Autochthonous acute Chagas’ disease in São Paulo State, Brazil: Epidemiological aspects

Abstract

Since the beginning of the seventies the natural transmission of Chagas' infection has been considered to be under control in the State of São Paulo and not even a case of American Trypanosomiasis, transmitted by triatomine bugs, has been detected by the epidemiological surveillance system. This situation justifies the report of a case of acute Chagas' disease that occurred in a forest area considered free of domiciliary triatomines along the Southern seacoast of São Paulo State. In May, 1995 the presence of trypomastigote forms of Trypanosoma cruzi had been diagnosed in a retired 57 year-old male patient, born and living in Santos (São Paulo State), complaining of fever, fatigue and malaise. The patient reported that 40 days before he had participated with 17 friends in a 7-day excursion in a forest area of the municipalities of Itanhaém and Peruíbe. During this period the group had been lodged in three houses located within the forest. Eight days after the end of the excursion the patient began to have fever, malaise and fatigue. During the next 31 days he had received medical care both as an inpatient and an outpatient, without any significant improvement. After the detection of T. cruzi trypomastigotes in his blood stream the patient began to be treated with benzonidazole in a hospital but died 8 days after the beginning of treatment. The epidemiological investigation carried out showed no signs of the presence of triatomine bugs in the three houses where the group had been lodged, or any indication of Chagas' infection in other excursionists.

Soroepidemiologia da tripanosomíase americana na região do litoral sul, São Paulo

“…Ciaravolo et al 4 descreveram um caso agudo de doença de Chagas, em paciente que foi a óbito em 1995, que relatara excursão em ambiente silvestre localizado entre os municípios de Itanhaém e Peruíbe. Forattini et al…”

Chagas' heart disease

“…On the basis of such figures, interruption of transmission is expected to occur between 1998 and 2000 in Brazil, Argentina, Chile and Uruguay 5,18 . However, it may be too early for such high expectations, as suggested by sporadic reports of transmission of the disease in areas previously consi-dered under epidemiological control 19 .…”

Programa de Controle da Doença de Chagas no estado de São Paulo, Brasil: o controle e a vigilância da transmissão vetorial

“…No atual contexto do controle da transmissão da doença de Chagas, no Estado de São Paulo, a detecção da forma aguda da doença deve tornar-se cada vez mais rara, e o mecanismo de transmissão deve ser exaustivamente investigado, como aconteceu com o caso confirmado na Baixada Santista em 1995, em que o paciente foi a óbito, com história de excursão em ambiente silvestre localizado entre os municípios de Itanhaém e Peruíbe, região de Mata Atlântica, no Vale do Ribeira, com pernoite em domicílios livres da presença de triatomíneos 23 e o recente caso de óbito em criança que teve a doença confirmada por necropsia no município de Itaporanga, Região de Botucatu, em cuja residência não foi constatada a presença de foco de triatomíneos 24 .…”