Correction: Mixed infections by different Trypanosoma cruzi discrete typing units among Chagas disease patients in an endemic community in Panama.

[This corrects the article DOI: 10.1371/journal.pone.0241921.].

Mixed infections by different Trypanosoma cruzi discrete typing units among Chagas disease patients in an endemic community in Panama.

BACKGROUND: Trypanosoma cruzi, the hemoparasite that causes Chagas disease, is divided into six Discrete Typing Units or DTUs: TcI-TcVI plus Tcbat. This genetic diversity is based on ecobiological and clinical characteristics associated with particular populations of the parasite. The main objective of this study was the identification of DTUs in patients with chronic chagasic infections from a mountainous rural community in the eastern region of Panama. METHODS: A total of 106 patients were tested for Chagas disease with three serological tests (ELISA, rapid test, and Western blot). Molecular diagnosis and DTU typing were carried out by conventional PCRs and qPCR targeting different genomic markers, respectively. As a control sample for the typing, 28 patients suspected to be chagasic from the metropolitan area of Panama City were included. RESULTS: Results showed a positivity in the evaluated patients of 42.3% (33/78); high compared to other endemic regions in the country. In the control group, 20/28 (71.43%) patients presented positive serology. The typing of samples from rural patients showed that 78.78% (26/33) corresponded to TcI, while 9.09% (3/33) were mixed infections (TcI plus TcII/V/VI). Seventy-five percent (15/20) of the patients in the control group presented TcI, and in five samples it was not possible to typify the T. cruzi genotype involved. CONCLUSIONS: These results confirm that TcI is the main DTU of T. cruzi present in chronic chagasic patients from Panama. However, the circulation of other genotypes (TcII/V/VI) in this country is described for the first time. The eco-epidemiological characteristics that condition the circulation of TcII/V/VI, as well as the immune and clinical impact of mixed infections in this remote mountainous region should be investigated, which will help local action programs in the surveillance, prevention, and management of Chagas disease.

[Prevalence of autoantibodies against autonomic receptors in patients with chronic cardiopathies]. / Prevalencia de autoanticuerpos contra receptores autonómicos en pacientes panameños con cardiopatía chagásica crónica y con otras formas de cardiopatía.

INTRODUCTION: Chagas disease is the main cause of chronic myocardiopathy in Central America. The mechanisms proposed for this cardiac pathology during the chronic phase remain controversial. Several studies have detected the presence of circulating autoantibodies against beta-adrenergic and cholinergic muscarinic receptors of the myocardium in patients with Chagas disease. These autoantibodies can trigger intracellular signals and modify the cardiac function during the progression of the disease. OBJECTIVES: The serological frequency of these autoantibodies was compared among patients with chronic Chagas disease, patients with other cardiopathies and healthy controls. MATERIALS AND METHODS: The prevalence of autoantibodies against beta-adrenergic and cholinergic muscarinic receptors was determined in four groups of Panamenian patients: 53 chagasic patients, 25 serologically negative patients with cardiac insufficiency, 25 patients with cardiac arrhythmia and 25 healthy individuals. RESULTS: The antibodies against autonomic receptors were more frequently observed in patients with chronic chagasic cardiomyopathy (24.5%) compared to the cardiac insufficiency group (20.0%) and the cardiac arrhythmia group (16.0%). The proportion of autoantibodies was significantly different between the groups with chronic chagasic cardiomyopathy and healthy controls (24.5% versus 0%; p = 0.015). Of the 53 chronically infected chagasic patients, 48 (90%) showed some degree of cardiac dysfunction. CONCLUSIONS: The frequency of autoantibodies against autonomic receptors is significantly increased in patients with chronic Chagas disease and in patients with other cardiopathies.

Prevalencia de autoanticuerpos contra receptores autonómicos en pacientes panameños con cardiopatía chagásica crónica y con otras formas de cardiopatía / Prevalence of autoantibodies against autonomic receptors in patients with chronic cardiopathies

Introducción. La enfermedad de Chagas es la principal causa de cardiomiopatía crónica en Centroamérica. Existe controversia sobre los mecanismos causantes de la patología cardiaca observada durante la fase crónica de esta parasitosis. Varios estudios han detectado la presencia de autoanticuerpos circulantes dirigidos contra receptores beta-adrenérgicos y colinérgicos muscarínicos del miocardio en pacientes chagásicos, que pueden desencadenar señales intracelulares y alterar la función cardiaca durante el curso de la enfermedad. Objetivo. Nuestro objetivo principal fue comparar la frecuencia sérica de estos autoanticuerpos en pacientes chagásicos crónicos con la observada en pacientes con otras formas de cardiopatía y en controles sanos. Materiales y métodos. Se determinó la prevalencia de autoanticuerpos contra receptores beta-adrenérgicos y colinérgicos muscarínicos en cuatro grupos de pacientes panamelos: 53 pacientes chagásicos, 25 pacientes seronegativos con insuficiencia cardiaca, 25 pacientes con diferentes tipos de arritmia cardiaca y 25 controles sanos. Resultados. Los autoanticuerpos contra receptores autonómicos fueron más frecuentes en el grupo de pacientes con cardiopatía chagásica crónica (24,5%) comparados con el grupo de insuficiencia cardiaca (20,0%) y con el grupo con arritmias cardiacas (16,0%). Al comparar la proporción de autoanticuerpos entre el grupo de pacientes con cardiopatía chagásica crónica y los controles sanos, se detectaron diferencias muy significativas (24,5% versus 0%; p=0,0015). De los 53 pacientes con infección crónica, 48 (90,6%) presentaron algún grado de alteración cardiaca. Conclusiones. En comparación con el grupo de controles sanos, la frecuencia de los autoanticuerpos contra receptores autonómicos se encuentra significativamente aumentada en pacientes con enfermedad de Chagas crónica y con otras formas de cardiopatía.

Introduction. ChagasL disease is the main cause of chronic myocardiopathy in Central America. The mechanisms proposed for this cardiac pathology during the chronic phase remain controversial. Several studies have detected the presence of circulating autoantibodies against ƒÀ-adrenergic and cholinergic muscarinic receptors of the myocardium in patients with Chagas disease. These autoantibodies can trigger intracellular signals and modify the cardiac function during the progression of the disease. Objectives. The serological frequency of these autoantibodies was compared among patients with chronic Chagas disease, patients with other cardiopathies and healthy controls. Materials and methods. The prevalence of autoantibodies against ƒÀ-adrenergic and cholinergic muscarinic receptors was determined in four groups of Panamenian patients: 53 chagasic patients, 25 serologically negative patients with cardiac insufficiency, 25 patients with cardiac arrhythmia and 25 healthy individuals. Results. The antibodies against autonomic receptors were more frequently observed in patients with chronic chagasic cardiomyopathy (24.5%) compared to the cardiac insufficiency group (20.0%) and the cardiac arrhythmia group (16.0%). The proportion of autoantibodies was significantly different between the groups with chronic chagasic cardiomyopathy and healthy controls (24.5% versus 0%; p=0.015). Of the 53 chronically infected chagasic patients, 48 (90%) showed some degree of cardiac dysfunction. Conclusions. The frequency of autoantibodies against autonomic receptors is significantly increased in patients with chronic Chagas disease and in patients with other cardiopathies.

Diagnóstico prenatal y manejo de un caso de tumor cardiaco / Prenatal diagnostic and handling of one case the cardiac tumor

Se informa el primer caso de tumor en el corazón diagnosticado en el período prenatal, por medio del ecocardiograma, cuando se encontraba en la 27 semana de gestación

Tratamiento quirúrgico de la arritmia cardíaca refractaria a medicamentos en pacientes con cardiopatia chagasica crónica / Surgical treatment of refractory arrythmia to drug therapy in patients with chronic Chagas' cardiopathy

Se informa un caso de aneurisma ventricular de etiología chagásica, que sufría de arritmia refractaria al tratamiento farmacológico. Por esa razón se le practicó la resección del aneurisma. Desde entonces efectúa sus actividades en forma normal y no ha presentado nuevamente la arritmia que tenía

Arritmia cardíaca fetal: experiencia clínica con drogas antiarrítmicas / Fetal arrhythmia: clinic experience with anti-arrhythmia agents

El examen ecocardiográfico de 13628 gestantes de la Maternidad del Hospital Santo Tomás (HST), de Clínicas Privadas y algunas del Seguro Social demostró que 1.132 tenían arritmia cardíaca, la cual era de tipo persistente en 397 y de tipo transitorio en 735 gestantes. Se menciona el resultado del tratamiento con Verapamil, Propranolol o Amiodarona en 520 fetos que sufrían de arritmia cardíaca. Se observó que el Verapamil controló en un 100% todas las arritmias de origen supraventricular; y que el Propranolol y la Amiodarona pueden ser prescritos con éxito en la arritmia refractaria; también, que el Alfa tocoferol (Vit. E), protege el miocardio fetal de gestantes fumadoras o alcohólicas

Hipertensión renovascular secundaria a estenosis de la arteria renal izquierda, por enfermedad fibromuscular: un caso operado en el Hospital del Niño / Renovascular hypertension secondary to stenosis of renal left artery by fibromuscular disease: an operated case in the Hospital del Niño

Se reporta un caso de Hipertensión Renovascular secundaria a Estenosis de la Arteria Renal izquierda debido a enfermedad fibromuscular y probable Endarteritis Sistémica en adolescente de 13 años. Hallazgo de Hipertensión casual en consulta por resfriado. Se realizaron estudios pertinentes: Arteriografía Renal, Pruebas Inmunológicas, P.I.V., pruebas de Funcionamiento Renal y se somete a cirugía con puente Aorta-Renal con éxito. Actualmente normotensa y controlada en la Consulta Externa por Urología y Cirugía Cardiovascular. Al momento de confeccionar el material la paciente tenía un mes de operada