Involvement of the central nervous system in the chronic form of Chagas' disease

Wackermann, Paula Viana; Fernandes, Regina Maria França; Elías, Jorge; Santos, Antônio Carlos dos; Marques, Wilson; Barreira, Amilton Antunes

doi:10.1016/j.jns.2008.01.006

Cited by 24 publications

(21 citation statements)

References 31 publications

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“…Additionally, while 53.3% of our patients presented hyperintensities in MRI, only 13% subjects present similar lesions in the general population 10 . In agreement with our findings, other authors also demonstrated the presence of white matter lesions in brain MRI of early phase Chagas' disease patients, possibly associated with unspecific electroencephalographic disorders 11 .…”

Section: Discussionsupporting

confidence: 93%

“…In contrast, white matter hyperintense lesions are described in up to 13% of general population 10 . other authors also found white matter lesions in brain MRI of early phase Chagas' disease patients, associated with unspecific electroencephalographic disorders 11 . Aging and arterial hypertension have been related to these lesions 10 , but correlation between them and strokes are still disputed [12][13][14] .…”

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confidence: 87%

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The presence of antiautonomic membrane receptor antibodies do not correlate with brain lesions in Chagas' disease

Maciel

Pedrosa

et al. 2009

Arq. Neuro-Psiquiatr.

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-We previously demonstrated correlation between parasympathetic dysfunction and brain white matter lesions in chronic chagasic patients. Objective: To correlate serum functional circulating antibodies with beta adrenergic (Ab-β), muscarinic (Ab-M) or muscarinic and beta adrenergic (Ab-Mβ) activity, the autonomic system function and brain lesions in chronic chagasic patients. Method: In fifteen consecutive chagasic patients, the autonomic nervous system was evaluated and brain magnetic resonance imaging (MRI) was performed. The sera of all patients were tested to the presence of circulating functional antibodies. Results: Sera from 11 of 15 chronic chagasic patients had some activity (Ab-β: 7; Ab-M: 1; Ab-Mβ: 3); however, there was no significant correlation between the presence of antibodies and the autonomic system function or the presence of hyperintensities in MRI. Conclusion: The mechanism involved in the genesis of hyperintense lesions seen in brain MRI of chronic chagasic patients is still unresolved, although apparently related to parasympathetic dysfunction.Key WoRdS: Chagas' disease, American trypanosomiasis, autonomic dysfunction, antibodies, magnetic resonance imaging, hyperintense lesions. a presença de anticorpos anti-autonômicos não se correlaciona a lesões cerebrais na doença de chagas resumo -A correlação entre disfunção parassimpática e lesões de substância branca cerebral em pacientes chagásicos já foi previamente demonstrada. Objetivo: Correlacionar a presença de anticorpos circulantes funcionais com atividade beta-adrenérgica (Ab-β), muscarínica (Ab-M) ou muscarínica e beta adrenérgica (Ab-Mβ), a presença de disautonomia e lesões de substância branca cerebral em pacientes chagásicos crônicos. Método: em quinze pacientes chagásicos consecutivos, foram realizados a avaliação do sistema nervoso autônomo e ressonância magnética (RM) do crânio. o soro dos pacientes foi testado para a presença de anticorpos funcionais circulantes. Resultados: o soro de 11 dos 15 pacientes chagásicos apresentou alguma atividade (Ab-β: 7; Ab-M: 1; Ab-Mβ: 3); porém não houve correlação significativa entre a presença de anticorpos circulantes e disautonomia ou de hiperintensidades à RM. Conclusão: o mecanismo envolvido na gênese das lesões hiperintensas à RM do crânio dos pacientes chagásicos crônicos não está esclarecida ainda, apesar de aparentemente relacionada à disfunção parassimpática.PAlAvRAS-ChAve: doença de Chagas, tripanossomíase americana, disfunção autonômica, anticorpos, ressonância magnética, lesões hiperintensas.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 87%

The presence of antiautonomic membrane receptor antibodies do not correlate with brain lesions in Chagas' disease

Maciel

Pedrosa

et al. 2009

Arq. Neuro-Psiquiatr.

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“…Clinical, electroencephalographic, and magnetic resonance imaging evaluation of the involvement of the central nervous system in the chronic form of Chagas' disease found limited and focal nervous system dysfunction that did not cause dysphagia [20]. The similar results for the duration of stage transition obtained with patients and controls suggest that the control of swallowing dynamics is preserved in the disease.…”

Section: Discussionmentioning

confidence: 59%

Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease

2011

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Dysphagia is the most common digestive symptom reported by patients with Chagas' disease. The condition results from abnormalities of esophageal motility. Our hypothesis is that there are also alterations of oral and pharyngeal transit during swallowing. We studied by videofluoroscopy the oral and pharyngeal transit during swallowing in 17 patients with dysphagia, a positive serologic test for Chagas' disease, and radiologic demonstration of esophageal involvement. The study also included 15 asymptomatic healthy volunteers. Each subject swallowed in duplicate 5 and 10 ml of liquid and paste barium boluses. Chagas' disease patients had a longer oropharyngeal transit with the 5-ml liquid bolus (p = 0.03), and a longer oral transit (p = 0.01) and pharyngeal transit (p = 0.04) with the 10-ml liquid bolus than controls. There was no difference between patients and controls with swallows of the 5-ml paste bolus. With swallows of the 10-ml paste bolus, the oropharyngeal transit (p = 0.05), pharyngeal transit (p = 0.04), pharyngeal clearance (p = 0.02), and UES opening (p = 0.01) took a longer amount of time in Chagas' disease patients than in controls. We conclude that the duration of pharyngeal transit is longer in patients with Chagas' disease than in normal subjects, especially with a bolus of pasty consistency and a volume of 10 ml.

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“…In the acute phase the parasite produces direct destructive and infl ammatory changes in the CNS, which can be life threatening, but no anatomic basis exists that might characterize the existence of a chronic nervous form of Chagas' disease [14,15]. A recent study did not fi nd major neurological deficits or dysfunctions in patients with the chronic form of Chagas' disease [16].…”

Section: Discussionmentioning

confidence: 99%

Clinical measurement of swallowing and proximal esophageal contractions in Chagas’ disease

Dantas¹,

Alves²,

Cassiani³

et al. 2009

Esophagus

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Background. Chagas' disease causes esophageal motility impairment similar to that seen in idiopathic achalasia. Our hypothesis is that the disease could affect the results of swallowing evaluation and the esophageal response to swallows. Methods. We studied, by the water-swallowing test, the swallowing dynamics of 40 patients with esophageal involvement by Chagas' disease and 75 controls. During the clinical test, each subject ingested 50 ml of water while we precisely timed and counted the number of swallows. We calculated the interswallow interval, the swallowing fl ow rate, and the swallowing volume capacity. We also evaluated the proximal esophageal contractions of 32 patients with Chagas' disease and 31 controls. After swallows in duplicate of 3 ml water, the pharyngeal contractions 1 cm above the upper esophageal sphincter and the proximal esophageal body contractions 5 cm from the pharyngeal recording point were recorded. Results. In the water-swallowing test, patients with Chagas' disease took a longer time to drink all the volume, had a higher number of swallows, a longer interswallow interval, a lower swallowing fl ow rate, and took a smaller volume in each swallow than the control subjects. Patients with Chagas' disease had a longer interval between onset of pharyngeal and onset of proximal esophageal contractions and had contractions of lower amplitude. Conclusions. We conclude that patients with esophageal involvement by Chagas' disease ingest water more slowly, with a smaller volume in each swallow, and have a later proximal esophageal response to swallows than normal subjects.

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Involvement of the central nervous system in the chronic form of Chagas' disease

Cited by 24 publications

References 31 publications

The presence of antiautonomic membrane receptor antibodies do not correlate with brain lesions in Chagas' disease

The presence of antiautonomic membrane receptor antibodies do not correlate with brain lesions in Chagas' disease

Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease

Clinical measurement of swallowing and proximal esophageal contractions in Chagas’ disease

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