[Comparative controlled study on the use of benznidazole, nifurtimox and placebo, in the chronic form of Chagas' disease, in a field area with interrupted transmission. I. Preliminary evaluation]. / Estudo comparativo controloado com emprego de benznidazole, nifurtimox e placebo, na forma crônica da doença de Chagas; em uma área de campo com transmissão interrompida. I. Avalição preliminar.

A controlled clinical trial was carried out to evaluate the therapeutic efficacy and tolerance of nifurtimox and benznidazole in patients with chronic Chagas' disease. All patients had immunofluorescence and complement fixation reactions positives for T. cruzi antibodies and at least two xenodiagnoses positives in three performed before treatment, and they were submitted to clinical examinations, ECG and X-ray of the heart and esophagus. Of 77 patients studied, 27 were treated with nifurtimox and 26 with benznidazole in the dosage of 5 m/kg/day for 30 consecutive days, and 24 received a placebo in tablets similar to benznidazole. From the 77 patients, 64 (83.1%) accomplished the treatment: 23 (88.4%) with benznidazole, 19 (70.3%) with nifurtimox and 22 (91.6%) with placebo. The patients were evaluated, clinically, serologically and parasitologically (six xenodiagnoses within one year after treatment). The benznidazole group showed only 1.8% of positive xenodiagnoses post-treatment, the nifurtimox 9.6% and the placebo 34.3%. All serologic reactions continued positive and there were no clinical, ECG or X-ray changes one year after treatment.

Evaluation of the xenodiagnosis of chronic Chagas patients infected ten years or over in an area where transmission has been interrupted--Iguatama and Pains, west Minas Gerais State, Brazil.

To evaluate the results of xenodiagnosis in chronic Chagas patients infected for ten years or over in an area where transmission has been stemmed as well as the performance of these tests applied one or more times to determine the presence of the parasite in serum-positive patients for Trypanosoma cruzi infection, 570 xenodiagnosis were performed in 246 patients by exposing each patient to 40 Triatoma infestans nymphs of 3rd/4th stage once, twice or three times, at 30 days intervals. The 570 xenodiagnosis showed overall positive results in 50.7% with a peak 78% in patients under 20 years of age, and 60.5% in those over 60. Of the 158 patients who underwent three xenodiagnosis, 51 (32.3%) had three positive tests, 48 (30.3%) had all negative results, and the remainder had alternating positive and negative findings. There was no difference in number of positive results between the 1st, 2nd and 3rd tests; however, the 1st and 2nd trials added up to 53.2% and the sum total of all three trials was 57.7%.

Morbidade da doença de Chagas. II. Estudos seccionais em quatro áreas de campo no Brasil / Morbidity of Chagas' disease. II - Sectional studies in 4 field areas in Brazil

Foi realizado um estudo seccional de campo do tipo "caso controle" sobre a morbilidade da doença de Chagas em quatro áreas endêmicas no Brasil, duas no Estado de Minas Gerais, uma no Estado do Piauí e outra no Estado da Paraíba, incluindo 716 pares de indivíduos da mesma idade e sexo, cada par constando de um indivíduo com sorologia positiva e outro com sorologia negativa para a infecçäo chagásica. Com esse tipo de estudo procurou-se determinar o componente exclusivamente chagásico na morbidade da doença em diferentes áreas do país. O gradiente de manifestaçöes clínicas e alteraçöes eletrocardiográficas entre o grupo com sorologia positiva e outro com sorologia negativa, estudado em 264 pares na área de Iguatama-Paris e 274 em Virgem da Lapa, ambas em Minas Gerais, e em 109 pares estudados nas localidades de Colônia e Oitis, em Oeiras, Piauí e em 69 nos municípios de Aguiar e Boqueiräo dos Cochos na Paraíba, mostra nitidas diferenças regionais na morbilidade da doença. Nas áreas de Minas Gerais, embora a transmissäo natural da infecçäo estivesse interrompida há 15 e 5 anos, respectivamente, o grau de morbilidade cardiológica pelo componente chagásico, considerando apenas as alteraçöes eletrocardiográficas mais expressivas e específicas, no momento do estudo, foi de aproximadamente 30%, enquanto em Oeiras, no Piauí e em Aguiar e Boqueiräo dos Cochos, na Paraíba, mesmo com transmissäo ativa da infecçäo, a morbidade cardiológica pelo componente chagásico foi inferior a 15 e 10%, respectivamente

American trypanosomiasis (Chagas' disease) in the Caribbean.

Chagas' disease (American trypanosomiasis) is endemic in nearly all Central and South American countries facing the Caribbean basin. Since 1960, reports from the islands of Aruba, Curaçao, Jamaica, and Trinidad have confirmed the presence of Trypanosoma cruzi, blood-sucking triatomine bugs, and wild animals infected with the parasite. It was also established that T. cruzi, triatomine bugs, infected wild animal reservoirs, and people with a positive serologic test for T. cruzi antibodies are to be found in Belize, the last country in Central America once thought to be free of Chagas' disease.

Educational approach in the control of Chagas' disease.

The serious threat posed by Chagas' disease demands an urgent and realistic approach to controlling the infection in multitudes of affected Latin American communities. Education is undoubtedly the best current means available for combating widespread public ignorance, both of the threat posed by reduviid bugs and of the association between the bugs and the disease. Especially high priority should be given to informing schoolchildren about the disease and to providing adults with an appropriate education on elementary hygiene and advice about how to make their homes secure against reduviid bug infestations. In general, the obstacles to control of Chagas' disease do not involve lack of a cure so much as lack of public awareness and education. A need thus exists for public health and education authorities to take an active interest in the implementation of control programs, and to make a determined effort to overcome existing difficulties by means of an educational approach.

Educational approach in the control of Chagas' disease

The serious threat posed by Chagas' disease demands an urgent and realistic approach to controlling the infection in multitudes of affected Latin American communities. Education is undoubtedly the best current means available for combating widespread public ignorance, both of the threat posed by reduviid bugs and of the association between the bugs and the disease. Especially high priority should be given to informing schoolchildren about the disease and to providing adults with an appropriate education on elementary hygiene and advice about how to make their homes secure against reduviid bug infestations. In general, the obstacles to control of Chagas' disease do not involve lack of a cure so much as lack of public awareness and education. A need thus exists for public health and education authorities to take an active interest in the implementation of control programs, and to make a determined effort to overcome existing difficulties by means of an educational approach (Au)

Educational approach in the control of Chagas' disease

The serious threat posed by Chagas' disease demands an urgent and realistic approach to controlling the infection in multitudes of affected Latin American communities. Education is undoubtedly the best current means available for combating widespread public ignorance, both of the threat posed by reduviid bugs and of the association between the bugs and the disease. Especially high priority should be given to informing schoolchildren about the disease and to providing adults with an appropriate education on elementary hygiene and advice about how to make their homes secure against reduviid bug infestations. In general, the obstacles to control of Chagas' disease do not involve lack of a cure so much as lack of public awareness and education. A need thus exists for public health and education authorities to take an active interest in the implementation of control programs, and to make a determined effort to overcome existing difficulties by means of an educational approach (Au)