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Guevara Moctezuma EI, Smith Doria S, Ortiz JV, Teixeira de Sousa DR, Mwangi VI, do Nascimento Couceiro K, Brandão ARJ, Guerra JADO, Vale Barbosa Guerra MDG, Barbosa Bemfica Ferreira JM. Chronic Chagas Cardiomyopathy in the Brazilian Amazon region: clinical characteristics and regional distinctiveness. Front Public Health 2023; 11:1284639. [PMID: 38089032 PMCID: PMC10711604 DOI: 10.3389/fpubh.2023.1284639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aims to provide a comprehensive analysis of clinical and epidemiological data related to Chronic Chagas Cardiomyopathy (CCC) in the Amazon region of Brazil. Methods A review of observational, retrospective, and cross-sectional studies related to Chagas Disease in the Amazon region of Brazil was conducted, and a case series addressing CCC in patients treated at the FMT-HVD outpatient clinic, a reference center for Chagas disease in Brazil, was carried out. Results Clinical characteristics of 55 patients from the Amazon region with CCC were described. The most common electrocardiographic alteration observed was abnormal ventricular repolarization (AVR), present in 40% of cases. The most common echocardiographic finding was left ventricular systolic dysfunction (49%), followed by akinesia or hypokinesia of the inferior and/or inferolateral walls (38.1%) and the presence of an apical aneurysm (32.7%). Conclusions Overall, this study demonstrates that CCC in the Amazon region presents clinical characteristics and severity that are similar to those observed in other regions. However, certain peculiarities, such as the frequency of right bundle branch block (RBBB) and anterior and septal involvement during the acute phase, require additional investigation to better comprehend the disease in the region. Overall, the study provides crucial clinical insights for the diagnosis and treatment of CCC in the Amazon region.
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Affiliation(s)
- Elsa Isela Guevara Moctezuma
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Susan Smith Doria
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jessica Vanina Ortiz
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Débora Raysa Teixeira de Sousa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Victor Irungu Mwangi
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Katia do Nascimento Couceiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alba Regina Jorge Brandão
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jorge Augusto de Oliveira Guerra
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Maria das Graças Vale Barbosa Guerra
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - João Marcos Barbosa Bemfica Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Leishmaniose e Gerencia de Entomologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
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Couceiro KDN, Ortiz JV, Hosannah da Silva E Silva MR, Teixeira de Sousa DR, Andrade RC, Brandão ARJ, de Morais RF, Smith Doria S, Fonseca RA, da Silva PRL, Fernandes F, Guerra MDGVB, Rochitte CE, Ferreira JMBB, Guerra JADO. Myocardial Injury in Patients With Acute and Subacute Chagas Disease in the Brazilian Amazon Using Cardiovascular Magnetic Resonance. J Am Heart Assoc 2022; 11:e021806. [PMID: 35730620 PMCID: PMC9333391 DOI: 10.1161/jaha.121.021806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Chagas disease is a neglected tropical disease that is still considered a global health emergency. In the Amazon region, most of the reports are of acute cases that are associated with oral transmission. This study aimed to evaluate myocardial injury in patients with acute Chagas disease before and after treatment. Methods and Results We evaluated 23 patients with acute Chagas disease in 3 different stages of progression. Group 1 had 12 patients evaluated during the acute phase, at the time of diagnosis, and 1 year after treatment, and Group 2 had 11 patients in the late postacute phase who were evaluated 5.2 years on average after diagnosis and treatment. ECGs with the Selvester score, 24-hour Holter exam, and cardiovascular magnetic resonance imaging were performed. The mean age of the 23 patients was 44.3±18.9 years, and they were mostly men (15/65.24%) from Amazonas state (22/95.6%). In 69.6% (n=16) of the patients, some ECG alterations were found, the most frequent being left anterior fascicular block and ventricular repolarization. In Group 1, the 24-hour Holter exam showed atrial tachycardia in 3 (25%) patients and ventricular extrasystoles in 2 (16.7%) patients. In Group 2, 1 patient had ventricular extrasystoles. Myocardial injury was observed in 7 patients (58.3%) at the acute phase and in 5 (50%) patients at the 1-year follow-up in Group 1 and in 2 (18.2%) patients in Group 2. Conclusions This article describes, for the first time, myocardial injury shown by cardiovascular magnetic resonance imaging in a group of patients with acute Chagas disease and reveals the importance of early detection and follow-up of the cardiac impairment in these patients.
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Affiliation(s)
| | - Jessica Vanina Ortiz
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil.,Universidade Nilton Lins Manaus Amazonas Brazil
| | | | | | - Rubens Celso Andrade
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil
| | - Alba Regina Jorge Brandão
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil
| | - Rômulo Freire de Morais
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil
| | - Susan Smith Doria
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil
| | | | - Paula Rita Leite da Silva
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil
| | - Fabio Fernandes
- Instituto do Coração-Setor de Cardiomiopatias São Paulo São Paulo Brazil
| | | | | | - João Marcos Bemfica Barbosa Ferreira
- Programa de Pós-Graduação em Medicina Tropical-Universidade do Estado do Amazonas Manaus Amazonas Brazil.,Universidade Nilton Lins Manaus Amazonas Brazil
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Ortiz JV, Couceiro KDN, Doria SS, Sousa DRTD, Silveira HMCD, Kesper Junior N, Guerra MDGVB, Guerra JADO, Barbosa-Ferreira JMB. Chagas Cardiomyopathy in the Brazilian Amazon Region: Low Prevalence or Underdiagnosis? Arq Bras Cardiol 2021; 117:770-774. [PMID: 34709304 PMCID: PMC8528347 DOI: 10.36660/abc.20201236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jessica Vanina Ortiz
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Katia do Nascimento Couceiro
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Susan Smith Doria
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Débora Raysa Teixeira de Sousa
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | | | | | - Maria das Graças Vale Barbosa Guerra
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brasil
| | - Jorge Augusto de Oliveira Guerra
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brasil
| | - João Marcos Bemfica Barbosa-Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM - Brasil.,Fundação Hospital do Coração Francisca Mendes, Manaus, AM - Brasil
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do Nascimento Couceiro K, Ortiz JV, do Nascimento Correia M, da Silva E Silva MRH, Brandão AR, da Silva PRL, Doria SS, Bestetti RB, de Sousa DRT, da Silva Junior RCA, das Graças Vale Barbosa Guerra M, Ferreira JMBB, de Oliveira Guerra JA. The Selvester QRS score as an estimative of myocardial injury in acute chagasic patients from the Brazilian Amazon. BMC Infect Dis 2021; 21:396. [PMID: 33926389 PMCID: PMC8082885 DOI: 10.1186/s12879-021-06083-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Brazilian Amazon, a new epidemiological profile of Chagas disease transmission, the oral route, has been detected and cited as being responsible for the increase in acute cases in Brazil. The clinical evaluation of acute Chagas disease (ACD) has been a challenge since it can progress to a chronic phase with cardiac alterations, and the follow-up by modern diagnostic methods is very difficult due to the socio-geographical characteristics of the Brazilian Amazon. Thus, alternatives should be sought to alleviate this problem. We conducted a study to evaluate subjects with ACD using the 12-lead ECG QRS score (Selvester score) as an estimative of myocardial injury progression before and after ACD treatment. METHODS The study included indigenous subjects from the Amazon region with ACD in clinical follow-up at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) Chagas Disease outpatient clinic in the state of Amazonas, Brazil. The control group consisted of 31 healthy volunteers with no history of heart disease and no reactive serology for Chagas disease. Baseline ECG was performed in all subjects. The Selvester scoring method was performed according to the standardized guide (< 3 points: no myocardial injury,> 3: points × 3% = % of the predicted LV infarction). RESULTS A total of 62 subjects were included, 31 as cases and 31 as controls. The mean follow-up of the case group was 17 months. The control group presented normal ECG. The case group presented 13 alterations before treatment and 11 after. Nineteen individuals presented scores > 3 points, 6 before and 13 after. In 19.36% of subjects, myocardial injury was found before treatment and in 41.94% after treatment. CONCLUSION This is the first study that uses the Selvester score (SS) to predict myocardial injury in subjects with ACD. The results of this study suggest the significant presence of myocardial injury from the beginning of treatment to the period post treatment of ACD, which demonstrates that the SS can be applied for stratification and follow-up of Chagas disease in the Amazon region.
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Affiliation(s)
- Katia do Nascimento Couceiro
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil.
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
| | - Jessica Vanina Ortiz
- Departamento de Ciências Fisiológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | | | - Mônica Regina Hosannah da Silva E Silva
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil
| | | | - Paula Rita Leite da Silva
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Susan Smith Doria
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Débora Raysa Teixeira de Sousa
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Rubens Celso Andrade da Silva Junior
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Maria das Graças Vale Barbosa Guerra
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - João Marcos Bemfica Barbosa Ferreira
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jorge Augusto de Oliveira Guerra
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
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Mendes L, Guerra JO, Costa B, Silva ASD, Guerra MDGB, Ortiz J, Doria SS, Silva GVD, de Jesus DV, Barral-Netto M, Penna G, Carvalho EM, Machado PRL. Association of miltefosine with granulocyte and macrophage colony-stimulating factor (GM-CSF) in the treatment of cutaneous leishmaniasis in the Amazon region: A randomized and controlled trial. Int J Infect Dis 2020; 103:358-363. [PMID: 33253864 DOI: 10.1016/j.ijid.2020.11.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine (G + M) versus placebo and miltefosine (P + M) or parenteral meglumine antimoniate (MA) in the treatment of 150 patients with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis in the Amazon. DESIGN A randomized and double-blinded clinical trial. RESULTS At 90 days after the initiation of therapy, the cure rates were 66%, 58%, and 52% for the groups P + M, G + M, and MA, respectively (p > 0.05). Cure rates at 180 days did not differ. Healing time was similar in the 3 groups, but faster in the MA group as compared to the G + M group (p = 0.04). Mild and transitory systemic adverse events were frequent in all groups (above 85%). Nausea (85%) and vomiting (39%) predominated in the miltefosine groups and arthralgia (51%) and myalgia (48%) in the MA group. One patient (group MA) stopped treatment after presenting with fever, exanthema, and severe arthralgia. CONCLUSIONS Miltefosine did not present a higher cure rate than MA, and the association of GM-CSF did not improve the therapeutic response. Nevertheless, because of its less toxicity, easier administration, and a similar cure rate when compared with MA, miltefosine should remain as one of the main drugs for treating CL due to L. guyanensis. (Clinicaltrials.gov Identifier NCT03023111).
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Affiliation(s)
- Luciana Mendes
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil; Universidade Federal do Amazonas, Brazil
| | - Jorge Oliveira Guerra
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | | | - Aríneia Soares da Silva
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Maria das Graças Barbosa Guerra
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Jéssica Ortiz
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Susan Smith Doria
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - George Villarouco da Silva
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Denison Vital de Jesus
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | | | - Gerson Penna
- Núcleo de Medicina Tropical, Universidade de Brasília (UnB), Brasília-DF, e Escola Fiocruz de Governo, Fundação Oswaldo Cruz Brasília, Brazil
| | - Edgar M Carvalho
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil; Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Paulo R L Machado
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil; Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil.
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Ortiz JV, Pereira BVM, Couceiro KDN, Silva MRHDSE, Doria SS, Silva PRLD, Lira EDFD, Guerra MDGVB, Guerra JADO, Ferreira JMBB. Cardiac Evaluation in the Acute Phase of Chagas' Disease with Post-Treatment Evolution in Patients Attended in the State of Amazonas, Brazil. Arq Bras Cardiol 2019; 112:240-246. [PMID: 30916205 PMCID: PMC6424035 DOI: 10.5935/abc.20190007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022] Open
Abstract
Background In the past two decades, a new epidemiological profile of Chagas' disease
(CD) has been registered in the Brazilian Amazon where oral transmission has
been indicated as responsible for the increase of acute cases. In the
Amazonas state, five outbreaks of acute CD have been registered since 2004.
The cardiac manifestations in these cases may be characterized by diffuse
myocarditis, with alteration in the electrocardiogram (ECG) and
transthoracic echocardiogram (TTE). Objective To perform a cardiac evaluation in autochthonous patients in the acute phase
and at least one year after submitted to treatment for acute CD and evaluate
the demographic variables associated with the presence of cardiac
alterations. Methods We evaluated patients diagnosed with acute CD through direct parasitological
or serological (IgM) methods from 2007 to 2015. These patients were treated
with benznidazole and underwent ECG and TTE before and after treatment. We
assumed a confidence interval of 95% (CI 95%, p < 0.05) for all variables
analyzed. Results We observed 63 cases of an acute CD in which oral transmission corresponded
to 75%. Cardiac alterations were found in 33% of the cases, with a greater
frequency of ventricular repolarization alteration (13%), followed by
pericardial effusion (10%) and right bundle branch block and left anterior
fascicular block (2%). The follow-up occurred in 48 patients with ECG and 25
with TTE for a mean period of 15.5 ± 4.1 months after treatment. Of
these, 8% presented normalization of the cardiac alterations in ECG, 62.5%
remained with the normal exams. All of the patients presented normal results
in TTE in the post-treatment period. As for the demographic variables,
isolated cases presented more cardiac alterations than outbreaks (p = 0.044)
as well as cases from Central Amazonas mesoregion (p = 0.020). Conclusions Although cardiac alterations have not been frequent in most of the studied
population, a continuous evaluation of the clinical-epidemiological dynamics
of the disease in the region is necessary in order to establish preventive
measures.
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Affiliation(s)
- Jessica Vanina Ortiz
- Universidade do Estado do Amazonas, Manaus, AM - Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brazil
| | | | - Katia do Nascimento Couceiro
- Universidade do Estado do Amazonas, Manaus, AM - Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brazil
| | | | - Susan Smith Doria
- Universidade do Estado do Amazonas, Manaus, AM - Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brazil
| | | | | | | | - Jorge Augusto de Oliveira Guerra
- Universidade do Estado do Amazonas, Manaus, AM - Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brazil
| | - João Marcos Bemfica Barbosa Ferreira
- Universidade do Estado do Amazonas, Manaus, AM - Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM - Brazil.,Hospital Universitário Francisca Mendes, Manaus, AM - Brazil
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