Date of Award

7-9-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Michele Barry

Abstract

The purpose of this study was to evaluate the epidemiology of Trypanosoma cruzi infection, to valuate the TESA blot, and to characterize cardiac findings of patients with Chagas disease in a rural setting near Arequipa, Peru. The study site was the town of Quequeña, Peru with a population of 774 with 236 inhabitants under the age of 18 according to the 2005 census conducted by Peru. A fumigation/insect collection campaign was done in December of 2006 to quantify household infestation levels, document housing characteristics, and GPS household locations. Of the 602 people surveyed to be living in Quequeña, blood samples were taken from 445 (73.9%), and 15 (3.37%) were positive for Chagas disease by ELISA and confirmed by immunofluorescence. The TESA blot was also performed on all positives (N=15) and a random subset of negative (N=20) blood samples with a sensitivity of 93% and a specificity of 100%. Electrocardiograms (EKGs) were performed on 37 people, 9 of whom were positive for Chagas disease and the other 28 were age and sex matched controls. All EKGs of Chagas positive patients were normal and 27 of 28 EKGs were normal in the control group. Of the 284 households in Quequeña, 242 (85.2%) were sprayed, and fifty-eight (24.0%) were infested with triatomines. Nineteen households (7.85%) harbored triatomines infected with T. cruzi. Of the 15 patients positive for Chagas disease, 9 lived in a house positive for triatomines (60%), of which 3 were positive for T. cruzi (33%). A serosurvey for Chagas disease in a rural community of Peru was successfully conducted with a prevalence of 3.4%. This information will aid the local Chagas Control Program in its estimates as it continues its fumigation campaign. In addition, the TESA blot was successfully employed in a community based setting enabling its role to be expanded in Chagas diagnosis.

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