Chagas Heart Disease: Beyond a Single Complication, from Asymptomatic Disease to Heart Failure

Abstract

Chagas cardiomyopathy (CC), caused by the protozoan Trypanosoma cruzi, is an important cause of cardiovascular morbidity and mortality in developing countries. It is estimated that 6 to 7 million people worldwide are infected, and it is predicted that it will be responsible for 200,000 deaths by 2025. The World Health Organization (WHO) considers Chagas disease (CD) as a Neglected Tropical Disease (NTD), which must be acknowledged and detected in time, as it remains a clinical and diagnostic challenge in both endemic and non-endemic regions and at different levels of care. The literature on CC was analyzed by searching different databases (Medline, Cochrane Central, EMBASE, PubMed, Google Scholar, EBSCO) from 1968 until October 2022. Multicenter and bioinformatics trials, systematic and bibliographic reviews, international guidelines, and clinical cases were included. The reference lists of the included papers were checked. No linguistic restrictions or study designs were applied. This review is intended to address the current incidence and prevalence of CD and to identify the main pathogenic mechanisms, clinical presentation, and diagnosis of CC.

TNF blockers alone and associated with Benznidazole impact in vitro cytokine dynamics in chronic Chagas disease

“…Even though the proliferative response of circulating T cells in chronic carriers is impaired, these cells are producers of pro‐ and anti‐inflammatory cytokines. They are responsible for the low parasitaemia during this phase 7–9 …”

“…There is still much to be understood about how chronic carriers evolve to severe clinical forms of the disease, such as CCC, or leave asymptomatic forms and start to develop symptoms. It is believed that the immune response has a significant contribution, whether to prevent, attenuate, or even accelerate this process 7,8 …”

“…They are responsible for the low parasitaemia during this phase. [7][8][9] The variety of different profiles of Th lymphocytes is defined by the cytokines they produce and their antigenic nature. 9,10 In Chagas disease, there is a predominance of the Th1 profile, being related to parasite control and/or elimination, but also participation in inflammation, especially in the cardiac form, where these mechanisms are better elucidated.…”

“…It is believed that the immune response has a significant contribution, whether to prevent, attenuate, or even accelerate this process. 7,8 T. cruzi interacts with the different immune responses: innate and adaptive of the host in a very complex way. Even though the proliferative response of circulating T cells in chronic carriers is impaired, these cells are producers of pro-and anti-inflammatory cytokines.…”

Unraveling the role of miRNAs as biomarkers in Chagas cardiomyopathy: Insights into molecular pathophysiology

“…Despite being described over a century ago, many aspects of ChD remain unresolved. Currently, conventional diagnostic and prognostic methods for ChCM primarily detect functional and structural changes in the heart [ 5 ]. Consequently, clinical and therapeutic interventions rely on the onset and progression of cardiac damage [ 6 ].…”