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In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Panstrongylus geniculatus has become the most frequently registered vector of Chagas disease in the metropolitan area of Caracas, Venezuela. This triatomine species has invaded urban areas in recent years and has been implicated in multiple oral outbreaks of Chagas disease in the region. The study of genetic variability and spatial structure in P. geniculatus populations can provide information about possible events of domiciliation and aid intervention programs against triatomine species rapidly adapting to urban ecotopes. We sequenced a region of the cytochrome-b gene in 114 specimens of P. geniculatus from the Metropolitan District of Caracas and assessed patterns of gene flow and phylogenetic relationships among these individuals. A total of 29 haplotypes were detected in the two sampled municipalities, Sucre and Libertador. Though high genetic connectivity was observed between the municipalities (F ST  = 0.10796; N m  = 11.20), subtle genetic structuring was also observed in particular geographic sub regions. Based on neutrality tests and the observed allele-frequency distribution, the Panstrongylus geniculatus population appears to be expanding and adapting to different microhabitats present in the study area. Our findings affirm the capacity of this insect to adapt to different environments and emphasize its principal role in the epidemiology of Chagas disease in northern Venezuela., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Chagas disease, marked by life-long chronic infection with Trypanosoma cruzi, remains a major parasitic disease in Latin America. Genetically heterogeneous, T. cruzi is divided into six discrete typing units (DTUs), most recently grouped as TcI-VI. The trypomastigote small surface antigen (TSSA) of T. cruzi has been described as the only known serological marker to identify infection by TcII-VI, as distinct from TcI. Here, by comparative analysis of a cohort of 25 reference strains representing all the known DTUs, we show that TSSA intra-specific diversity is greater than previously reported. Furthermore, TcIII and IV TSSA PCR products are, contrary to expectation, both digested by PvuII, revealing a more nuanced genotyping pattern. Amino acid sequence diversity reveals that the TSSA epitope considered to be serologically characteristic of TcII-VI is restricted to TcII, V and VI, but not of III or IV, and that the diagnostic peptide described as TcI-specific shares key features with TcIII and IV. Notably, TSSA sequences inferred greater phylogenetic affinities of TcIII and IV to TcI than to TcII, V or VI. A high ratio of non-synonymous to synonymous nucleotide substitutions (omega=1.233) indicates that the TSSA gene has been under positive selection pressure. The demonstration of lineage-specific epitopes within TcII-VI has implications for sero-epidemiological studies of Chagas disease based on this antigen., (2010 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.)

Trypanosoma cruzi exhibits remarkable genetic heterogeneity. This is evident at the nucleotide level but also structurally, in the form of karyotypic variation and DNA content differences between strains. Although natural populations of T. cruzi are predominantly clonal, hybrid lineages (TcIId and TcIIe) have been identified and hybridisation has been demonstrated in vitro, raising the possibility that genetic exchange may continue to shape the evolution of this pathogen. The mechanism of genetic exchange identified in the laboratory is unusual, apparently involving fusion of diploid parents followed by genome erosion. We investigated DNA content diversity in natural populations of T. cruzi in the context of its genetic subdivisions by using flow cytometric analysis and multilocus microsatellite genotyping to determine the relative DNA content and estimate the ploidy of 54 cloned isolates. The maximum difference observed was 47.5% between strain Tu18 cl2 (TcIIb) and strain C8 cl1 (TcI), which we estimated to be equivalent to approximately 73 Mb of DNA. Large DNA content differences were identified within and between discrete typing units (DTUs). In particular, the mean DNA content of TcI strains was significantly less than that for TcII strains (P<0.001). Comparisons of hybrid DTUs TcIId/IIe with corresponding parental DTUs TcIIb/IIc indicated that natural hybrids are predominantly diploid. We also measured the relative DNA content of six in vitro-generated TcI hybrid clones and their parents. In contrast to TcIId/IIe hybrid strains these experimental hybrids comprised populations of sub-tetraploid organisms with mean DNA contents 1.65-1.72 times higher than the parental organisms. The DNA contents of both parents and hybrids were shown to be relatively stable after passage through a mammalian host, heat shock or nutritional stress. The results are discussed in the context of hybridisation mechanisms in both natural and in vitro settings.

The isolation of biological clones of Trypanosoma cruzi by microscopically dispensing individual organisms or by serial dilution is laborious and time consuming. The inability to resolve mixed T. cruzi infections, from vectors and hosts, and to isolate clones of slow growing genotypes by efficient plating on solid media, has hindered characterisation studies and downstream applications. We have devised and validated a sensitive, solid medium plating technique for rapid in vitro isolation of clones representative of all the recognised T. cruzi lineages (TCI, TCIIa-e), including the slow growing strain CANIII (TC IIa) and Trypanosoma rangeli, with high plating efficiencies. Furthermore, the method is effective for the isolation of clones directly from silvatic triatomine bugs and from experimentally infected mice harbouring mixed infections, allowing resolution of multiclonal infections from varied sources.

The collection of Panstrongylus geniculatus bugs by inhabitants of dwellings in Caracas city (Metropolitan District) and in the neighboring Miranda and Vargas Sates, Venezuela, allowed for the gathering of data on the potential role of this sylvatic triatomine bug as a vector of Chagas disease in this area. The natural infection by Trypanosoma cruzi was recorded by examining fresh and stained faeces of the bugs. Additionally, a random amplification of polymorphic DNA technique for parasite identification and group typing was employed. A dot-ELISA test was used to identify the gut content of the triatomine bugs with the aim of assessing and quantifying the vector-human contact. Sixty-seven specimens (76.1%) were positive to T. cruzi (identified as T. cruzi I) and 60.2% (53/88) gave a positive reaction to the human antiserum. The human blood-positive samples included mixed blood meals with domestic animals (dog, pig and cow) (9.4%) and with mouse (3.8%). The overall Human Blood Index, measured as the percentage of bugs whose gut contents reacted with human antiserum on the total numbers of bugs that reacted with all the antisera tested, was 98.1%. Almost 41% of the bugs that had fed on humans were also positive for T. cruzi. These data show that the feeding of P. geniculatus on humans does not seem to be accidental and that its rate of infection by T. cruzi is high in this area which is not regarded as endemic for Chagas disease by the National Control Programme. This situation is particularly striking because it occurs in and around Caracas, the capital city, where 20% of the whole population of Venezuela live, human migrations from endemic areas are continuous, people in the crowded shantytown as well as people living in high-quality country houses are equally at risk and the epidemiological cycle Didelphis marsupialis/Rattus rattus-P. geniculatus-human does appear to occur successfully.