2 nd Brazilian Consensus on Chagas Disease, 2015.

Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research .

[Brazilian Consensus on Chagas Disease, 2015]. / II Consenso Brasileiro em Doença de Chagas, 2015.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

II Consenso Brasileiro em Doença de Chagas, 2015 / Brazilian Consensus on Chagas Disease, 2015

A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

2 nd Brazilian consensus on Chagas Disease, 2015

Chagas disease is a neglected chronic condition with ahigh burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and controlof Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health...

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant.

The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patient's electrocardiogram, echocardiogram, and chest radiography remained normal.

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant / Lactente de um ano e oito meses de idade com megaesôfago (Grupo III) por doença de Chagas adquirida vetorialmente

The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patient's electrocardiogram, echocardiogram, and chest radiography remained normal.

Os autores relatam um caso de lactente com megaesôfago do Grupo III por doença de Chagas vetorialmente adquirida, responsável por acentuada desnutrição, da qual se recuperou com a cirurgia de Heller. Submetida em seguida a tratamento da infecção chagásica com benzonidazol, logrou cura, parasito e sorologicamente demonstrada. Seguiram-se anos sem qualquer incidente, com desenvolvimento pondo-estatural normal. Teve seu primeiro filho aos 23 anos, em quem as provas sorológicas para doença de Chagas resultaram negativas. Decorridos 30 anos após o atendimento inicial, continuava com eletrocardiograma e ecocardiograma e/ou exame radiológico do coração normais.

[Clinical and radiological evaluation of the esophagus and colon in the acute phase of Chagas disease with Report of three cases of spontaneous remission of esophageal group I aperistalsis]. / Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I.

INTRODUCTION: The esophagus and colons of patients with acute Chagas disease were studied. METHODS: Deglutition and radiological examination of the esophagus were assessed in 94 (90.4%) patients, 10 children were excluded due to their age. Intestinal transit was assessed in 59 (56.7%) patients. RESULTS: Deglutition was normal in 86 (91.5%) patients, 5 of whom presented aperistalsis (group I). Incipient dysphagia was reported by 8 patients, 7 of whom normal barium swallowing, while only one presented esophageal aperistalsis (group I). A second radiological examination of the esophagus was performed in 4 of the 6 cases with aperistalsis 6 months after the initial test. It was normal in 3, and showed aperistalsis in one case, the only patient who was treated with benznidazole and considered cured of the infection. Intestinal transit was normal in 96 (92.3%) patients, constipated in 7 (6.7%), and diarrheic in one (1%). Barium enema was normal in 54/59 (91.5%), showed a dolichosigmoid in 4 (6.8%) and a dolichorectomegasigmoid in one (1.7%), of functional origin, according to the electromanometric results. CONCLUSIONS: To explain the regression of aperistalsis, 2 non-excluding hypothesis were postulated: the intramural inflammatory process, established during the acute phase, could interfere with esophageal motility by weakening the peristaltic waves; with the remission of the inflammatory reaction, the peristaltic activity of the esophagus would return to normal, as long as no extensive denervation occurred; and/or a definitive reinnervation is responsible for the recuperation of the normal esophageal peristaltic activity.

Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I / Clinical and radiological evaluation of the esophagus and colon in the acute phase of Chagas disease with Report of three cases of spontaneous remission of esophageal group I aperistalsis

INTRODUÇÃO: O esôfago e os cólons foram investigados em pacientes na fase aguda da doença de Chagas, entre 1956 e 1989. MÉTODOS: A deglutição e o exame radiológico do esôfago foram explorados em 94 (90,4 por cento) pacientes, sendo excluídas 10 crianças em virtude de tenra idade. O enema opaco foi realizado em 59 (56,7 por cento) pacientes. RESULTADOS: A deglutição foi referida como normal em 86 (91,5 por cento) pacientes, 5 dos quais apresentaram aperistalse do grupo I, enquanto a disfagia incipiente foi referida por 8, dos quais 7 apresentaram exame radiológico normal e apenas um, aperistalse do grupo I. Um segundo exame radiológico, realizado em 4 dos 6 casos, 6 meses após o primeiro, mostrou-se normal em 3 e permaneceu inalterado em um, o único que recebeu tratamento (benzonidazol) e considerado como curado da infecção. O ritmo intestinal resultou normal em 96 (92,3 por cento) pacientes, obstipado em 7 (6,7 por cento) e diarreico em um (1 por cento). O enema evidenciou resultado normal em 54 (91,5 por cento) pacientes, dolicossigmoide em 4 (6,8 por cento) e dolicorretomegassigmoide em um (1,7 por cento), que a eletromanometria demonstrou ser de natureza funcional. CONCLUSÕES: Para explicar a regressão da aperistalse, aventaram os autores duas hipóteses que não se excluem. A primeira,é a de que o processo inflamatório intramural na fase inicial da infecção poderia interferir na motilidade esofagiana, enfraquecendo a onda peristáltica; com a regressão do processo inflamatório, o peristaltismo voltaria ao normal, desde que a desnervação fosse limitada; a segunda hipótese é a de que tenha havido real re-inervação, com recuperação normal da onda peristáltica.

INTRODUCTION: The esophagus and colons of patients with acute Chagas disease were studied. METHODS: Deglutition and radiological examination of the esophagus were assessed in 94 (90.4 percent) patients, 10 children were excluded due to their age. Intestinal transit was assessed in 59 (56.7 percent) patients. RESULTS: Deglutition was normal in 86 (91.5 percent) patients, 5 of whom presented aperistalsis (group I). Incipient dysphagia was reported by 8 patients, 7 of whom normal barium swallowing, while only one presented esophageal aperistalsis (group I). A second radiological examination of the esophagus was performed in 4 of the 6 cases with aperistalsis 6 months after the initial test. It was normal in 3, and showed aperistalsis in one case, the only patient who was treated with benznidazole and considered cured of the infection. Intestinal transit was normal in 96 (92.3 percent) patients, constipated in 7 (6.7 percent), and diarrheic in one (1 percent). Barium enema was normal in 54/59 (91.5 percent), showed a dolichosigmoid in 4 (6.8 percent) and a dolichorectomegasigmoid in one (1.7 percent), of functional origin, according to the electromanometric results. CONCLUSIONS: To explain the regression of aperistalsis, 2 non-excluding hypothesis were postulated: the intramural inflammatory process, established during the acute phase, could interfere with esophageal motility by weakening the peristaltic waves; with the remission of the inflammatory reaction, the peristaltic activity of the esophagus would return to normal, as long as no extensive denervation occurred; and/or a definitive reinnervation is responsible for the recuperation of the normal esophageal peristaltic activity.

Megaesôfago por doença de Chagas / Megaesophagus due to Chagas disease

Revisões históricas aos avanços científicos para o controle da doença, o Simpósio Internacional Comemorativo do Centenário da Descoberta da Doença de Chagas (1909-2009).

Por que os triatomíneos são chamados de barbeiros? / Why triatomine bugs are called barbeiros?

Comumente se atribui o nome de barbeiro, dado ao triatomíneo transmissor da doença de Chagas ao homem, ao fato do inseto picar principalmente a face por ser a mesma mais acessível, em virtude de permanecer descoberta durante o sono. A associação de face com barba teria dado origem à denominação de barbeiro. Esta explicação, no entanto, não parece correta. O próprio Carlos Chagas que a mencionara em seu primeiro artigo escrito em alemão, em 1909, descartou-a no trabalho seguinte, escrito em português em 1910, e concluiu que o nome de barbeiro estaria relacionado com a função deste profissional de praticar sangrias e aplicar sanguessugas no passado. Na história da medicina brasileira dos tempos coloniais, o profissional barbeiro, além de cortar o cabelo e a barba, era um humilde profissional da medicina, cabendo-lhe, entre outros misteres, praticar a sangria, então usada como panacéia para todas as doenças. Em numerosas vilas e povoados, o barbeiro foi, por muito tempo, o único profissional da medicina existente, registra o historiador Lycurgo Santos Filho. A literatura médica realça a espoliação de sangue como um dos aspectos mais importantes na transmissão vetorial da doença de Chagas. O inseto, ao sugar o sangue de sua vítima, imita o profissional barbeiro quando este realiza uma sangria e não quando corta a barba de seus clientes. Embora aceita pela maioria das instituições oficiais de saúde, os autores discordam da interpretação de atribuir o nome de barbeiro dado ao inseto por ele picar mais vezes a face e defendem a que foi dada por Chagas em seu trabalho de 1910, segundo a qual o nome procede da prática da sangria por aquele profissional no passado.

Participação de Carlos Chagas e seus colaboradores no conhecimento e reconhecimento do megaesôfago de etiologia chagásica / Participation of Carlos Chagas and his collaborators in the knowledge and recognition of the mega oesophagus of chagasic aetiology

Revê-se a participação de Carlos Chagas e colaboradores mais próximos no reconhecimento e detecção do megaesôfago chagásico, através de registros feitos em alguns trabalhos pioneiros. A disperistalse é claramente mencionada e bem descrita em observações originais por eles realizadas em áreas endêmicas e material hospitalar. Revê-se a indagação de Chagas quanto à possibilidade da etiologia esquizotripanósica do agravo, em 1916, assunto que não retoma em trabalhos posteriores. Na oportunidade, são discutidos alguns fatos eventualmente explicativos a respeito desta história.

Electrogastrography in patients with Chagas' disease.

Electrogastrograghy (EGG) was performed in 33 patients with Chagas' disease and in 15 healthy volunteers-control group. The EGG was performed in two different periods: in fasting and postprandial. The EGG was submitted to a continuous spectral analysis. The following parameters were evaluated: % dominant frequency in spectral bands: normogastria (2-4 cpm), bradygastria (1-2 cpm), tachygastria (4-10 cpm) and duod/resp (10-15 cpm). EGG was considered normal if normogastria > 65% in both EGG periods. The chagasic group showed % normogastria significantly lower (basal, P < 0.01), % bradygastria (basal, P = 0.01) and % tachygastria (basal and postprandial, P =.001) significantly higher than the control group. EGG was normal in 14/15 (93%) in control group x 16/33 (53%) in chagasic group (P < 0.05). It was concluded that: 1) the prevalence of gastric dysrhythmias was higher in chagasic patients than in comparison to a control group 2) gastric dysrhythmias may be considered one of the abnormalities presented in the chagasic gastropathy.