Estudo radiológico do megacólon em área endêmica de doença de Chagas

Introduction: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. Methods: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. Results: Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). Conclusions: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.

Section: Clinical Forms Of Chronic Chagas Diseasementioning

confidence: 99%

Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

Lidani

Sandri

Castillo-Neyra

et al. 2020

“…Also, among these individuals, 14 (6.2%) cases of megacolon or dolichomegacolon were diagnosed 8 . This higher prevalence of dolichocolon, in relation to megacolon or dolichomegacolon, provides a strong indication that lengthening precedes dilatation.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to visual analysis of the radiographs on an X-ray film viewer, the largest diameters of the rectum and sigmoid 8 and the length of the distal colon were measured. To make these measurements, preference was given to anteroposterior radiographs, whereas posteroanterior views were only used when no measurement could be obtained using the anteroposterior view.…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…Dos indivíduos com cólon distal ≥70cm, os 31 chagásicos tiveram comprimento médio de 77,9 (±7,1)cm, enquanto nos três não chagásicos foi de 71,3 (±1,1)cm, (p=0,000). Nos 179 com cólon distal <70cm, os soropositivos tiveram em média 53,6 (±8, 8)cm, e os soronegativos 51,2 (±7,8)cm, (p=0,059). Dentre os com sorologia positiva, as mulheres apresentaram cólon distal maior que os homens (p=0,02), enquanto naqueles com sorologia negativa o comprimento médio foi igual (p=0,16 …”

Section: Introductionunclassified

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Occurrence of dolichocolon without megacolon in chronic Chagas disease patients

Castro

Hernandez²,

Rezende

et al. 2012

Self Cite

Introduction: Since 1970, lengthening of the rectosigmoid has been suspected to be a solitary manifestation of Chagas colopathy. Methods: To test this hypothesis, opaque enema was administered on 210 seropositive and 63 seronegative patients, and radiographs in the anteroposterior and posteroanterior positions were examined blind to the serological and clinical findings. The distal colon was measured using a flexible ruler along the central axis of the image from the anus to the iliac crest. Results: Dolichocolon was diagnosed in 31 (14.8%) seropositive and 3 (4.8%) seronegative patients. The mean length was 57.2 (±12.2)cm in seropositive patients and 52.1 (±8.8)cm in the seronegative patients (p = 0.000), that is, the distal colon in Chagas patients was, on average, 5.1cm longer. Seropositive female patients presented a mean length of 58.8 (±12.3)cm, and seronegative female patients presented 53.2 (±9.1)cm (p = 0.002). Seropositive male patients had a mean length of 55 (±11.6)cm, and seronegative male patients had 49.9 (±7.8)cm (p = 0.02). Among 191 patients without megacolon and suspected megacolon, the mean length was 56.3 (±11.6)cm in seropositive individuals and 52 (±8.8)cm in seronegative patients (p = 0.003). Among individuals with distal colon ≥70cm, there were 31 Chagas patients with mean length of 77.9 (±7.1)cm and three seronegative with 71.3 (±1.1)cm (p = 0.000). Among 179 with distal colon <70cm, seropositive individuals had a mean length of 53.6 (±8.8)cm, and seronegative patients had 51.2 (±7.8)cm (p = 0.059). Serological positive women had longer distal colon than men (p = 0.02), whereas the mean length were the same among seronegative individuals (p = 0.16). Conclusions: In endemic areas of Brazil Central, solitary dolichocolon is a radiological Chagas disease signal. Keywords: Dolichocolon. Solitary dolichocolon. Chagas disease. Lengthening of the sigmoid. Length of the sigmoid.

“…Radiological analysis of colonic segments is difficult because of diversity in measurement methods 11,12 , and no standards exist to describe normal or abnormal colopathy. Therefore, to examine variations, it is necessary to compare normal colons to those of patients with HCd.…”

mentioning

confidence: 99%

Length and caliber of the rectosigmoid colon among patients with Chagas disease and controls from areas at different altitudes

Lopes

Ferreira-Silva

A³

et al. 2013

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Introduction:In this study, we investigated radiological changes in the sigmoid colon in chagasic patients by comparing their colon lengths and caliber with those of non-chagasic living in the same region and non-chagasic living at high altitudes. Methods: A total of 317 individuals were evaluated using clinical, serological and radiological methods and divided into three groups: 1) one hundred and nine non-chagasic individuals from Uberaba, Brazil; 2) sixty-one non-chagasic from Puno, Peru; 3) one hundred forty-seven chagasics examined in Uberaba, being 62 without megacolon (3A), 72 with megacolon (3B) and 13 with doubtful diagnosis of megacolon (3C). Results: In group 2, the sigmoid colon had a signifi cantly larger caliber (p=0.001) and the rectosigmoid colon was longer (p<0.001) than group 1. In subgroup 3A, the sigmoid colon (p<0.001) and rectum (p<0.001) had a signifi cantly larger caliber and the rectosigmoid was longer (p<0.001) than that of the non-chagasic individuals. In subgroup 3B, the rectosigmoid was longer in all patients, and the caliber of the sigmoid was signifi cantly larger than that of subjects in subgroups 3A and 3C (p<0.001). Conclusions: Morphometric analysis confi rms that Chagas disease may increase the caliber and length of the rectosigmoid. Our results suggest that altitude, ethnicity and diet may have infl uenced the size and length of the rectosigmoid of andean patients.