Indeterminate form of Chagas disease

Macêdo, Vanize

doi:10.1590/s0074-02761999000700059

Cited by 29 publications

(30 citation statements)

References 11 publications

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“…Thus most patients with indeterminate infections are 20 to 50 years of age, comprising approximately 12 million people with positive immunologic tests for the parasite. Their life span is similar to that observed for the general population (Macedo 1999). Usually indeterminate phase individuals are identified as such during job application or blood bank screening.…”

Section: Indeterminate Phasesupporting

confidence: 58%

“…A clinical study aimed at the evaluation of autonomic function in chagasic patients showed esophageal alterations usually occurred earlier in the course of the chronic infections when compared to similar abnormalities in the heart (reviewed in Macedo 1999). A digestive disease patient may complain of difficulty swallowing and regurgitation of food, clinical symptoms related to megaesophagous.…”

Section: Digestive Form Of Chagas Diseasementioning

confidence: 99%

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Evolution and pathology in Chagas disease: a review

Teixeira

Nascimento

Sturm³

2006

Mem. Inst. Oswaldo Cruz

191

192

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Section: Indeterminate Phasesupporting

confidence: 58%

Section: Digestive Form Of Chagas Diseasementioning

confidence: 99%

Evolution and pathology in Chagas disease: a review

Teixeira

Nascimento

Sturm³

2006

Mem. Inst. Oswaldo Cruz

191

192

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“…Although the incidence of new cases of Chagas' disease has fallen close to zero after the successful control of the vector transmission (Schofield and Dias, 1998), it remains a large group of chronically infected individuals, the majority in the indeterminate form of the disease, which is emerging as one of the great focuses of interest (Oliveira et al, 1986;Dias, 1989;Ribeiro and Rocha, 1998;Macêdo, 1999). This form ever shows intriguing pathological, functional, clinical, and epidemiological aspects, incorporating several unsolved or controversial questions, one of which is concerned with the cardiac sinus node autonomic modulation.…”

Section: Discussionmentioning

confidence: 99%

“…It is defined by the lack of overt expression of organ involvement traduced by the absence of clinical manifestations, a normal conventional electrocardiogram and radiological exploration of the heart and the upper and lower digestive tract, in the presence of positive serological reaction for the infection (Dias, 1989;Macêdo, 1999). The forms with overt organ damage, which develops up to 30 years after the acute phase of infection affecting 2-3 million people (WHO, 1991;Macêdo, 1999), are characterized by peculiar clinical, electrocardiographic, echocar-diographic, and/or radiological evidences of cardiac or digestive involvement in the presence of positive serology. It is estimated that 2 -5% of cases with indeterminate form evolve toward the overt organic forms each year (Dias, 1989).…”

Section: Introductionmentioning

confidence: 99%

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Soares

2002

Autonomic Neuroscience

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Background: In the apparent indeterminate form of Chagas' disease, which lacks any overt clinical, electrocardiographic, and radiological manifestations of organ damage, lesions of the intrinsic autonomic innervation of heart are not striking features and evidences for cardiac autonomic dysfunction are elusive and conflicting. Objective: To evaluate the cardiac autonomic modulation based on Valsalva manoeuvreassociated heart interval variation in Chagas' disease subjects with apparent indeterminate form. Subjects and methods: We examined 36 outpatient volunteers aged 15 -51 years old (median: 36.5), in comparison with 52 healthy control individuals aged 17 -49 years old (median: 29) ( p < 0.001). Each subject sequentially performed in the supine position three to four manoeuvres at an intra-oral pressure of 40 mm Hg during 20 s, under continuous DII lead electrocardiographic registration, and rate-and time-dependent indices of Valsalva manoeuvre-associated R -R interval variation were obtained. The t-test or the Mann -Whitney test was employed to compare the data between the groups. Results: No correlation was found between every index and age for the control group ( p = 0.39 -0.71). The chagasic group presented similar basal to phase IV median increment (relative bradycardia) (23.7% vs. 22.7%; p = 0.63) and smaller basal to phase III median decrement of R -R interval (relative tachycardia) ( À 31.7% vs. À 35%; p = 0.02) in comparison to the control group, respectively. The median Valsalva ratio showed a tendency for reduction in chagasics (1.78 vs. 1.90; p = 0.08). Prolonged median time (14.2 vs. 10.3 s; p < 0.001) and slowed median velocity (5.1%/s vs. 8.9%/s; p < 0.001) of the phases III -IV bradycardia were also observed in chagasic group. The majority (58.3%) of the chagasics presented exclusively at least one depressed, and 8.3% presented at least one enhanced index of rateand/or time-dependent heart interval responses beyond the 25th or 75th control percentiles, and 27.8% presented at least one depressed and other enhanced index, while 5.6% showed all indices within the control interquartile range. All the indices outside the 25th or 75th control percentiles were noted in 13.9% of chagasics. Conclusion: Chagas' disease subjects without overt manifestations presented variable and subtle depression and less frequent enhancement or normality of the rate-and time-dependent tachycardia and bradycardia reflex responses related to Valsalva manoeuvre, which demonstrates distinct patterns of finely disturbed cardiac sinus parasympathetic and sympathetic modulation, probably due to inflammatory or autoimmunological damage of intrinsic innervation and/or to autoantibodies-induced derangement in neurotransmitter receptors. D

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“…Approximately 60-70% of individuals will never develop apparent disease and are characterized as indeterminate; these patients present positive serologic reactivity for T. cruzi, which can sometimes be identified by hemoculture, xenodiagnoses, and polymerase chain reaction (PCR) [4][5][6][7] . Patients within this clinical form present normal 12-lead electrocardiogram (ECG) results, as well as normal radiological examinations of the chest, esophagus, and colon [8][9][10][11] . Moreover, 10-30 years after initial infection, some patients may develop the cardiac, digestive, and/or cardiodigestive clinical forms 12 .…”

Section: Introductionmentioning

confidence: 99%

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Volpato

Sousa

D’Ávila

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Introduction:In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. Methods: Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T. cruzi isolates were genotyped using three different genetic markers. Results: Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T. cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. Conclusions: Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.

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Indeterminate form of Chagas disease

Cited by 29 publications

References 11 publications

Evolution and pathology in Chagas disease: a review

Evolution and pathology in Chagas disease: a review

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

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