Chagas disease in 2 geriatric rhesus macaques (Macaca mulatta) housed in the Pacific Northwest.

Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. It is endemic in Latin America but also is found in the southern United States, particularly Texas and along the Gulf Coast. Typical clinical manifestations of Chagas disease are not well-characterized in rhesus macaques, but conduction abnormalities, myocarditis, and encephalitis and megaesophagus have been described. Here we report 2 cases of Chagas disease in rhesus macaques housed in the northwestern United States. The first case involved a geriatric male macaque with cardiomegaly, diagnosed as dilated cardiomyopathy on ultrasonographic examination. Postmortem findings included myocarditis as well as ganglioneuritis in the esophagus, stomach, and colon. The second case affected a geriatric female macaque experimentally infected with SIV. She was euthanized for a protocol-related time point. Microscopic examination revealed chronic myocarditis with amastigotes present in the cardiomyocytes, ganglioneuritis, and opportunistic infections attributed to her immunocompromised status. Banked serum samples from both macaques had positive titers for T. cruzi. T. cruzi DNA was amplified by conventional PCR from multiple tissues from both animals. Review of their histories revealed that both animals had been obtained from facilities in South Texas more than 12 y earlier. Given the long period of clinical latency, Chagas disease may be more prevalent in rhesus macaques than typically has been reported. T. cruzi infection should be considered for animals with unexplained cardiac or gastrointestinal pathology and that originated from areas known to have a high risk for disease transmission.

Alteraciones electrocardiográficas en pacientes con enfermedad de chagas. Hospital José Rangel de Villa de Cura. 1998 - 2008 / Electrocardiographic abnormalities in patients with. chagas disease. Hospital José Rangel of Villa de Cura. 1998 - 2008

Objetivo: Analizar las principales alteraciones electrocardiográficas en pacientes con Enfermedad de Chagas que asistieron al Hospital José Rangel de Villa de Cura Edo. Aragua, entre los años 1998 -2008. Se realizó una revisión de historias clínicas y electrocardiogramas de la Unidad de Archivos del Hospital José Rangel de Villa de Cura. La población estuvo conformada por 85 pacientes con enfermedad de Chagas que asistieron al Hospital José Rangel de Villa de Cura entre los años 1998 - 2008. De ellos, 64 % de los pacientes tuvo edades comprendidas entre los 60 a 84 años, a predominio del sexo masculino en 55%. El trastorno de conducción más frecuente fue el bloqueo de rama (52,9%), principalmente bloqueo de rama derecha; El trastorno del ritmo más frecuente fue fibrilación auricular (55.3%), principalmente fibrilación auricular con respuesta ventricular rápida. También se observó extrasístole ventricular, bradicardia sinusal, arritmia ventricular, y otras alteraciones electrocardiográficas, principalmente alteraciones del segmento ST, alteraciones de la onda P y bajo voltaje. Las principales patologías cardiovasculares fueron: hipertensión arterial (49,4 %), insuficiencia cardíaca (57,6) enfermedad cerebrovascular (22,4%). Los medicamentos más utilizados fueron Ácido acetilsalicílico (60%), (55,3%), Digoxina (35,6%), Amiodarona (29,4%), Furosemida (57,3%), Espironolactona (31,8%), Captopril (44,7%), Enalapril (22,4%) y Clonidina (20%). solo 4,7% ameritó el uso de marcapasos. Metodología: La investigación se enmarca como un estudio epidemiológico descriptivo de corte transversal. Conclusiones: Se concluye que en estos pacientes la presencia de fibrilación auricular fue levemente más frecuente que el bloqueo de rama, con alta frecuencia de hipertensión arterial e insuficiencia cardíaca, indicando grave compromiso cardíaco y mal pronóstico.

Objective: To analyze the electrocardiographic changes in patients with Chagas disease who attended the Hospital José Rangel de Villa de Cura Edo. Aragua, between the years 1998 -2008. Clinical records and electrocardiograms in the archives unit were reviewed. The population consisted of 85 patients with Chagas disease who attended the Hospital José Rangel of Villa de Cura between the years 1998 to 2008. Of these, 64% of patients were aged 60-84 years, 55% of patients were male. Branch block disorder was the most frequent (52,9%), with predominance of right bundle branch block (31,7%), Atrial fibrillation was the most common rhythm disorder (55,3%), with predominance of atrial fibrillation with rapid ventricular response. (3,7%) was also observed ventricular extrasystole, sinus bradycardia, ventricular arrhythmia and other ECG abnormalities, particularly ST-segment abnormalities, alterations in the P wave and low voltage. The major cardiovascular diseases were: hypertension (49,4%), heart failure (57,6) cerebrovascular disease (22,4%). Acetylsalicylic acid was the drug most used (60%), and also Isosorbide (55,3%), Digoxin (35.6%), Amiodarone (29,4%), Furosemide (57,3%), Spironolactone (31,8%), Captopril (44,7%), Enalapril (22,4%) and Clonidine (20%). just 4,7% required the use of pacemakers. Methodology: The research was framed as cross sectional a descriptive epidemiological study. Conclusions: We conclude that in these patients the presence of atrial fibrillation was slightly more common than bundle branch block, with a high frequency of hypertension and heart failure, indicating severe heart failure and poor prognosis.

Enfermedad de Chagas en el grupo familiar de un caso crónico de curso fatal en un área sin triatominos del departamento de Ica Perú / Chagas disease in the familial group of a chronic case with fatal course in an area free of triatomines at Ica department, Peru

El propósito de esta comunicación es presentar dos casos de enfermedad de Chagas en el grupo familiar de un caso índice, procedente de Arequipa región sudoccidental del Perú, el cual es una área endémica. El caso índice sufrió una muerte súbita por cardiomiopatía chagásica en una localidad sin triatominos del departamento de Ica. Su hermana y su sobrino mostraron anticuerpos IgG específicos contra Trypanosoma cruzi por Inmunoensayo Enzimático (ELISA) e Inmunofluorescencia Indirecta (IFI), ambos familiares tenían antecedentes de haber vivido en el valle endémico de Vítor (Arequipa). Nuestros resultados enfatizan la importancia de la investigación epidemiológica en el grupo familiar de un caso crónico en áreas de bajo riesgo

Evidence of Trypanosoma cruzi infection (Chagas' disease) among patients undergoing cardiac surgery.

BACKGROUND: Trypanosoma cruzi, the agent of Chagas' heart disease, is transmitted by triatomine insects and by blood transfusion. The emigration of several million people from T cruzi-endemic countries to the United States has raised concerns regarding a possible increase in cases of Chagas' heart disease here, as well as an increased risk of transfusion-transmitted T cruzi. To investigate these 2 possible outcomes, we tested a repository of blood specimens from multiply transfused cardiac surgery patients for antibodies to T cruzi. METHODS AND RESULTS: Postoperative blood specimens from 11 430 cardiac surgery patients were tested by enzyme immunoassay, and if repeat-reactive, were confirmed by radioimmunoprecipitation. Six postoperative specimens (0.05%) were confirmed positive. Corresponding preoperative specimens, available for 4 of these patients, were also positive. The other 2 patients had undergone heart transplantations. Tissue samples from their excised hearts were tested for T cruzi by polymerase chain reaction and were positive. Despite the fact that several of these 6 patients had histories and clinical findings suggestive of Chagas' disease, none of them were diagnosed with or tested for it. Patient demographics showed that 5 of 6 positive patients were Hispanic, and overall, 2. 7% of Hispanic patients in the repository were positive. CONCLUSIONS: No evidence for transfusion-transmitted T cruzi was found. All 6 seropositive patients apparently were infected with T cruzi before surgery; however, a diagnosis of Chagas' disease was not known or even considered in any of these patients. Indeed, Chagas' disease may be an underdiagnosed cause of cardiac disease in the United States, particularly among patients born in countries in which T cruzi is endemic.

Regresión de la cardiopatía chagásica aguda en un lactante menor con sospecha de infección transfusional. Nueve años de seguimiento / Regression of acute chagasic cardiopathy in a nine months old infant with suspected transfusional infection. Nine years follow up

La enfermedad de Chagas o Tripanosomosis Americana fue descrita en México por Mazzotti en 1940. No ha sido documentada la transmisión a través de transfusión sanguínea. Presentamos el caso de una niña de 9 meses de edad con diagnóstico comprobado de cardiopatía chagásica aguda, el antecedente de transfusión sanguínea nos hace sospechar la transmisión por esta vía. Recibió manejo a base de Nifurtomox con los que se obtuvo negativización de la parasitología. En su seguimiento de nueve años se observa una regresión paulatina de la cardiopatía, tanto en estudios radiológicos como ecocardiográficos, hasta llegar a la normalidad. En su control durante este tiempo conserva la negatividad en los exámenes serológicos y parasitológicos, ha permanecido asintomática y su desarrollo y crecimiento son adecuados

Epidemiology of Chagas' heart disease

Chagas' disease is a major public health problem in Latin America. About 16 million persons are affected and 90 million others are exposed to the risk of being infected by the parasite. The knowledge of epidemiological aspects of the disease allowed to delineate the strategies for the control of the disease related with the vectorial transmission. However, these strategies have had no priority in all endemic countries. Rural-urban migration in most endemic areas carried infected individuals to urban centers increasing the problem of Chagas' disease by blood transfusion. In Brazil the control program has reached good results in the last years and in several states the vectorial transmission was controlled. More recently, hemotherapic practices are performed using screening procedures but this practice must be improved in order to eliminate the possibility of Chagas' disease transmission by another ways (congenital, accidental, oral, etc.). An adequate health care to the infected persons must be improved in order to diminish the social costs of the severe cardiopathy which has been responsible for the adults premature deaths.

Doença de Chagas: revisäo de 8 casos simultâneos de miocardite aguda chagásica; 25 anos após / Chagas disease: review of 8 simultaneous cases of acute Chagas myocarditis; 25 years after

Objetivo - Relatar a evoluçäo de pacientes após 25 anos após uma miciroepidemia de doença de Chagas, surgida em Teotônia-RS em 1965 e discutir a importância da transnissäo via oral (VO) como porta de entrada. Métodos - Oito pacientes de um grupo de 17 pessoas acometidas de infecçäo chagásica aguda, em 1965, estäo fichadas no IC/FUC do RS com diagnóstico de doença de Chagas. Foram examinadas clinicamente e se submeteram a exames laboratoriais de rotina, provas específicas para o Trypanozoma cruzi, eletrocardiograma (ECG), radiografia de tórax (RX) e ecocardiograma (ECO) em 1991. Resultados - Nenhum dos 8 pacientes apresentou manifestaçöes orgânicas da doença de Chagas, os exames laboratoriais, ECG, RX e ECO foram normais. Na imunofluorescência somente um paciente apresentou indice 1/20. Conclusäo - 1) A evoluçäo dos oito casos nestes 25 anos foi benigna, näo apresentando nenhum sinal ou manifestaçäo orgânica de doença de Chagas e, especificamente, sem miocardiopatia; 2) a transmissäo VO deve ser considerada definitivamente como porta de entrada para a doença de Chagas e, provavelmente, influi na evoluçäo da fase crônica

Purpose - To analyse the evolution of 8 cases of Chagas' disease after a microepidemy of 17 cases which ocurred in Teotonia - RS - in 1965 and to discuss the importance of oral contamination in Chagas' disease. Methods - All 8 patients are followed at the IC/ FUC - RS - Brazil since 1980. Clinical examinations, blood tests, ECG, Cx-Ray and Echo were made in 1991. Results - None of the eight cases presented any sign of chronic Chagas' disease manifestation. The blood tests, ECG, Cx-Ray and Echo were normais. Only one case showed a imunofluorescence of 1/20. Conclusion - 1) The follow-up after 25 years in all the 8 cases did not show clinical alterations or any chronic manifestation of Chagas' disease. All the tests performed had normal results; 2) the oral transmission must be considered definitive in Chagas' disease

Doença de Chagas aguda pós-transfusional sem miocardite: relato de caso / Post-transfusion acute Chagas' disease without myocarditis: case report

Trata-se de paciente do sexo feminino, com 59 anos de idade, procedente de Itaporanga (SP), diabética e nefropata crônica, internada em virtude de surtos de pielonefrite e insuficiência renal aguda. Dentre outras medidas terapêuticas, recebeu transfusäo de sangue. Cerca de dois dias após a última transfusäo (sangue oriundo de doador, posteriormente identificado como chagásico) encontraram-se formas tripomastigotas de Trypanosoma cruzi em lâmina preparada para execuçäo de hemograma. Iniciou-se tratamento com Benzonidazol. A paciente cursou para pleuropneumonia e de secreçäo purulenta cirúrgica isolou-se Klebsiella spp. A septicemia conduziu a paciente ao êxito letal. Nenhuma lesäo tecidual foi observada no miocárdio, no sistema nervoso central, adrenal ou nos demais órgäos examinados