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Congenital and oral transmission of American trypanosomiasis: an overview of physiopathogenic aspects


Chagas disease or American trypanosomiasis is a pathology affecting about 8–11 million people in Mexico, Central America, and South America, more than 300 000 persons in the United States as well as an indeterminate number of people in other non-endemic countries such as USA, Spain, Canada and Switzerland. The aetiological agent is Trypanosoma cruzi, a protozoan transmitted by multiple routes; among them, congenital route emerges as one of the most important mechanisms of spreading Chagas disease worldwide even in non-endemic countries and the oral route as the responsible of multiple outbreaks of acute Chagas disease in regions where the vectorial route has been interrupted. The aim of this review is to illustrate the recent research and advances in host-pathogen interaction making a model of how the virulence factors of the parasite would interact with the physiology and immune system components of the placental barrier and gastrointestinal tract in order to establish a response against T. cruzi infection. This review also presents the epidemiological, clinical and diagnostic features of congenital and oral Chagas disease in order to update the reader about the emerging scenarios of Chagas disease transmission.

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*Corresponding author: Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Universidad de los Andes, Bogotá, Colombia. Tel: +571 3324540. E-mail:
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V. M. Abrahams and G. Mor (2005). Toll-like receptors and their role in the trophoblast. Placenta 26, 540547. doi: 10.1016/j.placenta.2004.08.010.

A. Acosta-Serrano , I. C. Almeida , L. H. Freitas-Junior , N. Yoshida and S. Schenkman (2001). The mucin-like glycoprotein super-family of Trypanosoma cruzi: structure and biological roles. Molecular and Biochemical Parasitology 114, 143150. doi: S0166685101002456.

E. Azogue , C. La Fuente and C. Darras (1985). Congenital Chagas’ disease in Bolivia: epidemiological aspects and pathological findings. Royal Society of Tropical Medicine and Hygiene 79, 176180.

F. Bhaijee , C. Subramony , S. J. Tang and D. J. Pepper (2011). Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Pathology Research International 2011, 18. doi: 10.4061/2011/247923.

M. Bisio , M. E. Seidenstein , J. M. Burgos , G. Ballering , M. Risso , R. Pontoriero , M. Moreau , J. Altcheh , M. S. Leguizamon , H. Freilij , M. Marceillac and A. G. Schijman (2011) Urbanization of congenital transmission of Trypanosoma cruzi: prospective polymerase chain reaction study in pregnancy. Royal Society of Tropical Medicine and Hygiene 105, 543549. doi: 10.1016/j.trstmh.2011.07.003.

J. M. Burgos , J. Altcheh , N. Petrucelli , M. Bisio , M. J. Levin , H. Freilij and A. G. Schijman (2009). Molecular diagnosis and treatment monitoring of congenital transmission of Trypanosoma cruzi to twins of a triplet delivery. Diagnostic Microbiology and Infectious Disease 65, 5861. doi: 10.1016/j.diagmicrobio.2009.04.010.

A. Buschiazzo , M. F. Amaya , M. L. Cremona , A. C. Frasch and P. M. Alzari (2002). The crystal structure and mode of action of trans-sialidase, a key enzyme in Trypanosoma cruzi pathogenesis. Molecular Cell 10, 757768. doi: S1097276502006809.

D. A. Campbell , S. J. Westenberger and N. R. Sturm (2004). The determinants of Chagas disease: connecting parasite and host genetics. Current Molecular Medicine 4, 549562.

Y. Carlier and F. Torrico (2003). Congenital infection with Trypanosoma cruzi: from mechanisms of transmission to strategies for diagnosis and control. Revista da Sociedade Brasileira de Medicina Tropical 36, 767771.

Y. Carlier , F. Torrico , S. Sosa-Estani , G. Russomando , A. Luquetti , H. Freilij and P. Albajar Vinas (2011 a). Congenital Chagas disease: recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women. PLoS Neglected Tropical Diseases 5, e1250. doi: 10.1371/journal.pntd.0001250.

Y. Carlier , C. Truyens , P. Deloron and F. Peyron (2011 b). Congenital parasitic infections: a review. Acta Tropica 121, 5570. doi: 10.1016/j.actatropica.2011.10.018.

D. A. Clark , J. W. Ding , G. Yu , G. A. Levy and R. M. Gorczynski (2001). Fgl2 prothrombinase expression in mouse trophoblast and decidua triggers abortion but may be countered by OX-2. Molecular Human Reproduction 7, 185194.

R. M. Corrales , M. C. Mora , O. S. Negrette , P. Diosque , D. Lacunza , M. Virreira , S. F. Breniere and M. A. Basombrio (2009). Congenital Chagas disease involves Trypanosoma cruzi sub-lineage IId in the northwestern province of Salta, Argentina. Infection, Genetics and Evolution 9, 278282. doi: 10.1016/j.meegid.2008.12.008.

M. Cortez , M. R. Silva , I. Neira , D. Ferreira , G. R. Sasso , A. O. Luquetti , A. Rassi and N. Yoshida (2006). Trypanosoma cruzi surface molecule gp90 downregulates invasion of gastric mucosal epithelium in orally infected mice. Microbes and Infection 8, 3644. doi: 10.1016/j.micinf.2005.05.016.

M. Corti , H. Metta , O. Palmieri and R. Schtirbu (2007). Acute phlegmonous gastritis in a patient with AIDS. Enfermedades Infecciosas y Microbiología Clínica 25, 218220. doi: 13099379.

J. R. Coura (2007). Chagas disease: what is known and what is needed-a background article. Memórias do Instituto Oswaldo Cruz 102 (Suppl.) S113S122. doi: S0074-02762007000900018.

J. R. Coura and J. C. Dias (2009). Epidemiology, control and surveillance of Chagas disease: 100 years after its discovery. Memórias do Instituto Oswaldo Cruz 104 (Suppl.) S31S40. doi: S0074-02762009000900006.

J. R. Coura , A. C. Junqueira , O. Fernandes , S. A. Valente and M. A. Miles (2002). Emerging Chagas disease in Amazonian Brazil. Trends in Parasitology 18, 171176. doi: S1471492201022000.

J. C. Dias (2006). Notes about of Trypanosoma cruzi and yours bio-ecology characteristics with agents of the transmission by meals. Revista da Sociedade Brasileira de Medicina Tropical 39, 370375. doi: S0037-86822006000400010.

R. Docampo and O. P. Pignataro (1991) The inositol phosphate/diacylglycerol signalling pathway in Trypanosoma cruzi. The Biochemical Journal 275, 407411.

T. Duffy , M. Bisio , J. Altcheh , J. M. Burgos , M. Diez , M. J. Levin , R. R. Favaloro , H. Freilij and A. G. Schijman (2009). Accurate real-time PCR strategy for monitoring bloodstream parasitic loads in chagas disease patients. PLoS Neglected Tropical Diseases 3, e419. doi: 10.1371/journal.pntd.0000419.

S. A. Elmore , J. L. Jones , P. A. Conrad , S. Patton , D. S. Lindsay and J. P. Dubey (2010). Toxoplasma gondii: epidemiology, feline clinical aspects, and prevention. Trends in Parasitology 26, 190196. doi: 10.1016/

A. Falla , C. Herrera , A. Fajardo , M. Montilla , G. A. Vallejo and F. Guhl (2009). Haplotype identification within Trypanosoma cruzi I in Colombian isolates from several reservoirs, vectors and humans. Acta Tropica 110, 1521. doi: 10.1016/j.actatropica.2008.12.003.

C. S. Ferreira , P. C. Martinho , V. Amato Neto and R. R. Cruz (2001). Pasteurization of human milk to prevent transmission of Chagas disease. Revista do Instituto de Medicina Tropical de São Paulo 43, 161162. doi: S0036-46652001000300008.

A. C. Frasch (2000). Functional diversity in the trans-sialidase and mucin families in Trypanosoma cruzi. Parasitology Today 16, 282286. doi: S0169-4758(00)01698-7.

L. Fumarola , R. Monno , E. Ierardi , G. Rizzo , G. Giannelli , M. Lalle and E. Pozio (2009). Anisakis pegreffi etiological agent of gastric infections in two Italian women. Foodborne Pathogens and Disease 6, 11571159. doi: 10.1089/fpd.2009.0325.

P. S. Ganga-Zandzou , E. K. Nguema , M. M. Mbo and B. Ondimba el (2005). Congenital malaria falciparum. Archives de Pédiatrie 12, 11641166. doi: 10.1016/j.arcped.2005.04.070.

J. Gascon , C. Bern and M. J. Pinazo (2009). Chagas disease in Spain, the United States and other non-endemic countries. Acta Tropica 115, 2227. doi:10.1016/j.actatropica.2009.07.019.

A. Greenough (1994). The TORCH screen and intrauterine infections. Archives of Disease In Childhood Fetal and Neonatal Edition 70, 163165.

F. Guhl and J. D. Ramirez (2011). Trypanosoma cruzi I diversity: towards the need of genetic subdivision?. Acta Tropica 119, 14. doi: 10.1016/j.actatropica.2011.04.002.

F. Guhl and G. A. Vallejo (1999). Interruption of Chagas disease transmission in the Andean countries: Colombia. Memórias do Instituto Oswaldo Cruz 94 (Suppl.) S413S415. doi: S0074-0276(99)09400081.

Y. Hasegawa , A. Goto , S. Nishimura , Y. Sukawa , K. Fujii , K. Suzuki , K. Yonezawa , T. Abe , Y. Shinomura and Y. Yoshida (2009). Cytomegalovirus gastritis after treatment with rituximab. Endoscopy 41 (Suppl.) 199. doi: 10.1055/s-0029-1214855.

J. Heikkinen , M. Mottonen , J. Komi , A. Alanen and O. Lassila (2003). Phenotypic characterization of human decidual macrophages. Clinical Experimental Immunology 131, 498505.

E. Hermann , C. Truyens , C. Alonso-Vega , P. Rodriguez , A. Berthe , F. Torrico and Y. Carlier (2004). Congenital transmission of Trypanosoma cruzi is associated with maternal enhanced parasitaemia and decreased production of interferon- gamma in response to parasite antigens. Journal of Infectious Diseases 189, 12741281. doi: 10.1086/382511.

S. Hindupur and V. Despotovic (2006). Gastric histoplasmosis. The Lancet Infectious Diseases 6, 60. doi: 10.1016/S1473-3099(05)70328-5.

A. Hokama , K. Taira , Y. Yamamoto , N. Kinjo , F. Kinjo , K. Takahashi and J. Fujita (2010). Cytomegalovirus gastritis. World Journal of Gastrointestinal Endoscopy 2, 379380. doi: 10.4253/wjge.v2.i11.379.

K. Ikeda , R. Kumashiro and T. Kifune (1989). Nine cases of acute gastric anisakiasis. Gastrointesinal Endoscopy 35, 304308.

T. Jacobs , H. Erdmann and B. Fleischer (2009). Molecular interaction of Siglecs (sialic acid-binding Ig-like lectins) with sialylated ligands on Trypanosoma cruzi. European Journal of Cell Biology 89, 113116. doi: 10.1016/j.ejcb.2009.10.006.

M. L. Jofre , O. P. Neira , H. I. Noemi and C. J. Cerva (2008). Pseudoterranovosis and sushi. Revista chilena de infectología 25, 200205. doi: S0716-10182008000300010.

J. L. Jones , A. Krueger , J. Schulkin and P. M. Schantz (2009). Toxoplasmosis prevention and testing in pregnancy, survey of obstetrician-gynaecologists. Zoonoses and Public Health 57, 2733. doi: 10.1111/j.1863-2378.2009.01277.x.

Y. Kakugawa , M. Kami , T. Matsuda , Y. Saito , S. W. Kim , T. Fukuda , S. Mori , T. Shimoda , R. Tanosaki and D. Saito (2010). Endoscopic diagnosis of cytomegalovirus gastritis after allogeneic hematopoietic stem cell transplantation. World Journal of Gastroenterology 16, 29072912.

H. Kayama , R. Koga , K. Atarashi , M. Okuyama , T. Kimura , T. W. Mak , S. Uematsu , S. Akira , H. Takayanagi , K. Honda , M. Yamamoto and K. Takeda (2009). NFATc1 mediates Toll-like receptor-independent innate immune responses during Trypanosoma cruzi infection. PLoS Pathogens 5, e1000514. doi: 10.1371/journal.ppat.1000514.

H. Kayama and K. Takeda (2010). The innate immune response to Trypanosoma cruzi infection. Microbes and Infection 12, 511517. doi: 10.1016/j.micinf.2010.03.005.

L. Kodjikian (2010). Toxoplasmosis and pregnancy. Journal Français D'Ophtalmologie 33, 362367. doi: 10.1016/j.jfo.2010.03.002.

R. E. Lagerberg (2008). Malaria in pregnancy: a literature review. Journal of Midwifery & Women's Health 53, 209215. doi: 10.1016/j.jmwh.2008.02.012.

A. M. Macedo , C. R. Machado , R. P. Oliveira and S. D. Pena (2004). Trypanosoma cruzi: genetic structure of populations and relevance of genetic variability to the pathogenesis of chagas disease. Memórias do Instituto Oswaldo Cruz 99, 112. doi: S0074-02762004000100001.

F. Macian (2005). NFAT proteins: key regulators of T-cell development and function. Nature Reviews Immunology 5, 472484. doi: 10.1038/nri1632.

L. Maeng , A. Lee , K. Choi , C. S. Kang and K. M. Kim (2004). Granulomatous gastritis: a clinicopathologic analysis of 18 biopsy cases. American Journal of Surgical Pathology 28, 941945. doi: 00000478-200407000-00015.

M. C. Mallimaci , S. Sosa-Estani , G. Russomando , Z. Sanchez , C. Sijvarger , I. M. Alvarez , L. Barrionuevo , C. Lopez and E. L. Segura (2010). Early diagnosis of congenital Trypanosoma cruzi infection, using shed acute phase antigen, in Ushuaia, Tierra del Fuego, Argentina. The American Journal of Tropical Medicine and Hygiene 82, 5559. doi: 10.4269/ajtmh.2010.09-0219.

A. Marcili , V. C. Valente , S. A. Valente , A. C. Junqueira , F. M. da Silva , A. Y. Pinto , R. D. Naiff , M. Campaner , J. R. Coura , E. P. Camargo , M. A. Miles and M. M. Teixeira (2009). Trypanosoma cruzi in Brazilian Amazonia: Lineages TCI and TCIIa in wild primates, Rhodnius spp. and in humans with Chagas disease associated with oral transmission. International Journal for Parasitology 39, 615623. doi: 10.1016/j.ijpara.2008.09.015.

J. R. McGhee , J. Mestecky , M. T. Dertzbaugh , J. H. Eldridge , M. Hirasawa and H. Kiyono (1992). The mucosal immune system: from fundamental concepts to vaccine development. Vaccine 10, 7588.

G. C. Meine , J. Dietz , M. Rocha , T. Mattos , A. R. de Souza and F. R. Conteletti (2004). Atypical gastric presentation of strongyloidiasis in HIV-infected patient–case report. Digestive and Liver Disease 36, 760762.

A. Moncayo and A. C. Silveira (2009). Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy. Memórias do Instituto Oswaldo Cruz 104 (Suppl.) 1730. doi: S0074-02762009000900005.

G. Mor and I. Cardenas (2010). The immune system in pregnancy: a unique complexity. American Journal of Reproductive Immunology 63, 425433. doi: 10.1111/j.1600-0897.2010.00836.x.

D. H. Munn , M. Zhou , J. T. Attwood , I. Bondarev , S. J. Conway , B. Marshall , C. Brown and A. L. Mellor (1998). Prevention of allogeneic fetal rejection by tryptophan catabolism. Science 281, 11911193.

N. C. Nevin , D. Eakins , S. D. Clarke and D. J. Carson (1969). Acute phlegmonous gastritis. British Journal of Surgery 56, 268270.

A. C. Oliveira , B. C. de Alencar , F. Tzelepis , W. Klezewsky , R. N. da Silva , F. S. Neves , G. S. Cavalcanti , S. Boscardin , M. P. Nunes , M. F. Santiago , A. Nobrega , M. M. Rodrigues and M. Bellio (2010). Impaired innate immunity in Tlr4(−/−) mice but preserved CD8+ T cell responses against Trypanosoma cruzi in Tlr4-, Tlr2-, Tlr9- or Myd88-deficient mice. PLoS Pathogens 6, e1000870. doi: 10.1371/journal.ppat.1000870.

I. Oliveira , F. Torrico , J. Muñoz and J. Gascon (2010). Congenital transmission of Chagas disease: a clinical approach. Expert Review of Anti-Infective Therapy 8, 945956.

G. Ozturk , B. Aydinli , F. Celebi and N. Gursan (2011). Gastric perforation caused by Strongyloides stercoralis: a case report. (2011). Ulus Travma Acil Cerrahi Derg 17, 9092.

N. W. Palm and R. Medzhitov (2009). Pattern recognition receptors and control of adaptive immunity. Immunological Reviews 227, 221233. doi: 10.1111/j.1600-065X.2008.00731.x.

K. S. Pereira , F. L. Schmidt , R. L. Barbosa , A. M. Guaraldo , R. M. Franco , V. L. Dias and L. A. Passos (2010). Transmission of chagas disease (american trypanosomiasis) by food. Advances in Food & Nutrition Research 59, 6385. doi: 10.1016/S1043-4526(10)59003-X.

M. Piron , M. Verges , J. Munoz , N. Casamitjana , S. Sanz , R. M. Maymo , J. M. Hernandez , L. Puig , M. Portus , J. Gascon and S. Sauleda (2008). Seroprevalence of Trypanosoma cruzi infection in at-risk blood donors in Catalonia (Spain). Transfusion 48, 18621868. doi:10.1111/j.1537-2995.2008.01789.x.

C. Ponce , E. Ponce , E. Vinelli , A. Montoya , V. de Aguilar , A. Gonzalez , B. Zingales , R. Rangel-Aldao , M. J. Levin , J. Esfandiari , E. S. Umezawa , A. O. Luquetti and J. F. da Silveira (2005). Validation of a rapid and reliable test for diagnosis of Chagas ‘disease by detection of Trypanosoma cruzi-specific antibodies in blood of donors and patients in Central America. Journal of Clinical Microbiology 43, 50655068. doi: 10.1128/JCM.43.10.5065-5068.2005.

S. Priotto , M. J. Sartori , G. Repossi and M. A. Valentich (2009). Trypanosoma cruzi: participation of cholesterol and placental alkaline phosphatase in the host cell invasion. Experimental Parasitology 122, 7073. doi: 10.1016/j.exppara.2009.01.004.

G. Punukollu , R. M. Gowda , I. A. Khan , V. S. Navarro and B. C. Vasavada (2007). Clinical aspects of the Chagas’ heart disease. International Journal of Cardiology 115, 279283. doi:10.1016/j.ijcard.2006.03.004.

R. Raghupathy (1997). Th1-type immunity is incompatible with successful pregnancy. Immunology Today 18, 478482. doi: S0167569997011274.

R. Raghupathy , E. Al-Mutawa , M. Al-Azemi , M. Makhseed , F. Azizieh and J. Szekeres-Bartho (2009). Progesterone-induced blocking factor (PIBF) modulates cytokine production by lymphocytes from women with recurrent miscarriage or preterm delivery. Journal of Reproductive Immunology 80, 9199. doi: 10.1016/j.jri.2009.01.004.

S. M. Raimundo , E. Massad and H. M. Yang (2009). Modelling congenital transmission of Chagas’ disease. Biosystems 99, 215222. doi: 10.1016/j.biosystems.2009.11.005.

J. D. Ramírez , M. C. Duque and F. Guhl (2011). Phylogenetic reconstruction based on Cytochrome b (Cytb) gene sequences reveals distinct genotypes within Colombian Trypanosoma cruzi I populations. Acta Tropica 119, 6165. doi: 10.1016/j.actatropica.2011.04.009.

J. D. Ramírez , F. Guhl , L. M. Rendon , F. Rosas , J. A. Marin-Neto and C. A. Morillo (2010). Chagas cardiomyopathy manifestations and Trypanosoma cruzi genotypes circulating in chronic Chagasic patients. PLoS Neglected Tropical Diseases 4, e899. doi: 10.1371/journal.pntd.0000899.

J. D. Ramírez , F. Guhl , E. S. Umezawa , C. A. Morillo , F. Rosas , J. A. Marin-Neto and S. Restrepo (2009). Evaluation of adult chronic Chagas’ heart disease diagnosis by molecular and serological methods. Journal of Clinical Microbiology 47, 39453951. doi:10.1128/JCM.01601-09.

J. D. Ramírez , F. Guhl , L. A. Messenger , M. D. Lewis , M. Montilla , Z. Cucunubá , M. A. Miles and M. S. Llewellyn (2012). Contemporary cryptic sexuality in Trypanosoma cruzi. Molecular Ecology (in the Press).

A. Rassi Jr., A. Rassi and J. A. Marin-Neto (2010). Chagas disease. The Lancet 375, 13881402. doi: 10.1016/S0140-6736(10)60061-X.

R. W. Redline (2006). Inflammatory responses in the placenta and umbilical cord. Seminars in Fetal and Neonatal Medicine 11, 296301. doi: 10.1016/j.siny.2006.02.011.

M. B. Reyes , M. Lorca , P. Munoz and A. C. Frasch (1990). Fetal IgG specificities against Trypanosoma cruzi antigens in infected newborns. Proceedings of the National Academy of Sciences, USA 87, 28462850.

P. Roddy , J. Goiri , L. Flevaud , P. P. Palma , S. Morote , N. Lima , L. Villa , F. Torrico and P. Albajar-Vinas (2008). Field evaluation of a rapid immunochromatographic assay for detection of Trypanosoma cruzi infection by use of whole blood. Journal of Clinical Microbiology 46, 20222027. doi: 10.1128/JCM.02303-07.

R. Romero , F. Gotsch , B. Pineles and J. P. Kusanovic (2007). Inflammation in pregnancy: its roles in reproductive physiology, obstetrical complications, and fetal injury. Nutrition Reviews 65, 194202.

M. J. Sartori , S. Lin , F. M. Frank , E. L. Malchiodi and S. P. de Fabro (2002). Role of placental alkaline phosphatase in the interaction between human placental trophoblast and Trypanosoma cruzi. Experimental and Molecular Pathology 72, 8490. doi: 10.1006/exmp.2001.2412.

W. Savino , D. M. Villa-Verde , D. A. Mendes-da-Cruz , E. Silva-Monteiro , A. R. Perez , P. Aoki Mdel , O. Bottasso , N. Guinazu , S. D. Silva-Barbosa and S. Gea (2007). Cytokines and cell adhesion receptors in the regulation of immunity to Trypanosoma cruzi. Cytokine & Growth Factor Reviews 18, 107124. doi: 10.1016/j.cytogfr.2007.01.010.

A. Schijman (2006). Congenital Chagas disease. Perspectives in Medical Virology 13, 223258. doi: 10.1016/S0168-7069(06)13012.

A. Schijman , M. Bisio , L. Orellana , M. Sued , T. Duffy , A. Mejía-Jaramillo , C. Cura , F. Auter , V. Veron , Y. Qvarnstrong , S. Deborggraeve , G. Hijar , I. Zulantay , R. Lucero , El. Velazquez , T. Tellez , Z. Sanchez-Leon , L. Galvao , D. Nolder , M. Monje-Rumi , J. Levi , J. D. Ramírez , P. Zorrilla , M. Flores , M. Jercic , G. Grisante , N. Añez , A. De Castro , C. I. Gonzalez , K. Acosta , P. Yachelini , F. Torrico , C. Robello , P. Diosque , O. Triana , C. Aznar , G. Russomando , P. Buscher , A. Assal , F. Guhl , S. Sosa-Estani , A. Da Silva , C. Britto , A. Luquetti and J. Ladzins (2011). International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. PLoS Neglected Tropical Diseases 5, e931. doi:10.1371/journal.pntd.0000931.

B. Schmausser , M. Andrulis , S. Endrich , S. K. Lee , C. Josenhans , H. K. Muller-Hermelink and M. Eck (2004). Expression and subcellular distribution of toll-like receptors TLR4, TLR5 and TLR9 on the gastric epithelium in Helicobacter pylori infection. Clinical & Experimental Immunology 136, 521526. doi: 10.1111/j.1365-2249.2004.02464.x.

G. A. Schmunis and Z. E. Yadon (2009). Chagas disease: a Latin American health problem becoming a world health problem. Acta Tropica 115, 1421. doi: 10.1016/j.actatropica.2009.11.003.

A. Shakhawat , V. Shaikly , E. Elzatma , E. Mavrakos , A. Jabeen and N. Fernandez (2010). Interaction between HLA-G and monocyte/macrophages in human pregnancy. Journal of Reproductive Immunology 85, 4046. doi: 10.1016/j.jri.2010.02.004.

A. Shet (2011). Congenital and perinatal infections: throwing new light with an old TORCH. The Indian Journal of Pediatrics 78, 8895. doi: 10.1007/s12098-010-0254-3.

M. A. Shikanai-Yasuda , C. B. Marcondes , L. A. Guedes , G. S. Siqueira , A. A. Barone , J. C. Dias , V. Amato Neto , J. E. Tolezano , B. A. Peres , E. R. Arruda Junior, M. H. Lopes , M. Shiroma and E. Chapadeiro (1991). Possible oral transmission of acute Chagas' disease in Brazil. Revista do Instituto de Medicina Tropical de São Paulo 33, 351357.

E. Sicuri , J. Munoz , M. J. Pinazo , E. Posada , J. Sanchez , P. L. Alonso and J. Gascon (2011). Economic evaluation of Chagas disease screening of pregnant Latin American women and of their infants in a non endemic area. Acta Tropica 118, 110117. doi: 10.1016/j.actatropica.2011.02.012.

A. Silveira and M. Vinhaes (1999). Elimination of vector-borne transmission of Chagas disease. Memórias do Instituto Oswaldo Cruz 94 (Suppl.) S405S411. doi: S0074-0276(99)09400080.

D. I. Staquicini , R. M. Martins , S. Macedo , G. R. Sasso , V. D. Atayde , M. A. Juliano and N. Yoshida (2010). Role of GP82 in the selective binding to gastric mucin during oral infection with Trypanosoma cruzi. PLoS Neglected Tropical Diseases 4, e613. doi: 10.1371/journal.pntd.0000613.

M. Steindel , L. Kramer Pacheco , D. Scholl , M. Soares , M. H. de Moraes , I. Eger , C. Kosmann , T. C. Sincero , P. H. Stoco , S. M. Murta , C. J. de Carvalho-Pinto and E. C. Grisard (2008). Characterization of Trypanosoma cruzi isolated from humans, vectors, and animal reservoirs following an outbreak of acute human Chagas disease in Santa Catarina State, Brazil. Diagnostic Microbiology and Infectious Disease 60, 2532. doi: 10.1016/j.diagmicrobio.2007.07.016.

R. Storino , S. Auger , O. Caravello , M. Urrutia , M. Sanmartino and M. Jörg (2002). Cardiopatía chagásica en pacientes de área endémica versus contagiados en forma ocasional. Revista de Saúde Pública 36, 755758. doi: 10.1590/S0034-89102002000700016.

L. Svensson , M. Arvola , M. A. Sallstrom , R. Holmdahl and R. Mattsson (2001). The Th2 cytokines IL-4 and IL-10 are not crucial for the completion of allogeneic pregnancy in mice. Journal of Reproductive Immunology 51, 37.

R. L. Tarleton (2007). Immune system recognition of Trypanosoma cruzi. Current Opinion in Immunology 19, 430434. doi:10.1016/j.coi.2007.06.003.

G. A. Taylor , C. G. Feng. and A. Sher (2004). P47 GTPases: regulators of immunity to intracellular pathogens. Nat Review of Immunology, 4, 100109.

O. Thellin and E. Heinen (2003). Pregnancy and the immune system: between tolerance and rejection. Toxicology 185, 179184. doi: S0300483X02006078.

Z. Tulassay and L. Herszenyi (2010). Gastric mucosal defense and cytoprotection. Best Practice & Research Clinical Gastroenterology 24, 99108. doi: 10.1016/j.bpg.2010.02.006.

F. Villalta , J. Scharfstein , A. W. Ashton , K. M. Tyler , F. Guan , S. Mukherjee , M. F. Lima , S. Alvarez , L. M. Weiss , H. Huang , F. S. Machado and H. B. Tanowitz (2009). Perspectives on the Trypanosoma cruzi-host cell receptor interactions. Parasitology Research 104, 12511260. doi: 10.1007/s00436-009-1383-3.

A. Y. Wang and D. A. Peura (2011). The prevalence and incidence of Helicobacter pylori-associated peptic ulcer disease and upper gastrointestinal bleeding throughout the world. Gastrointestinal Endoscopy Clinics of North America 21, 613635. doi: 10.1016/j.giec.2011.07.011.

N. Yoshida (2006). Molecular basis of mammalian cell invasion by Trypanosoma cruzi. Anais da Academia Brasileira de Ciências 78, 87111. doi: S0001-37652006000100010/S0001-37652006000100010.

N. Yoshida (2008). Trypanosoma cruzi infection by oral route: how the interplay between parasite and host components modulates infectivity. Parasitology International 57, 105109. doi: 10.1016/j.parint.2007.12.008.

N. Yoshida (2009). Molecular mechanisms of Trypanosoma cruzi infection by oral route. Memórias do Instituto Oswaldo Cruz 104 (Suppl.) 101107. doi: S0074-02762009000900015.

N. Yoshida and M. Cortez (2008). Trypanosoma cruzi: parasite and host cell signaling during the invasion process. Subcellular Biochemistry 47, 8291.

N. Yoshida , S. Favoreto , A. T. Ferreira and P. M. Manque (2000). Signal transduction induced in Trypanosoma cruzi metacyclic trypomastigotes during the invasion of mammalian cells. Brazilian Journal of Medical and Biological Research 33, 269278. doi: S0100-879X2000000300003.

N. Yoshida , K. M. Tyler and M. S. Llewellyn (2011). Invasion mechanisms among emerging food-borne protozoan parasites. Trends in Parasitology 27, 459466. doi: 10.1016/

B. Zingales , S. G. Andrade , M. R. Briones , D. A. Campbell , E. Chiari , O. Fernandes , F. Guhl , E. Lages-Silva , A. M. Macedo , C. R. Machado , M. A. Miles , A. J. Romanha , N. R. Sturm , M. Tibayrenc and A. G. Schijman (2009). A new consensus for Trypanosoma cruzi intraspecific nomenclature: second revision meeting recommends TcI to TcVI. Memórias do Instituto Oswaldo Cruz 104, 10511054. doi: S0074-02762009000700021.

B. Zingales , M. Miles , D. Campbell , M. Tibayrenc , A. Macedo , M. Teixeira , A. Schijman , M. Llewellyn , E. Lages-Silva , C. Machado , S. Andrade and N. R. Sturm (2012). The revised Trypanosoma cruzi subspecific nomenclature: Rationale, epidemiological relevance and research applications. Infection, Genetics and Evolution 12, 240253.

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