Orally-transmitted acute Chagas disease (CD) is emerging as an important public health problem. The prognosis of acute infection following oral transmission is unknown. The aim of this paper was to analyze and summarize data on orally-transmitted acute CD. We searched for studies from 1968 to January 31, 2018. We included studies and unpublished data from government sources that reported patients with acute CD orally-transmitted. We identified 41 papers and we added 932 unpublished cases. In all, our study covered 2470 cases and occurrence of 97 deaths. Our meta-analysis estimated that the case-fatality rate was 1.0% (95% CI 0.0 – 4.0%). Lethality rates have been declined over time (p = 0.02). In conclusion, orally-transmitted acute CD has considerable lethality in the first year after infection. The lethality in symptomatic cases is similar to that from other routes of infection. The lethality rate of orally-acquired disease have declined over the years.
Protozoan diseases such as Visceral Leishmaniasis (VL) have re-emerged in Northern Brazil and cases of Chagas Disease also occur. This VL increase leads to early therapy for the public. Confirmatory parasitological diagnoses in VL are performed by bone marrow or spleen aspiration, but ELISA, IFA or immunochromatographic tests for antibody detection are easily performed and can be used in the presence of clinical signs as confirmatory for specific therapy. This approach is successful in providing therapy and prevention of death in VL, but there is a chance of confusion with the emerging disease, Chagas Disease (CD), due to cross-reacting and similar clinical pictures, as in this case. Both VL and CD presented many asymptomatic or oligosymptomatic cases, complicating the picture. Our case report emphasizes these aspects. Positive serology, with an IIF titer of 1/160, and epidemiological correlation, suggests the diagnosis of VL and imposes antimony therapy. Despite the unfavorable evolution and signs of cardiac involvement, the presence of pericarditis and cardiac tamponade confirmed by the echocardiogram suggests CD. We reassessed the profiles of a suggested CD serology, the diagnosis was corrected and treatment with CD specific benznidazole. The good evolution started with benznidazole corroborates the diagnosis of CD and discards the hypothesis of double infection.
A avaliação do comprometimento cardíaco inicia-se no exame clínico completo.Investigam-se sinais e sintomas de insuficiência ventricular, taquiarritmias, bradiarritmias ou fenômenos tromboembólicos.A solicitação de exames complementares, incluindo eletrocardiograma convencional de 12 derivações (ECG) e radiografia do tórax em PA e perfil, deve ser feita em todos os casos.As técnicas não-invasivas de propedêutica cardiovascular revestem-se de grande importância na avaliação clínica, evolutiva, terapêutica, médico-trabalhista e prognóstica dos pacientes chagásicos, tornando sua utilização mais freqüente uma necessidade concreta, quando se pretende aferir adequadamente um número significativo de cardiopatas chagásicos, com suspeita de comprometimento funcional (Rocha et al., 1997).Esses relatos, aliados a fatores como: presença de triatomíneos na área urbana de Araguaína -TO; ausência de estudos epidemiológicos e levantamento do panorama atual dos pacientes chagásicos, evidenciam a necessidade de traçar um perfil da Doença de Chagas no Estado, dado o grande impacto social, médico e trabalhista causado pela forma crônica da doença, até então classificada como negligenciável.
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