Abstrato Introdução: A triagem metabólica neonatal refere-se a um grupo de procedimentos e testes realizados a fim de separar entre recém-nascidos aparentemente saudáveis, aqueles com suspeita de erros congênitos de metabolismo. Portanto, permite detectar a doença antes que ela apareça e iniciar o tratamento a tempo, a fim de evitar complicações, incapacidade e morte. Atualmente, a triagem metabólica neonatal é decisiva para resultados confiáveis. Objetivo: Realizar uma revisão integrativa da literatura sobre intervenção de enfermagem na triagem metabólica neonatal. Metodologia: Pesquisa integrativa nas bases de dados Web of Science, Scielo, Scopus, Pubmed, Sciencedirect, Dialnet, OVID e EBSCO, utilizando os descritores triagem neonatal, cuidados de enfermagem, erros inatos de metabolismo, neonatologia e analgesia; com os operadores booleanos e, ou não, com os operadores booleanos. Dos 116 documentos obtidos, 36 preenchiam os critérios de elegibilidade e representavam o material de estudo. Resultados: A coleta de amostras de sangue para triagem foi realizada entre o terceiro e quinto dia de vida, essencialmente por punção capilar do calcanhar. As medidas analgésicas não-farmacológicas são a amamentação, método canguru e contenção. A amostra deve ser protegida de contaminação, e sua estabilidade depende da temperatura de armazenamento até que a análise seja realizada. Conclusões: A literatura científica revisada capacita o profissional de enfermagem a fornecer cuidados abrangentes e seguros ao recém-nascido que participa do programa.

Abstract Introduction: Neonatal metabolic screening refers to a group of procedures and tests performed in order to separate among apparently healthy newborns, those with suspected inborn errors of metabolism. Therefore, it allows detecting the disease before it appears and initiating the treatment in time in order to prevent complications, disability and death. Currently, the neonatal metabolic screening is decisive for reliable results. Objective: Conduct an integrative literature review of nursing intervention in neonatal metabolic screening. Methodology: Integrative research in the databases Web of Science, Scielo, Scopus, Pubmed, Sciencedirect, Dialnet, OVID and EBSCO, using the descriptors neonatal screening, nursing care, inborn errors of metabolism, neonatology and analgesia; with the Boolean operators and, or and not. Of 116 documents obtained, 36 met eligibility criteria and represent the study material. Results: Blood sample collection for screening was performed between the third and fifth day of life, essentially by capillary puncture of the heel. Non-pharmacological analgesic measures are breastfeeding, kangaroo method and containment. The sample shall be protected from contamination, and its stability depends on the storage temperature until analysis is performed. Conclusions: The scientific literature reviewed empowers the nursing professional to provide comprehensive and safe care to the newborn who participates in the program.

Resumen Introducción: El tamiz metabólico neonatal es el conjunto de procedimientos y pruebas que se realizan para separar entre recién nacidos aparentemente sanos, aquellos con sospecha de errores innatos del metabolismo. Por tanto, permite detectar la enfermedad antes que se manifieste e iniciar tratamiento oportuno para evitar complicaciones, discapacidad y muerte. Actualmente, es un programa neonatal prioritario para la salud infantil. En la etapa operativa, la estandarización de criterios es determinante para resultados confiables. Objetivo: Realizar revisión bibliográfica integrativa de la intervención de enfermería en tamiz metabólico neonatal. Metodología: Investigación integrativa en las bases de datos Web of Science, Scielo, Scopus, Pubmed, Sciencedirect, Dialnet, OVID y EBSCO, utilizando los descriptores tamizaje neonatal, atención de enfermería, errores innatos del metabolismo, neonatología y analgesia; con los operadores booleanos and, or y not. De 116 documentos obtenidos, 36 cumplen criterios de elegibilidad y representan el material de estudio. Resultados: La recolección de muestra de sangre para tamiz se realiza entre el tercer y quinto día de vida, esencialmente mediante punción capilar del talón. Las medidas analgésicas no farmacológicas son lactancia materna, método canguro y contención. La muestra debe protegerse de contaminación, y su estabilidad depende de la temperatura de conservación hasta su análisis. Conclusiones: La literatura científica revisada, faculta al profesional de enfermería para proporcionar atención integral y segura al recién nacido que participa en el programa.

Resumo As espécies de Heliconia com inflorescências pendentes e brácteas coloridas são uma boa opção para o mercado de flores de corte, mas apenas algumas espécies de Heliconia, por exemplo. H. rostrata, H. rauliniana e H. chartacea, são comercialmente produzidas no Brasil. Este estudo foi realizado para caracterizar 36 acessos de diferentes espécies, com inflorescências pendentes para serem utilizadas como flor de corte, visando a aumentar o conhecimento e a utilização destas plantas excepcionais pelos consumidores e entusiastas das flores tropicais. As avaliações foram realizadas em plantas da Coleção de Germoplasma do Instituto Agronômico (IAC) Ubatuba, São Paulo, Brasil, crescendo em condição de sombra, sombra parcial ou pleno sol. Foram analisadas características qualitativas e quantitativas relacionadas ao crescimento da touceira e características da haste floral. Um sistema de pontuação foi usado para determinar as espécies mais adequadas para a utilização de flores de corte. Todos os genótipos avaliados foram adequados para serem usados como flores de corte, mesmo as de inflorescências grandes e brácteas dispostas em vários planos, fatos que afetam ou dificultam o manuseio, embalamento e transporte. H. mariae, H. fernandezii, H. platystachys, H. rauliniana, H. rostrata, H. standley, H. necrobracteata e H. laxa foram considerados excelentes. Esta caracterização e sistema de pontuação foram importantes para facilitar a seleção de genótipos de helicônias como flores de corte.

Abstract The Heliconia species with pendent inflorescences and colorful bracts are a good option as a cut flower for floriculture market, but only a few species of this type of Heliconia eg. H. rostrata, H. rauliniana and H. chartacea are commercially produced in Brazil. This study was carried out to characterize 36 Heliconia accessions, with pendent inflorescences, to be used as cut flower, intending to increase knowledge and use of these exceptional plants among tropical flower enthusiasts and consumers. The evaluations were performed on plants of the Germplasm Collection of the Instituto Agronômico (IAC) growing in shade, partial shade or full sun conditions. Qualitative and quantitative characteristics, related to clump growth and flower stem aspects were analyzed. A point scoring system was used to determine the species most suitable for cut flower utilization. All evaluated genotypes reached enough points to be considered suitable for use as cut flowers, even those with large inflorescences and bracts arranged in different planes, facts that affect and limit handling, packaging and transportation. H. mariae, H. fernandezii, H. platystachys, H. rauliniana, H. rostrata, H. standley, H. necrobracteata and H. laxa were considered outstanding. This characterization and scoring system were important to facilitate the selection of heliconia genotypes for use as cut flowers.

ABSTRACT Acute Chagas disease (ACD) cases are reported sporadically in Peru. In this report we describe the clinical and epidemiological characteristics of eight new ACD cases detected by the surveillance system in the Amazon basin, between 2009 and 2016. The average age was 12,7 ±13.7 years, range between 1 to 44 years and 4/8 cases were men. One case was associated with acute diarrheal disease, another with Leptospirosis, and two with urinary tract infection. The global case fatality-rate was 12.5% (1/8). Late detection is a frequent characteristic related with low diagnostic suspicion in patients with a history of fever. The TcI and TcIV lineage was identified as the etiological agent of Chagas disease. Eight new cases of ACDs are reported, of which seven were children.

RESUMEN Los casos de la enfermedad de Chagas aguda (ECA) se reportan en forma esporádica en el Perú. En este artículo se describe las características clínicas y epidemiológicas de ocho nuevos casos de ECA detectados por el sistema de vigilancia en la cuenca amazónica, entre 2009 y 2016. La media de la edad fue 12,7 ± 13,7 años, rango de 1 a 44 años y 4/8 casos fueron varones. Un caso se asoció a enfermedad diarreica aguda, otro a leptospirosis y dos a infección del tracto urinario. La tasa de letalidad global fue 12,5% (1/8). La detección tardía es una característica frecuente relacionada a una escasa sospecha diagnóstica en pacientes con historial de fiebre. Se identificó el linaje TcI y TcIV del agente etiológico de la enfermedad de Chagas. Se reporta ocho nuevos casos de ECA, de los cuales siete fueron menores de edad.

ABSTRACT Acute Chagas disease (ACD) cases are reported sporadically in Peru. In this report we describe the clinical and epidemiological characteristics of eight new ACD cases detected by the surveillance system in the Amazon basin, between 2009 and 2016. The average age was 12,7 ±13.7 years, range between 1 to 44 years and 4/8 cases were men. One case was associated with acute diarrheal disease, another with Leptospirosis, and two with urinary tract infection. The global case fatality-rate was 12.5% (1/8). Late detection is a frequent characteristic related with low diagnostic suspicion in patients with a history of fever. The TcI and TcIV lineage was identified as the etiological agent of Chagas disease. Eight new cases of ACDs are reported, of which seven were children.

RESUMEN Los casos de la enfermedad de Chagas aguda (ECA) se reportan en forma esporádica en el Perú. En este artículo se describe las características clínicas y epidemiológicas de ocho nuevos casos de ECA detectados por el sistema de vigilancia en la cuenca amazónica, entre 2009 y 2016. La media de la edad fue 12,7 ± 13,7 años, rango de 1 a 44 años y 4/8 casos fueron varones. Un caso se asoció a enfermedad diarreica aguda, otro a leptospirosis y dos a infección del tracto urinario. La tasa de letalidad global fue 12,5% (1/8). La detección tardía es una característica frecuente relacionada a una escasa sospecha diagnóstica en pacientes con historial de fiebre. Se identificó el linaje TcI y TcIV del agente etiológico de la enfermedad de Chagas. Se reporta ocho nuevos casos de ECA, de los cuales siete fueron menores de edad.

Cattle are the main reservoir of Shiga toxin-producing Escherichia coli (STEC), and the strategies to prevent the transmission of these microorganisms are concentrated in the slaughtering plant. The aim of this study was to evaluate the hygienic-sanitary quality and the frequency of detection of STEC in beef carcasses in abattoirs from Tucuman province. Two hundred and seventy four beef carcass sponges were processed; the count of generic E. coli was marginal in 9 (3,3%) of them. Escherichia coli O157 was isolated in 4 (1,4%) samples; 2 of which were characterized as stx2c(vh-a)/eae/ehxA whereas the other 2 were non-toxigenic strains. Non-O157 E. coli ONT:H49, stx2a/ehxA/saa was isolated from 1 sample (0,4%). In this work the quality of the analyzed product indicates that the good practices of manufacture are fulfilled in slaughtering facilities in Tucumán province.

Los bovinos son el principal reservorio de Escherichia coli productor de toxina Shiga (STEC); las estrategias para evitar su transmisión se concentran en la planta de faena. El objetivo de este trabajo fue evaluar la calidad higiénico-sanitaria y la frecuencia de detección de STEC en medias reses bovinas de frigoríficos de tránsito provincial. Se procesaron 274 esponjados de media res; en 9 (3,3%) el recuento de E. coli genérico fue marginal, en 4 (1,4%) se aisló E. coli O157, de los cuales 2 fueron caracterizados como stx2c(vh-a)/eae/ehxA, y los otros 2 como no toxigénicos. A partir de una (0,4%) muestra se aisló E. coli no-O157 ONT:H49, stx2a/ehxA/saa. En este trabajo la calidad del producto analizado indica que en la provincia de Tucumán se cumplen las buenas prácticas de manufactura en la faena de bovinos.

Introduction Several cases of acute Chagas disease (ACD) have been reported in the Peruvian Amazon basin. Methods The objective was to describe and investigate 6 ACD cases in children from indigenous Amazon communities in the province of Datem del Marañón in Loreto department (2006-2010). Results The mean age was 3.6 years. All patients had fever, 4/6 hepatomegaly, 2/6 splenomegaly, and 5/6 had trypomastigotes of Trypanosoma cruzi on thick smears. The fatality rate was 33.3%. Rhodnius pictipes and Rhodnius robustus adults were found inside the homes and in the peri-domiciles. Conclusions All cases reported were isolated cases. We report a new focus of ACD in indigenous populations.

O objetivo deste trabalho foi estudar caso da doença de Chagas aguda na comunidade indígena de San Pedro de Shishita, sem conhecimento da origem da transmissão. San Pedro de Shishita, distrito Pebas, região da Amazônia peruana é uma área não endêmica. Foram entrevistados os pais do paciente e feito inquérito soroepidemiológico dos participantes e estudos parasitológicos da família e procurou-se também triatomíneos no ambiente doméstico, peridomiciliar e silvestre. A soroprevalência de anticorpos IgG anti-T. cruzi foi 1/ 104 (0,96%) por ELISA e imunofluorescência indireta. Foram encontrados adultos de Panstrongylus geniculatus e Rhodnius pictipes

The study objective was to investigate an acute case of Chagas disease in the San Pedro de Shishita community, Pebas District, in the Peruvian Amazon basin, a non-endemic area. Both parents of the index case (acute case) were thoroughly interviewed, a seroepidemiological survey was carried out in the community, parasitological exams were carried out only in relatives of the index case, and triatomine bugs were searched for inside houses, peridomiciliary, and in wild environments. Seroprevalence for IgG anti-T. cruzi antibodies was 1/104 (0.96%), using an ELISA test and an indirect immunofluorescence assay. Panstrongylus geniculatus and Rhodnius pictipes adults were found. The index case is autochthonous from San Pedro de Shishita, but the source of transmission is unknown.

Introduction: There is little and not recent information on the presence of triatomine bugs in San Martin department, Amazon area of our country where Chagas disease has been reported by wild triatomine insects as vectors. Objectives: To determine the geographic distribution of hematophagous triatomine insects in Huallaga and Picota provinces, San Martin department, Peru. To determine the domiciliary infestation by triatomine vectors indexes, trypano-triatomine infection as well as their dispersion. To determine the insects feeding source and to genetically characterize the tripanosomatidae they carry. Design: Observational and descriptive study. Setting: Health and Laboratories region networks. National Institute of Health laboratories. Participants: Houses from 6 districts of Huallaga province and 9 from Picota province (San Martin department). Interventions: Triatomine insect’s collection was carried out in 3 362 homes located in semi-urban and rural zones accounting for 30% of the total area of studied provinces. Feeding preferences were assessed by a precipitin test using specific antibodies against guinea pig, dog, cat, chicken and human beings sera. Trypanosomes were isolated by inoculation of stool samples from infected insects in Balb/c mice and using axenic culture media. Genetic characterization was done by PCR amplification of the genome by gene intergenic spacer of the miniexon. Main outcome measures: To assess if Huallaga and Picota, San Martin, Peru, are Chagas disease risk areas. Results: In 46 of the 3 368 homes visited, 53 triatomine adults were collected belonging to the species Rhodnius pictipes (56,6%), Panstrongylus geniculatus (41,5%) and Eratyrus mucronatus (1,9%). For the first time, P. geniculatus was reported in both provinces included in the study. Domiciliary infestation index was 1,4%, trypano-triatomine infection index was 3,8% and dispersion index was 30,1%. For R. pictipes 5 sources of food were identified (chicken, human, dog, guinea pig and cat) and for P. geniculatus, a mix feed: dog, cat and chicken. Trypanosoma spp. isolates of R. pictipes from Sacanche (Huallaga) belonged to T. cruzi TCI (350 pb); similar result was obtained in 10 clones studied. Conclusions: Results indicate that R. pictipes and P. geniculatus are undergoing colonization of the regions included in this study. Within the province of Huallaga, R. pictipes is the predominant vector of T. cruzi; therefore these locations must be considered high risk areas for Chagas disease.

Introducción: Existe escasa información y no actualizada sobre la presencia de triatominos en el departamento de San Martín, zona amazónica de nuestro país, y es importante actualizarla, ya que hay reportes recientes de casos de enfermedad de Chagas procedentes de la amazonía peruana cuyos vectores serían triatominos silvestres. Objetivos: Conocer la distribución geográfica de triatominos hematófagos en Huallaga y Picota, San Martín, Perú. Determinar los índices entomológicos, sus hábitos alimenticios y caracterizar los tripanosomatídeos que portan. Diseño: Investigación descriptiva observacional. Lugar: Red de Salud Huallaga y Picota, Laboratorio Regional de la Región de Salud San Martín. Laboratorios del Instituto Nacional de Salud. Participantes: Viviendas de 6 distritos de las provincia de Huallaga y 9 de Picota, del Departamento de San Martín. Intervenciones: La búsqueda de triatominos fue en 3 362 viviendas de áreas periurbanas y rurales. Mediante la prueba de precipitina, se determinó la fuente de alimentación. Se aisló tripanosomatídeos mediante infección en ratones Balb/C e inoculación en medio agar sangre, y por PCR se caracterizó el genoma por amplificación del espaciador intergénico del gen miniexón. Principales medidas de resultados: Determinar si Huallaga y Picota, San Martín, Perú, son zonas de riesgo de enfermedad de Chagas. Resultados: En 46 viviendas, de 3 362 muestreadas se capturó 53 triatominos adultos pertenecientes a Rhodnius pictipes (56,6%), Panstrongylus geniculatus (41,5%) y Eratyrus mucronatus (1,9%). Se reporta P. geniculatus por primera vez para las dos provincias. Los índices de infestación para ambas provincias fueron 1,4% y 3,8%, respectivamente, y corresponden al índice de infección natural; mientras que el índice de dispersión fue 30,1%. En R. pictipes se identificó cinco fuentes de alimentación (pollo, humano, perro, cobayo y gato) y en P. geniculatus un perfil alimentario mixto: perro/gato/pollo. Los Trypanosoma spp. aislados de R. pictipes, procedente de Sacanche (Huallaga), corresponden a TCI (350 pb); resultado similar se obtuvo en los 10 clones de este aislamiento. Conclusiones: Los resultados nos indican que, en las localidades estudiadas, R. pictipes y P. geniculatus estarían pasando por un proceso de domiciliación y que en las localidades de Huallaga R. pictipes sería el principal vector de Trypanosoma cruzi TC1; por lo que, dichas localidades estarían consideradas como zonas de riesgo de enfermedad de Chagas.

Objective. To identify the food sources of Panstrongylus herreri from district of Cajaruro, province of Utcubamba, department of Amazonas. Material and methods. The study was performed in two steps: in the first, a precipitin test was standardized using as antigen, blood sera from human being, dog, cat, guinea pig and chicken and the specific antibodies obtained by inoculation of the antigens in rabbits. Nymphs of Triatoma infestans (IV and V instars) maintained in the laboratory were fed on dog, cat, guinea pig, and human being to determine the sensitivity and the specificity of the precipitin test. In the second step, 102 P. herreri specimens collected from houses of the two villages were submitted to the standardized precipitin test. Results. The developed test permitted good titles of antibodies in the range from 1:10 000 to 1:30 000. The specificity was 100% and the sensitivity was 70 % to 100%. Of the 102 P. herreri specimens were detected intestinal content in 93 and found the food source in 77 of them, the blood of guinea pig (36.3%) was the main source of food, followed by human (18.2%) and chicken (14.3%).The Trypano-triatomine index was 62.4%. Conclusions. The precipitin test showed better specificity than sensitivity. In this study sites, the main food source of P. herreri was guinea pig follow by the human being and chicken. The high rate of insects carrying Trypanosoma sp. was related to the insects fed on guinea pig pointing it out as reservoir of the parasite.

Objetivo. Identificar las fuentes de alimentación de Panstrongylus herreri, procedente del distrito de Cajaruro, provincia de Utcubamba, departamento de Amazonas. Materiales y métodos. El estudio se realizó en dos etapas: primera, se estandarizó la prueba de precipitina usando como antígenos sueros sanguíneos de: humano, perro, gato, cobayo y pollo, y anticuerpos específicos obtenidos por inoculación de los antígenos en conejos. Se alimentaron ninfas de Triatoma infestans del IV y V estadio criadas en laboratorio con sangre de perro, cobayo, pollo y humano para luego determinar la sensibilidad y especificidad de la prueba. Segunda, se aplicó la prueba de precipitina a 102 ejemplares de P. herreri domiciliarios, procedentes de la zona de estudio. Resultados. Se obtuvo títulos de anticuerpos desde 1:10 000 a 1:30 000. La especificidad de la prueba fue 100% para todos los intervalos de tiempo evaluados; mientras, que la sensibilidad varió de 70 a 100%. De los 102 P. herreri, en 93 ejemplares se detectó contenido intestinal y se encontró la fuente alimenticia en 77 de ellos, la sangre de cobayo (36,3%) fue la principal fuente de alimentación, seguido de humano (18,2%) y pollo (14,3%). El índice de infección tripano-triatomíno fue 62,4%. Conclusiones. La prueba de precipitina mostró mejor especificidad que sensibilidad. En las áreas de estudio, la fuente principal de alimentación de P. herreri es la sangre de cobayo, seguido del humano y pollo. El elevado índice de infección a Trypanosoma sp. relacionado con la fuente de alimentación por cobayo, nos indicaría que es el principal reservorio.

Objective. To compare the morphology, feeding and the genetic profile of specimens of Panstrongylus herreri from districts of Jaen (Cajamarca) and Cajaruro (Amazonas). Material and methods. Adult specimens of P. herreri were collected, 42 from Jaen and 68 from Cajaruro. Geometric morphometrics was used to evaluate the sexual differences in size and form. The genetic profile was done using the PCR amplification, second internal transcribed spacer (ITS-2) of the ribosomal ADN. The molecular characterization of the isolated trypanosomes was made by the amplification the parasite. We used the precipitin test for identification the feeding sources and thus be able to associate them with the potential reservoir of the parasite. Results. The morphometric analyses showed no difference (p<0,05) in sex between the insects from both departments, but there was difference in the form between females. The genetic profile showed by ITS-2 similar bands of 960 pb in both groups (five insects) from Jaen and Cajaruro. The trypanosoma isolated from P. herreri (only in Cajaruro) was identify as Trypanosoma cruzi TCI (350 pb). Guinea pig blood was the main source of food for the insects. Conclusions. P. herreri from both localities no showed important differences under geometric morphometry and genetic studies. These results indicate the same population with similar origin. The guinea pig blood was the main source of food of P. herrei, may be the principal reservoir for the Chagas disease from this Peruvian area.

Objetivo. Comparar las características morfológicas, alimenticias y genéticas de dos poblaciones de Panstrongylus herreri, de los distritos de Jaén (Cajamarca) y Cajaruro (Amazonas). Materiales y métodos. Se colectó especímenes adultos de P. herreri, 42 (Jaén) y 68 (Cajaruro). Se utilizó la morfometría geométrica para evaluar el dimorfismo sexual de tamaño y conformación. El perfil genómico se realizó por amplificación del espaciador interno transcrito del ADNr (ITS-2). La amplificación del espaciador intergénico del gen mini-exón, permitió la caracterización molecular de los trypanosomas aislados. Se utilizó la prueba de precipitina para conocer las fuentes de alimentación de los vectores y así poder asociarlos a posibles reservorios del parásito. Resultados. El análisis morfométrico demostró que el dimorfismo sexual de tamaño fue similar (p>0,05); no ocurrió lo mismo con el dimorfismo de la conformación; asimismo no se encontró diferencias de tamaño al comparar por separado hembras y machos de Jaén y Cajaruro. Por ITS-2, se evaluó cinco especímenes de cada distrito, en ellos se observó una banda de 960 pb aproximadamente. Sólo en Cajaruro se encontraron triatominos parasitados, que fue caracterizado como Trypanosoma cruzi TCI (350 pb). Se identificó al cobayo como la fuente de alimento más frecuente. Conclusiones. Ambas poblaciones de P. herreri por morfometría geométrica e ITS-2, no evidenció diferencias, indicando que se trataría de una misma población y por consiguiente de la misma procedencia. La sangre de cobayo fue la más frecuente fuente de alimento, pudiendo ser el principal reservorio para la enfermedad de Chagas en esta zona del Perú.

This article is based on a case report that described a six-year old girl who had a confirmed diagnosis of acute Chagas' disease in Pozuzo (Oxapampa- Junín, central Peruvian jungle), a recognized non-endemic area for this condition. An epidemiological study was performed in the patient's household and the surrounding neighborhood. Households visited did not have appropriate conditions for colonization with Triatoma insects. These insects were not found in active searches performed at daytime hours; however, at night time searches, two insects were captured in the patient's home, and seven in the surrounding houses, and they were identified as adult Panstrongylus geniculatus, and two of the bugs were infected with Trypanosoma microorganisms. Every person interviewed identified the vector, and 8/13 of them reported having been bitten by these bugs, locally known as "chirimachas". Clinical and serological examinations looking for T. cruzi reactive among neighbors were negative. We think that knowing that this is a wild vector, its presence in a household is related to the growing extension of agriculture-dedicated areas in the jungle. As wild mammals and birds move towards more rural areas, this leads to changes in the Triatoma insects environment, and they start looking for food within households and sporadically attack human beings, with the consequent risk for T. cruzi transmission.

A partir del caso de una niña de seis años con diagnóstico confirmado de enfermedad de Chagas aguda, procedente de la localidad de Pozuzo (Oxapampa-Junín) en al selva central del Perú, un área no señalada como endémica en el país, se realizó un estudio epidemiológico a partir de la vivienda de la niña y se extendió a la población cercana. Las viviendas visitadas no presentaron condiciones apropiadas para la colonización de triatominos, no se encontraron en la búsqueda activa durante el día, sin embargo, en búsqueda nocturna se capturaron dos ejemplares en casa de la niña y siete en casas vecinas que fueron identificados como Panstrongylus geniculatus adultos, dos estaban infestados con trypanosomatideos. Todos los entrevistados identificaron al vector, 8/13 manifestaron haber sufrido picaduras de "chirimachas", nombre por el cual lo conocen. El examen clínico y serológico en busca de reactivos a T. cruzi entre los pobladores de las viviendas cercanas fue negativo. Consideramos que siendo el vector de hábitos silvestres, su presencia en la vivienda está relacionada con la ampliación de la zona agrícola ganada a la selva. El alejamiento de los mamíferos y aves silvestres esta determinando cambios en el biotopo de los triatominos, que buscan su alimento en el interior de las viviendas e infectan en forma esporádica a la población humana.

The purpose of this communication is to present two cases of Chagas' disease in a familial group of a index case, coming from the Arequipa region in southwestern Peru, an endemic area. The case suffered sudden death because of chagasic cardiomyopathy in an area free triatomines in Department Ica. His sister and his nephew showed IgG specific antibodies anti - Trypanosoma cruzi detected by enzime-linked immunosorbent assay (ELISA) and indirect immunofluorescence assay (IFA), both households had lived in an endemic valley (Vitor-Arequipa). Our results underscore the importance of the epidemiological survey in the familial group of the chronic case in low risk-areas.