Neurological Manifestations in Chagas Disease without Cardiac Dysfunction: Correlation between Dysfunction of the Parasympathetic Nervous System and White Matter Lesions in the Brain

Py, Marco Oliveira; Pedrosa, Roberto Coury; Silveira, Juliana Serafim da; Medeiros, A. S.; André, Charles

doi:10.1111/j.1552-6569.2008.00305.x

Cited by 11 publications

(9 citation statements)

References 27 publications

(31 reference statements)

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“…There was a significant correlation between the presence of hyperintense lesions in MRI and: pNN50 (p<0.01), rMSSd (p<0.01) and lF/hF (p<0.04), as published elsewhere 9 . on the other hand, there was no significant correlation between pNN50, rMSSd or lF/hF and the presence of the antibodies Ab-β, Ab-M or Ab-Mβ (p>0.05).…”

Section: Resultsmentioning

confidence: 62%

“…This was demonstrated by an inverse and significant correlation between lower pNN50 and rMSSd values (representing reduced cardiac frequency variability) and the presence and number of hyperintense lesions in MRI; and by the direct correlation between the lF/hF ratio and the presence of hyperintensities 9 . It shows that parasympathetic dysfunction may enhance the probability to have hyperintense lesions in brain MRI.…”

Section: Discussionmentioning

confidence: 98%

“…These lesions significantly correlated to parasympathetic dysfunction, evaluated by sinus arrhythmia test 9 . In contrast, white matter hyperintense lesions are described in up to 13% of general population 10 .…”

mentioning

confidence: 99%

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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: Resultsmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 98%

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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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“…The nerve system in chronic Chagas' disease The damage to the parasympathetic nervous system may be the main driver of alterations in the vegetative nervous system in chronic Chagas' disease [64]. It is assumed that the damage to the parasympathetic nervous system starts in the acute phase and proceeds into the chronic phase.…”

Section: Symptomatic Phasementioning

confidence: 99%

Chronic Chagas’ heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine

et al. 2010

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Chagas' disease, caused by Trypanosoma cruzi infection, is ranked as the most serious parasitic disease in Latin America. Nearly 30% of infected patients develop life-threatening complications, and with a latency of 10-30 years, mostly Chagas' heart disease which is currently the major cause of morbidity and mortality in Latin America, enormously burdening economic resources and dramatically affecting patients' social and labor situations. Because of increasing migration, international tourism and parasite transfer by blood contact, intrauterine transfer and organ transplantation, Chagas' heart disease could potentially become a worldwide problem. To raise awareness of this problem, we reflect on the epidemiology and etiopathology of Chagas' disease, particularly Chagas' heart disease. To counteract Chagas' heart disease, in addition to the general interruption of the infection cycle and chemotherapeutic elimination of the infection agent, early and effective causal or symptomatic therapies would be indispensable. Prerequisites for this are improved knowledge of the pathogenesis and optimized patient management. From economic and logistics viewpoints, this last prerequisite should be performed using laboratory medicine tools. Consequently, we first summarize the mechanisms that have been suggested as driving Chagas' heart disease, mainly those associated with the presence of autoantibodies against G-protein-coupled receptors; secondly, we indicate new treatment strategies involving autoantibody apheresis and in vivo autoantibody neutralization; thirdly, we present laboratory medicine tools such as autoantibody estimation and heart marker measurement, proposed for diagnosis, risk assessment and patient guidance and lastly, we critically reflect upon the increase in inflammation and oxidative stress markers in Chagas' heart disease.

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“…Damage to the parasympathetic nervous system may be one of the primary events in the pathogenesis of symptomatic Chagas disease and may contribute to heart and gastrointestinal Chagas disease in this way [44,45] . It is assumed that the damage to the parasympathetic nervous system starts in the acute phase and proceeds into the chronic phase.…”

Section: The Nervous System In Chronic Chagas Diseasementioning

confidence: 99%

Chronic Chagas disease: from basics to laboratory medicine

Haberland

Saravia

Wallukat

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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Chagas disease, caused by Trypanosoma cruzi infection, is ranked as the most serious parasitic disease in Latin America and has huge potential to become a worldwide problem, due to increasing migration, and international tourism, as well as infectant transfer by blood contact and transfusion, intrauterine transfer, and organ transplantation. Nearly 30% of chronically-infected patients become symptomatic, often with a latency of 10–30 years, developing life-threatening complications. Of those, nearly 90% develop Chagas heart disease, while the others manifest gastrointestinal disease and neuronal disorders. Besides interrupting the infection cycle and chemotherapeutic infectant elimination, starting therapy early in symptomatic patients is important for counteracting the disease. This would be essentially supported by optimized patient management, involving risk assessment, early diagnosis and monitoring of the disease and its treatment. From economic and logistic viewpoints, the tools of laboratory medicine should be especially able to guarantee this. After summarizing the basics of chronic Chagas disease, such as the epidemiological data, the pathogenetic mechanisms thought to drive symptomatic Chagas disease and also treatment options, we present tools of laboratory medicine that address patient diagnosis, risk assessment for becoming symptomatic and guidance, focusing on autoantibody estimation for risk assessment and heart marker measurement for patient guidance. In addition, increases in levels of inflammation and oxidative stress markers in chronic Chagas disease are discussed.

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Neurological Manifestations in Chagas Disease without Cardiac Dysfunction: Correlation between Dysfunction of the Parasympathetic Nervous System and White Matter Lesions in the Brain

Cited by 11 publications

References 27 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

Chronic Chagas’ heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine

Chronic Chagas disease: from basics to laboratory medicine

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