Socio-cultural aspects of Chagas disease: a systematic review of qualitative research.

BACKGROUND: Globally, more than 10 million people are infected with Trypanosoma cruzi, which causes about 20 000 annual deaths. Although Chagas disease is endemic to certain regions of Latin America, migratory flows have enabled its expansion into areas where it was previously unknown. Economic, social and cultural factors play a significant role in its presence and perpetuation. This systematic review aims to provide a comprehensive overview of qualitative research on Chagas disease, both in endemic and non-endemic countries. METHODOLOGY/PRINCIPAL FINDINGS: Searches were carried out in ten databases, and the bibliographies of retrieved studies were examined. Data from thirty-three identified studies were extracted, and findings were analyzed and synthesized along key themes. Themes identified for endemic countries included: socio-structural determinants of Chagas disease; health practices; biomedical conceptions of Chagas disease; patient's experience; and institutional strategies adopted. Concerning non-endemic countries, identified issues related to access to health services and health seeking. CONCLUSIONS: The emergence and perpetuation of Chagas disease depends largely on socio-cultural aspects influencing health. As most interventions do not address the clinical, environmental, social and cultural aspects jointly, an explicitly multidimensional approach, incorporating the experiences of those affected is a potential tool for the development of long-term successful programs. Further research is needed to evaluate this approach.

Myocardial deformation analysis in Chagas heart disease with the use of speckle tracking echocardiography.

BACKGROUND: Assessment of myocardial deformation in Chagas disease may help us to better understand the disease pathophysiology and to detect early myocardial involvement. We aimed to characterize myocardial deformation in patients in different forms of Chagas disease and, specifically, assess differences between patients in the indeterminate form and controls. METHODS AND RESULTS: Speckle tracking echocardiography was performed in 98 subjects (22 with Chagas cardiomyopathy, 32 in the indeterminate form, and 44 control subjects) to quantify global and segmental left ventricular (LV) radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). In a subset of patients from the indeterminate and control groups (n = 25), LV peak systolic twist and untwisting velocities were additionally assessed. Global RS, CS, and LS showed a significant decreasing trend across groups. Patients in the indeterminate form had significantly lower global RS and RS in the midinferior segment (median 39.8% vs 49.3% [P = .046] and 44.0% vs 56.0% [P = .038], respectively) and lower twist and untwisting velocity (P < .05 for both) compared with control subjects. CONCLUSION: Evaluation of myocardial deformation, particularly of RS, appears to be a sensitive technique for detection of myocardial involvement in patients in the indeterminate form and provides insights into the still unrevealed pathophysiology of Chagas heart involvement.

Función endotelial y concentración de proteína C reactiva de alta sensibilidad en pacientes con enfermedad de Chagas que viven en áreas no endémicas / Endothelial function and high-sensitivity C-reactive protein levels in patients with Chagas disease living in a nonendemic area

Introducción y objetivos. El número de pacientes con enfermedad de Chagas ha aumentado de manera significativa en España. La inflamación crónica y la disfunción endotelial han sido consideradas mecanismos fisiopatológicos de la cardiopatía chagásica. Sin embargo, en los estudios clínicos se han obtenido datos contradictorios. Nuestro objetivo fue evaluar la función endotelial y las concentraciones sistémicas de óxido nítrico y proteína C reactiva de alta sensibilidad en pacientes con la forma indeterminada de la enfermedad y con miocardiopatía chagásica crónica que vivían en un área no endémica. Métodos. Se determinó la vasodilatación mediada por flujo, dependiente del endotelio, y la vasodilatación mediada por nitroglicerina mediante ecografía de alta resolución de la arteria humeral en 98 individuos (32 con la forma indeterminada de la enfermedad, 22 con miocardiopatía chagásica crónica y 44 controles). Se efectuaron determinaciones de las concentraciones de óxido nítrico y proteína C reactiva de alta sensibilidad en sangre venosa periférica. Resultados. La media de edad fue 37,6±10,2 años; el 60% eran mujeres. La vasodilatación mediada por nitroglicerina estaba significativamente reducida en la miocardiopatía chagásica crónica en comparación con los controles (mediana, 16,8 frente a 22,5%; p=0,03). No se observaron diferencias significativas en la vasodilatación mediada por flujo ni en los valores de óxido nítrico, aunque se vió una tendencia a una menor vasodilatación mediada por flujo tras la corrección según el diámetro basal de la arteria humeral en la miocardiopatía chagásica crónica. Las cifras de proteína C reactiva fueron significativamente mayores en los pacientes con la forma indeterminada de la enfermedad y con miocardiopatía chagásica que en los controles (p<0,05). Conclusiones. Se observó una reducción de la vasodilatación mediada por nitroglicerina que sugiere una disfunción de las células de músculo liso vascular en pacientes con miocardiopatía chagásica crónica residentes en un área no endémica. Se observaron cifras superiores de proteína C reactiva en la forma indeterminada de la enfermedad y en las fases iniciales de la miocardiopatía chagásica crónica, lo que podría estar relacionado con la respuesta inflamatoria a la infección o la afección cardiovascular temprana (AU)

Introduction and objectives. The number of patients with Chagas disease in Spain has increased significantly. Chronic inflammation and endothelial dysfunction have been considered among the physiopathological mechanisms of Chagas heart disease. However, there have been conflicting data from clinical studies. Our purpose was to assess endothelial function and systemic levels of nitric oxide and high-sensitivity C-reactive protein in patients with the indeterminate form and with chronic Chagas cardiomyopathy living in a nonendemic area. Methods. Flow-mediated endothelium-dependent vasodilatation and nitroglycerin-mediated vasodilatation were assessed with high-resolution ultrasound of the brachial artery in 98 subjects (32 with the indeterminate form, 22 with chronic Chagas cardiomyopathy and 44 controls). Nitric oxide and high-sensitivity C-reactive protein levels were measured in peripheral venous blood. Results. Mean age was 37.6±10.2 years and 60% were female. Nitroglycerin-mediated vasodilatation was significantly reduced in chronic Chagas cardiomyopathy compared to controls (median 16.8% vs 22.5%; P=.03). No significant differences were observed in flow-mediated vasodilatation and nitric oxide levels, although a trend towards lower flow-mediated vasodilatation after correction by baseline brachial artery diameter was observed in chronic Chagas cardiomyopathy. Levels of C-reactive protein were significantly higher in patients with the indeterminate form and with Chagas cardiomyopathy compared with controls (P<.05). Conclusions. Reduced nitroglycerin-mediated vasodilatation suggesting dysfunction of vascular smooth muscle cells was found in patients with chronic Chagas cardiomyopathy living in a nonendemic area. Higher C-reactive protein levels were observed in the indeterminate form and early stages of chronic Chagas cardiomyopathy, which could be related to the inflammatory response to the infection or early cardiovascular involvement (AU)

[Endothelial function and high-sensitivity C-reactive protein levels in patients with Chagas disease living in a nonendemic area]. / Función endotelial y concentración de proteína C reactiva de alta sensibilidad en pacientes con enfermedad de Chagas que viven en áreas no endémicas.

INTRODUCTION AND OBJECTIVES: The number of patients with Chagas disease in Spain has increased significantly. Chronic inflammation and endothelial dysfunction have been considered among the physiopathological mechanisms of Chagas heart disease. However, there have been conflicting data from clinical studies. Our purpose was to assess endothelial function and systemic levels of nitric oxide and high-sensitivity C-reactive protein in patients with the indeterminate form and with chronic Chagas cardiomyopathy living in a nonendemic area. METHODS: Flow-mediated endothelium-dependent vasodilatation and nitroglycerin-mediated vasodilatation were assessed with high-resolution ultrasound of the brachial artery in 98 subjects (32 with the indeterminate form, 22 with chronic Chagas cardiomyopathy and 44 controls). Nitric oxide and high-sensitivity C-reactive protein levels were measured in peripheral venous blood. RESULTS: Mean age was 37.6 ± 10.2 years and 60% were female. Nitroglycerin-mediated vasodilatation was significantly reduced in chronic Chagas cardiomyopathy compared to controls (median 16.8% vs 22.5%; P=.03). No significant differences were observed in flow-mediated vasodilatation and nitric oxide levels, although a trend towards lower flow-mediated vasodilatation after correction by baseline brachial artery diameter was observed in chronic Chagas cardiomyopathy. Levels of C-reactive protein were significantly higher in patients with the indeterminate form and with Chagas cardiomyopathy compared with controls (P<.05). CONCLUSIONS: Reduced nitroglycerin-mediated vasodilatation suggesting dysfunction of vascular smooth muscle cells was found in patients with chronic Chagas cardiomyopathy living in a nonendemic area. Higher C-reactive protein levels were observed in the indeterminate form and early stages of chronic Chagas cardiomyopathy, which could be related to the inflammatory response to the infection or early cardiovascular involvement.