Chagas disease is an endemic zoonosis native to the Americas and is caused by the kinetoplastid protozoan parasite Trypanosoma cruzi. The parasite is also highly genetically diverse, with six discrete typing units (DTUs) reported TcI – TcVI. These DTUs broadly correlate with several epidemiogical, ecological and pathological features of Chagas disease. In this manuscript we report the most comprehensive evaluation to date of the genetic diversity of T. cruzi in Venezuela. The dataset includes 778 samples collected and genotyped over the last twelve years from multiple hosts and vectors, including nine wild and domestic mammalian host species, and seven species of triatomine bug, as well as from human sources. Most isolates (732) can be assigned to the TcI clade (94.1%); 24 to the TcIV group (3.1%) and 22 to TcIII (2.8%). Importantly, among the 95 isolates genotyped from human disease cases, 79% belonged to TcI - a DTU common in the Americas, however, 21% belonged to TcIV- a little known genotype previously thought to be rare in humans. Furthermore, were able to assign multiple oral Chagas diseases cases to TcI in the area around the capital, Caracas. We discuss our findings in the context of T. cruzi DTU distributions elsewhere in the Americas, and evaluate the impact they have on the future of Chagas disease control in Venezuela. Chagas disease is caused by a protozoan parasite called Trypanosoma cruzi. T. cruzi infects a wide variety of mammal species in Latin America as well as man, and is spread by multiple species of blood sucking triatomine insect vectors. The presence of genetic diversity in T. cruzi in the Americas is well established, with six different major genetic types in circulation. The genetic diversity of T. cruzi in Venezuela is relatively poorly understood. In this work we present the results from the genotyping of over seven hundred isolates from 17 of the 24 states. Our dataset comprises strains isolated from wild and domestic animals, several species of triatomine vector, as well as from human Chagas disease cases, including those associated with oral transmission of T. cruzi. Amongst other findings, our data reveal a surprisingly high frequency of atypical genotypes in humans, particularly TcIV, which has rarely been reported. We evaluate our findings in the context of T. cruzi diversity elsewhere in the Americas, and assess the impact they have on the future of Chagas disease control in Venezuela.

Direct blood examination and xenodiagnosis of 47 synanthropic rodents (Rattus rattus, R. norvegicus, Mus musculus) captured in the valley of Caracas, Venezuela, revealed trypanosomal infections in 12 R. rattus, 10 with T. lewisi and 2 with T. cruzi. Of the latter the course of parasitemia, the pleomorphism of the bloodstream trypomastigotes, tissue tropism in naturally and experimentally infected rats and mice, host mortality, morphology of fecal parasites in Rhodnius prolixus used for xenodiagnosis, and infectivity of the bug feces for NMRI mice, were all characteristic of Trypanosoma (Schizotrypanum) cruzi. One rat, with a patent parasitemia, had numerous nests of amastigotes in cardiac muscle and moderate parasitism of the smooth muscle of the duodenum and of skeletal muscle. Mice inoculated with fecal flagellates from the bugs had moderate tissue tropism in the same organs and also in the colon and pancreas. The possible role of R. rattus in the establishment of foci of Chagas’ disease in Caracas is discussed

Direct blood examination and xenodiagnosis of 45 sylvatic, peridomestic or domestic mammals from the Caracas valley, Venezuela, revealed trypanosome infection in six of the 24 opossums, Didelphis marsupialis, collected in urban areas. Isolates were successfully made of trypanosomes from four of the opossums, using the parasites which developed in Rhodnius prolixus fed on the infected opossums to infect NMRI mice. The prepatent period, course of parasitaemia, morphology of bloodstream trypomastigotes, tissue tropism of parasites in the opossums and/or mice, host mortality, morphology of parasites in the bugs, and infectivity to mice of parasites in the faeces of infected bugs, were all characteristic of Trypanosoma (Schizotrypanum) cruzi. In mice, the parasites showed marked myotropism; the heart, skeletal muscle and the smooth muscle of the urinary bladder, penis, prostate, seminal vesicle, lung, stomach, jejunum and colon were frequently invaded, and pseudocysts were also occasionally found in the liver, brain and pancreas. The significance of the invasion of the genito-urinary structures as a possible alternative parasite transmission route is discussed. The possible role of D. marsupialis, as a primary reservoir of T. cruzi, in the establishment of foci of Chagas' disease in Caracas and other Latin American cities, is emphasized.