyya
authors: Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, USA. bburleig@hsph.harvard.edu.
authors: Barbara A
authors: BA
authors: Burleigh
mesh_terms: D000328:Adult; D002598:Chagas Cardiomyopathy / Q000469:parasitology*; D016054:DNA, Protozoan / Q000302:isolation & purification; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D009547:Nifurtimox / Q000009:adverse effects / Q000627:therapeutic use; D009593:Nitroimidazoles / Q000627:therapeutic use; D010802:Phylogeny; D012008:Recurrence; D014344:Trypanocidal Agents / Q000009:adverse effects / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000145:classification* / Q000235:genetics*
chemical_list: D016054:DNA, Protozoan; D009593:Nitroimidazoles; D014344:Trypanocidal Agents; D009547:Nifurtimox; C009999:benzonidazole