RESUMO
Bovine trypanosomosis, caused by Trypanosoma vivax, currently affects cattle and has a significant economic impact in sub-Saharan Africa and South America. The development of new diagnostic antigens is essential to improve and refine existing methods. Our study evaluated the efficacy of two recombinant antigens in detecting specific antibodies in cattle. These antigens are derivatives of an invariant surface glycoprotein (ISG) from T. vivax. A fraction of a previously described antigen (TvY486_0045500), designated TvISGAf, from an African strain was evaluated, and a new ISG antigen from an American isolate, TvISGAm, was identified. The two antigens were expressed as fusion proteins in Escherichia coli: TvISGAf was fused to the MBP-His-tag, and TvISGAm was obtained as a His-tag fused protein. An ELISA evaluation was conducted using these antigens on 149 positive and 63 negative bovine samples. The diagnostic performance was enhanced by the use of a combination of both antigens (referred to as TvISG-based ELISA), achieving a sensitivity of 89.6% and specificity of 93.8%. Following the validation of the TvISG-based ELISA, the seroprevalence of T. vivax infection in 892 field samples from cattle in the central region of Argentina was determined. The mean seroprevalence of T. vivax was 53%, with variation ranging from 21% to 69% among the six departments studied. These results support the use of the TvISG ELISA as a valuable serological tool for the detection and monitoring of T. vivax infection in cattle. Furthermore, we report for the first time the seroprevalence of T. vivax in Argentina, which highlights the widespread endemic nature of the disease in the region. In order to effectively manage the increasing spread of T. vivax in the vast livestock production areas of South America, it is essential to implement consistent surveillance programs and to adopt preventive strategies.
Assuntos
Antígenos de Protozoários , Doenças dos Bovinos , Ensaio de Imunoadsorção Enzimática , Testes Sorológicos , Trypanosoma vivax , Animais , Bovinos , Argentina/epidemiologia , Trypanosoma vivax/imunologia , Trypanosoma vivax/genética , Trypanosoma vivax/isolamento & purificação , Testes Sorológicos/métodos , Testes Sorológicos/veterinária , Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/parasitologia , Antígenos de Protozoários/imunologia , Antígenos de Protozoários/genética , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática/veterinária , Anticorpos Antiprotozoários/sangue , Sensibilidade e Especificidade , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/veterinária , Tripanossomíase Africana/epidemiologia , Gado/parasitologiaRESUMO
Chagas disease (CD) affects about 7 million people worldwide, presents a large prevalence in Latin America, and is growing in the rest of the world, where congenital CD is the main mode of transmission. Point-of-care testing (POCT) methods are increasingly required to ease early diagnostics and increase treatment success. This work presents the development and validation of a smartphone-integrated ELISA-based POCT system for the detection of both chronic and congenital CD. Expensive and bulky equipment used for ELISA in conventional laboratories was replaced as follows. A miniaturized device was fabricated for incubation of commercial ELISA plates, achieving â¼±1 °C uniformity and stability. The ELISA plate reader was replaced by smartphone camera and image processing, comprising algorithms to account for variability sources and spatial light non-uniformity; thus, additional hardware like a dark-box is not required. The agreement between samples classified with this novel reading method vs. ELISA plate reader was found to be 99.7% and 95.4% for chronic and congenital CD, respectively. Furthermore, a smartphone application was designed and implemented to guide the user during the assay, provide connectivity, and access databases, facilitating patient monitoring and health-policy making. The whole system is aimed to be used as a practical diagnostic tool in primary health care settings, as well as to facilitate patients' follow-up to provide better treatment. Concerning the technology itself, the proposed POCT platform is versatile enough to be readily adapted for the detection of other infectious diseases.
Assuntos
Doença de Chagas , Smartphone , Humanos , Testes Imediatos , Ensaio de Imunoadsorção Enzimática , Sistemas Automatizados de Assistência Junto ao Leito , Doença de Chagas/diagnósticoRESUMO
OBJECTIVE: To evaluate the seroprevalence of COVID-19 infection in pauci-symptomatic and asymptomatic people, the associated epidemiological factors, and IgG antibody kinetic over a 5-month period to get a better knowledge of the disease transmissibility and the rate of susceptible persons that might be infected. METHODS: Seroprevalence was evaluated by a cross-sectional study based on the general population of Santa Fe, Argentina (non-probabilistic sample) carried out between July and November 2020. A subgroup of 20 seropositive individuals was followed-up to analyze IgG persistence. For the IgG anti-SARS-CoV-2 antibodies detection, the COVID-AR IgG® ELISA kit was used. RESULTS: 3 000 individuals were included conforming asymptomatic and pauci-symptomatic groups (n=1 500 each). From the total sample, only 8.83% (n=265) presented reactivity for IgG anti-SARS-CoV-2. A significant association was observed between positive anti-SARS-CoV-2 IgG and a history of contact with a confirmed case; the transmission rate within households was approximately 30%. In the pauci-symptomatic group, among the seropositive ones, anosmia and fever presented an OR of 16.8 (95% CI 9.5-29.8) and 2.7 (95% CI 1.6-4.6), respectively (p <0.001). In asymptomatic patients, IgG levels were lower compared to pauci-symptomatic patients, tending to decline after 4 months since the symptoms onset. CONCLUSION: We observed a low seroprevalence, suggestive of a large population susceptible to the infection. Anosmia and fever were independent significant predictors for seropositivity. Asymptomatic patients showed lower levels of antibodies during the 5-month follow-up. IgG antibodies tended to decrease over the end of this period regardless of symptoms.
RESUMO
Potential activation of ß2 adrenergic receptors (ß2AR) by specific autoreactive antibodies (Abs) that arise during the host reaction to Trypanosoma cruzi, could contribute to the elevated prevalence of metabolic disturbances described in patients with chronic Chagas disease (CCD). This study aimed to determine the prevalence of anti-ß2AR Abs in patients with CCD, as well as the correlation of these Abs with the presence of glucose and lipid metabolism disturbances, in order to explore their association with an insulin resistance profile. Additionally, we tested the functional effects of anti-ß2AR Abs employing an in vitro bioassay with neuroendocrine cells expressing ß2AR. A clinical and metabolic evaluation including an OGTT was performed in 80 CCD patients and 40 controls. Anti-ß2AR Abs were measured by an in-house-developed ELISA, and the ß2 adrenergic activity of affinity-purified IgG fractions from patient' sera were assayed in CRE-Luc and POMCLuc transfected AtT-20 cells. A higher proportion of dysglycemia (72.5% vs. 37.5%; p = 0.001) was observed in the CCD group, accompanied by increased HOMA2-IR (p = 0.019), especially in subjects with Abs (+). Anti-ß2AR Abs reactivity (7.01 (2.39-20.5); p = 0.0004) and age >50 years (3.83 (1.30-11.25); p = 0.014) resulted as relevant for IR prediction (AUC: 0.786). Concordantly, Abs (+) CCD patients showed elevated metabolic risk scores and an increased prevalence of atherogenic dyslipidemia (p = 0.040), as compared to Abs (-) patients and controls. On functional bioassays, Abs exerted specific and dose-dependent ß2-agonist effects. Our findings suggest that anti-ß2AR Abs may induce the activation of ß2AR in other tissues besides the heart; furthermore, we show that in patients with CCD these Abs are associated with an insulin resistance profile and atherogenic dyslipidemia, providing biological plausibility to the hypothesis that adrenergic activation by anti-ß2AR Abs could contribute to the pathogenesis of metabolic disturbances described in CCD patients, increasing their cardiovascular risk.
RESUMO
BACKGROUND: It has been described that Trypanosoma cruzi is capable of promoting metabolic disturbances currently considered as cardiovascular risk factors. Moreover, it has been observed that the protozoa can remain in adipose tissue and alter its immune endocrine functions. The aim of this study was to characterize the thickness of epicardial adipose tissue (EAT) in patients with chronic Chagas disease (CCD) concerning their cardiovascular metabolic risk profile compared with those without CCD. METHODS: A cross-sectional study was performed including T. cruzi seropositive individuals categorized according to a standard CCD classification and a matched seronegative control group. Complete clinical examination, metabolic laboratory tests and transthoracic echocardiography to assess cardiac function and to quantify EAT were performed. RESULTS: Fifty-five individuals aged 46.7±11.9 y, 34 with CCD and 21 in the control group, were included. The CCD group presented higher EAT thickness in relation to controls (4.54±1.28 vs 3.22±0.99 mm; p=0.001), which was significantly associated with the presence of insulin resistance (OR=3, 95% CI 1.58 to 5.73; p<0.001). This group presented lower levels of plasmatic adiponectin than controls, especially in those patients with EAT ≥4.5 mm (p=0.005) who also presented with heart failure more frequently (p=0.01). CONCLUSION: In patients with CCD, a higher EAT thickness is observed and is associated with an increased metabolic risk profile indicated mainly by insulin resistance.
Assuntos
Doença de Chagas , Insuficiência Cardíaca , Tecido Adiposo/diagnóstico por imagem , Doença de Chagas/complicações , Estudos Transversais , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Pericárdio/diagnóstico por imagemRESUMO
Transplacental transmission by Trypanosoma cruzi (T. cruzi) infection can be effectively treated if parasiticide drugs are administered as early as possible during childhood. Furthermore, an ideal situation would be to diagnose the infection near birth in order to avoid the loss of patients during the subsequent follow-up. These situation are desirable due to the maximum benefit of drugs in early stages which, consequently, implies a relevant contribution to eliminate mother-to-child transmission. However, available techniques for that purpose have limitations as being operator-dependent (microhematocrit), require several months follow-up (IgG detection) or specialized laboratories (PCR). In this study we propose to detect specific IgM antibodies (Ab) by developing a capture-based ELISA employing an improved antigen (Ag) to diagnose the transplacental transmission of T. cruzi, and in consequence, to enhance access to effective treatment. Firstly, a new chimera Ag (CP4) was obtained from the fusion of CP1 and CP3 protein, carrying FRA, SAPA, MAP, TSSAII/V/VI and TcD Ag from T. cruzi. Then, we optimized the assay by capturing IgM Ab with a polyclonal anti-IgM Ab and evaluating three Ag formulations to detect specific IgM bound. The formulations were formed as follows: i) F1: CP1 and CP3; ii) F2: CP1, CP3, B13 and P2ß; iii) F3: by CP4. Detection of Ab-binding Ag was carried out using an anti-His Ab since all Ag were expressed with a His-tag. The evaluation panel consisted of sera from vertically infected children under 1-year-old (6 younger than 15 days, 7 older) and samples from non-infected children of women with chronic Chagas Disease. The ELISA assay employing CP4 showed better performance with notable high sensitivity and specificity (92.3% and 93.9%, respectively). Positive and negative likelihood ratios of the test (15.2 and 0.082) suggest its potential clinical relevance in term of post-test probability of infection. In conclution, we developed a standardized and non-operator dependent test to detect specific anti-T. cruzi IgM Ab. Although increased sample size is needed for its validation, our results indicate that this capture-based technique employing CP4 Ag can certainly improve the diagnosis of connatal infection.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/congênito , Ensaio de Imunoadsorção Enzimática/métodos , Imunoglobulina M/sangue , Trypanosoma cruzi/imunologia , Doença de Chagas/diagnóstico , Doença de Chagas/transmissão , Feminino , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças InfecciosasRESUMO
ABSTRACT Objective. To evaluate the seroprevalence of COVID-19 infection in pauci-symptomatic and asymptomatic people, the associated epidemiological factors, and IgG antibody kinetic over a 5-month period to get a better knowledge of the disease transmissibility and the rate of susceptible persons that might be infected. Methods. Seroprevalence was evaluated by a cross-sectional study based on the general population of Santa Fe, Argentina (non-probabilistic sample) carried out between July and November 2020. A subgroup of 20 seropositive individuals was followed-up to analyze IgG persistence. For the IgG anti-SARS-CoV-2 antibodies detection, the COVID-AR IgG® ELISA kit was used. Results. 3 000 individuals were included conforming asymptomatic and pauci-symptomatic groups (n=1 500 each). From the total sample, only 8.83% (n=265) presented reactivity for IgG anti-SARS-CoV-2. A significant association was observed between positive anti-SARS-CoV-2 IgG and a history of contact with a confirmed case; the transmission rate within households was approximately 30%. In the pauci-symptomatic group, among the seropositive ones, anosmia and fever presented an OR of 16.8 (95% CI 9.5-29.8) and 2.7 (95% CI 1.6-4.6), respectively (p <0.001). In asymptomatic patients, IgG levels were lower compared to pauci-symptomatic patients, tending to decline after 4 months since the symptoms onset. Conclusion. We observed a low seroprevalence, suggestive of a large population susceptible to the infection. Anosmia and fever were independent significant predictors for seropositivity. Asymptomatic patients showed lower levels of antibodies during the 5-month follow-up. IgG antibodies tended to decrease over the end of this period regardless of symptoms.
RESUMEN Objetivo. Evaluar la seroprevalencia de la infección por el virus causante de la COVID-19 en personas paucisintomáticas y asintomáticas, los factores epidemiológicos asociados y la cinética de los anticuerpos IgG durante un período de cinco meses para conocer mejor la transmisibilidad de la enfermedad y la tasa de personas susceptibles a estar infectadas. Métodos. Se evaluó la seroprevalencia mediante un estudio transversal basado en la población general de Santa Fe, Argentina (muestra no probabilística) llevado a cabo entre julio y noviembre del 2020. Se realizó un seguimiento de un subgrupo de 20 personas seropositivas para analizar la persistencia de los anticuerpos IgG. Para la detección de los anticuerpos IgG contra SARS-COV-2, se empleó el kit ELISA COVID-AR IgG®. Resultados. Hubo 3 000 participantes divididos en un grupo asintomático y un grupo paucisintomático (n=1 500 cada grupo). De la muestra total, solo 8,83% (n=265) presentó una reactividad de IgG contra el SARS-CoV-2. Se observó una asociación significativa entre anticuerpos IgG positivos contra el SARS-CoV-2 y antecedente de contacto con un caso confirmado. La tasa de transmisión en el hogar fue de 30% aproximadamente. En el grupo paucisintomático, entre las personas seropositivas, la anosmia y la fiebre presentaron un OR de 16,8 (IC 95% 9,5-29,8) y 2,7 (IC 95% 1,6-4,6), respectivamente (p <0,001). En los pacientes asintomáticos, los niveles de IgG fueron inferiores en comparación con los pacientes paucisintomáticos, con tendencia a la baja pasados cuatro meses desde la aparición de los síntomas. Conclusiones. Se observó una seroprevalencia baja, indicadora de una gran población susceptible a la infección. La anosmia y la fiebre fueron factores predictivos independientes de relevancia para la seropositividad. Los pacientes asintomáticos mostraron niveles inferiores de anticuerpos durante el seguimiento de cinco meses. Los anticuerpos IgG tendieron a disminuir hacia el final del período con independencia de los síntomas.
RESUMO Objetivo. Avaliar a soroprevalência de anticorpos contra a COVID-19 em indivíduos paucissintomáticos e assintomáticos, os fatores epidemiológicos associados e a cinética dos anticorpos da classe IgG em um período de 5 meses, visando aprimorar o conhecimento sobre a transmissibilidade da doença e a taxa de suscetíveis à infecção. Métodos. Inquérito transversal de soroprevalência realizado na população geral (amostra não probabilística) de Santa Fé, na Argentina, entre julho e novembro de 2020. Um subgrupo de 20 indivíduos soropositivos foi acompanhado para analisar a persistência de anticorpos IgG. O kit de ensaio imunoenzimático (ELISA) COVID-AR IgG® foi usado para a detecção de anticorpos IgG contra SARS-CoV-2. Resultados. A amostra compreendeu 3 000 indivíduos, divididos entre assintomáticos e paucissintomáticos (n = 1.500 por grupo). Deste total, somente 8,83% (n = 265) apresentaram reatividade, com a detecção de anticorpos IgG contra SARS-CoV-2. Observou-se uma associação significativa entre a presença de anticorpos IgG contra SARS-CoV-2 e histórico de contato com caso confirmado. A taxa de transmissão intradomiciliar foi de aproximadamente 30%. No grupo paucissintomático, entre os soropositivos, o odds ratio (OR) para anosmia foi de 16,8 (IC 95% 9,5-29,8), e para febre, 2,7 (IC 95% 1,6-4,6) (p <0,001). Os indivíduos assintomáticos apresentaram níveis de IgG mais baixos que os paucissintomáticos, com uma tendência de declínio após 4 meses do início dos sintomas. Conclusões. Observou-se uma soroprevalência baixa de anticorpos contra a COVID-19 na população estudada, o que indica um grande número de pessoas suscetíveis à infecção. Anosmia e febre foram preditores importantes independentes de soropositividade. Os assintomáticos apresentaram níveis mais baixos de anticorpos aos 5 meses de acompanhamento. Houve uma tendência de redução dos anticorpos IgG ao final deste período, independentemente da presença de sintomas.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Portador Sadio/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Argentina/epidemiologia , Imunoglobulina G/sangue , Ensaio de Imunoadsorção Enzimática , Estudos Soroepidemiológicos , Estudos Transversais , Teste Sorológico para COVID-19 , Anosmia/virologiaAssuntos
Anticorpos Antiprotozoários/imunologia , Afinidade de Anticorpos , Imunoglobulina G/imunologia , Complicações Neoplásicas na Gravidez/diagnóstico , Toxoplasmose/diagnóstico , Técnicas de Laboratório Clínico/métodos , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Gravidez , Proteínas de Protozoários/imunologia , Proteínas Recombinantes/imunologia , Toxoplasma/imunologiaRESUMO
The use of chimeric molecules fusing several antigenic determinants is a promising strategy for the development of low-cost, standardized and reliable kits to determine specific antibodies. In this study, we designed and assessed a novel recombinant chimera that complements the performance of our previously developed chimera, CP1 [FRA and SAPA antigens (Ags)], to diagnose chronic Chagas disease. The new chimeric protein, named CP3, is composed of MAP, TcD and TSSAII/V/VI antigenic determinants. We compared the performance of both chimeric Ags using a panel of 67 Trypanosoma cruzi-reactive sera and 67 non-reactive ones. The sensitivity of CP3 vs CP1 was 100 and 90.2%, and specificity was 92.5 and 100%, respectively. The mixture of CP1 + CP3 achieved 100% of sensitivity and specificity. More importantly, an additional subset of 17 sera from patients with discordant results of conventional serological methods was analysed; the CP1 + CP3 mixture allowed us to accurately classify 14 of them with respect to IIF, the usual technique used in most of the reference centres. These results show an improved performance of the CP1 + CP3 mixture in comparison with enzyme-linked immunosorbent assay and indirect haemagglutination commercial assays.
Assuntos
Doença de Chagas/diagnóstico , Epitopos/imunologia , Trypanosoma cruzi/imunologia , Sequência de Aminoácidos , Doença de Chagas/parasitologia , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoensaio , Dados de Sequência Molecular , Proteínas Recombinantes/imunologia , Sensibilidade e EspecificidadeRESUMO
Prophylactic and/or therapeutic vaccines have an important potential to control Trypanosoma cruzi (T. cruzi)infection. The involvement of regulatory/suppressor immune cells after an immunization treatment and T. cruzi infection has never been addressed. Here we show that a new trans-sialidase-based immunogen (TSf) was able to confer protection, correlating not only with beneficial changes in effector immune parameters, but also influencing populations of cells related to immune control. Regarding the effector response, mice immunized with TSf showed a TS-specific antibody response, significant delayed-type hypersensitivity (DTH) reactivity and increased production of IFN-γ by CD8+ splenocytes. After a challenge with T. cruzi, TSf-immunized mice showed 90% survival and low parasitemia as compared with 40% survival and high parasitemia in PBS-immunized mice. In relation to the regulatory/suppressor arm of the immune system, after T. cruzi infection TSf-immunized mice showed an increase in spleen CD4+ Foxp3+ regulatory T cells (Treg) as compared to PBS-inoculated and infected mice. Moreover, although T. cruzi infection elicited a notable increase in myeloid derived suppressor cells (MDSC) in the spleen of PBS-inoculated mice, TSf-immunized mice showed a significantly lower increase of MDSC. Results presented herein highlight the need of studying the immune response as a whole when a vaccine candidate is rationally tested.
RESUMO
BACKGROUND: P35 and P22 Toxoplasma gondii proteins are recognized by specific IgG at the early infection stage, making them ideal for acute toxoplasmosis pregnancy control. Both proteins have been studied to discriminate between acute and chronic toxoplasmosis. However, results were hardly comparable because different protein obtainment procedures led to different antigens, the reference panels used were not optimally typified, and avidity tests were either not performed or narrowly examined. METHODS: We bioinformatically predicted P35 and P22 regions with the highest density of epitopes, and expressed them in pET32/BL21DE3 alternative expression system, obtaining the soluble proteins rP35a and rP22a. We assessed their diagnostic performance using pregnant woman serum samples typified as: not infected, NI (IgG-, IgM-), typical-chronic, TC (IgM-, IgG+), presumably acute, A (IgG+, IgM+, low-avidity IgG), and recently chronic, RC (IgG+, IgM+, high-avidity IgG). RESULTS: rP35a performed better than rP22a to differentiate A from RC, the areas under the curve (AUC) being 0.911 and 0.818, respectively. They, however, performed similarly to differentiate A from TC+RC (AUC: 0.915 and 0.907, respectively). rP35a and rP22a evaluation by avidity ELISA to discriminate A from RC rendered AUC values of 0.974 and 0.921, respectively. The indirect ELISA and avidity ELISA results analyzed in tandem were consistent with those obtained using commercial kits. CONCLUSIONS: rP35a and rP22a features suggest that, with complementary use, they could replace parasite lysate for toxoplasmosis infection screening and for acute toxoplasmosis diagnosis. Our proposal should be validated by a longitudinal study and may lead to a reliable toxoplasmosis pregnancy control, performing tests in only one serum sample.
Assuntos
Antígenos de Protozoários/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Complicações Parasitárias na Gravidez/diagnóstico , Proteínas de Protozoários/sangue , Toxoplasmose/diagnóstico , Antígenos de Protozoários/genética , Antígenos de Protozoários/imunologia , Antígenos de Protozoários/metabolismo , Feminino , Humanos , Imunoglobulina G/sangue , Gravidez , Proteínas de Protozoários/genética , Proteínas de Protozoários/imunologia , Proteínas de Protozoários/metabolismo , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Toxoplasma/patogenicidadeRESUMO
Since the immune response mounted by the host to a particular microorganism might be influenced by the acquired immunological experience due to previous contact with other microorganisms, we performed a cross-sectional study to explore the pattern of Trypanosoma cruzi infection-related antibodies in T. cruzi-seropositive individuals presenting concomitant tuberculosis, or the antecedent of BCG vaccination. Sampled individuals were grouped as follows: patients with Chagas disease, not vaccinated with BCG, who further developed pulmonary tuberculosis; individuals with Chagas disease, BCG-vaccinated; and subjects with Chagas disease, presenting neither BCG scar nor tuberculosis disease. Non-vaccinated individuals or without tuberculosis, presented the highest values of anti-PH (P < 0.001), anti-FRA (P < 0.001), anti-p2ß (P = 0.0023) and anti-B13 (P < 0.001) antibodies. The present findings constitute the first demonstration of the potential influence of concomitant tuberculosis on Chagas disease.
Assuntos
Anticorpos Antiprotozoários/imunologia , Doença de Chagas/imunologia , Coinfecção , Infecções por Mycobacterium/imunologia , Mycobacterium/imunologia , Trypanosoma cruzi/imunologia , Anticorpos Antiprotozoários/sangue , Doença de Chagas/microbiologia , Doença de Chagas/parasitologia , Interações Hospedeiro-Parasita/imunologia , Interações Hospedeiro-Patógeno/imunologia , Humanos , Infecções por Mycobacterium/microbiologiaRESUMO
INTRODUCTION: chronic Chagas heart disease (CCHD) is the most common manifestation of American Trypanosomiasis, causing about 50,000 deaths annually. Several factors bear correlation with the severity of CCHD. However, to our knowledge, the assessment on the contribution of major cardiovascular risk factors (CRF), such as hypertension and atherogenic dyslipidemia (AD) to CCHD severity is scarce, despite their well-established role in coronary artery disease, heart failure and stroke. OBJECTIVE: to explore the potential relationship of blood pressure and AD with the clinical profile of patients with CCHD. METHODS: we performed a cross-sectional study in T. cruziseropositive patients categorized according to a standard CCHD classification. All individuals were subjected to complete clinical examination. Autoantibodies induced by T. cruzi were assessed by ELISA. RESULTS: we observed that Atherogenic index (AI) levels rose significantly in relation to the severity of the CCHD stage, with CCHD III cases showing the highest values of AI. Furthermore, those patients with globally dilated cardiomyopathy with reduced ejection fraction showed higher levels of AI. In regard to autoantibodies, anti-B13 also showed relation with the severity of the disease. CONCLUSION: we observed that AI correlated with CCHD stages and contributed, in association with anti-B13 antibodies and age, to the prediction of systolic heart failure.
Assuntos
Aterosclerose/fisiopatologia , Pressão Sanguínea/fisiologia , Cardiomiopatia Chagásica/fisiopatologia , Dislipidemias/fisiopatologia , Adulto , Idoso , Análise de Variância , Aterosclerose/complicações , Cardiomiopatia Chagásica/complicações , Doença Crônica , Estudos Transversais , Dislipidemias/complicações , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
SUMMARY Introduction: chronic Chagas heart disease (CCHD) is the most common manifestation of American Trypanosomiasis, causing about 50,000 deaths annually. Several factors bear correlation with the severity of CCHD. However, to our knowledge, the assessment on the contribution of major cardiovascular risk factors (CRF), such as hypertension and atherogenic dyslipidemia (AD) to CCHD severity is scarce, despite their well-established role in coronary artery disease, heart failure and stroke. Objective: to explore the potential relationship of blood pressure and AD with the clinical profile of patients with CCHD. Methods: we performed a cross-sectional study in T. cruziseropositive patients categorized according to a standard CCHD classification. All individuals were subjected to complete clinical examination. Autoantibodies induced by T. cruzi were assessed by ELISA. Results: we observed that Atherogenic index (AI) levels rose significantly in relation to the severity of the CCHD stage, with CCHD III cases showing the highest values of AI. Furthermore, those patients with globally dilated cardiomyopathy with reduced ejection fraction showed higher levels of AI. In regard to autoantibodies, anti-B13 also showed relation with the severity of the disease. Conclusion: we observed that AI correlated with CCHD stages and contributed, in association with anti-B13 antibodies and age, to the prediction of systolic heart failure.
RESUMO Introducción: la miocardiopatía chagásica (MCC) es la manifestación más común de la tripanosomiasis americana, causando cerca de 50.000 muertes al año. Varios factores se asocian con la gravedad de MCC. Sin embargo, la evaluación de la contribución de los principales factores de riesgo cardiovascular (FRC), como la hipertensión y la dislipidemia aterogénica (DA), a la gravedad de la MCC es escasa, a pesar de su papel bien establecido en la enfermedad arterial coronaria, insuficiencia cardíaca y accidente cerebrovascular. Objetivo: explorar la posible relación de la presión arterial y la DA con el perfil clínico de los pacientes con MCC. Método: estudio transversal en pacientes con serología positiva para T. cruzi categorizados de acuerdo a la clasificación estándar de MCC. Se realizó en todos los pacientes un examen clínico-cardiológico completo. Los autoanticuerpos inducidos por T. cruzi se evaluaron mediante ELISA. Resultados: se observó que los niveles de índice aterogénico (IA) aumentaron significativamente en relación con la gravedad de la etapa de la MCC, siendo que los pacientes pertenecientes al grupo MCC III mostraron los más altos valores de IA. Por otra parte, los pacientes con miocardiopatía dilatada global con fracción de eyección reducida mostraron mayores niveles de IA. En lo que respecta a autoanticuerpos, anti-B13 también mostró relación con la gravedad de la enfermedad. Conclusión: observamos que el IA se correlacionó con las etapas de MCC y contribuyó, en asociación con anticuerpos anti-B13, a la predicción de insuficiencia cardíaca sistólica.