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Ribeiro ALP, Machado Í, Cousin E, Perel P, Demacq C, Geissbühler Y, de Souza A, Liprandi AS, Nascimento BR, França EF, Martins-Melo FR, Roth GA, Molina I, Noronha K, Ishitani L, Carneiro M, Quijano M, Andrade MV, Naghavi M, Mosser JF, Piñeiro DJ. The Burden of Chagas Disease in the Contemporary World: The RAISE Study. Glob Heart 2024; 19:2. [PMID: 38222097 PMCID: PMC10785959 DOI: 10.5334/gh.1280] [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: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024] Open
Abstract
Chagas disease (ChD), a Neglected Tropical Disease, has witnessed a transformative epidemiological landscape characterized by a trend of reduction in prevalence, shifting modes of transmission, urbanization, and globalization. Historically a vector-borne disease in rural areas of Latin America, effective control measures have reduced the incidence in many countries, leading to a demographic shift where most affected individuals are now adults. However, challenges persist in regions like the Gran Chaco, and emerging oral transmission in the Amazon basin adds complexity. Urbanization and migration from rural to urban areas and to non-endemic countries, especially in Europe and the US, have redefined the disease's reach. These changing patterns contribute to uncertainties in estimating ChD prevalence, exacerbated by the lack of recent data, scarcity of surveys, and reliance on outdated models. Besides, ChD's lifelong natural history, marked by acute and chronic phases, introduces complexities in diagnosis, particularly in non-endemic regions where healthcare provider awareness is low. The temporal dissociation of infection and clinical manifestations, coupled with underreporting, has rendered ChD invisible in health statistics. Deaths attributed to ChD cardiomyopathy often go unrecognized, camouflaged under alternative causes. Understanding these challenges, the RAISE project aims to reassess the burden of ChD and ChD cardiomyopathy. The project is a collaborative effort of the World Heart Federation, Novartis Global Health, the University of Washington's Institute for Health Metrics and Evaluation, and a team of specialists coordinated by Brazil's Federal University of Minas Gerais. Employing a multidimensional strategy, the project seeks to refine estimates of ChD-related deaths, conduct systematic reviews on seroprevalence and prevalence of clinical forms, enhance existing modeling frameworks, and calculate the global economic burden, considering healthcare expenditures and service access. The RAISE project aspires to bridge knowledge gaps, raise awareness, and inform evidence-based health policies and research initiatives, positioning ChD prominently on the global health agenda.
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Affiliation(s)
- Antonio Luiz Pinho Ribeiro
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 –Santa Efigênia, Belo Horizonte –MG, 30130-100, BR
| | | | - Ísis Machado
- Department of Family Medicine, Mental and Collective Health, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Ewerton Cousin
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
| | - Pablo Perel
- World Heart Federation, Geneva, Switzerland
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Aline de Souza
- Department of Economics, Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Bruno R. Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 –Santa Efigênia, Belo Horizonte –MG, 30130-100, BR
| | - Elisabeth F. França
- Postgraduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Gregory A. Roth
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
| | - Israel Molina
- International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Kenya Noronha
- Department of Economics, Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lenice Ishitani
- Epidemiological Surveillance Division, Belo Horizonte Municipal Health Department Belo Horizonte, Brazil
| | - Mariângela Carneiro
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Monica V. Andrade
- Department of Economics, Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
| | - Daniel J. Piñeiro
- World Heart Federation, Geneva, Switzerland
- Cardiology Department, Universidad de Buenos Aires, Buenos Aires, Argentina
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Reifler KA, Wheelock A, Hall SM, Salazar A, Hassan S, Bostrom JA, Barnett ED, Carrion M, Hochberg NS, Hamer DH, Gopal DM, Bourque D. Chagas cardiomyopathy in Boston, Massachusetts: Identifying disease and improving management after community and hospital-based screening. PLoS Negl Trop Dis 2024; 18:e0011913. [PMID: 38241361 PMCID: PMC10830043 DOI: 10.1371/journal.pntd.0011913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/31/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. METHODS A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. RESULTS Mean age of the 109 patients was 43 years (range 19-76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. CONCLUSIONS These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.
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Affiliation(s)
- Katherine A. Reifler
- Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Alyse Wheelock
- Section of Preventative Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Samantha M. Hall
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Alejandra Salazar
- Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Shahzad Hassan
- Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - John A. Bostrom
- Cardiovascular Division, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Elizabeth D. Barnett
- Section of Pediatric Infectious Disease, Department of Pediatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Malwina Carrion
- Boston University College of Health and Rehabilitation Sciences: Sargent College, Massachusetts, United States of America
| | - Natasha S. Hochberg
- Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Davidson H. Hamer
- Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Center for Emerging Infectious Disease Policy & Research, Boston University, Boston, Massachusetts, United States of America
| | - Deepa M. Gopal
- Cardiovascular Division, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Daniel Bourque
- Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
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Echeverría LE, Saldarriaga C, Rivera-Toquica AA, Gómez-Ochoa SA, Cadena-Bonfanti AJ, Zarama-Márquez MH, Ramírez-Puentes EG, Bustamante RI, Palacio R, Ávila-Barros LM, Campbell-Quintero S, Morales-Rodríguez LN, López-Ponce de León JD, Buitrago AF, Martínez-Carreño E, Gómez-Mesa JE. Characterization of Patients With Heart Failure of Chagas Etiology in Colombia: An Analysis Based on the Colombian Registry of Heart Failure (RECOLFACA). Curr Probl Cardiol 2023; 48:101964. [PMID: 37473940 DOI: 10.1016/j.cpcardiol.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
Chronic Chagas cardiomyopathy (CCM) represents a relevant origin of Heart Failure (HF) in countries where the disease is endemic. CCM exhibits distinct myocardial involvement and is associated with a poorer prognosis compared to different HF etiologies. The aim is to explain the features and prognosis of individuals with HF resultant to CCM registered in the Colombian Registry of Heart Failure (RECOLFACA). RECOLFACA registry enrolled 2528 adult patients with HF. A comparison was made between patients diagnosed with CCM and those diagnosed with other etiologies of HF. Eighty-eight patients (3.5%) present CCM diagnosis. The individuals diagnosed with both HF and CCM were notably younger in age, had less comorbidities, poorer functional class, and significantly inferior ejection fraction. Finally, the presence of CCM diagnosis was linked to a substantially elevated mortality risk throughout the follow-up period (HR 2.01; 95% CI, 1.01-4.00) according to a multivariate model adjusted. CCM represents an important etiology of HF in Colombia, drawing attention to a distinct clinical profile and a higher risk of mortality compared to other HF etiologies.
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Affiliation(s)
| | | | - Alex Arnulfo Rivera-Toquica
- Department of Cardiology, Centro Médico para el Corazón. Clínica los Rosales. Universidad Tecnológica de Pereira, Pereira, Colombia
| | | | | | | | | | | | - Rolando Palacio
- Department of Cardiology, Clínica Renacer, Riohacha, Colombia
| | | | | | | | | | | | - Erika Martínez-Carreño
- Department of Cardiology, Institución Clínica Iberoamérica Sanitas, Barranquilla, Colombia
| | - Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Universidad Icesi, Faculty of Medicine, Cali, Colombia.
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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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Tavares de Oliveira M, Fuzo CA, da Silva MC, Donadi EA, da Silva JS, Moreira HT, Schmidt A, Marin-Neto JA. Correlation of TcII discrete typing units with severe chronic Chagas cardiomyopathy in patients from various Brazilian geographic regions. PLoS Negl Trop Dis 2022; 16:e0010713. [PMID: 36508471 PMCID: PMC9794067 DOI: 10.1371/journal.pntd.0010713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/27/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chagas disease (ChD) is caused by Trypanosoma cruzi. The genetic structure of the species is divided into seven distinct genetic groups, TcI to TcVI, and Tcbat, which have shown differences in terms of geographic distribution, biological properties, and susceptibility to drugs. However, the association between genetic variability and clinical forms of ChD has not yet been fully elucidated. The predominance of TcII and TcVI discrete typing units (DTUs) (genetic groups) is known to occur in several Brazilian regions and is associated with both the domestic and the wild cycles of ChD. Thus, this study aimed to verify the genotypes of the parasites present in 330 patients with chronic Chagas cardiomyopathy (CCC) from different Brazilian states attended at the Clinical Hospital of the Ribeirão Preto Medical School and to assess the existence of a correlation between the clinical forms with the main cardiovascular risk factors and the genetics of the parasite. METHODOLOGY PRINCIPAL FINDINGS All patients with CCC were clinically evaluated through anamnesis, physical examination, biochemical tests, 12-lead electrocardiogram, echocardiogram and chest X-ray. Peripheral blood (5 mL) was collected in guanidine/ethylenediaminetetraacetic acid from each patient for DNA extraction and real-time polymerase chain reaction (PCR) for Chagas disease and genotyping of the parasite in the 7 DTUs. Parasite genotyping was performed using conventional multilocus PCR. Samples of only 175 patients were positive after amplification of the specific genes contained in the T. cruzi genotyping criteria. TcII (64/175), TcVI (9/175), and TcI (3/175) DTUs were predominant, followed by TcII/TcV/TcVI (74/175), and TcII/TcVI (23/175). The TcIII and TcIV DTU´s was detected in only one sample of CCC patients. CONCLUSIONS/SIGNIFICANCE Our data corroborate previous findings, indicating the predominance of the TcII genotype in patients with CCC of Brazilian origin. Moreover, this study pioneered disclosing a direct correlation between the TcII DTU and severe CCC.
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Affiliation(s)
- Maykon Tavares de Oliveira
- Department of Internal Medicine, Cardiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Carlos Alessandro Fuzo
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Cláudia da Silva
- Fiocruz-Bi-Institutional Translational Medicine Plataform, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Antônio Donadi
- Department of Internal Medicine, Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - João Santana da Silva
- Fiocruz-Bi-Institutional Translational Medicine Plataform, Ribeirão Preto, São Paulo, Brazil
| | - Henrique Turin Moreira
- Department of Internal Medicine, Cardiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - André Schmidt
- Department of Internal Medicine, Cardiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Antônio Marin-Neto
- Department of Internal Medicine, Cardiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Moreira HT, Volpe GJ, Mesquita GM, Braggion-Santos MF, Pazin-Filho A, Marin-Neto JA, Schmidt A. Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy. J Cardiovasc Magn Reson 2022; 24:52. [PMID: 36329520 PMCID: PMC9632087 DOI: 10.1186/s12968-022-00885-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy. METHODS This retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack-TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up. RESULTS A total of 113 patients were included. Median age was 56 years (IQR: 45-67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41-62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93-0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38-7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year. CONCLUSIONS LV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.
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Affiliation(s)
- Henrique Turin Moreira
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Gustavo Marques Mesquita
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Maria Fernanda Braggion-Santos
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Antonio Pazin-Filho
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - André Schmidt
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
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Abstract
This cross-sectional study examines characteristics and outcomes of estimated discharges for Chagas heart disease in the United States from 2002 to 2017.
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Affiliation(s)
- Neiberg de Alcantara Lima
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
- Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit, Michigan
| | - David T. Martin
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ricardo Lessa de Castro
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Adam Ladzinski
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Anya Ring
- Department of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Duncan Vos
- Department of Statistics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Thomas A. Melgar
- Department of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
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Vergara C, Muñoz G, Martínez G, Apt W, Zulantay I. Detection of Trypanosoma cruzi by PCR in adults with chronic Chagas disease treated with nifurtimox. PLoS One 2019; 14:e0221100. [PMID: 31433828 PMCID: PMC6703690 DOI: 10.1371/journal.pone.0221100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022] Open
Abstract
Chagas disease, a vector-borne parasitosis caused by Trypanosoma cruzi, is endemic to Latin America and has spread to other countries due to immigration of infected persons. It is estimated that 160,000 people are infected in Chile, most of them in the chronic phase and without etiological treatment. The infection is confirmed by conventional serological methods while molecular methods have become in valuable tools to evaluate parasitemia in treated and non-treated chronic Chagas disease patients. The objective of this study was to determine, by conventional Polymerase Chain Reaction, the presence of T. cruzi kinetoplastid DNA in peripheral blood samples from 114 adult individuals with confirmed chronic Chagas disease, before and 6.6 years (average) after treatment with nifurtimox. The samples were received and preserved in guanidine-EDTA until DNA purification. Conventional PCR assays were performed in triplicate with T. cruzi kinetoplastid DNA primers 121 and 122. The amplified products were fractionated by electrophoresis in 2% agarose gels. A 330 bp product represented a positive assay. 84.2% (96 cases) and 6.1% (7 cases) of the samples taken before and after the treatment, respectively, were positive. The McNemar test showed a statistically significant difference between the groups of samples (p<0.001). Since serological negativization (the current cure criterion) delay many years after therapy and positive parasitological results represent a treatment failure, the conversion of pre-therapy positive conventional PCR is a qualitative and complementary tool that could be included in protocols of prolonged follow-up.
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Affiliation(s)
- Camilo Vergara
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gabriela Muñoz
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gabriela Martínez
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Werner Apt
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Inés Zulantay
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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9
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Merás P, Caro J, Trigo E, Irazusta J, López-Sendón JL, Refoyo E. Diagnostic Value of NT-proBNP for Early Identification of Chagas Cardiomyopathy in Non-endemic Areas. ACTA ACUST UNITED AC 2017; 70:783-785. [PMID: 28238648 DOI: 10.1016/j.rec.2016.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/06/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Pablo Merás
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Juan Caro
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Trigo
- Unidad de Enfermedades Tropicales, Servicio de Medicina Interna, Hospital Carlos III-La Paz, Madrid, Spain
| | - Javier Irazusta
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Elena Refoyo
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
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Ferreira AM, Sabino EC, de Oliveira LC, Oliveira CDL, Cardoso CS, Ribeiro ALP, Haikal DS. Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil. PLoS One 2016; 11:e0165950. [PMID: 27855177 PMCID: PMC5113907 DOI: 10.1371/journal.pone.0165950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023] Open
Abstract
Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies.
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Affiliation(s)
- Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Institute of the University of São Paulo, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Lea Campos de Oliveira
- Medical Investigation Laboratories-03 Clinics Hospital, Medical School, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais (Universidade Federal de Minas Gerais), Belo Horizonte, Minas Gerais, Brazil
| | - Desirée Sant’Ana Haikal
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
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Apt W, Arribada A, Zulantay I, Saavedra M, Muñoz C, Toro B, Vega B, Rodríguez J. Chronic Chagas cardiopathy in Chile. Importance of Trypanosoma cruzi burden and clinical evaluation. Acta Trop 2016; 162:155-166. [PMID: 27353063 DOI: 10.1016/j.actatropica.2016.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/13/2016] [Accepted: 06/21/2016] [Indexed: 01/11/2023]
Abstract
Currently there are no biological markers to indicate which individuals with chronic indeterminate period of Chagas disease develop heart disease and who will remain all his life in this phase. The aim of this survey was to determine if Trypanosoma cruzi burden is related to the presence of heart disease in patients with chronic Chagas disease. 200 patients who had not been treated, 100 with cardiopathy and 100 without, groups A and B respectively, were submitted to clinical study and electrocardiogram, Echo-Doppler was performed for group A in which all important known causes of cardiopathy were discarded. In both groups xenodiagnosis, conventional PCR and quantitative PCR were undertaken. The 100 cardiopaths had 133 electrocardiographic alterations most of them in grade II of the New York Heart Association classification. 98 cardiopaths were classified in grade I by Echo-Doppler and only 2 cases were in grade III due to low ejection fraction. The difference in average parasitemia in patients of group A and B was not significant and no statistically differences were observed between average parasitemia of cardiopaths grade II versus grade I of NYHA. This results allow to characterize same clinical, electrocardiographical and parasitological features in chagasic cardiopaths of Chile.
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Affiliation(s)
- Werner Apt
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | | | - Inés Zulantay
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Miguel Saavedra
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Catalina Muñoz
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Bruno Toro
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Bastián Vega
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Rodríguez
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Lima-Costa MF, Macinko J, Mambrini JVDM, Peixoto SV, Pereira AC, Tarazona-Santos E, Ribeiro ALP. Genomic African and Native American Ancestry and Chagas Disease: The Bambui (Brazil) Epigen Cohort Study of Aging. PLoS Negl Trop Dis 2016; 10:e0004724. [PMID: 27182885 PMCID: PMC4868305 DOI: 10.1371/journal.pntd.0004724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/29/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The influence of genetic ancestry on Trypanosoma cruzi infection and Chagas disease outcomes is unknown. METHODOLOGY/PRINCIPAL FINDINGS We used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual proportions of African, European and Native American genomic ancestry with T. cruzi infection and related outcomes in 1,341 participants (aged ≥ 60 years) of the Bambui (Brazil) population-based cohort study of aging. Potential confounding variables included sociodemographic characteristics and an array of health measures. The prevalence of T. cruzi infection was 37.5% and 56.3% of those infected had a major ECG abnormality. Baseline T. cruzi infection was correlated with higher levels of African and Native American ancestry, which in turn were strongly associated with poor socioeconomic circumstances. Cardiomyopathy in infected persons was not significantly associated with African or Native American ancestry levels. Infected persons with a major ECG abnormality were at increased risk of 15-year mortality relative to their counterparts with no such abnormalities (adjusted hazard ratio = 1.80; 95% 1.41, 2.32). African and Native American ancestry levels had no significant effect modifying this association. CONCLUSIONS/SIGNIFICANCE Our findings indicate that African and Native American ancestry have no influence on the presence of major ECG abnormalities and had no influence on the ability of an ECG abnormality to predict mortality in older people infected with T. cruzi. In contrast, our results revealed a strong and independent association between prevalent T. cruzi infection and higher levels of African and Native American ancestry. Whether this association is a consequence of genetic background or differential exposure to infection remains to be determined.
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Affiliation(s)
- M. Fernanda Lima-Costa
- Fundação Oswaldo Cruz, Instituto de Pesquisas René Rachou, Belo Horizonte, Brazil
- * E-mail:
| | - James Macinko
- University of California, Fielding School of Public Health, Departments of Health Policy and Management and Community Health Sciences, Los Angeles, California, United States of America
| | | | - Sérgio Viana Peixoto
- Fundação Oswaldo Cruz, Instituto de Pesquisas René Rachou, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Aplicada, Belo Horizonte, Brazil
| | | | - Eduardo Tarazona-Santos
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Biologia Geral, Belo Horizonte, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais, Hospital das Clínicas e Faculdade de Medicina, Belo Horizonte, Brazil
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Colantonio LD, Prado N, Segura EL, Sosa-Estani S. Electrocardiographic Abnormalities and Treatment with Benznidazole among Children with Chronic Infection by Trypanosoma cruzi: A Retrospective Cohort Study. PLoS Negl Trop Dis 2016; 10:e0004651. [PMID: 27158908 PMCID: PMC4861278 DOI: 10.1371/journal.pntd.0004651] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
Background Chronic infection by Trypanosoma cruzi could cause heart conduction disturbances. We sought to analyze electrocardiographic abnormalities among children with chronic T. cruzi infection with and without trypanocidal treatment with benznidazole. Methodology/Principal Findings We studied 111 children 6–16 years of age with asymptomatic chronic T. cruzi infection who were recruited in 1991–1992 in Salta, Argentina. Most children were randomly assigned to benznidazole 5 mg/Kg/day (n = 47) or matching placebo (n = 48) for 60 days. Remaining children (n = 16) received treatment with benznidazole 5 mg/Kg/day open-label. Electrocardiograms were obtained at baseline and in 1995–1996, 1998, 2000 and 2005, and were analyzed using the Buenos Aires method. Among the 94 children with an electrocardiogram at baseline, 8 (8.5%) had electrocardiographic abnormalities, including 4 (4.7%) children with right bundle branch block. Proportion of abnormal electrocardiograms in the full population (n = 111) remained constant over time (media follow-up 8.6 years). Multivariable adjusted prevalence ratios (95% confidence interval [95%CI]) for electrocardiographic abnormalities in 1995–1996, 1998, 2000 and 2005 comparing children treated with benznidazole versus those not treated were 2.76 (0.66, 11.60), 2.33 (0.44, 12.31), 3.06 (0.48, 19.56), and 1.94 (0.33, 11.25), respectively. Among the 86 children with a normal electrocardiogram at baseline, 16 (18.6%) developed electrocardiographic abnormalities during follow-up. The multivariable adjusted hazard ratio for incident electrocardiographic abnormalities comparing children treated with benznidazole versus those not treated was 0.68 (95%CI: 0.25, 1.88). Conclusions/Significance Electrocardiographic abnormalities are frequent among children with chronic T. cruzi infection. Treatment with benznidazole for 60 days may not be associated with less electrocardiographic abnormalities. There are few data available on the natural history of electrocardiographic abnormalities among children with chronic Trypanosoma cruzi infection. Also, few studies analyzed the effect of benznidazole to prevent electrocardiographic abnormalities in this population. In the current study, electrocardiographic abnormalities were frequent among children with chronic T. cruzi infection. Results from the current study also suggest that treatment with benznidazole may not be associated with less electrocardiographic abnormalities. The current study highlights the need of further research to prevent cardiovascular manifestations associated with chronic T. cruzi infection.
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Affiliation(s)
- Lisandro D. Colantonio
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Public Health, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Nilda Prado
- National Institute of Parasitology “Dr. Mario Fatala Chaben”-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina
| | - Elsa L. Segura
- National Institute of Parasitology “Dr. Mario Fatala Chaben”-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- National Institute of Parasitology “Dr. Mario Fatala Chaben”-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina
- * E-mail:
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Cardoso CS, Sabino EC, Oliveira CDL, de Oliveira LC, Ferreira AM, Cunha-Neto E, Bierrenbach AL, Ferreira JE, Haikal DS, Reingold AL, Ribeiro ALP. Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile. BMJ Open 2016; 6:e011181. [PMID: 27147390 PMCID: PMC4861110 DOI: 10.1136/bmjopen-2016-011181] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants. PARTICIPANTS The study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample. FINDINGS TO DATE Clinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare. FUTURE PLANS We will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities. TRIAL REGISTRATION NUMBER NCT02646943; Pre-results.
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Affiliation(s)
- Clareci Silva Cardoso
- Federal University of São João del-Rei, Brazil
- University of California, Berkeley, California, USA
| | - Ester Cerdeira Sabino
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Lea Campos de Oliveira
- Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ariela Mota Ferreira
- Health Science Programme, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Edécio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT, São Paulo, Brazil
| | - Ana Luiza Bierrenbach
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - João Eduardo Ferreira
- Institute of Mathematics and Statistics (IME), University of São Paulo, São Paulo, Brazil
| | - Desirée Sant'Ana Haikal
- Health Science Programme, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Clark EH, Sherbuk J, Okamoto E, Jois M, Galdos-Cardenas G, Vela-Guerra J, Menacho-Mendez GS, Bozo-Gutierrez RW, Fernandez AB, Crawford TC, Colanzi R, Gilman RH, Bern C. Hyperendemic Chagas disease and the unmet need for pacemakers in the Bolivian Chaco. PLoS Negl Trop Dis 2014; 8:e2801. [PMID: 24901942 PMCID: PMC4046936 DOI: 10.1371/journal.pntd.0002801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eva H. Clark
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Jackie Sherbuk
- New York University School of Medicine, New York, New York, United States of America
| | - Emi Okamoto
- New York University School of Medicine, New York, New York, United States of America
| | - Malasa Jois
- Rowan University of School of Osteopathic Medicine, Stratford, New Jersey, United States of America
| | | | | | | | | | | | - Thomas C. Crawford
- University of Michigan Health System, Ann Arbor, Michigan, United States of America
| | - Rony Colanzi
- Universidad Catolica San Pablo, Santa Cruz, Bolivia
| | - Robert H. Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caryn Bern
- University of California San Francisco, San Francisco, California, United States of America
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16
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González B, Silva M, Al-Atrache Y, Delgado Y, Serrano JL, Doccimo A, Hernández H, Verde J, Morillo D, Marín J, Concepción JL, Bonfante-Cabarcas R, Rodríguez-Bonfante C. [Risk factors associated with the diagnosis of chronic Chagasic miocardiopathy in seropositive individuals from Barinas state, Venezuela]. Invest Clin 2014; 55:119-132. [PMID: 24974628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study evaluates the risk factors associated with the diagnosis of chronic chagasic miocardiopathy (CChM) in 115 seropositive individuals to anti-Trypanosoma cruzi antibodies, in Barinas state, Venezuela. Serology was performed with ELISA and MABA; while the CChM diagnosis was established by electrocardiography and echocardiography. A complete clinical history including epidemiological, personal/familiar antecedents and psychobiological habits, plus socioeconomic, psychosocial and alimentary habits interviews were performed for each individual. Risk factors were determined through binary logistic regression. Results showed that 81 patients (70,4%; CI 95% = 66.4-74.4) had criteria for CChM, of which 74 (64.4%; IC 95% = 60.2-68.6) were in phase II; while 34 (29.6%; IC 95% = 25.5-33.5) were in phase I of the disease and 7 (6.1%; IC 95% = 4.0-8.2) in phase III. In a one year period, two patients in phase III died of heart failure. The diagnosis of CChM was associated with hunting practice, maternal history of cardiopathies, chewing chimó, medical history of hypertension and apex beat visible; it was negatively associated with canned and preserved foods ingest. In conclusion the CChM diagnosis has high frequency in seropositive individuals in Barinas and heart failure prevention must be based on an early medical attention and educative strategies in order to control risk factors.
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17
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Botoni FA, Ribeiro ALP, Marinho CC, Lima MMO, Nunes MDCP, Rocha MOC. Treatment of Chagas cardiomyopathy. Biomed Res Int 2013; 2013:849504. [PMID: 24350293 PMCID: PMC3857751 DOI: 10.1155/2013/849504] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 12/13/2022]
Abstract
Chagas' disease (ChD), caused by the protozoa Trypanosoma cruzi (T. cruzi), was discovered and described by the Brazilian physician Carlos Chagas in 1909. After a century of original description, trypanosomiasis still brings much misery to humanity and is classified as a neglected tropical disease prevalent in underdeveloped countries, particularly in South America. It is an increasing worldwide problem due to the number of cases in endemic areas and the migration of infected subjects to more developed regions, mainly North America and Europe. Despite its importance, chronic chagas cardiomyopathy (CCC) pathophysiology is yet poorly understood, and independently of its social, clinical, and epidemiological importance, the therapeutic approach of CCC is still transposed from the knowledge acquired from other cardiomyopathies. Therefore, the objective of this review is to describe the treatment of Chagas cardiomyopathy with emphasis on its peculiarities.
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Affiliation(s)
- Fernando A. Botoni
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
- Fundação Hospitalar do Estado de Minas Gerais, 30150 260 Belo Horizonte, MG, Brazil
| | - Antonio Luiz P. Ribeiro
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
| | | | - Marcia Maria Oliveira Lima
- Departamento de Fisioterapia, Universidade Federal do Vale do Mucuri e Jequitinhonha, 39100 000 Diamantina, MG, Brazil
| | - Maria do Carmo Pereira Nunes
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
| | - Manoel Otávio C. Rocha
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, 30130 100 Belo Horizonte, MG, Brazil
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18
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Pisharath H, Zao CL, Kreeger J, Portugal S, Kawabe T, Burton T, Tomaeck L, Shoieb A, Campbell BM, Franco J. Immunopathologic characterization of naturally acquired Trypanosoma cruzi infection and cardiac sequalae in cynomolgus macaques (Macaca fascicularis). J Am Assoc Lab Anim Sci 2013; 52:545-552. [PMID: 24041209 PMCID: PMC3784659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/03/2013] [Accepted: 04/30/2013] [Indexed: 06/02/2023]
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, is endemic in south Texas due to the abundant vector and wild small mammalian reservoir populations. This situation predisposes nonhuman primate colonies exposed to outdoor housing to infection from ingestion or bite of triatomid insects. Using a T. cruzi-specific real-time PCR and Trypanosome spp.-specific ELISA, we revealed a prevalence rate of 8.5% in a colony of outdoor-housed cynomolgus macaques. By using a discriminating kinetoplastid minicircle PCR, we eliminated the possibility of mixed prevalence with nonpathogenic trypanosomes and showed the ELISA results were specific for T. cruzi. In this study, we found an inverse relationship between antibody titers and circulating parasite load. Also, 23% of T. cruzi IgG ELISA-positive macaques were negative by real-time PCR. Furthermore, in a subset of infected macaques, cardiac tissue was infiltrated by inflammatory mononuclear cells and contained T. cruzi genomic and kinetoplast DNA despite lacking microscopic evidence of discrete parasite stages. In addition, 19% of the infected macaques had titers for cardiac troponin I autoantibody, which could contribute to autoimmune myocarditis or interfere with circulating troponin I measurements. These findings indicate the possibility of T. cruzi to interfere with the assessment of cardiac safety signals in preclinical toxicology and safety pharmacology studies and the necessity for prestudy screening for T. cruzi in outdoor-housed nonhuman primates from endemic areas.
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Affiliation(s)
| | | | - John Kreeger
- Drug Safety R&D, Worldwide R&D, Pfizer, Groton, Connecticut
| | - Susan Portugal
- Drug Safety R&D, Worldwide R&D, Pfizer, Groton, Connecticut
| | - Thomas Kawabe
- Drug Safety R&D, Worldwide R&D, Pfizer, Groton, Connecticut
| | | | | | - Ahmed Shoieb
- Drug Safety R&D, Worldwide R&D, Pfizer, Groton, Connecticut
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Abstract
BACKGROUND As Chagas disease continues to expand beyond tropical and subtropical zones, a growing need exists to better understand its resulting economic burden to help guide stakeholders such as policy makers, funders, and product developers. We developed a Markov simulation model to estimate the global and regional health and economic burden of Chagas disease from the societal perspective. METHODS Our Markov model structure had a 1 year cycle length and consisted of five states: acute disease, indeterminate disease, cardiomyopathy with or without congestive heart failure, megaviscera, and death. Major model parameter inputs, including the annual probabilities of transitioning from one state to another, and present case estimates for Chagas disease came from various sources, including WHO and other epidemiological and disease-surveillance-based reports. We calculated annual and lifetime health-care costs and disability-adjusted life-years (DALYs) for individuals, countries, and regions. We used a discount rate of 3% to adjust all costs and DALYs to present-day values. FINDINGS On average, an infected individual incurs US$474 in health-care costs and 0·51 DALYs annually. Over his or her lifetime, an infected individual accrues an average net present value of $3456 and 3·57 DALYs. Globally, the annual burden is $627·46 million in health-care costs and 806,170 DALYs. The global net present value of currently infected individuals is $24·73 billion in health-care costs and 29,385,250 DALYs. Conversion of this burden into costs results in annual per-person costs of $4660 and lifetime per-person costs of $27,684. Global costs are $7·19 billion per year and $188·80 billion per lifetime. More than 10% of these costs emanate from the USA and Canada, where Chagas disease has not been traditionally endemic. A substantial proportion of the burden emerges from lost productivity from cardiovascular disease-induced early mortality. INTERPRETATION The economic burden of Chagas disease is similar to or exceeds those of other prominent diseases globally (eg, rotavirus $2·0 billion, cervical cancer $4·7 billion) even in the USA (Lyme disease $2·5 billion), where Chagas disease has not been traditionally endemic, suggesting an economic argument for more attention and efforts towards control of Chagas disease. FUNDING Bill & Melinda Gates Foundation, the National Institute of General Medical Sciences Models of Infectious Disease Agent Study.
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Affiliation(s)
- Bruce Y Lee
- Public Health Computational and Operations Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Ribeiro AL, Sabino EC, Marcolino MS, Salemi VMC, Ianni BM, Fernandes F, Nastari L, Antunes A, Menezes M, Oliveira CDL, Sachdev V, Carrick DM, Busch MP, Murphy EL. Electrocardiographic abnormalities in Trypanosoma cruzi seropositive and seronegative former blood donors. PLoS Negl Trop Dis 2013; 7:e2078. [PMID: 23469305 PMCID: PMC3585012 DOI: 10.1371/journal.pntd.0002078] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease. OBJECTIVES To assess the frequency of ECG abnormalities in T.cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction. METHODS The study retrospectively enrolled 499 seropositive blood donors in São Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%. RESULTS Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction. CONCLUSIONS ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.
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Affiliation(s)
- Antonio L. Ribeiro
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester C. Sabino
- Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Milena S. Marcolino
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vera M. C. Salemi
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Barbara M. Ianni
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Fernandes
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciano Nastari
- Cardiomyopathy Unit ofthe Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Antunes
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Márcia Menezes
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | | | - Vandana Sachdev
- National Heart, Lung and Blood Institute, Bethesda, Maryland, United States of America
| | | | - Michael P. Busch
- Blood Systems Research Institute (BSRI) and University of California at San Francisco, San Francisco, California, United States of America
| | - Eduard L. Murphy
- Blood Systems Research Institute (BSRI) and University of California at San Francisco, San Francisco, California, United States of America
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Machado FS, Jelicks LA, Kirchhoff LV, Shirani J, Nagajyothi F, Mukherjee S, Nelson R, Coyle CM, Spray DC, Campos de Carvalho AC, Guan F, Prado CM, Lisanti MP, Weiss LM, Montgomery SP, Tanowitz HB. Chagas heart disease: report on recent developments. Cardiol Rev 2012; 20:53-65. [PMID: 22293860 PMCID: PMC3275684 DOI: 10.1097/crd.0b013e31823efde2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is an important cause of cardiac disease in endemic areas of Latin America. It is now being diagnosed in nonendemic areas because of immigration. Typical cardiac manifestations of Chagas disease include dilated cardiomyopathy, congestive heart failure, arrhythmias, cardioembolism, and stroke. Clinical and laboratory-based research to define the pathology resulting from T. cruzi infection has shed light on many of the cellular and molecular mechanisms leading to these manifestations. Antiparasitic treatment may not be appropriate for patients with advanced cardiac disease. Clinical management of Chagas heart disease is similar to that used for cardiomyopathies caused by other processes. Cardiac transplantation has been successfully performed in a small number of patients with Chagas heart disease.
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Affiliation(s)
- Fabiana S. Machado
- Departments of Biochemistry and Immunology, Institute of Biological Sciences, and Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Linda A. Jelicks
- Gruss Magnetic Resonance Research Center and Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY
| | - Louis V. Kirchhoff
- Departments of Internal Medicine and Epidemiology, University of Iowa, Iowa City, IA
- Department of Veterans Affairs Medical Center, Iowa City, IA
| | - Jamshid Shirani
- Department of Cardiology St Luke’s Hospital and Health Network, Bethlehem, PA
| | - Fnu Nagajyothi
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - Shankar Mukherjee
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - Randin Nelson
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - Christina M. Coyle
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Parasitology, Jacobi Medical Center, Bronx, NY
| | - David C. Spray
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY
| | - Antonio C. Campos de Carvalho
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY
- National Cardiology Institute, Rio de Janeiro, Brazil
- Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Fangxia Guan
- Bioengineering Department of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Cibele M. Prado
- Department of Pathology, University of São Paulo, Ribeirão Preto, Brazil
| | - Michael P. Lisanti
- Kimmel Cancer Center, Departments of Cancer Biology and Stem Cell Biology and Regenerative Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Parasitology, Jacobi Medical Center, Bronx, NY
- Global Health Center, Albert Einstein College of Medicine, Bronx, NY
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Parasitology, Jacobi Medical Center, Bronx, NY
- Global Health Center, Albert Einstein College of Medicine, Bronx, NY
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Beleigoli AM, Lima-Costa MF, Diniz MDFH, Ribeiro AL. B-type natriuretic peptide and anthropometric measures in a Brazilian elderly population with a high prevalence of Trypanosoma cruzi infection. Peptides 2011; 32:1787-92. [PMID: 21884743 DOI: 10.1016/j.peptides.2011.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 11/30/2022]
Abstract
B-type natriuretic peptide (BNP) is a diagnostic and prognostic tool in heart failure and also in Chagas disease, which is caused by the protozoan Trypanosoma cruzi and has cardiomyopathy as a main feature. BNP lipolytic actions and T. cruzi infection in the adipose tissue have been recently described. We aim to investigate the relationship between BNP and anthropometric measures and whether it is influenced by T. cruzi infection. We measured BNP, body mass index (BMI), waist circumference (WC), triceps skin-fold thickness (TSF) and performed serological, biochemical and electrocardiographic exams in 1398 subjects (37.5% infected with T. cruzi) in a community-dwelling elderly population in Bambui city, Brazil. Linear multivariate regression analysis was performed to investigate determinants of BNP levels. BNP levels were significantly (p<0.05) higher in T. cruzi-infected subjects than in the non-infected group (median=121 and 64pg/mL, respectively). BMI, WC and TSF in infected subjects were significantly lower than those in non-infected subjects (24.3 vs. 25.5kg/m2; 89.2 vs. 92.4cm; and 14.5 vs. 16.0mm, respectively). There was an inverse relationship between BNP levels and BMI (b=-0.018), WC (b=-0.005) and TSF (b=-0.193) levels. Infected and non-infected groups showed similar inverse relationships between BNP and BMI (b=-0.021 and b=-0.015, respectively). In conclusion, there was an inverse relationship between BNP levels and the anthropometric measures. Despite the actions in the adipose tissue, T. cruzi infection did not modify the associations between BNP and BMI, suggesting that body mass does not modify the accuracy of BNP in Chagas disease.
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Affiliation(s)
- Alline Maria Beleigoli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30130-100, Brazil.
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Alducin-Téllez C, Rueda-Villegas E, Medina-Yerbes I, Hernández O, López R, Peña-Hernández V, Monteón V. [Prevalence of positive serology to Trypanosoma cruzi in patients with clinical diagnosis of dilated myocardiopathy in the state of Campeche]. Arch Cardiol Mex 2011; 81:204-207. [PMID: 21975234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The prevalence of chronic Chagas' heart disease as a cause of dilated cardiomyopathy is unknown in the State of Campeche, Mexico. A study was conducted to determine the prevalence of positive serology for Trypanosoma cruzi in patients with clinical diagnosis of dilated cardiomyopathy. Of a total of 127 patients diagnosed with dilated cardiomyopathy, we studied 91 with two positive serological tests for T. cruzi. We identified 14 positive cases for a prevalence of 15 % of chronic Chagas' heart disease. This prevalence is similar to that reported for the rest of the Yucatan Peninsula.
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Valdigem BP, Pereira FBFCG, da Silva NJC, Dietrich CO, Sobral R, Nogueira FL, Berber RC, Mallman F, Pinto IM, Szarf G, Cirenza C, de Paola AAV. Ablation of ventricular tachycardia in chronic chagasic cardiomyopathy with giant basal aneurysm: Carto sound, CT, and MRI merge. Circ Arrhythm Electrophysiol 2011; 4:112-4. [PMID: 21325215 DOI: 10.1161/circep.110.957571] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bart A, Hodiamont CJ, Grobusch MP, van den Brink RBA, Smout AJPM, van Gool T. [Chagas disease in the Netherlands: an estimate of the number of patients]. Ned Tijdschr Geneeskd 2011; 155:A3170. [PMID: 21527056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A total of 8-10 million persons are infected worldwide with Trypanosoma cruzi, the causative parasite of Chagas disease, most of whom are inhabitants of Latin America. Due to the increased migration of peoples, Chagas disease has been on the uprise outside Latin America, including in Europe. The course of Chagas, also called American trypanosomiasis, runs in 2 phases: an acute phase lasting approximately 2 months, and a chronic phase in which symptoms may appear years after infection. Without treatment, the patient will remain infected for life. The acute phase is usually asymptomatic; in the chronic phase of American trypanosomiasis, severe gastro-intestinal and cardiac abnormalities may develop, finally with fatal course. In the Netherlands, the number of immigrants who would serologically test positive for American trypanosomiasis is estimated to be between 726 and 2929. Healthcare providers in the Netherlands may encounter patients who have Chagas disease more and more frequently. The screening of pregnant women and blood donors at risk for American trypanosomiasis should be considered.
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Affiliation(s)
- Aldert Bart
- Academisch Medisch Centrum, Amsterdam, the Netherlands.
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26
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Hidron AI, Gilman RH, Justiniano J, Blackstock AJ, LaFuente C, Selum W, Calderon M, Verastegui M, Ferrufino L, Valencia E, Tornheim JA, O'Neal S, Comer R, Galdos-Cardenas G, Bern C. Chagas cardiomyopathy in the context of the chronic disease transition. PLoS Negl Trop Dis 2010; 4:e688. [PMID: 20502520 PMCID: PMC2872643 DOI: 10.1371/journal.pntd.0000688] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 03/29/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common. METHODOLOGY/PRINCIPAL FINDINGS The study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI =25 had significantly higher likelihood of positive PCR results compared to females or overweight participants. CONCLUSIONS Chagas cardiomyopathy remains an important cause of congestive heart failure in this hospital population, and should be evaluated in the context of the epidemiological transition that has increased risk of obesity, hypertension and chronic cardiovascular disease.
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Affiliation(s)
- Alicia I. Hidron
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Robert H. Gilman
- Asociacion Benefica PRISMA, Lima, Peru
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Justiniano
- Hospital Universitario Japones, Santa Cruz de la Sierra, Bolivia
| | - Anna J. Blackstock
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Atlanta Research and Education Foundation, Decatur, Georgia, United States of America
| | - Carlos LaFuente
- Hospital Universitario Japones, Santa Cruz de la Sierra, Bolivia
| | - Walter Selum
- Hospital Universitario Japones, Santa Cruz de la Sierra, Bolivia
| | - Martiza Calderon
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuela Verastegui
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Eduardo Valencia
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey A. Tornheim
- Mount Sinai School of Medicine, New York, New York, United States of America
| | - Seth O'Neal
- Oregon Health Sciences University, Portland, Oregon, United States of America
| | - Robert Comer
- Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States of America
| | | | - Caryn Bern
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Luz PR, Miyazaki MI, Neto NC, Nisihara RM, Messias-Reason IJ. High levels of mannose-binding lectin are associated with the risk of severe cardiomyopathy in chronic Chagas Disease. Int J Cardiol 2009; 143:448-50. [PMID: 19853314 DOI: 10.1016/j.ijcard.2009.09.467] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/26/2009] [Indexed: 11/30/2022]
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28
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Barbabosa-Pliego A, Díaz-Albiter HM, Ochoa-García L, Aparicio-Burgos E, López-Heydeck SM, Velásquez-Ordoñez V, Fajardo-Muñoz RC, Díaz-González S, De Oca-Jimenez RM, Barbosa-Mireles M, Guzmán-Bracho C, Estrada-Franco JG, Garg NJ, Vázquez-Chagoyán JC. Trypanosoma cruzi circulating in the southern region of the State of Mexico (Zumpahuacan) are pathogenic: a dog model. Am J Trop Med Hyg 2009; 81:390-395. [PMID: 19706902 PMCID: PMC2784919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Here we describe clinical and pathologic evidence of Chagas disease caused in dogs by circulating Trypanosoma cruzi from a newly recognized endemic area in Mexico. We show that the Zumpahuacan isolate, although less virulent than the Sylvio-X10 reference strain that caused acute myocarditis and death, was pathogenic in dogs. Dogs infected with the Zumpahuacan isolate exhibited electrocardiographic alterations, left- and right-ventricle dilation, and hydropericardium. Histologically, diffused perimysial and endomysial lymphoplasmacytic cell infiltration, cardiomyocyte necrosis, and amastigote nests were noted in Zumpahuacan-infected dogs. These findings suggest that the risk of T. cruzi infection and Chagas disease is present in the State of Mexico, and further research is needed to identify the T. cruzi bio-types circulating in southern State of Mexico.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Nisha Jain Garg
- Address correspondence to Nisha J. Garg, 301 University Boulevard, Galveston, TX 77555-1070, or Juan C. Vázquez-Chagoyán, Centro de Investigación y Estudios Avanzados en Salud Animal, Facultad de Medicina Veterimaria y Zootecnia, Universidad Autónoma del Estado de México, Autopista Toluca-Atlacomulco km 15.5, Toluca 50200, México,
| | - Juan C. Vázquez-Chagoyán
- Address correspondence to Nisha J. Garg, 301 University Boulevard, Galveston, TX 77555-1070, or Juan C. Vázquez-Chagoyán, Centro de Investigación y Estudios Avanzados en Salud Animal, Facultad de Medicina Veterimaria y Zootecnia, Universidad Autónoma del Estado de México, Autopista Toluca-Atlacomulco km 15.5, Toluca 50200, México,
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Tanowitz HB, Machado FS, Jelicks LA, Shirani J, de Carvalho ACC, Spray DC, Factor SM, Kirchhoff LV, Weiss LM. Perspectives on Trypanosoma cruzi-induced heart disease (Chagas disease). Prog Cardiovasc Dis 2009; 51:524-39. [PMID: 19410685 PMCID: PMC2677559 DOI: 10.1016/j.pcad.2009.02.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chagas disease is caused by the parasite Trypanosoma cruzi. It is a common cause of heart disease in endemic areas of Latin America. The year 2009 marks the 100th anniversary of the discovery of T cruzi infection and Chagas disease by the Brazilian physician Carlos Chagas. Chagasic cardiomyopathy develops in from 10% to 30% of persons who are chronically infected with this parasite. Echocardiography and magnetic resonance imaging (MRI) are important modalities in the evaluation and prognostication of individuals with chagasic heart disease. The etiology of chagasic heart disease likely is multifactorial. Parasite persistence, autoimmunity, and microvascular abnormalities have been studied extensively as possible pathogenic mechanisms. Experimental studies suggest that alterations in cardiac gap junctions may be etiologic in the pathogenesis of conduction abnormalities. The diagnosis of chronic Chagas disease is made by serology. The treatment of this infection has shortcomings that need to be addressed. Cardiac transplantation and bone marrow stem cell therapy for persons with Chagas disease have received increasing research attention in recent years.
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Affiliation(s)
- Herbert B Tanowitz
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Guerri-Guttenberg RA, Di Girolamo C, Ciannameo A, Milei J. [Migration flow and imported diseases: chronic chagasic cardiomyopathy]. G Ital Cardiol (Rome) 2009; 10:234-240. [PMID: 19475878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is transmitted by triatomine bugs in endemic regions of the American continent and less frequently by blood transfusion and congenital transmission. Immigration rates explain why the disease can be found worldwide. Non-endemic countries that receive a significant amount of Latin American immigrants should be familiarized with the disease to allow prevention, diagnosis and early treatment. In Italy, where no serologic screening is routinely performed to detect Trypanosoma cruzi in blood donations, a special consideration must be held. Accordingly, attention to congenital transmissions of the disease should be drawn considering the lack of newborn screening. Though commonly unrecognized, chronic chagasic cardiomyopathy is the most common type of chronic myocarditis in the world.
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Abstract
The authors discuss the key challenges that undermine the control of Chagas disease and that must be urgently addressed to ensure long-term, sustainable control.
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Affiliation(s)
- Rick L Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America.
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Mora G, Echeverry MC, Rey GE, López MC, Posada LF, Rivas FA. [Frequency of Trypanosoma cruzi infection in patients with implanted pacemaker]. Biomedica 2007; 27:483-489. [PMID: 18320115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 06/26/2007] [Indexed: 05/26/2023]
Abstract
INTRODUCTION In Colombia the impact of infections of Trypanosoma cruzi are known to produce chronic cardiopathy and expressed by bradycardia. In Colombia the extent and impact of these infections has not been examined. OBJECTIVE The current study aimed to determine the prevalence of T. cruzi infection as measured by serology, in a population of patients with cardiopathy that required a permanent pacemaker as treatment for cardiac rhythm abnormalities and conduction blocking. MATERIALS AND METHODS A cross sectional study sampled 332 patients from the pacemaker clinic at the San Pedro Claver Hospital in Bogotá, Colombia, for one year (2004-2005). Epidemiological and clinical data were obtained through interviews and physical examination. Serological tests consisted of indirect inmunofluorescence assay and ELISA. Statistical analyses were accomplished with chi-square and Students t tests. RESULTS Of patients with pacemakers, 17.1% had anti-T. cruzi antibodies (seropositive). At the time when the pacemaker was implanted, chronic Chagas disease patients were younger (55+/-13 years) than those patients with cardiopathy (60+/-17 years) with no anti-T. cruzi antibodies (p<0.01). The seropositive group was aware of the Chagas disease vector (83.6%) in contrast to the seronegative group (39.6%, p<0.001). In 60% of the patients of the seropositive group, no clinical signs of the disease were apparent. The geographical origin of the seropositive group were traced to regions in Colombia known to be endemic for Chagas disease transmission. CONCLUSION Chagas disease prevalence is high in Colombian patients who required a permanent cardiac pacemaker. Chronic Chagas disease patients required pacemaker implant at a younger age in contrast with patients with other cardiac pathologies. The clinical recognition of Chagas disease associated with cardiopathy is low despite the epidemiological data.
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Affiliation(s)
- Guillermo Mora
- Departamento de Medicina, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, DC, Colombia
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Tempone AG, Sartorelli P, Mady C, Fernandes F. Natural products to anti-trypanosomal drugs: an overview of new drug prototypes for American Trypanosomiasis. Cardiovasc Hematol Agents Med Chem 2007; 5:222-35. [PMID: 17630949 DOI: 10.2174/187152507781058726] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Protozoan tropical diseases cause great suffering throughout developing countries, with high rates of morbidity and mortality. American Trypanosomiasis affects 16-18 million people in Latin America, representing a dramatic disease among symptomatic patients. Old, toxic and ineffective chemotherapeutic agents continue to be used for the treatment of Chagas' disease. Since the early days of medicine, chemical substances derived from plants and animals have been used to treat human diseases. In the marine ecosystem ecological pressures, such as competition for space and predation, may have favored several invertebrate organisms to select unique metabolites with an assortment of astonishing biological activities. In terrestrial ecosystems, amphibians present a unique efficient skin secretion system with a variety of glands which produce a myriad of potent bioactive compounds such as peptides, alkaloids, biogenic amines and lipids. Plants contribute with several antitrypanosomal compounds derived mainly from their secondary metabolism. Proteins and peptides from snake venoms have also been considered as novel drug candidates, showing effective activities. In this review, we broadly discuss the epidemiology, pathology, and current treatment of Chagas' disease as well as the contributions of pharmacologically tested marine invertebrate, amphibian, snake and plant compounds which have shown promising antitrypanosomal activities. We also explore these possibilities for developing new chemotherapeutics against Chagas' disease.
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Affiliation(s)
- André Gustavo Tempone
- Laboratório de Toxinologia Aplicada, Departamento de Parasitologia, Inst. Adolfo Lutz - Av. Dr. Arnaldo 355, 8 andar, CEP 01246-000, São Paulo, Brazil.
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Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, infects nearly 18 million people in Latin America and mainly affects the heart, causing heart failure, arrhythmias, heart block, thromboembolism, stroke and death. In this review, the clinical diagnosis and management of Chagas cardiomyopathy are discussed. Particular emphasis is placed on the clinical staging of patients and the use of various diagnostic tests that may be useful in individualizing treatment of the two most relevant clinical syndromes, that is, heart failure and arrhythmias. The relevance of specific treatments are discussed, stressing the important role of parasite persistence in disease pathogenesis. We also discuss new therapy modalities that may have a role in the treatment of Chagas cardiomyopathy.
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Affiliation(s)
- Manoel O C Rocha
- Internal Medicine Department and Coordinator, Postgraduate Course of Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Abstract
The authors discuss the epidemiology and pathogenesis of Chagas' disease in Brazil, including the use of treatment with a cardioverter-defibrillator in patients with low ejection fraction. Select patients may benefit from resynchronization therapy associated with cardioverter-defibrillator treatment. Electrophysiologic study is indicated in the assessment of the potential utility of an implantable cardioverter-defibrillator.
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Affiliation(s)
- Ronaldo F Rosa
- Geriatric Cardiology Department, Brazilian Cardiology Society and Santa Casa Hospital, Rua Dias Leme 11, CEP 03118-040 São Paulo, SP, Brazil.
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Sartori AMC, Ibrahim KY, Nunes Westphalen EV, Braz LMA, Oliveira OC, Gakiya E, Lopes MH, Shikanai-Yasuda MA. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Ann Trop Med Parasitol 2007; 101:31-50. [PMID: 17244408 DOI: 10.1179/136485907x154629] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Between June 1989 and December 2005, an observational study of adults co-infected with HIV and Trypanosoma cruzi was conducted, to investigate the spectrum of manifestations of chronic Chagas disease (American trypanosomiasis) in the HIV-positive. The 31 men and 22 women investigated were aged 23-59 years. Each subject was investigated by ambulatory (Holter) and non-ambulatory electrocardiography, chest X-ray, oesophagography and echocardiography (to determine the clinical form of trypanosomiasis), by xenodiagnosis, blood culture and the microscopical examination of blood (to explore their T. cruzi parasitaemia), and by counting their CD4 T cells (to stage their HIV infection). The subjects were followed-up for 1-190 months (median = 58 months) and checked for re-activation of their Chagas disease, which was usually defined by the occurrence of unusual clinical manifestations and/or the detection, by microscopical examination, of trypanosomes in the blood or cerebrospinal fluid. Eleven (20.8%) of the subjects showed re-activation, another nine (17.0%) were found to have developed high T. cruzi parasitaemias but these were only detected by xenodiagnosis or culture, and 15 (28.3%) had illnesses typical of chronic Chagas disease in HIV-negative individuals, with low parasitaemias. Anti-T. cruzi therapy (benznidazole), recommended for 17 patients, resulted in the sustained reduction of parasitaemia in 11 of the 12 subjects who completed treatment. Chagas disease was the cause of death of eight of the 14 subjects who died during the study. Four of the women investigated gave birth, each to a single child, during follow-up, and three of the four babies showed evidence of the congenital transmission of T. cruzi.
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Affiliation(s)
- A M C Sartori
- AIDS Clinic and Clinic of Infectious and Parasitic Diseases, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Frei Caneca 557, São Paulo, SP, 01307 001, Brazil.
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Punukollu G, Gowda RM, Khan IA, Navarro VS, Vasavada BC. Clinical aspects of the Chagas' heart disease. Int J Cardiol 2007; 115:279-83. [PMID: 16769134 DOI: 10.1016/j.ijcard.2006.03.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 11/29/2005] [Accepted: 03/11/2006] [Indexed: 11/30/2022]
Abstract
Chagas' heart disease, caused by protozoan Trypanosoma cruzi, is a common cause of cardiomyopathy in the Americas. Transmission of T. cruzi occurs through Reduviids, the kissing bugs. Less common ways of transmission are blood transfusion, congenital transmission, organ transplantation, laboratory accident, breastfeeding, and oral contamination. Infestation results in cardiac dysautonomia, myocardial apoptosis, and myocardial fibrosis. In acute phase, death is mostly caused by myocarditis and in chronic phase, it is mostly by irreversible cardiomyopathy. A majority of the patients with Chagas' disease remain in the latent phase of disease for 10 to 30 years or even for life. Specific anti-Chagas' therapy with trypanocide drugs is useful in acute phase but the management of chronic Chagas' heart disease is mostly empirical. The mortality during the acute phase of cardiac Chagas is around 5%. Five-year mortality of chronic Chagas' disease with cardiac dysfunction is above 50%. The clinical aspects of the Chagas' heart disease are concisely reviewed.
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Drigo SA, Cunha-Neto E, Ianni B, Mady C, Faé KC, Buck P, Kalil J, Goldberg AC. Lack of association of tumor necrosis factor-α polymorphisms with Chagas disease in Brazilian patients. Immunol Lett 2007; 108:109-11. [PMID: 17141882 DOI: 10.1016/j.imlet.2006.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 10/17/2006] [Accepted: 10/31/2006] [Indexed: 11/26/2022]
Abstract
One third of Trypanosoma cruzi-infected individuals develop chronic Chagas disease cardiomyopathy (CCC) while the majority remains asymptomatic (ASY). About 30% of CCC patients develop heart failure due to end-stage inflammatory dilated cardiomyopathy. Increased production of tumor necrosis factor (TNF)-alpha has been described in all clinical forms of Chagas disease, and the highest levels are detected in CCC patients with severe ventricular dysfunction. Genetic susceptibility may play a role in the clinical outcome of Chagas disease. We investigated TNF as a candidate gene for susceptibility to development and/or progression of CCC. We analyzed the TNFa microsatellite and the -308 TNF promoter polymorphisms, in 166 CCC compared to 80 ASY geographically and age-matched patients in an association study. To analyze the association of TNF polymorphisms with progression of the cardiomyopathy, CCC patients were also grouped in three categories according to degree of left ventricular (LV) dysfunction into severe (n=57), mild to moderate (n=21) and absent (n=88). Our results show no significant differences either between CCC and ASY patients, or among CCC patients according to severity of cardiomyopathy with respect to TNFa or -308 TNF promoter polymorphisms. These results indicate that TNF polymorphisms are associated neither to CCC development nor to progression to more severe forms of cardiomyopathy in Brazilian Chagas disease patients.
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Affiliation(s)
- Sandra A Drigo
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
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Olivera-Mar A, Hernández-Vicencio C, Camacho-Marie M, Hernández-Becerril N, Monteón-Padilla VM, Vallejo M, Reyes PA. [Chronic Chagasic Cardiomyopathy at the Hospital General de Zona no. 24 IMSS. Poza Rica, Veracruz]. Arch Cardiol Mex 2006; 76:269-76. [PMID: 17091798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
UNLABELLED Northern Veracruz has conditions, biotic and abiotic, to support Triatomine bugs and vectorial transmission of Trypanosoma cruzi to human beings. Therefore we explore seroprevalence of antibodies to this parasite and the presence of Chronic Chagasic Cardiopathy (CCC) at Cardiology ward in a General Hospital serving North of Veracruz State, and neighbord states Hidalgo, Puebla San Luis Potosi and Tamaulipas. MATERIAL AND METHODS We search for consecutive adult patients attending outpatient and beds assigned to Cardiology between March through September, 2003. An epidemiology questionnaire, clinical work up, chest roentgenogram, 12 lead peripheral EKG and transthoracic echocardiogram were performed in 240 female/males patients. All of them were bled to blindly search for T. cruzi antibodies. RESULTS Seroprevalence was 8%, 49 cases of dilated cardiomyopathy were diagnosed 23 attributed to chronic diseases such as systemic hypertension diabetes mellitus or ischemic heart disease 12 with idiopathic disease and 14 (29%) had CCC. The latter accumulated epidemiologic features suggestive of vectorial infection. Four additional individuals without CCC but having specific antibodies were considered indeterminate Chagasic cases. DISCUSSION AND CONCLUSIONS This case series identify American Trypanosomiasis among 19 people attending a Cardiology Service, and 14 of them had a severe heart disease linked to progressive and fatal course. This observation points out that Chagas disease could be a regional public health problem in Northern Veracruz.
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Cardinalli-Neto A, Greco OT, Bestetti RB. Automatic Implantable Cardioverter-Defibrillators in Chagas' Heart Disease Patients with Malignant Ventricular Arrhythmias. Pacing and Clinical Electrophysiology 2006; 29:467-70. [PMID: 16689840 DOI: 10.1111/j.1540-8159.2006.00377.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A total of 46 consecutive Chagas' disease patients had an automatic cardioverter defibrillator implanted at our institution from October 1998 to January 2004. A retrospective longitudinal study was carried out to identity type of life-threatening ventricular arrhythmias as well as type of therapy delivered. Of these, 41 (91%) had been recovered from cardiac arrest. Five (15%) of 33 patients in whom echocardiography was done had no left ventricular function. Antiarrhythmic therapy was delivered to 37 (80%) patients during postimplant follow-up. Thirty-one of 37 (84%) patients received both shock and antitachycardia pacing, five (13%) only antitachycardia pacing, and one (3%) patient only shock. Median time to first shock was 16 days, varying from 1 to 576 days. Ventricular fibrillation was the cause of first shock in 12 patients (32%), ventricular tachycardia in 11 (29%), and ventricular tachycardia not responding to antitachycardia pacing degenerating into ventricular fibrillation in nine (24%). Five patients with ventricular tachycardia were treated with antitachycardia pacing. Probability of freedom from device discharged was 47% at 90 days, 34% at 180 days, and 9% at 360 days in the postimplant follow-up. Thus, patients with chronic Chagas' heart disease recovered from cardiac arrest have a peculiar arrhythmogenic profile characterized by a high frequency of ventricular fibrillation and no left ventricular systolic dysfunction and a short period of time for first shock.
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Affiliation(s)
- Augusto Cardinalli-Neto
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, Sâo José do Rio Preto Medical School, São José do Rio Preto city, Brazil
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Braga JCV, Reis F, Aras R, Costa ND, Bastos C, Silva R, Soares A, Moura Júnior A, Asfora S, Latado AL. [Clinical and therapeutics aspects of heart failure due to Chagas disease]. Arq Bras Cardiol 2006; 86:297-302. [PMID: 16680295 DOI: 10.1590/s0066-782x2006000400010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Describe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS A prospective analysis of the patients treated between August 2003 and June 2004 at a HF referral outpatient clinic was conducted. RESULTS Three hundred and fifty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 +/- 4.1 vs. 5.7 +/- 4.2 years of study; p = 0.004), had a lower heart rate (69 +/- 12 vs. 73 +/- 13; p = 0.03) and a lower systolic blood pressure (121 +/- 25 vs. 129 +/- 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artificial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSION In this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients.
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de Oliveira-Marques DS, Bonametti AM, Matsuo T, Gregori Junior F. The epidemiologic profile and prevalence of cardiopathy in Trypanosoma cruzi infected blood donor candidates, Londrina, Paraná, Brazil. Rev Inst Med Trop Sao Paulo 2005; 47:321-6. [PMID: 16553321 DOI: 10.1590/s0036-46652005000600003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
To describe the epidemiologic profile and prevalence of cardiopathy in 163 Trypanosoma cruzi serum positive blood donor candidates, a descriptive study was carried out between August, 1996 and November, 1997 at the Londrina State University Chagas Disease Outpatient Clinic. The profile found was: young, average age 42.95 ± 8.62 years; male (65%); Caucasian (84%); low level of schooling; low family income; agricultural worker (26%); born in the state of Paraná (67%); from rural areas (85%); migrated to the city (85%); and the vector as the main mechanism of transmission. During the clinical characterization a chronic cardiac form was found in 38% of the patients and classified as cardiac suggestive form in 21% and little suggestive of Chagas disease in 17%. No significant difference was found among age group distribution, sex and the presence of cardiac symptoms in patients with or without cardiopathy. This study emphasizes the importance of expanding medical services to areas with a greater prevalence of infected individuals, in a hierarchical manner and aiming at decentralization.
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Pompilio MA, Dorval MEMC, Cunha RVD, Britto C, Borges-Pereira J. Aspectos epidemiológicos, clínicos e parasitológicos da doença de Chagas em Mato Grosso do Sul. Rev Soc Bras Med Trop 2005; 38:473-8. [PMID: 16410921 DOI: 10.1590/s0037-86822005000600005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Com o objetivo de avaliar aspectos epidemiológicos, clínicos e parasitológicos da doença de Chagas crônica, em pacientes do Hospital Universitário da Universidade Federal de Mato Grosso do Sul, realizamos um estudo seccional envolvendo 120 chagásicos e 120 controles não-chagásicos, de ambos os sexos, com idades de 16 a 82 anos. Os aspectos epidemiológicos foram avaliados por questionário, a cardiopatia por exame clínico, eletrocardiograma convencional, radiologia e ecodopplercardiograma e a presença de Trypanosoma cruzi no sangue por xenodiagnóstico e teste da reação em cadeia da polimerase. Os resultados mostraram predominância de alóctones com baixa escolaridade e referência de contato prévio com triatomíneos entre os chagásicos. Abortamento espontâneo foi mais freqüente nas mulheres chagásicas. A cardiopatia devido ao componente chagásico foi estimada em 20,2%. Apresentou-se com 7,5% de cardiomegalia, 6,2% de aneurisma de ventrículo esquerdo e com predominância de dispnéia, palpitações e hipertensão arterial. O xenodiagnóstico foi positivo em 26,1% dos chagásicos enquanto a PCR foi positiva em 53,7%. A análise dos resultados indicou que a doença de Chagas no grupo estudado apresenta características clínicas e parasitológicas que revelam peculiaridades regionais.
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Gomes JAS, Bahia-Oliveira LMG, Rocha MOC, Busek SCU, Teixeira MM, Silva JS, Correa-Oliveira R. Type 1 chemokine receptor expression in Chagas' disease correlates with morbidity in cardiac patients. Infect Immun 2005; 73:7960-6. [PMID: 16299288 PMCID: PMC1307097 DOI: 10.1128/iai.73.12.7960-7966.2005] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chemokines and chemokine receptors (CKRs) control the migration of leukocytes during the inflammatory process and are important immunological markers of type 1 (CCR5 and CXCR3) and type 2 (CCR3 and CCR4) responses. The coexpression of CKRs (CCR2, CCR3, CCR5, CXCR3, and CXCR4) and intracellular cytokines (interleukin-10 [IL-10], IL-4, tumor necrosis factor alpha [TNF-alpha], and gamma interferon [IFN-gamma]) on T CD4+ and CD8+ peripheral cells from individuals with indeterminate (IND) or cardiac (CARD) clinical forms of Chagas' disease after in vitro stimulation with Trypanosoma cruzi antigens, were evaluated in this study. The percentage of T CD4+ and CD8+ cells coexpressing CCR5 and IFN-gamma, CXCR3 and IFN-gamma, and CXCR3 and TNF-alpha were higher in CARD than in IND individuals; on the other hand, the percentage of T CD4+ or CD8+ cells coexpressing CCR3 and IL-10 or coexpressing CCR3 and IL-4 were lower in CARD individuals than in IND individuals. In addition, a significant positive correlation between the expression of CCR5 or CXCR3 and IFN-gamma was observed in CARD individuals contrasting with a significant positive correlation between the expression of CCR3 and IL-4 and of CCR3 and IL-10 in IND patients. These results reinforce the hypothesis that a T. cruzi-exacerbated specific type 1 immune response developed by CARD chagasic patients is associated with the development of heart pathology.
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Affiliation(s)
- Juliana A S Gomes
- Laboratório de Imunologia Celular e Molecular-Centro de Pesquisas René Rachou/FIOCRUZ, Av. Augusto de Lima 1715, 30190-002, Belo Horizonte, MG, Brazil
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Florián Sanz F, Gómez Navarro C, Castrillo García N, Pedrote Martínez A, Lage Gallé E. Miocardiopatía chagásica en España: un diagnóstico a tener en cuenta. ACTA ACUST UNITED AC 2005; 22:538-40. [PMID: 16454589 DOI: 10.4321/s0212-71992005001100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chagas' disease is an important public health problem in Latin America and one of the specific causes of dilated cardiomyopathy. Chronic chagasic cardiomyopathy is the worse result of this disease and its main cause of mortality. Rural migrations from endemic to nonendemic countries make possible observing affected patients in United States and Europe. We report the case of a patient with congestive heart failure who was diagnosed with chronic chagasic cardiomyopathy. This is the first case of chagasic dilated cardiomyopathy in Spain.
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Affiliation(s)
- F Florián Sanz
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla.
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Sierra-Johnson J, Olivera-Mar A, Monteón-Padilla VM, Reyes PA, Vallejo M. [Epidemiological and clinical outlook of chronic Chagas' heart disease in Mexico]. Rev Saude Publica 2005; 39:754-60. [PMID: 16254651 DOI: 10.1590/s0034-89102005000500009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare the epidemiological and clinical characteristics of chronic Chagas' heart disease to other dilated cardiomyopathies. METHODS A study comprising 128 patients from a heart disease center was carried out from 1993 to 2003. Of them, 51 (40%) were Trypasonoma cruzi positive. Epidemiological data was obtained through interviews and clinical and serological data from health services. Statistic analysis was conducted using the Chi-square, Fischer, Mann-Whitney or Students' t-test as well as multivariate analysis. RESULTS Chronic Chagas' disease patients were older (55+/-10 years old) than those patients with cardiopathy (42+/-17 years old). Most of them were born in rural areas (90% vs 68%), lived in poor (75% vs 16%), crowded households (45% vs 20%), together with domestic animals (71% vs 61%) and were aware of the Chagas' vector (73% vs 25%). Rhythm and conduction ECG abnormalities as well as permanent pacemaker were common among Chagas' patients (84% vs 55%, 78% vs 64% and 24% vs 10%, respectively). Congestive heart failure was more frequent among cardiomiopathy patients (88% vs 71%). Both groups had abnormal myocardial perfusion with normal epicardial arteries. Comorbidities were more frequent in cardiomiopathy patients than in chronic Chagas' disease patient (two cases only). CONCLUSIONS Chagas' disease is the most common cause of dilated cardiomiopathy in the study hospital. Due to its regional distribution in Mexico, it deserves special attention and control programs proven to be effective in other countries.
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Nunes MDCP, Barbosa MM, Rocha MOC. Peculiar Aspects of Cardiogenic Embolism in Patients with Chagas’ Cardiomyopathy: A Transthoracic and Transesophageal Echocardiographic Study. J Am Soc Echocardiogr 2005; 18:761-7. [PMID: 16003275 DOI: 10.1016/j.echo.2005.01.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to detect cardiac thrombi by transthoracic and transesophageal echocardiography in patients with Chagas' cardiomyopathy and to determine the relationship of these thrombi with left ventricular systolic function and with the presence of stroke. BACKGROUND Thromboembolic events are a serious complication of Chagas' cardiomyopathy. Because most data come from autopsy studies, the prevalence of cardiac thrombi for patients who are clinically stable is unknown. METHODS A total of 75 patients (52 men; mean age 48 +/- 13 years) with Chagas' cardiomyopathy were prospectively studied by transthoracic and transesophageal echocardiography and followed for 24 +/- 10 months. RESULTS In all, 14 patients (19%) had a history of stroke at the time of enrollment and two had this complication at follow-up. Most patients (88%) were in New York Heart Association (NYHA) functional classes I and II and 9 (12%) were in classes III and IV. Mean ejection fraction was 40 +/- 13%. A total of 17 patients (23%) had left ventricular thrombus on transthoracic echocardiography and this finding was associated with a history of stroke ( P = .01). Apical aneurysm occurred in 35 patients (47%) and it was associated both with thrombus and stroke ( P = .04). Strokes were more frequent ( P = .04) among patients with mild systolic dysfunction (57% of patients with strokes were in NYHA I). Four patients (5%) had thrombi at the left atrial appendage, and one (1%) at the right atrial appendage. A total of 13 patients (17%) died at follow-up. CONCLUSIONS Stroke was frequent in Chagas' cardiomyopathy and associated with mild systolic dysfunction and with intracardiac thrombi. These occurred mainly in the typical apical aneurysm of Chagas' disease.
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Affiliation(s)
- Maria do Carmo P Nunes
- Postgraduate Course of Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Dávila DF, Donis JH, Torres A, Ferrer JA. A modified and unifying neurogenic hypothesis can explain the natural history of chronic Chagas heart disease. Int J Cardiol 2004; 96:191-5. [PMID: 15262032 DOI: 10.1016/j.ijcard.2003.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2003] [Revised: 06/02/2003] [Accepted: 06/09/2003] [Indexed: 11/18/2022]
Abstract
The pathogenesis of chronic Chagas disease still is an unresolved and controversial issue. Parasite persistence and autoimmune responses cannot explain the spectrum of chronic Chagas disease. However, a modified neurogenic hypothesis, concerning the timing and mechanisms responsible for the cardiac parasympathetic damage and for the activation of the sympathetic nervous system and of other neurohormonal systems, unifies cardiac remodelling and neurohormonal activation to explain most of the events of the natural history of Chagas disease.
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Affiliation(s)
- Diego F Dávila
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Universidad de Los Andes, Apartado Postal 590, 5101 Mérida, Venezuela.
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Abstract
OBJECTIVES To conduct a study in a small rural hospital located in the state of Chiapas, Mexico, to: (1) examine the prevalence of chagasic cardiomyopathy among patients with the diagnosis of congestive heart failure and (2) assess the prevalence of positive serologic results in blood donors in the hospital, in an attempt to ascertain whether Chagas' disease remains an important cause of heart failure at least in some areas of Mexico. METHODS The study of patients with cardiomyopathy was conducted by retrospective chart review of patients with the diagnosis of congestive heart failure treated at the hospital during the years 2000-2002. With the blood donors, the results of their serologic screening were reviewed for a six-month period beginning in April 2002. Serologic testing was done in both groups with either indirect hemagglutination (IHA) or enzyme-linked immunosorbent assay (ELISA), or with both. RESULTS Of 67 patients with heart failure and no risk factors for other causes of heart failure, 40 of them had serologic tests performed. Thirty-three of these 40 (82.5%) were positive by ELISA, IHA, or both. With 97 blood donors, one or both serologic tests were positive in 17 of them (17.5%). CONCLUSIONS This research adds to the evidence that Chagas' disease continues to be a major cause of heart failure in some areas of Mexico and that there continues to be a risk of transmission by blood transfusion if donated blood is not consistently screened.
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Affiliation(s)
- Linnea Capps
- Columbia University College of Physicians and Surgeons/Harlem Hospital, Department of Internal Medicine, New York, New York, United States of America.
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