Histopathological and immunohistochemical study of the brain and heart in the chronic cardiac form of Chagas' disease

Abstract

A histopathological and immunohistochemical study of the brain and heart was made in 50 patients with the chronic cardiac form of Chagas' disease. The immunohistochemical technique used was the peroxidase-antiperoxidase method adapted for the demonstration of the T. cruzi amastigotes. Histological and immunohistochemical examination of the brain showed encephalitis in multiple foci, although sparse, in four patients (8%). In one of the patients the process was recent, active, and containing parasites. In the other three patients, the lesions were of minor intensity, with light exudative inflammatory changes, suggesting a process becoming inactive, or already inactive. The search for parasites in these three patients was negative, even with use of immunoperoxidase. The heart histological and immunohistochemical study showed, besides the chronic myocarditis in multiple foci associated with interstitial fibrosis, amastigotes in seven patients (14%). The absence of parasites and of inflammatory changes in the brain in the great majority of patients with chronic Chagas' disease, contrasting with the constant finding of inflammatory changes and the occasional finding of amastigotes in the myocardium of the same patients, allows us to state, in the same way other authors did, that there is no histopathological basis to support the existence of the chronic nervous form of Chagas' disease.

Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: A prospective follow-up study

“…Although necropsy studies report a high frequency of embolic events [6,7] the long-term risk of stroke has not been fully determined. A clinical study with a cohort of patients with mild to moderate heart failure due to Chagas disease reported a stroke frequency of 1.2% during the first year of follow-up [8].…”

“…Previous studies have shown that stroke may be the first manifestation of this disease, regardless of systolic dysfunction or presence of cardiac arrhythmias. In contrast to autopsy studies, which report a high frequency of cerebral infarction [6,7], clinical studies have demonstrated a low prevalence of stroke in patients with chronic Chagas heart disease [8].…”

Chagasic Cardiomyopathy Is Independently Associated With Ischemic Stroke in Chagas Disease

“…7 Heart-related diseases in CD includes cardiomegaly, dysrhythmia, heart failure, and sudden cardiac death. 8 Pathologic studies of the brain have shown cerebral infarction in 9.4% and 26.3% 9,10 of patients with the chronic form of CD. Previous studies described a predominant cardioembolic cause of ischemic stroke in CD.…”

Acute Chagas’ Disease Presenting with a Suprasellar Mass and Panhypopituitarism

“…Acute disease has been reported to cause tumor-like masses of polymorphous chronic granulomatous inflammation in the central nervous system in immunocompromised individuals [10][11][12][13]. As the patient traveled to Mexico 5 months prior to presentation, it is possible that he was infected with T. cruzi during that trip and developed an acute form of Chagas' disease in the subsequent months, although an incubation time of 5 months is longer than expected.…”