Myocardial Injury in Patients With Acute and Subacute Chagas Disease in the Brazilian Amazon Using Cardiovascular Magnetic Resonance

Abstract

Background Chagas disease is a neglected tropical disease that is still considered a global health emergency. In the Amazon region, most of the reports are of acute cases that are associated with oral transmission. This study aimed to evaluate myocardial injury in patients with acute Chagas disease before and after treatment. Methods and Results We evaluated 23 patients with acute Chagas disease in 3 different stages of progression. Group 1 had 12 patients evaluated during the acute phase, at the time of diagnosis, and 1 year after treatment, and Group 2 had 11 patients in the late postacute phase who were evaluated 5.2 years on average after diagnosis and treatment. ECGs with the Selvester score, 24‐hour Holter exam, and cardiovascular magnetic resonance imaging were performed. The mean age of the 23 patients was 44.3±18.9 years, and they were mostly men (15/65.24%) from Amazonas state (22/95.6%). In 69.6% (n=16) of the patients, some ECG alterations were found, the most frequent being left anterior fascicular block and ventricular repolarization. In Group 1, the 24‐hour Holter exam showed atrial tachycardia in 3 (25%) patients and ventricular extrasystoles in 2 (16.7%) patients. In Group 2, 1 patient had ventricular extrasystoles. Myocardial injury was observed in 7 patients (58.3%) at the acute phase and in 5 (50%) patients at the 1‐year follow‐up in Group 1 and in 2 (18.2%) patients in Group 2. Conclusions This article describes, for the first time, myocardial injury shown by cardiovascular magnetic resonance imaging in a group of patients with acute Chagas disease and reveals the importance of early detection and follow‐up of the cardiac impairment in these patients.

Spatial Distribution of Acute Cases of Chagas Disease Reported From 2010 to 2020 in the State of Amazonas

“…2019).Research points to the prevalence of brown individuals affected by the disease in the northern region(SOUZA et al, 2021;SAMPAIO et al, 2020), the greater record of ACD in brown individuals may be related to the increase in the number of people of this color in the country, also reflecting in the number of cases of the disease over the years.However, it is necessary to correlate other socioeconomic aspects such as family income, schooling and habits that indicate the existence of social inequality, which is significantly reflected in unfavorable living and health conditions in this social group(COUCEIRO et al, 2022).High rates of oral transmission, attributed to the ingestion of contaminated food, such as sugarcane juice and drinks based on açaí, bacaba and buriti, have contributed to the significant growth of the disease in the Western Amazon (Amazonas, Acre, Rondônia and Roraima). The transmission of T. cruzi through the consumption of açaí, is justified by the inadequate cleaning of the fruits in the crushing process to extract the pulp, resulting in the parasite being crushed together with the fruits, contaminating them and, consequently, causing outbreaks by oral transmission of CD, the same may occur with sugarcane, raw material for the production of sugarcane juice(MENEZES et al, 2019;SOUZA et al, 2016).…”