Diversidade genética de Trypanosoma cruzi em indivíduos com doença de Chagas crônica no Norte de Minas e Vale do Jequitinhonha: uma abordagem integrada com ações de uma só saúde

Abstract

Chagas disease is one of the main parasitic endemics in Latin America, affecting millions of people. Caused by the protozoan Trypanosoma cruzi, the disease is characterized by considerable genetic diversity in the parasite, which can influence the clinical progression of the disease in individuals. Given this genetic variability, it is essential to investigate how different T. cruzi isolates impact disease progression. This study is composed of four scientific outputs. The first aimed to assess the genetic diversity of Trypanosoma cruzi in individuals with chronic Chagas disease from endemic municipalities in the North of Minas Gerais and the Jequitinhonha Valley, Minas Gerais, Brazil. The research sought to correlate the identified genotypes with age, parasite load, antibody levels, and cardiac severity in participants from the SaMi- Trop cohort. Molecular typing was performed using conventional multilocus PCR on blood samples from individuals with the cardiac form of the disease. Of the 80 samples analyzed, 37 (46%) were successfully genotyped. The most frequent of the genotypes observed were TcII/TcVI (40.54%) and TcII (16.21%), followed by similar frequencies for TcVI and TcI (13.51% each) and TcV (8.10%). Three individuals presented mixed infections. Most DTUs (67.6%) were identified in individuals over 61 years old, although no statistically significant difference was observed. Parasite load varied widely among individuals, ranging from 0.06 to 667 parasite equivalents/mL. Participants infected with TcV showed higher mean parasite loads and elevated anti-T. cruzi antibody titers. A significant association was found between DTUs and levels of B-type natriuretic peptide (BNP), a marker of heart failure. Understanding DTU diversity is critical for improving diagnostic approaches, optimizing treatments, and strengthening epidemiological control strategies for Chagas disease. The second product aimed to report the experience of conducting a health education activity on Chagas disease in endemic areas in Minas Gerais, specifically in Espinosa and São Francisco municipalities. The activity included dialogued banner presentations, displays of vector insects, T. cruzi microscopy, human anatomical models, distribution of pamphlets and booklets, and educational activities for children. A multidisciplinary team addressed topics related to the disease's transmission, lifecycle, diagnosis, treatment, and prevention. The activity reached approximately 500 participants in each municipality. It modes and clinical manifestations and had difficulty identifying the vector. The educational activity demonstrated that public knowledge of Chagas disease is limited or nonexistent even in endemic areas. The third and fourth scientific products, a pitch and a children's booklet were developed to raise awareness about Chagas disease. The pitch is available on different digital platforms, providing feedback to the community. The booklet, used in the health education activity, presents Chagas disease playfully and interactively, with activities specifically designed for children, who act as knowledge multipliers by disseminating information about the disease in an accessible and educational manner, contributing to increased awareness about Chagas disease. In summary, this thesis contributed to understanding the eco- epidemiology of Chagas disease and promoted educational activities aligned with the One Health approach