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首页> 美国卫生研究院文献>PLoS Neglected Tropical Diseases >The Improbable Transmission of Trypanosoma cruzi to Human: The Missing Link in the Dynamics and Control of Chagas Disease
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The Improbable Transmission of Trypanosoma cruzi to Human: The Missing Link in the Dynamics and Control of Chagas Disease

机译：克氏锥虫不可能传播给人：南美锥虫病动力学和控制中的缺失环节

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Chagas disease has a major impact on human health in Latin America and is becoming of global concern due to international migrations. Trypanosoma cruzi, the etiological agent of the disease, is one of the rare human parasites transmitted by the feces of its vector, as it is unable to reach the salivary gland of the insect. This stercorarian transmission is notoriously poorly understood, despite its crucial role in the ecology and evolution of the pathogen and the disease. The objective of this study was to quantify the probability of T. cruzi vectorial transmission to humans, and to use such an estimate to predict human prevalence from entomological data. We developed several models of T. cruzi transmission to estimate the probability of transmission from vector to host. Using datasets from the literature, we estimated the probability of transmission per contact with an infected triatomine to be 5.8×10−4 (95%CI: [2.6 ; 11.0]×10−4). This estimate was consistent across triatomine species, robust to variations in other parameters, and corresponded to 900–4,000 contacts per case. Our models subsequently allowed predicting human prevalence from vector abundance and infection rate in 7/10 independent datasets covering various triatomine species and epidemiological situations. This low probability of T. cruzi transmission reflected well the complex and unlikely mechanism of transmission via insect feces, and allowed predicting human prevalence from basic entomological data. Although a proof of principle study would now be valuable to validate our models' predictive ability in an even broader range of entomological and ecological settings, our quantitative estimate could allow switching the evaluation of disease risk and vector control program from purely entomological indexes to parasitological measures, as commonly done for other major vector borne diseases. This might lead to different quantitative perspectives as these indexes are well known not to be proportional one to another.
机译：南美锥虫病对拉丁美洲的人类健康有重大影响，由于国际移民，这种病正引起全球关注。该病的病原体克氏锥虫是通过其载体的粪便传播的稀有人类寄生虫之一，因为它无法到达昆虫的唾液腺。尽管它在病原体和疾病的生态学和进化中起着至关重要的作用，但众所周知，这种甾体传递途径知之甚少。这项研究的目的是量化克氏锥虫向人类传播矢量的可能性，并使用这种估计从昆虫学数据预测人类的流行。我们开发了克氏锥虫传播的几种模型，以估计从载体传播到宿主的可能性。使用文献中的数据集，我们估计与受感染的三氢紫杉醇每次接触传播的概率为5.8×10 -4 （95％CI：[2.6; 11.0]×10 −4 < / sup>）。该估计值在三类松果素物种中是一致的，对其他参数的变化具有鲁棒性，并且对应于每例900–4,000个接触者。随后，我们的模型允许在7/10个独立的数据集中，从载体的丰度和感染率预测人类的患病率，这些数据集涵盖了各种三角藻类和流行病学情况。克氏锥虫传播的这种低概率很好地反映了通过昆虫粪便传播的复杂且不太可能的机制，并允许从基本昆虫学数据预测人类的流行。尽管原则研究的证明现在对于在更广泛的昆虫和生态环境中验证我们模型的预测能力非常有价值，但我们的定量估计可以使疾病风险和病媒控制程序的评估从单纯的昆虫学指标转向寄生虫学措施，就像其他主要媒介传播疾病一样。这可能会导致不同的定量观点，因为众所周知这些指标并不成正比。

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