RESUMEN
Resumen Chagas es una infección causada por Trypanosoma cruzi. Actualmente la principal vía de transmisión en la Argentina es la vertical y es prioritario el diagnóstico oportuno. El objetivo de este trabajo fue analizar características epidemiológicas y de seguimiento de pacientes con sospecha de Chagas agudo. Se realizó un estudio observacional, descriptivo y retrospectivo, analizando las historias clínicas de pacientes con pedido de parasitemia entre 2015 y 2022. Se registró resultado, antecedentes epidemiológicos y si se completó el algoritmo diagnóstico. Se analizaron 254 pacientes con una mediana de edad de 6 meses. Veintidós fueron diagnosticados con Chagas; 17 fueron por transmisión vertical, 1 por transmisión vertical/trasplante y 4 por vertical/vectorial. En 126 pacientes se descartó la infección, mientras que en 99 no se completó el algoritmo diagnóstico. Siete pacientes fueron excluidos del estudio. Se diagnosticó Chagas en el 8,7% de los pacientes y se observó pérdida de seguimiento en un 36,2%.
Abstract Chagas is an infection caused by Trypanosoma cruzi. Nowadays, in Argentina vertical transmission is the main source of infection, which makes opportunistic diagnosis mandatory. The aim of this study was to analyse the epidemiological characteristics and follow-up of patients with suspected acute Chagas infection. An observational, descriptive, retrospective study was carried out. Medical records of patients with parasitemia test solicitude in the period between 2015 and 2022 were analysed, and results were registered, along with epidemiological background and if diagnosis algorithm were completed; 254 patients were analysed with a median age of 6 months: 22 patients were diagnosed with Chagas, 17 of whom had a vertical transmission, 1 was vertical/transplant transmission and there were 4 cases of vertical/vectorial transmission. Infection was ruled out in 126 patients, while in 99 children algorithm diagnosis was not completed. Seven patients were excluded from this study. Chagas was diagnosed in 8.7% of the patients studied and there was loss in follow-up in 36.2% of patients.
Resumo Chagas é uma infecção causada pelo Trypanosoma cruzi. Atualmente, na Argentina, a principal via de transmissão é a vertical e é prioritário o diagnóstico oportuno. O objetivo deste trabalho foi analisar as características epidemiológicas e de seguimento de pacientes com suspeita de Chagas agudo. Foi realizado um estudo observacional, descritivo e retrospectivo. Analisaram-se osprontuarios médicos dos pacientes com pedido de parasitemia entre 2015 e 2022. Foram registrados resultado e antecedentes epidemiológicos, e se completou o algoritmo diagnóstico. Analisaram-se 254 pacientes com uma mediana de idade de 6 meses: 22 foram diagnosticados com Chagas; 17 foram por transmissão vertical, 1 transmissão vertical/transplante, e 4 vertical/vetorial. Em 126 pacientes foi descartada a infecção, enquanto que em 99 não se completou o algoritmo diagnóstico. Sete pacientes foram excluídos do estudo. Foi diagnosticado Chagas em 8,7% dos pacientes e se observou perda de seguimento em 36,2%.
RESUMEN
Accumulated evidence suggests that an abnormal placentation and an altered expression of a variety of trophoblast transporters are associated to preeclampsia. In this regard, an abnormal expression of AQP3 and AQP9 was reported in these placentas. Recent data suggests that placental AQPs are not only water channel proteins and that may participate in relevant processes required for a normal placental development, such as cell migration and apoptosis. Recently we reported that a normal expression of AQP3 is required for the migration of extravillous trophoblast (EVT) cells. Thus, alterations in this protein might lead to an insufficient transformation of the maternal spiral arteries resulting in fluctuations of oxygen tension, a potent stimulus for oxidative damage and trophoblast apoptosis. In this context, the increase of oxygen and nitrogen reactive species could nitrate AQP9, producing the accumulation of a non-functional protein affecting the survival of the villous trophoblast (VT). This may trigger the exacerbated release of apoptotic VT fragments into maternal circulation producing the systemic endothelial dysfunction underlying the maternal syndrome. Therefore, our hypothesis is that the alteration in the expression of placental AQPs observed at the end of gestation may take place during the trophoblast stem cell differentiation, disturbing both EVT and VT cells development, or during the VT differentiation and turnover. In both situations, VT is affected and at last the maternal vascular system is activated leading to the clinical manifestations of preeclampsia.