The expression of immune response appears to be associated with morbidity in Chagas disease. However, the studies in this field have usually employed small samples of patients and statistical analyses that do not consider the wide dispersion of cytokine production observed in these patients. The aim of this study was to evaluate the plasma cytokine levels in well-defined clinical polar groups of chagasic patients divided into categories that better reflect the wide cytokine profile and its relationship with morbidity. Patients infected with Trypanosoma cruzi (T. cruzi) were grouped as indeterminate (IND) and cardiac (CARD) forms ranging from 23 to 69 years of age (mean of 45.6±11.25). The IND group included 82 individuals, ranging from 24 to 66 years of age (mean of 39.6±10.3). The CARD group included 94 patients ranging from 23 to 69 years of age (mean of 48±12.52) presenting dilated cardiomyopathy. None of the patients have undergone chemotherapeutic treatment, nor had been previously treated for T. cruzi infection. Healthy non-chagasic individuals, ranging from 29 to 55 years of age (mean of 42.6±8.8) were included as a control group (NI). IND patients have a higher intensity of interleukin 10 (IL-10) expression when compared with individuals in the other groups. By contrast, inflammatory cytokine expression, such as interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and interleukin 1 beta (IL-1β), proved to be the highest in the CARD group. Correlation analysis showed that higher IL-10 expression was associated with better cardiac function, as determined by left ventricular ejection fraction and left ventricular diastolic diameter values. Altogether, these findings reinforce the concept that a fine balance between regulatory and inflammatory cytokines represents a key element in the establishment of distinct forms of chronic Chagas disease.

This study was designed to determine whether the functional IL-10 gene polymorphism -1082G/A is associated with the development of cardiomyopathy in individuals infected with Trypanosoma cruzi and whether interleukin (IL)-10 expression can be correlated with patients' cardiac function. Our results demonstrated that the polymorphic allele, which correlates with lower expression of IL-10, was associated with the development of Chagas disease cardiomyopathy. Accordingly, correlative analysis showed that low IL-10 expression was associated with worse cardiac function, as determined by left-ventricular ejection fraction values. Therefore, the IL-10 gene polymorphism and IL-10 expression are important in determining susceptibility to chagasic cardiomyopathy.

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Two functionally distinct antibodies, categorized as conventional serology antibodies (CSA) and lytic antibodies (LA) have been described in Chagas' disease, based on their ability to bind to fixed epimastigotes (EPI) or live trypomastigotes (TRYPO), respectively. In this study, the profile of immunoglobulin G (IgG) subclasses of CSA and LA were analyzed by flow cytometry using serum samples from chronic chagasic patients with the indeterminate (

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CD4؊ CD8 ؊ (double- negative

INTRODUCTION: Chagas disease (ChD) is a chronic illness related to significant morbidity and mortality that can affect the quality of life (QoL) of infected patients. However, there are few studies regarding QoL in ChD. The objectives of this study are to construct a health-related QoL (HRQoL) profile of ChD patients and compare this with a non-ChD (NChD) group to identify factors associated with the worst HRQoL scores in ChD patients. METHODS: HRQoL was investigated in 125 patients with ChD and 21 NChD individuals using the Medical Outcomes Study 36-item Short-Form (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). Patients were submitted to a standard protocol that included clinical examination, ECG, Holter monitoring, Doppler echocardiogram and autonomic function tests. RESULTS: HRQoL scores were significantly worse among the ChD group compared to the NChD group in the SF-36 domains of physical functioning and role-emotional and in the MLWHFQ scale. For the ChD group, univariate analysis showed that HRQoL score quartiles were associated with level of education, sex, marital status, use of medication, functional classification and cardiovascular and gastrointestinal symptoms. In the multivariate analysis, female sex, fewer years of education, single status, worst functional classification, presence of cardiovascular and gastrointestinal symptoms, associated illnesses, Doppler echocardiographic abnormalities and ventricular arrhythmia detected during Holter monitoring were predictors of lower HRQoL scores. CONCLUSIONS: ChD patients showed worse HRQoL scores compared to NChD. For the ChD group, sociodemographic and clinical variables were associated with worst scores.

RESUMO -Durante período de 20 anos , 56 pacientes com diagnóstico de mielorradiculopatia esquistossomótica foram internados em três hospitais de Belo Horizonte Minas Gerais. Dados de cada paciente foram coletados retrospectivamente de seus prontuários. Em todos os casos, o diagnóstico foi presumido e baseou-se nos seguintes critérios: 1) quadro de comprometimento medular torácico baixo ou lombossacro (síndrome de cone medular e/ou cauda equina); 2) epidemiologia positiva para esquistossomose; 3) comprovação laboratorial de esquistossomose através de exame parasitológico de fezes ou biópsia retal; e 4) exclusão de outras patologias que pudessem causar quadro semelhante. Vários aspectos clínicos e epidemiológicos foram estudados para determinar o perfil diagnóstico da mielorradiculopatia esquistossomótica nesta amostra e são apresentados neste artigo. Reconhecendo os vários problemas no diagnóstico da mielorradiculopatia esquistossomótica, enfatizamos a importância de se pensar nesta entidade e sugerimos critérios para definição diagnóstica.PALAVRAS-CHAVE: esquistossomose mansoni, radiculopatia, mielite. Clinical profile and criteria for the diagnosis of schistosomotic myeloradiculopathyABSTRACT -During 20 year period 56 patients with a diagnosis of schistosomotic myeloradiculopathy were admitted in three hospitals of Belo Horizonte -Minas Gerais. Data from pacients were collected retrospectively from their medical records. In all cases, the diagnosis was inferred in a presumably way and was based on the following considerations: 1) the finding of low thoracic/upper lumbar neurological symptoms; 2) positive epidemiology for schistosomiasis; 3) demonstration of exposure to schistosomiasis through parasitologic or serologic techniques; and 4) the exclusion of other known causes of transverse myelitis and myeloradiculitis. Several clinical and epidemiological aspects were studied to determine the diagnosis profiles of the schistosomotic myeloradiculopathy in this sample and are presented in this paper. In recognizing the many problems in diagnosis of schistosomotic myeloradiculopathy we emphasize how important is thinking about this entity and criteria to improve diagnostic evaluation are suggested. O comprometimento do sistema nervoso no curso da esquistossomose mansoni vem ganhando, paulatinamente, importância cada vez maior na literatura especializada. As dificuldades no seu reconhecimento provavelmente limitam seu diagnóstico. Com relação ao sistema nervoso, não se conhece a frequência do seu envolvimento. Scrimgeour & Gajdusek (1981) relatam que, na Tanzânia, a esquistossomose foi responsável por 1% dos casos de paraplegia não traumática e que, em 5% de outros casos, estabeleceu-se o seu diagnóstico presuntivo 4 . A neuroesquistossomose pode resultar numa grande variedade de complicações. Seu diagnóstico é difí-