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Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

This study was carried out to identify patients with Chagas’ disease at risk of sudden cardiac death, inasmuch as such patients have not been recognized thus far. Seventy-four consecutive patients with a positive complement fixation test for Chagas’ disease prospectively followed up at the Cardiomyopathy Clinic from January 1990 to June 1993 were entered into the study. Patients underwent medical history, physical examination, serological tests, resting electrocardiography, chest X-ray and two-dimensional echocardiography. Eighteen of 74 (24%) patients died during the study period, 8 (10%) suddenly and 10 (14%) from pump failure. Sudden death comprised 44% of total deaths. In the univariate model, cardiomegaly in the chest X-ray, left ventricular systolic and diastolic dimension, left ventricular ejection fraction, left atrial dimension and apical aneurysm as detected echocardiographically, and systolic blood pressure were associated with sudden cardiac death. In the multivariate model, however, apical aneurysm and left ventricular diastolic dimension were retained as predictors of sudden cardiac death. We conclude that chagasic patients with apical aneurysm and left ventricular dilation are at risk of sudden cardiac death.

This study examined the T cell responses in the early phase of Leishmania braziliensis infection. Cytokine profiles, lymphoproliferative responses, and skin test results in 25 patients with early cutaneous leishmaniasis (ECL; illness duration <60 days) were compared with those in persons with late cutaneous leishmaniasis (LCL; illness duration >2 months). Absent or low lymphoproliferative responses were observed in 8 (32%) of 25 patients and an absence of interferon (IFN)-gamma production in 9 (41%) of 22 patients prior to therapy. IFN-gamma production in ECL (mean +/- SD) was lower than in LCL (293+/-346 vs. 747+/-377 pg/mL, respectively; P<.01). In contrast, interleukin (IL)-10 production in ECL (mean +/- SD) was higher than in LCL (246+/-56 vs. 50+/-41 pg/mL, respectively; P<.01). Restoration of lymphoproliferative responses and IFN-gamma production was achieved when monoclonal antibody to IL-10 or IL-12 was added to the cultures. These results show that T cell responses during early-phase infection are down-regulated by IL-10 and may facilitate parasite multiplication.

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