Evolução da cardiopatia chagásica crônica humana no sertão do Estado da Paraíba, Brasil, no período de 4,5 anos

Abstract

Two sectional studies about chronic Chagas' disease were performed at a 4.5 year interval, involving the urban populations of Agua Branca, Catingueira, Emas, Imaculada, Mãe D'Agua, Olho D'Agua, Piancó and São José de Caiana counties in the Sertão region of the State of Paraíba. The evolution of heart disease was evaluated in 125 matched pairs of chronic chagasic and non-chagasic patients of the same sex, age and county of origin through electrocardiograms (ECG) at rest. The following evaluation criteria were considered: unchanged - no change in the original ECG pattern; progressive-changes in ECG pattern from normal to abnormal or deterioration of ECG abnormalities; and ECG normalization. In chagasic patients evolution of the disease was unchanged in 101 (80.8%), progressive in 13 (10.4%) and ECG normalization in 11 (8.8%), while those observed in non-chagasic patients were respectively values 117 (93.6%), 6 (4.8%) and 2%) patients. Findings indicate that the share of Chagas-linked etiological component affecting the development of chronic Chagas cardiopathy was 5.9% with an estimated annual average of 1.3%. There was no significant difference in the frequency of progressive disease between the sexes either in the chagasic or in the non-chagasic group. On the other hand, progression of heart disease occurred earlier among chagasic patients. Lethality caused by heart disease was 1.6% (2 cases) in the chagasic group and zero in the non-chagasic group during the period under survey. These morbidity and mortality rates were significantly lower than those found in endemic areas such as Virgem da Lapa and Pains-Iguatama in the State of Minas Gerais and can probably be attributed to the weaker pathogenic it of human infection by Trypanosoma cruzi in the Paraíba hinterland.

Trypanosoma cruzi burden, genotypes, and clinical evaluation of Chilean patients with chronic Chagas cardiopathy

“…Females predominated in both groups (60 and 80 % group A and B, respectively) due to the greater attendance of women in clinical controls for Chagas disease, while their husbands were working and the greater willingness of women from endemic zones to transfer to the Metropolitan Region to perform cardiac Echo-Doppler. No association between sex and cardiopathy was observed; similar results were obtained by other investigators (Pereira et al 1990 ; Silva et al 2007 ), but are discordant with Basquiera et al ( 2003 ), who reported more males with Chagas cardiomyopathy.…”

Progression Rate from the Indeterminate Form to the Cardiac Form in Patients with Chronic Chagas Disease: Twenty-Two-Year Follow-Up in a Brazilian Urban Cohort

“…However, they were mostly migrants from 19 endemic Brazilian states, mainly Bahia and Minas Gerais. These states present the highest prevalence of CD and CHD [31], which may be the result of the varying pathogenic degrees of T. cruzi [15]. Regional differences are associated with both disease severity and the predominance of clinical forms due to factors linked to the parasitized individual (immune status, nutritional status, genetic factors, and physical effort) and to other factors related to the parasite (different strains of T. cruzi, parasitism intensity, and reinfections) [32,33].…”

“…The few prospective studies that addressed this issue considerably differed in the study population age, number of cases, length of follow-up, geographical area, living in endemic area with or without active vectorial transmission, and migration to urban areas. More recent studies using methods similar to those of the present study were conducted in different countries (Brazil, Argentina, and Venezuela) with different geographic, climatic, and ecosystem configurations and with different vector transmission dynamics, which may explain the differences in the reported rates of disease progression [9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Risk of Chronic Cardiomyopathy Among Patients With the Acute Phase or Indeterminate Form of Chagas Disease

“…Twenty-three studies 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 had longitudinal observational outcomes for patients with the indeterminate chronic form of Chagas disease ( Table 1 ). Most of these studies were of prospective cohorts and were conducted in either Brazil or Argentina between 1960 and 2005.…”