[Radiographic study of the oesophagus of chagasic patients in 25 years of the Mambaí Project]

Clinical and epidemiological characteristics of Chagas disease in an endemic area of Sergipe State, Brazil

INTRODUCTION

We evaluated clinical and epidemiological characteristics of Trypanosoma cruzi infection in Sergipe.

METHODS

In this cross-sectional study, we collected serum samples to identify serological markers of Chagas disease. A questionnaire was used, and electrocardiogram, echocardiogram, chest radiography, and contrast radiography of esophagus and colon were performed.

RESULTS

T. cruzi infection seroprevalence was 12.1%, mean age of subjects was 55 years, 90% had an elementary school education, 78.6% were agriculture workers, and 60.5% had electrocardiographic abnormalities.

CONCLUSIONS

A high prevalence of T. cruzi infection was observed in mostly elderly individuals.

Oesophageal motility disorders in infected immigrants with Chagas disease in a non-endemic European area

BACKGROUND

Immigration-related new diseases pose a growing challenge for healthcare services in receptor countries. Following Latin American migration, Chagas disease has inevitably appeared in Europe.

AIM

To determine the prevalence and characteristics of oesophageal motility disorders in immigrants infected with Trypanosoma cruzi, using high resolution oesophageal manometry (HREM).

METHODS

In all newly-diagnosed cases with chronic Chagas infection referring upper digestive symptoms, a protocolized clinical evaluation and complementary tests including barium oesophagogram and HREM were carried out. As control group, 14 healthy subjects from the same endemic areas were studied with HREM.

RESULTS

We included 61 patients (46 female, 15 male; age range 26-63 years). Only seven patients (11%) had a minor alteration on barium oesophagogram. By contrast, 23 (37%) patients showed an alteration in oesophageal manometry, mainly minor motility disorders (34%). Only one healthy control (7%) had a minor motility disorder at HREM (p = 0.029 vs. patients).

CONCLUSIONS

Oesophageal motor disorders in infected immigrants with Chagas disease are common, and mainly characterized by a minor motility disorder that is not detected by barium oesophagogram. Hence, as well as barium oesophagogram examination, HREM should be considered, to assess oesophageal damage in this specific group of patients.

Esophageal body motility in achalasia and Chagas' disease

Previous studies have correlated esophageal body motility findings in idiopathic (IdAc) achalasia and achalasia secondary to Chagas' disease (ChAc) with degree of megaesophagus. The aim of this study was to compare esophageal body manometric data in patients with IdAc and achalasia secondary to Chagas' disease and correlate it with the degree of megaesophagus and symptom duration. One hundred nontreated patients with achalasia, 79% IdAc and 21% secondary to ChAc were compared with regards to age of presentation, duration of symptoms, amplitude and duration of simultaneous contractions, frequency of failed contractions, and degree of megaesophagus. Seventy-one percent of patients were classified as nonadvanced megaesophagus (60 [76%] with IdAc and 11 [52%] with ChAc) and 29% as advanced megaesophagus (19 [24%] with IdAc and 10 [48%] with ChAc, P= 0.04). In IdAc but not in ChAc, the symptom duration was significantly longer in advanced megaesophagus (A) compared with nonadvanced megaesophagus (NA) (34.8 ± 6.3 months vs. 95.4 ± 22.2 months, P= 0.001). There was no difference in amplitude and duration of simultaneous contractions in both achalasia groups (P > 0.05). Duration of contractions were longer in IdAc compared with ChAc in (NA) (P < 0.05), but not in (A). In IdAc but not in ChAc the amplitude of simultaneous contractions decreased with increased esophageal dilatation (P < 0.05). In ChAc but not in IdAC, the duration of contractions increased with esophageal dilatation (P < 0.05). Failed contractions were more frequent in ChAc group (28.6%) than in IdAc (10% -P= 0.03). Patients with ChAc have a higher prevalence of advanced megaesophagus compared with IdAc at diagnosis. In IdAc there was a strong correlation between advanced megaesophagus and longer symptom duration, suggesting disease progression over time, not observed in ChAc in which a more extensive denervation occurs earlier in the disease process.

Evidence of Chagas disease in seronegative Brazilian patients with megaesophagus

BACKGROUND

After 100 years of research, Chagas disease (CD) remains an important public health problem in Latin America. The symptomatic chronic phase is usually characterized by cardiac or digestive involvement and diagnosis currently relies on the measurement of Trypanosoma cruzi-specific antibodies produced in response to the infection. However, the detection of parasite DNA in seronegative persons has been reported.

METHODS

The prevalence of CD in a population with esophageal disorders was assessed by conventional serology. We also detected T. cruzi DNA in blood samples of seronegative and inconclusive patients by nested polymerase chain reaction (N-PCR).

RESULTS

The seroprevalence of CD determined by conventional serologic tests (indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA)) was 79% in 513 patients with esophageal disorders. Out of 41 blood samples, N-PCR was positive in 31 (76%) cases for which serology was negative or inconclusive.

CONCLUSIONS

As all patients presented with clinical signs suggestive of the digestive form of CD and most of them were born in endemic areas, we highlight the importance of improving diagnosis of the disease and the implications for blood bank screening. Our data suggest that N-PCR is effective in the detection of T. cruzi DNA in patients with inconclusive or negative serology, and it may eventually be useful in the determination of the etiology of megaesophagus.