Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological study

Parada, Henry; Carrasco, Hugo; Áñez, Néstor; Fuenmayor, Carmen; Inglessis, Ignacio

doi:10.1016/s0167-5273(97)02952-5

Cited by 135 publications

(112 citation statements)

References 9 publications

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“…A pesquisa de IgM e IgG foi essencial para o diagnóstico em casos de doença prolongada (diagnóstico finalizado com retardo de 32 dias em média), nos quais o diagnóstico foi muito retardado e os exames parasitológicos diretos se encontravam negativos. Em estudo feito em 59 casos agudos de doença de Chagas na Venezuela, foram encontrados percentuais de positividade de 34%, 61% e 53%, para gota espessa, xenodiagnóstico e hemocultura, respectivamente 31 . Isso demonstra a comparabilidade dos resultados de testes diagnósticos em doença de Chagas aguda, muito próxima aos casos ora descritos.…”

Section: Discussionunclassified

“…Em análise de casuísticas de doença de Chagas do Brasil e na Argentina, Dias 16 verificou a variação com que esses sinais estavam presentes, demonstrando percentuais de freqüência variáveis entre 12,5 e 95,5. Em estudo mais recente, em área endêmica na Venezuela, na cidade de Barinas, os autores também encontraram sinais de porta de entrada evidentes em 45,8% (27/59) e um chagoma de inoculação 31 . A despeito das descrições de área endêmica serem bastante variáveis, elas revelam a importância dos sinais de porta de entrada em algumas áreas e sua pouca importância em outras, mesmo naquelas de transmissão vetorial evidente.…”

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Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005

Pinto

Valente

et al. 2008

Rev. Soc. Bras. Med. Trop.

169

110

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Foram estudados 233 casos de fase aguda da doença de Chagas, oriundos do Pará, Amapá e Maranhão, observados no período de 1988 a 2005, cento e sessenta deles retrospectivamente de 1988 a 2002 e setenta e três prospectivamente de 2003 a 2005. Entre os casos estudados 78,5% (183/233) faziam parte de surtos provavelmente por transmissão oral, acometendo em média 4 pessoas e 21,5% (50/233) eram casos isolados. Foram considerados casos agudos aqueles que apresentaram exames parasitológicos diretos (a fresco, gota espessa ou Quantitative Buffy Coat - QBC) e/ou IgM anti-Trypanosoma cruzi positivos. Foram feitos ainda xenodiagnósticos em 224 pacientes e hemoculturas em 213. Todos foram avaliados clinica e epidemiologicamente. As manifestações clínicas mais freqüentes foram febre (100%), cefaléia (92,3%), mialgia (84,1%), palidez (67%), dispnéia (58,4%), edema de membros inferiores (57,9%), edema de face (57,5%) dor abdominal (44,2%), miocardite (39,9%) e exantema (27%). O eletrocardiograma mostrou alterações de repolarização ventricular em 38,5% dos casos, baixa voltagem de QRS em 15,4% e desvio de SAQRS em 11,5%, extra-sístoles ventriculares em 5,8%, bradicardia em 5,8% e taquicardia em 5,8%, bloqueio de ramo direito em 4,8% e fibrilação atrial em 4,8%. A alteração mais freqüente vista no ecocardiograma foi o derrame pericárdico em 46,2% dos casos. Treze (5,6%) pacientes evoluíram para o óbito, 10 (76,9%) dos quais por comprometimento cardiovascular, dois por complicações de origem digestiva e um de causa mal definida.

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Section: Discussionunclassified

Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005

Pinto

Valente

et al. 2008

Rev. Soc. Bras. Med. Trop.

169

110

View full text Add to dashboard Cite

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“…Several observational studies mainly conducted in endemic areas in Brazil, Argentina and Venezuela, since the early 1940s disclosed the natural history of Chagas' heart disease 7,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] .…”

Section: Natural History and Prognostic Factorsmentioning

confidence: 99%

Chagas' heart disease

Marin-Neto¹,

Simões²,

Sarabanda³

1999

Arq. Bras. Cardiol.

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“…These observations need to be considered vis a vis reported success in the nitroderivative treatment of Chagas patients [7][8][9][10][11]19,20 . Furthermore, reported success in treatment of T. cruzi infection should be analysed with further caution, because progression of heart lesions in treated patients has been reported on three different occasions 3,29,36 . In two series, the ECG recordings in acutely infected and treated, and in placebo patients were not statistically different, 3 to 4 years after chemotherapy 2,40 .…”

Section: Nitroderivatives Used For Treatment Of Chagas Diseasementioning

confidence: 99%

The treatment of Chagas disease patients with nitroderivative is unsatisfactory

2001

Rev. Inst. Med. trop. S. Paulo

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Re: "Persistent infections in chronic Chagas' disease patients treated with anti-Trypanosoma cruzi nitroderivatives" "Then I would still have this consolation -my joy in unrelenting pain -that I had not denied the words" … Brasília, March 3, 2001Sir,We are honoured to respond to the "Letter to the Editor", which was signed and forwarded for publication in the current issue of this journal by J. Romeu Cançado. First of all, we would like to praise him for the keen interest to open this important subject for discussion, thus recognizing that the treatment of Chagas disease patients with nitroderivatives is as yet unresolved for many physicians assisting people with this life threatening infectious disease, and for us. With respect to this, we appreciate Cançado's acknowledgment of the merit of our article recently published in this journal 6 , whereas we fully reject his comment that "the results shown do not support the conclusion drawn". On the other hand, we clearly understand Cançado's awareness that there is "controversy concerning the etiological treatment of chronic Chagas Disease, chiefly because there is no consensus for the criterion of cure". This controversy may be explained by lack of randomisation of research protocols, and by different criteria in obtaining data published by several authors in the last three decades. We believe that nitroderivatives may be life saving in those few patients with severe clinical manifestation of acute T. cruzi infection, or in immunosuppressed patients undergoing reactivation of the infection, only. We do not indicate treatment of the chronic T. cruzi infections, because we have not found a single benefit resulting from treatment of these Chagas patients with anti-trypanosoma drugs. In conjunction, it holds true that chemotherapy of T. cruzi infections with either benznidazole or nifurtimox nitroderivative is unsatisfactory and cannot be recommended since it fails to eradicate the parasite or to change the progression of heart disease in Chagas patients. Nitroderivatives used for treatment of Chagas Disease:The nifurtimox [4-(5-nitro-phurylideneamino-) tetrahydro-4-4-1, 4-thiazine-1-1-dioxide], and benznidazole [N-benzyl-2-nitro-imidazoleacetamide) are anti-trypanosoma nitroderivatives used to treat T. cruzi infections. Severe cytotoxicity has been described for several nitroderivatives, and, in recent decades, these compounds have been shown to possess a variable degree of mutagenic, teratogenic, carcinogenic and sterilizing activities 4,5,16,17,27,30,37,44,45,47 . Cytotoxicity and genotoxicity associated with nitroderivatives seem to depend on the binding of electrophilic radicals to macromolecules and DNA, after enzymatic reduction of the nitro-group and generation of free electrophilic radicals, such as nitro-anions, hydroxyl, singlet oxygen and hydrogen peroxide 18,21,30,31,41 . The drug toxicity targets the parasite and the mammalian host cell 18,27 . Table 1 shows data from nine research groups of treated acute or recent T. cruzi infections in different regions...

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Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological study

Cited by 135 publications

References 9 publications

Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005

Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005

Chagas' heart disease

The treatment of Chagas disease patients with nitroderivative is unsatisfactory

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