Browsing by Autor "Jois, Malasa"

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Hyperendemic Chagas Disease and the Unmet Need for Pacemakers in the Bolivian Chaco
(Alain Debrabant, US Food and Drug Administration, United States of America, 2022) Clark, Eva H.; Sherbuk, Jackie; Okamoto, Emi; Jois, Malasa; Galdos-Cardenas, Gerson; Vela-Guerra, Julio; Menacho-Mendez, Gilberto Silvio
Morbidity and mortality from Chagas cardiomyopathy have declined over the last three decades because of disruption of domestic vector-borne transmission, improved Trypanosoma cruzi infection treatment programs, and increasing availability of advanced cardiac care. However, the Gran Chaco, an ecological zone that includes parts of Argentina, Bolivia, and Paraguay, continues to struggle with extremely high rates of vector infestation and T. cruzi infection. In addition, this region is one of the poorest in the world, with most individuals living on less than US$2 per day. We estimate that thousands of patients are in need of pacemakers secondary to advanced Chagas cardiomyopathy. However, the vast majority of these individuals lack the resources to obtain these life-saving devices. A collaborative effort must be made by pacemaker donation programs, local implantation hospitals, and the governments of countries affected by Chagas disease to address this unmet need. With the necessary cooperation and infrastructure, pacemaker reuse programs have the potential to offer thousands of low-cost devices to impoverished patients with advancing Chagas cardiomyopathy.
Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia
(Oxford University Press on behalf of the Infectious Diseases Society of America, 2022) Kaplinski, Michelle; Jois, Malasa; Galdos-Cardenas, Gerson; Rendell, Victoria R.; Shah, Vishal; Do, Rose Q.
Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia
(Oxford University Press on behalf of the Infectious Diseases Society of America, 2018) Kaplinski, Michelle; Jois, Malasa; Galdos-Cardenas, Gerson; Rendell, Victoria R.; Shah, Vishal; Do, Rose Q.; Marcus, Rachel; Burroughs Pena, Melissa S.; Abastoﬂor, Maria del Carmen; LaFuente, Carlos; Bozo, Ricardo; Valencia, Edward; Verastegui, Manuela; Colanzi, Rony; Gilman, Robert H.; Bern, Caryn
Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia.
(2015) Kaplinski, Michelle; Jois, Malasa; Galdos-Cardenas, Gerson; Rendell, Victoria R; Shah, Vishal; Do, Rose Q; Marcus, Rachel; Pena, Melissa S Burroughs; Abastoflor, Maria del Carmen; LaFuente, Carlos; Bozo, Ricardo; Valencia, Edward; Verastegui, Manuela; Colanzi, Rony; Gilman, Robert H; Bern, Caryn
BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women. METHODS: Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). RESULTS: Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. CONCLUSIONS: We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.