Chagas disease, caused by parasite Trypanosoma cruzi, is the most important neglected tropical disease in the Americas. Two drugs are available for treatment, but access to them is challenging, in part due to complex diagnostic algorithms. These are stage-dependent, involve multiple tests and are ill-adapted to the reality of vast areas where the disease is endemic. Molecular and serologic tools are used to detect acute and chronic infections, with the performance of the latter showing geographic differences. Breakthroughs in the development of new diagnostic tools include the validation of a loop-mediated isothermal amplification assay for acute infections (T. cruzi-LAMP), and the regional validation of several rapid diagnostic tests (RDTs) for chronic infection, which simplify testing in resource-limited settings. The literature search was carried out in the MEDLINE database until NaN Invalid Date NaN. This review outlines existing algorithms, and proposes new ones focused on point-of-care testing. Integrating point-of-care testing into existing diagnostic algorithms in certain endemic areas will increase the access to timely diagnosis and treatment. However, additional research is needed to validate the use of these techniques across a wider geography, and to better understand the cost-effectiveness of their large-scale implementation.

A convincing case has been made that the scale of human activity has reached such pervasiveness that humans are akin to a force of nature. How environmental science responds to the many new challenges of the Anthropocene is at the forefront of the field. The aim of this perspective is to describe Anthropocene as a concept and a time period and discuss its relevance to the contemporary study of environmental science. Specifically, we consider areas in environmental science which may need to be revisited to adjust to complexity of the new era: (a) recalibrate the idea of environmental baselines as Anthropogenic baselines; (b) rethink multiple stressor approaches to recognize a system under flux; (c) re-evaluate the relationship of environmental science with other disciplines, particularly Earth Systems Science, but also social sciences and humanities. The all-encompassing nature of the Anthropocene necessitates the need to revise and reorganize to meet the challenge of complexity.

Chagas disease is a neglected tropical infection that affects millions of people. This study explores transcriptomic changes in T. cruzi-infected subjects before and after treatment. Using total RNA sequencing, gene transcription was analyzed in peripheral blood mononuclear cells from asymptomatic (n=19) and symptomatic (n=8) T. cruzi-infected individuals, and non-infected controls (n=15). Differential expression was compared across groups, and before/after treatment in infected subgroups. Untreated infection showed 12 upregulated and 206 downregulated genes in all T. cruzi-infected subjects, and 47 upregulated and 215 downregulated genes in the symptomatic group. Few differentially expressed genes were found after treatment and between the different infected groups. Gene set enrichment analysis highlighted immune-related pathways activated during infection, with therapy normalizing immune function. Changes in the kynurenine/tryptophan ratio, increased pre-treatment, suggested chronic immune fatigue, which was restored post-treatment. These differentially expressed genes offer insights for potential biomarkers and pathways associated with disease progression and treatment response.