ABSTRACT
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 .
Subject(s)
Chagas Disease , Consensus , Brazil/epidemiology , Chagas Disease/diagnosis , Chagas Disease/epidemiology , Chagas Disease/therapy , Chagas Disease/transmission , HumansABSTRACT
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.
Subject(s)
Chagas Disease/diagnosis , Chagas Disease/therapy , Neglected Diseases/diagnosis , Neglected Diseases/therapy , Brazil/epidemiology , Chagas Disease/mortality , Chagas Disease/transmission , Chronic Disease , Consensus , Disease Management , Humans , Neglected Diseases/mortality , Neglected Diseases/prevention & control , Public Health , Tropical MedicineABSTRACT
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.
Subject(s)
Humans , Male , Female , Chagas Disease/diagnosis , Chagas Disease/prevention & control , Chagas Disease/epidemiology , Brazil , Consensus Development Conference , Chagas Disease/therapy , Chagas Disease/transmissionABSTRACT
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...
Subject(s)
Delivery of Health Care , Brazil , Consensus , Diagnosis , Chagas Disease , Epidemiology , TherapeuticsABSTRACT
The aim of the present study was to evaluate the effects of changes to the autonomic nervous system in mice during the acute phase of Chagas disease, which is an infection caused by the parasite Trypanosoma cruzi. The following types of mice were inoculated with T. cruzi (CHG): wild-type (WT) and vesicular acetylcholine transporter knockdown (KDVAChT) C57BL/6j mice; wild-type non-treated (NT) FVB mice; FVB mice treated with pyridostigmine bromide (PYR) or salbutamol (SALB); and ß(2)-adrenergic receptor knockout (KOß2) FVB mice. During infection and at 18-21 days after infection (acute phase), the survival curves, parasitaemia, electrocardiograms, heart rate variability, autonomic tonus and histopathology of the animals were evaluated. Negative control groups were matched for age, genetic background and treatment. The KDVAChT-CHG mice exhibited a significant shift in the electrocardiographic, autonomic and histopathological profiles towards a greater inflammatory immune response that was associated with a reduction in blood and tissue parasitism. In contrast, the CHG-PYR mice manifested reduced myocardial inflammation and lower blood and tissue parasitism. Similar results were observed in CHG-SALB animals. Unexpectedly, the KOß2-CHG mice exhibited less myocardial inflammation and higher blood and tissue parasitism, which were associated with reduced mortality. These findings could have been due to the increase in vagal tone observed in the KOß2 mice, which rendered them more similar to the CHG-PYR animals. In conclusion, our results indicate a marked immunomodulatory role for the parasympathetic and sympathetic autonomic nervous systems, which inhibit both the inflammatory immune response and parasite clearance during the acute phase of experimental Chagas heart disease in mice.
Subject(s)
Chagas Disease/immunology , Chagas Disease/physiopathology , Inflammation/immunology , Inflammation/physiopathology , Parasympathetic Nervous System/physiopathology , Sympathetic Nervous System/physiopathology , Acute Disease , Animals , Atenolol/pharmacology , Chagas Disease/metabolism , Chagas Disease/parasitology , Electrocardiography/methods , Heart Rate/drug effects , Heart Rate/physiology , Inflammation/metabolism , Inflammation/parasitology , Male , Mice , Mice, Inbred C57BL , Myocardium/metabolism , Myocardium/pathology , Parasitemia/immunology , Parasitemia/metabolism , Parasitemia/parasitology , Parasitemia/physiopathology , Parasympathetic Nervous System/drug effects , Parasympathetic Nervous System/immunology , Parasympathetic Nervous System/metabolism , Propranolol/pharmacology , Pyridostigmine Bromide/pharmacology , Receptors, Adrenergic, beta-2/metabolism , Sympathetic Nervous System/drug effects , Sympathetic Nervous System/immunology , Sympathetic Nervous System/metabolismABSTRACT
Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Chagas Cardiomyopathy/diagnosis , Myocarditis/diagnosis , Acute Disease , Adult , Chagas Cardiomyopathy/complications , Chronic Disease , Diagnosis, Differential , Fatal Outcome , Humans , Male , Nitroimidazoles/therapeutic use , Trypanocidal Agents/therapeutic useABSTRACT
A doença de Chagas é uma parasitose causada pelo protozoário Trypanosoma cruzi, transmitido por insetos triatomíneos. A doença ocorre desde o sul dos Estados Unidos da América do Norte até a Argentina, sendo que, aproximadamente, 14 milhões de pessoas devam estar infectados na América Latina, predominantemente na forma crônica da doença. A reagudização da doença de Chagas pode ocorrer em imunossuprimidos, como tem sido observado em pacientes com aids. Verificou-se descompensação cardíaca em um destes casos, com grave disfunção ventricular e arritmias sendo considerada a possibilidade de reagudização da doença de Chagas no miocárdio, uma vez que o xenodiagnóstico foi positivo. Face a gravidade foi tratado especificamente para o Trypanosoma cruzi com benznidazol, porém sem completar o tempo estipulado para este fim, vindo a falecer em conseqüência de complicações da cardiopatia. A necropsia apresentou os estigmas habituais da cardiopatia chagásica crônica como miocardite fibrosante e redução do número de neurônios no tubo digestório, não sendo encontradas formas amastigotas do Trypanosoma cruzi em nenhum dos tecidos examinados. Assim, não ficou demonstrada a reagudização da doença de Chagas, mas sim evolução natural da cardiopatia chagásica crônica.
Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.
Subject(s)
Adult , Humans , Male , Acquired Immunodeficiency Syndrome/complications , Chagas Cardiomyopathy/diagnosis , Myocarditis/diagnosis , Acute Disease , Chronic Disease , Chagas Cardiomyopathy/complications , Diagnosis, Differential , Fatal Outcome , Nitroimidazoles/therapeutic use , Trypanocidal Agents/therapeutic useABSTRACT
This report describes the presence of Isospora belli unizoic cysts in mesenteric lymph nodes and of gametocytes in the gallbladder epitelium of a 26 year-old Brazilian male patient with Acquired Immune Deficiency Syndrome. This patient had received treatment for several times with sulfamethoxazole-trimethoprim. It is discussed the significance of I. belli tissue cysts as possible foci of resistance of the parasite and their association with the infection relapse even post-treatment with anticoccidian medication.
Subject(s)
AIDS-Related Opportunistic Infections/parasitology , Isospora/isolation & purification , Isosporiasis/diagnosis , Lymph Nodes/parasitology , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Adult , Animals , Anti-Infective Agents/therapeutic use , Fatal Outcome , Humans , Isosporiasis/drug therapy , Lymph Nodes/pathology , Male , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
Descreve-se a presença de cistos unizóicos de Isospora belli em linfonodos mesentéricos e de gametócitos no epitélio da vesícula biliar de um paciente brasileiro de 26 anos de idade, com a Síndrome da Imunodeficiência Adquirida que recebeu tratamento, por diversas vezes, com sulfametoxazol-trimetoprim. Discute-se a importância dos cistos teciduais de I. belli como possíveis focos de resistência do parasita e a associaçäo destes a episódios de recidivas da infecçäo mesmo após tratamento com medicaçäo anticoccídios
Subject(s)
Humans , Animals , Male , Adult , AIDS-Related Opportunistic Infections , Coccidiosis , Isospora , Lymph Nodes , AIDS-Related Opportunistic Infections , Fatal Outcome , Lymph Nodes , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
Com o objetivo de se obter um modelo experimental que permitisse estabelecer a despopulaçäo (desnervaçäo) neuronal cardíaca procurou-se pesquisar o comportamento do sistema nervoso intracardíaco em hamsters cronicamente infectados com o T. cruzi. Para tal fim, realizaram-se contagens dos neurônios do plexo nervoso autonômico intracardíaco em hamsters inoculados com 35.000 formas sanguíneas de três cepas diferentes, sacrificados 5, 8 e 10 meses depois da infecçäo. Demonstrou-se, pela primeira vez, destruiçäo neuronal significativa num modelo experimental, similar à que ocorre na doença de Chagas humana
Subject(s)
Animals , Male , Female , Cricetinae , Ganglia, Autonomic , Parasympathectomy , Trypanosoma cruzi/pathogenicity , Chagas DiseaseABSTRACT
A transfusäo de sangue é o segundo mais importante mecanismo de transmissäo da doença de Chagas em países endêmicos. Este trabalho tem como objetivo aprimorar o método de quimioprofilaxia da doença, reduzindo o tempo de esterilizaçäo do sangue chagásico de 24 para 6 horas. Sangue coletado de doadores normais foi infectado com diferentes concentraçöes de duas cepas de T. cruzi de alta e baixa virulência e tratado com a associaçäo de violeta de genciana (VG) 1:4000, ascorbato de sódio (AS) 1:500 e luz durante 6 horas. Em seguida o sangue, lavado ou näo, era inoculado em camundongos, submetido à hemocultura (LIT) e xenodiagnóstico artificial. Os resultados demonstraram que a associaçäo VG+AS e luz durante 6 horas é suficiente para a esterilizaçäo do sangue infectado. Concluimos que, na impossibilidade de se dispor de sorologia segura para doença de Chagas e visando o controle definitivo desta via de transmissäo, a quimioprofilaxia, através do emprego da associaçäo VG, AS e luz, deverá ser seriamente considerada e implementada. Entretanto, säo necessários estudos que permitam reduzir ainda mais o tempo para esterilizaçäo do sangue, favorecendo o rápido emprego deste método quimioprofilático nos pequenos serviços hemoterápicos de regioes endêmicas.