Triatomine home invasions in active foci of Chagas disease in Abaetetuba, Pará, Brazil.

BACKGROUND: Chagas disease is a parasitic infection with high re-emergence rates in some Amazon regions. The main vectors of Trypanosoma cruzi are haematophagous insects, the triatomines. Only a few reports are available about the occurrence of these wild vectors and their contact with the inhabitants of the riverside regions of the Amazon. This study describes the unusual behaviour of the triatomines that have invaded the homes of the residents of Abaetetuba, the city that has the second highest number of cases of Chagas disease. METHODS: Two cross-sectional studies were conducted using sero-epidemiological surveys of the inhabitants of Abaetetuba with registered triatomine home invasions. The frequencies of the variables of interest were analysed using Epi Info version 7.2. RESULTS: In 2014 and 2017, 145 persons registered home invasions of triatomines in their domiciles and 16.55% reported having been bitten by insects. The environmental features described indicated potential conditions for the persistence of the parasite's life cycle. Of the enrolled inhabitants, 0.47% were positive for immunoglobulin G anti-T. cruzi antibodies. CONCLUSIONS: Home invasions of triatomines were confirmed in two periods, with a description of unusual behaviour for the genus Rhodnius. The use of serological surveillance in human populations at risk of this occurrence may constitute a new tool for the early detection of silent infections.

Atrial fibrillation in acute Chagas disease acquired via oral transmission: a case report.

Atrial fibrillation (AF), a type of supraventricular arrhythmia increases the risk of thromboembolism. Chagas disease has been reported in the Brazilian Amazon region over approximately 20 years. Cardiac abnormalities are recorded in at least 50% of patients and among these, 3.3% develop AF. We describe a case of a 41-year-old man from Muaná, Pará State, who reported a 30-day history of a febrile illness. Acute Chagas disease was confirmed, and an electrocardiogram revealed AF. He was treated with antiparasitic and anti-arrhythmic drugs, beta blockers, and anticoagulants. Reversion to sinus rhythm was observed at his 9-month follow-up.

Atrial fibrillation in acute Chagas disease acquired via oral transmission: a case report

Abstract Atrial fibrillation (AF), a type of supraventricular arrhythmia increases the risk of thromboembolism. Chagas disease has been reported in the Brazilian Amazon region over approximately 20 years. Cardiac abnormalities are recorded in at least 50% of patients and among these, 3.3% develop AF. We describe a case of a 41-year-old man from Muaná, Pará State, who reported a 30-day history of a febrile illness. Acute Chagas disease was confirmed, and an electrocardiogram revealed AF. He was treated with antiparasitic and anti-arrhythmic drugs, beta blockers, and anticoagulants. Reversion to sinus rhythm was observed at his 9-month follow-up.

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.

Clinical follow-up of responses to treatment with benznidazol in Amazon: a cohort study of acute Chagas disease.

A total of 179 individuals with acute Chagas disease mainly transmitted by oral source, from Pará and Amapá State, Amazonian, Brazil were included during the period from 1988 to 2005. Blood samples were used to survey peripheral blood for T. cruzi hemoparasites by quantitative buffy coat (QBC), indirect xenodiagnosis, blood culture and serology to detection of total IgM and anti-T. cruzi IgG antibodies by indirect immunofluorescence assay (IFA) and indirect hemagglutination assay (HA). All assays were performed pre-treatment (0 days) and repeated 35 (±7) and 68 (±6) days after the initiation of treatment with benznidazol and every 6 months while remained seropositive. The endpoint of collection was performed in 2005. Total medium period of follow-up per person was 5.6 years. Also, a blood sample was collected from 72 randomly chosen treated patients to perform polimerase chain reaction (PCR) method. Proportions of subjects with negative or positive serology according to the number of years after treatment were compared. In the endpoint of follow-up we found 47 patients (26.7%) serologically negative, therefore considered cured and 5 (2.7%) exhibited mild cardiac Chagas disease. Other 132 patients had persistent positive serologic tests. The PCR carried out in 72 individuals was positive in 9.8%. Added, there was evidence of therapeutic failure immediately following treatment, as demonstrated by xenodiagnosis and blood culture methods in 2.3% and 3.5% of cases, respectively. There was a strong evidence of antibody clearing in the fourth year after treatment and continuous decrease of antibody titers. Authors suggest that control programs should apply operational researches with new drug interventions four years after the acute phase for those treated patients with persistently positive serology.

Infecção tripla por Trypanosoma cruzi, Plasmodium vivax e P. falciparum: relato de caso / Triple infection by Trypanosoma cruzi, Plasmodium vivax and P. falciparum: case report

O presente registro acerca da identificação de infecção aguda de dois plasmódios e um Trypanosoma constitui evento raro. Pré-escolar, sexo feminino, 5 anos de idade, apresentou síndrome febril; foi submetida a exame de gota espessa no qual foram identificadas formas assexuadas e sexuadas de Plasmodium vivax e P. falciparum, respectivamente, além de tripomastigotas sanguíneos de Trypanosoma cruzi. No peridomicílio, foram encontrados insetos da espécie Rhodnius sp. Os autores reforçam a importância dos estudos dos ciclos peridomiciliares de T. cruzi em ambientes silvestres na Amazônia e discutem a importância da estratégia de vigilância continuada de Trypanosomas spp. nos exames de gota espessa.

This report describes a rare case of acute infection caused by two Plasmodia and one Trypanosoma. 5 year-old female patient attending kindergarten presented persistent fever syndrome. She was submitted to thick smear exam, in which asexual and sexual forms of Plasmodium vivax and P. falciparum were detected, respectively, as well as trypomastigotes of Trypanosoma cruzi. Rhodnius sp. triatomines were found in the vicinity. The authors reinforce the importance of investigating the domiciliary cycles of T. cruzi in the Amazon region. Moreover, we discuss the importance of continuous monitoring of Trypanosomas spp. in thick smear exams.

Congenital Chagas disease due to acute maternal Trypanosoma cruzi infection transmitted by the oral route / Doença de Chagas congênita por infecção aguda maternal por Trypanosoma cruzi transmitida via oral

A family of four, including a 24-year-old female, presented to our laboratory in December 2006 with a prolonged febrile syndrome of unknown etiology. After extensive laboratory screening, acute Chagas disease was confirmed by positive T. cruzi blood culture, combined with clinical, epidemiological and serological findings. The young female, her parents and husband received a daily dose of benznidazole, but she developed serious drug intolerance and amenorrhea. Her treatment was interrupted by a confirmed pregnancy of about 12 weeks of gestational age. The child was born prematurely on April 18, 2007 with low weight and signs of respiratory distress syndrome. Diagnostic screening tests for congenital infections, including Chagas disease, were negative during the perinatal period. About four months after birth, clinical findings generated the following clinical indicators of congenital disease: convergent strabismus, microcephaly and delayed psychomotor development. Serological tests confirmed seroconversion, and magnetic resonance findings included cystic lesions and intracranial calcifications. The authors discuss the critical nature of this serious public health problem in the region and suggest necessary revisions to the recommended treatment for pregnant patients with acute Chagas disease.

Uma família de quatro pessoas, incluindo uma mulher de 24 anos de idade, apresentou-se em nosso laboratório em dezembro de 2006 com uma síndrome febril prolongada de etiologia desconhecida. Após uma triagem laboratorial extensa, foi confirmada, por meio de hemocultura positiva para T. cruzi, combinada com achados clínicos, epidemiológicos e sorológicos, a ocorrência de doença de Chagas aguda. A paciente, seus pais e marido receberam uma dose diária de benzonidazol, porém ela desenvolveu intolerância severa à droga e amenorreia. Seu tratamento foi interrompido devido à confirmação de gravidez de cerca de 12 semanas de idade gestacional. A criança nasceu prematuramente em 18 de abril de 2007 com baixo peso e sinais de síndrome do desconforto respiratório. Testes de triagem diagnóstica para infecções congênitas, incluindo a doença de Chagas, resultaram negativos durante o período perinatal. Aproximadamente quatro meses após o nascimento, os achados clínicos forneceram os seguintes indicadores clínicos de doença congênita: esotropia, microcefalia e atraso no desenvolvimento psicomotor. Testes sorológicos confirmaram a soroconversão e a ressonância magnética apresentou lesões císticas e calcificações intracranianas. Os autores discutem a natureza crítica deste grave problema de saúde pública na região e sugerem revisões necessárias ao tratamento recomendado para pacientes grávidas com a doença de Chagas aguda.

Alterações eletrocardiográficas durante e após tratamento com benzonidazol em fase aguda de doença de Chagas autóctone da Amazônia brasileira / Electrocardiographic changes during and after benznidazole treatment against acute-stage Chagas disease indigenous to the Brazilian Amazon

Avaliar o comprometimento cardíaco associado às infecções agudas por Tripanosomas considerando os distúrbios de condução elétrica e ritmo cardíacos apresentados durante a fase aguda e após tratamento, em uma casuística de doença de Chagas autóctone da Amazônia. Foram analisadas duas coortes de indivíduos: uma em fase aguda (coorte I) e outra (coorte II) feita nos mesmos pacientes reavaliados em período médio da primeira coorte, de 3,9 anos após tratamento. Entre os indivíduos da coorte I, a análise eletrocardiográfica foi realizada em eletrocardiogramas recuperados e submetidos à nova leitura e em eletrocardiogramas realizados prospectivamente. Todos foram submetidos a tratamentos regulares com benzonidazol. Foram estudados 179 indivíduos que tiveram doença de Chagas aguda no período entre 1992 e 2005. Na fase aguda, 47,7 por cento dos traçados eletrocardiográficos apresentaram-se normais e em 52,3 por cento registraram-se anormalidades. As alterações difusas de repolarização ventricular e baixa voltagem de QRS foram as principais anormalidades. Em 39,1 por cento dos pacientes houve comprometimento cardíaco caracterizado por miopericardite, sendo que 24,3 por cento (17/70) dos casos foram considerados graves. Foi demonstrada maior frequência de alterações eletrocardiográficas após tratamento em pacientes que manifestaram alteração eletrocardiográfica durante a fase aguda, comparativamente àqueles que não apresentaram. Outros cinco indivíduos que apresentaram diagnósticos tardios e manifestaram miocardite difusa durante o período agudo evoluíram insatisfatoriamente, uma vez que desenvolveram forma cardíaca com lesões de cardiopatia crônica...

This article aims to assess the cardiac impairment associated with acute infections by Trypanosoma considering abnormalities in electrical conduction and heart rate during the acute phase and after treatment in a case-study of Chagas' disease indigenous to the Amazon. The individuals assessed were grouped into two cohorts: cohort I had patients during the acute phase of the disease; and cohort II included the same patients re-evaluated at the average period of the first cohort, 3.9 years after treatment. The electrocardiographic analysis of the individuals in cohort I was based both on restored electrocardiograms that underwent a new reading and on electrocardiograms performed prospectively. All patients were treated with benznidazole on a regular basis. A total of 179 individuals that had acute Chagas disease in the period between 1992 and 2005 were assessed. During the acute phase, 47.7 per cent of the electrocardiographic tracings were normal, and 52.3 per cent reported abnormalities. The diffuse changes in ventricular repolarization and low QRS voltage were the main abnormalities reported. Cardiac impairment characterized by myopericarditis was observed in 39.1 per cent of the patients, and 24.3 per cent (17/70) of the cases were considered severe. The electrocardiographic changes were more frequent after treatment of patients who had shown electrocardiographic abnormalities during the acute phase, when compared to those who had not. Five other individuals who were diagnosed late and presented with diffuse myocarditis during the acute phase evolved poorly because they developed a clinical picture with lesions of chronic cardiopathy...

Investigation of two outbreaks of suspected oral transmission of acute Chagas disease in the Amazon region, Para State, Brazil, in 2007.

Acute Chagas disease (ACD) is caused by Trypanosoma cruzi. ACD outbreaks due to probable oral transmission occur regularly in small family gatherings that are exposed to contaminated foods. We studied two cohorts of residents on islands in the Breves and Bagre municipalities, in July and August 2007, to identify risk factors of transmission and to recommend preventative measures. Of the 25 cases identified in both cohorts, 13 (52%) were men, and the most frequent symptoms were fever (96%),asthenia (80%), myalgia (76%), abdominal pain (64%), retro-orbital pain, headaches and asthma (52%). We recommend detailed investigation of future outbreaks and other studies to better understand and control oral transmission of T. cruzi.

Urban outbreak of acute Chagas disease in Amazon region of Brazil: four-year follow-up after treatment with benznidazole.

The objective of this report is to describe treatment outcomes over a four-year period of patients with acute Chagas disease in the Amazon region of Brazil. An outbreak of Chagas disease in a low-income district of urban Belém, in September 2000, affected 11 people simultaneously, indicating the likelihood of indirect, oral transmission of Trypanosoma cruzi. Prior to treatment, patients underwent physical and clinical tests; blood samples were processed with immunofluorescence assay (IFA) and quantitative buffy coat (QBC). Following treatment with benznidazole, parasitological and serologic tests (artificial xenodiagnosis and blood culture for T. cruzi), electrocardiogram, and echocardiogram were administered at intervals over a four-year period. Four years after treatment for acute Chagas disease, all patients presented with negative parasitological tests and persistent IgG anti-T. cruzi antibodies with lowered titers; three patients presented electrocardiogram abnormalities consistent with chronic Chagas disease or sequel of acute disease. The satisfactory response to treatment and relevance of serial parasitological examinations of patients with acute Chagas disease are discussed.

Urban outbreak of acute Chagas disease in Amazon region of Brazil: four-year follow-up after treatment with benznidazole / Brote urbano de enfermedad aguda de Chagas en la región amazónica de Brasil: seguimiento de cuatro años después del tratamiento con benznidazol

The objective of this report is to describe treatment outcomes over a four-year period of patients with acute Chagas disease in the Amazon region of Brazil. An outbreak of Chagas disease in a low-income district of urban Belém, in September 2000, affected 11 people simultaneously, indicating the likelihood of indirect, oral transmission of Trypanosoma cruzi. Prior to treatment, patients underwent physical and clinical tests; blood samples were processed with immunofluorescence assay (IFA) and quantitative buffy coat (QBC). Following treatment with benznidazole, parasitological and serologic tests (artificial xenodiagnosis and blood culture for T. cruzi), electrocardiogram, and echocardiogram were administered at intervals over a four-year period. Four years after treatment for acute Chagas disease, all patients presented with negative parasitological tests and persistent IgG anti-T. cruzi antibodies with lowered titers; three patients presented electrocardiogram abnormalities consistent with chronic Chagas disease or sequel of acute disease. The satisfactory response to treatment and relevance of serial parasitological examinations of patients with acute Chagas disease are discussed.

El objetivo de este informe es describir los resultados del tratamiento para la enfermedad aguda de Chagas durante un seguimiento de cuatro años en pacientes de la región amazónica de Brasil. Un brote de la enfermedad de Chagas en un distrito de bajos ingresos de la parte urbana de Belém afectó simultáneamente a 11 personas en septiembre de 2000; al parecer, la transmisión de Trypanosoma cruzi fue indirecta por vía oral. Antes del tratamiento, los pacientes se sometieron a un examen físico y pruebas clínicas; las muestras de sangre se estudiaron mediante inmunofluorescencia - indirecta y análisis cuantitativo de la capa leucocitaria (buffy coat). Después del - tratamiento con benznidazol se realizaron pruebas parasitológicas y serológicas (xenodiagnóstico artificial y hemocultivo de T. cruzi), electrocardiogramas y ecocardiogramas periódicos durante cuatro años. Cuatro años después del tratamiento por enfermedad aguda de Chagas, todos los pacientes eran negativos en los análisis parasitológicos y disminuyeron los títulos de anticuerpos IgM anti-T. cruzi persistentes; tres pacientes presentaron alteraciones electrocardiográficas indicadoras de enfermedad crónica de Chagas o de secuelas de la enfermedad aguda. Se discute la respuesta satisfactoria al tratamiento y la importancia de los análisis parasitológicos seriados de los pacientes con enfermedad aguda de Chagas.

Trypanosoma cruzi in Brazilian Amazonia: Lineages TCI and TCIIa in wild primates, Rhodnius spp. and in humans with Chagas disease associated with oral transmission.

In this study, we provide phylogenetic and biogeographic evidence that the Trypanosoma cruzi lineages T. cruzi I (TCI) and T. cruzi IIa (TCIIa) circulate amongst non-human primates in Brazilian Amazonia, and are transmitted by Rhodnius species in overlapping arboreal transmission cycles, sporadically infecting humans. TCI presented higher prevalence rates, and no lineages other than TCI and TCIIa were found in this study in wild monkeys and Rhodnius from the Amazonian region. We characterised TCI and TCIIa from wild primates (16 TCI and five TCIIa), Rhodnius spp. (13 TCI and nine TCIIa), and humans with Chagas disease associated with oral transmission (14 TCI and five TCIIa) in Brazilian Amazonia. To our knowledge, TCIIa had not been associated with wild monkeys until now. Polymorphisms of ssrDNA, cytochrome b gene sequences and randomly amplified polymorphic DNA (RAPD) patterns clearly separated TCIIa from TCIIb-e and TCI lineages, and disclosed small intra-lineage polymorphisms amongst isolates from Amazonia. These data are important in understanding the complexity of the transmission cycles, genetic structure, and evolutionary history of T. cruzi populations circulating in Amazonia, and they contribute to both the unravelling of human infection routes and the pathological peculiarities of Chagas disease in this region.

Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005 / Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005

Foram estudados 233 casos de fase aguda da doença de Chagas, oriundos do Pará, Amapá e Maranhão, observados no período de 1988 a 2005, cento e sessenta deles retrospectivamente de 1988 a 2002 e setenta e três prospectivamente de 2003 a 2005. Entre os casos estudados 78,5 por cento (183/233) faziam parte de surtos provavelmente por transmissão oral, acometendo em média 4 pessoas e 21,5 por cento (50/233) eram casos isolados. Foram considerados casos agudos aqueles que apresentaram exames parasitológicos diretos (a fresco, gota espessa ou Quantitative Buffy Coat - QBC) e/ou IgM anti-Trypanosoma cruzi positivos. Foram feitos ainda xenodiagnósticos em 224 pacientes e hemoculturas em 213. Todos foram avaliados clinica e epidemiologicamente. As manifestações clínicas mais freqüentes foram febre (100 por cento), cefaléia (92,3 por cento), mialgia (84,1 por cento), palidez (67 por cento), dispnéia (58,4 por cento), edema de membros inferiores (57,9 por cento), edema de face (57,5 por cento) dor abdominal (44,2 por cento), miocardite (39,9 por cento) e exantema (27 por cento). O eletrocardiograma mostrou alterações de repolarização ventricular em 38,5 por cento dos casos, baixa voltagem de QRS em 15,4 por cento e desvio de SAQRS em 11,5 por cento, extra-sístoles ventriculares em 5,8 por cento, bradicardia em 5,8 por cento e taquicardia em 5,8 por cento, bloqueio de ramo direito em 4,8 por cento e fibrilação atrial em 4,8 por cento. A alteração mais freqüente vista no ecocardiograma foi o derrame pericárdico em 46,2 por cento dos casos. Treze (5,6 por cento) pacientes evoluíram para o óbito, 10 (76,9 por cento) dos quais por comprometimento cardiovascular, dois por complicações de origem digestiva e um de causa mal definida.

Two hundred and thirty-three cases of the acute phase of Chagas disease, from Pará, Amapá and Maranhão, were observed between 1988 and 2005. One hundred and sixty were studied retrospectively from 1988 to 2002 and seventy-three were prospectively followed up from 2003 to 2005. Among the cases studied, 78.5 percent (183/233) formed part of outbreaks, probably due to oral transmission (affecting a mean of 4 individuals), and 21.5 percent (50/233) were isolated cases. Cases were taken to be acute if they presented positive direct parasitological tests (fresh blood, thick drop or Quantitative Buffy Coat, QBC) and/or positive anti Trypanosoma cruzi IgM. Xenodiagnosis was also performed on 224 patients and blood culturing on 213. All the patients had clinical and epidemiological evaluations. The most frequent clinical manifestations were fever (100 percent), headache (92.3 percent), myalgia (84.1 percent), pallor (67 percent), dyspnea (58.4 percent), swelling of the legs (57.9 percent), facial edema (57.5 percent), abdominal pain (44.3 percent), myocarditis (39.9 percent) and exanthema (27 percent). The electrocardiogram showed abnormalities of ventricular repolarization in 38.5 percent, low QRS voltage in 15.4 percent, left-axis deviation in 11.5 percent, ventricular ectopic beats in 5.8 percent, bradycardia in 5.8 percent, tachycardia in 5.8 percent, right branch block in 4.8 percent and atrial fibrillation in 4.8 percent. The most frequently observed abnormality on the echocardiogram was pericardial effusion, in 46.2 percent of the cases. Thirteen (5.6 percent) patients died: ten (76.9 percent) of them due to cardiovascular involvement, two due to digestive complications and one due to indeterminate causes.

[Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005]. / Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005.

Two hundred and thirty-three cases of the acute phase of Chagas disease, from Pará, Amapá and Maranhão, were observed between 1988 and 2005. One hundred and sixty were studied retrospectively from 1988 to 2002 and seventy-three were prospectively followed up from 2003 to 2005. Among the cases studied, 78.5% (183/233) formed part of outbreaks, probably due to oral transmission (affecting a mean of 4 individuals), and 21.5% (50/233) were isolated cases. Cases were taken to be acute if they presented positive direct parasitological tests (fresh blood, thick drop or Quantitative Buffy Coat, QBC) and/or positive anti Trypanosoma cruzi IgM. Xenodiagnosis was also performed on 224 patients and blood culturing on 213. All the patients had clinical and epidemiological evaluations. The most frequent clinical manifestations were fever (100%), headache (92.3%), myalgia (84.1%), pallor (67%), dyspnea (58.4%), swelling of the legs (57.9%), facial edema (57.5%), abdominal pain (44.3%), myocarditis (39.9%) and exanthema (27%). The electrocardiogram showed abnormalities of ventricular repolarization in 38.5%, low QRS voltage in 15.4%, left-axis deviation in 11.5%, ventricular ectopic beats in 5.8%, bradycardia in 5.8%, tachycardia in 5.8%, right branch block in 4.8% and atrial fibrillation in 4.8%. The most frequently observed abnormality on the echocardiogram was pericardial effusion, in 46.2% of the cases. Thirteen (5.6%) patients died: ten (76.9%) of them due to cardiovascular involvement, two due to digestive complications and one due to indeterminate causes.

Reemergence of Oropouche fever, northern Brazil.

Oropouche fever has reemerged in Parauapebas and Porto de Moz municipalities, Pará State, Brazil. Serologic analysis (immunoglobulin M-ELISA) and virus isolation confirmed Oropouche virus (OROV) in both municipalities. Nucleotide sequencing of 2 OROV isolates from each location indicated genotypes I (Parauapebas) and II (Porto de Moz) in Brazil.