Pathogenesis and immunopathology of chronic Chagas' disease

Brener, Z.

doi:10.1590/s0074-02761987000500004

Cited by 42 publications

(24 citation statements)

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“…This denervation affects these organs' functions, and especially those of the esophagus and sigmoid colon, which require coordination to propel their contents through their distal sphincters. The climax of megaesophagus and megacolon is the decompensated stage of the disease (35) , which can be triggered by various parasite strains (36) or a cross-reaction between T. cruzi antigens and the host tissues (37) .…”

Section: Discussionmentioning

confidence: 99%

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Andrade

Câmara

Nunes

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Section: Discussionmentioning

confidence: 99%

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Andrade

Câmara

Nunes

et al. 2015

Rev. Soc. Bras. Med. Trop.

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“…26 The fact that autoimmune responses in patients with chronic disease have been detected as crossreactivity between T. cruzi antigens and host tissues 12 or T. cruzi anti-idiotypic interactions 27 has led several investigators to state that the autoimmune phenomenon occurs in the absence of the parasite, questioning the direct role of T. cruzi in the production of late cardiac injury. 12 However, other investigators have confirmed the presence of a portion of the parasite genome or T. cruzi amastigotes in the myocardium of autopsied patients with chronic disease using the PAP and PCR techniques, respectively. 11,28 This persistence appears to be the reason for the infrequent detection of parasitemia in cases with chronic disease when methods such as xenodiagnosis and/or hemoculture are used.…”

Section: Discussionmentioning

confidence: 99%

“…11 The use of these modern approaches in the detection of T. cruzi has made it easier to detect lesion-associated parasite persistence in chronic chagasic patients, which is demonstrable only in 30% of the cases by routine microscopic analysis. 12,13 The present paper deals with the persistence of T. cruzi in the myocardium of chronic chagasic patients using routine methodology, as well as endomyocardial biopsies (EMBs) performed on 18 untreated patients and on 10 patients at different times after treatment, using histopathologic, immunohistochemical (peroxidase-anti-peroxidase [PAP]), and molecular (polymerase chain reaction [PCR]) techniques.…”

mentioning

confidence: 99%

Myocardial parasite persistence in chronic chagasic patients.

Áñez¹,

Carrasco²,

Parada³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

132

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Abstract. The persistence of Trypanosoma cruzi tissue forms was detected in the myocardium of seropositive individuals clinically diagnosed as chronic chagasic patients following endomyocardial biopsies (EMBs) processed by immunohistochemical (peroxidase-anti-peroxidase [PAP] staining) and molecular (polymerase chain reaction [PCR]) techniques. An indirect immunofluorescent technique revealed antigenic deposits in the cardiac tissue in 24 (88.9%) of 27 patients. Persistent T. cruzi amastigotes were detected by PAP staining in the myocardium of 22 (84.6%) of 26 patients. This finding was confirmed with a PCR assay specific for T. cruzi in 21 (91.3%) of 23 biopsy specimens from the same patients. Statistical analysis revealed substantial agreement between PCR and PAP techniques (k ϭ 0.68) and the PCR and any serologic test (k ϭ 0.77). The histopathologic study of EMB specimens from these patients revealed necrosis, inflammatory infiltrates, and fibrosis, and made it possible to detect heart abnormalities not detected by electrocardiogram and/or cineventriculogram. These indications of myocarditis were supported by the detection of T. cruzi amastigotes by the PAP technique or its genome by PCR. They suggest that although the number of parasites is low in patients with chronic Chagas' disease, their potential for heart damage may be comparable with those present during the acute phase. The urgent necessity for testing new drugs with long-term effects on T. cruzi is discussed in the context of the present results.

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“…[3][4][5][6] The pathogenesis of chagasic megaesophagus may be related to host characteristics as well as to different strains of the parasite Trypanosoma cruzi. 7 One of the most important factors that determines both symptoms and complications of this clinical form is the denervation of the smooth muscle of the esophagus 8,9 causing several morphological and motor changes, according to which megaesophagi are classified by Grades I-IV. 10 Until a short time ago, microscopic techniques were unable to disclose parasites in the affected tissues, leading many authors to invoke autoimmune mechanisms as responsible for the cellular lesions.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Trypanosoma cruzi and human chagasic megaesophagus: blood and tissue parasitism.

Lages‐Silva

Crema²,

Ramı́rez³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. The persistence of Trypanosoma cruzi in tissue and blood of 52 patients in the digestive form of chronic Chagas disease was studied. These patients had chagasic megaesophagus and underwent corrective surgery. Parasitologic (xenodiagnosis, hemoculture, or both), histopathologic (hematoxylin and eosin, and peroxidase-anti-peroxidase staining), and molecular (polymerase chain reaction [PCR] followed by slot-blot hybridization) tests were used in the analysis. The presence of T. cruzi, its genomic fragments, or its antigens could be detected in 98% (51 of 52) of the patients. The parasite was randomly identified in 76.9% of esophageal tissues and in 90.4% by PCR and in 73.1% by parasitologic methods from the blood. Fifty percent (26 of 52) of tissue samples had inflammation, 80.8% of which was associated with the parasite. Trypanosoma cruzi was also identified unassociated with inflammatory alterations. Higher tissue parasitism and intense inflammatory processes were observed in esophageal tissue from patients with Grade IV megaesophagus. These data demonstrate that in the digestive form of Chagas' disease, particularly in cases of megaesophagus, T. cruzi is frequently found, both in blood and tissues and may contribute to the pathogenic mechanisms involved.

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Pathogenesis and immunopathology of chronic Chagas' disease

Cited by 42 publications

References 0 publications

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Myocardial parasite persistence in chronic chagasic patients.

Relationship between Trypanosoma cruzi and human chagasic megaesophagus: blood and tissue parasitism.

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