American trypanosomiasis (Chagas' disease) and the role of molecular epidemiology in guiding control strategies

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Abstract
Introduction In terms of public health and economic impact, American trypanosomiasis (Chagas' disease) is the most important parasitic infection in Latin America. More than 10 million people carry the protozoan agent Trypanosoma cruzi, which multiplies inside cells, particularly of heart and smooth muscle.1 In the chronic phase of infection up to 30% of infected people may develop severe abnormalities on the electrocardiogram and chagasic cardiomyopathy.2 Chagas' disease is a complex zoonosis, primarily transmitted by triatomine bugs, which infest poor quality housing. We describe how research in molecular genetics has shown the remarkable genetic diversity of T cruzi, and also detected cryptic species of triatomine vector. This insight into the genetic diversity of pathogen and vector helps both to unravel the complexities of transmission cycles and to guide control strategies. Chagas' disease thus provides an example of how molecular epidemiology can be applied to disease control. In addition it is also a model for the role that research collaboration has in stimulating international cooperation, in mobilising political will, and in driving international control programmes.3