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.

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant.

The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patient's electrocardiogram, echocardiogram, and chest radiography remained normal.

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant / Lactente de um ano e oito meses de idade com megaesôfago (Grupo III) por doença de Chagas adquirida vetorialmente

The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patient's electrocardiogram, echocardiogram, and chest radiography remained normal.

Os autores relatam um caso de lactente com megaesôfago do Grupo III por doença de Chagas vetorialmente adquirida, responsável por acentuada desnutrição, da qual se recuperou com a cirurgia de Heller. Submetida em seguida a tratamento da infecção chagásica com benzonidazol, logrou cura, parasito e sorologicamente demonstrada. Seguiram-se anos sem qualquer incidente, com desenvolvimento pondo-estatural normal. Teve seu primeiro filho aos 23 anos, em quem as provas sorológicas para doença de Chagas resultaram negativas. Decorridos 30 anos após o atendimento inicial, continuava com eletrocardiograma e ecocardiograma e/ou exame radiológico do coração normais.

[Clinical and radiological evaluation of the esophagus and colon in the acute phase of Chagas disease with Report of three cases of spontaneous remission of esophageal group I aperistalsis]. / Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I.

INTRODUCTION: The esophagus and colons of patients with acute Chagas disease were studied. METHODS: Deglutition and radiological examination of the esophagus were assessed in 94 (90.4%) patients, 10 children were excluded due to their age. Intestinal transit was assessed in 59 (56.7%) patients. RESULTS: Deglutition was normal in 86 (91.5%) patients, 5 of whom presented aperistalsis (group I). Incipient dysphagia was reported by 8 patients, 7 of whom normal barium swallowing, while only one presented esophageal aperistalsis (group I). A second radiological examination of the esophagus was performed in 4 of the 6 cases with aperistalsis 6 months after the initial test. It was normal in 3, and showed aperistalsis in one case, the only patient who was treated with benznidazole and considered cured of the infection. Intestinal transit was normal in 96 (92.3%) patients, constipated in 7 (6.7%), and diarrheic in one (1%). Barium enema was normal in 54/59 (91.5%), showed a dolichosigmoid in 4 (6.8%) and a dolichorectomegasigmoid in one (1.7%), of functional origin, according to the electromanometric results. CONCLUSIONS: To explain the regression of aperistalsis, 2 non-excluding hypothesis were postulated: the intramural inflammatory process, established during the acute phase, could interfere with esophageal motility by weakening the peristaltic waves; with the remission of the inflammatory reaction, the peristaltic activity of the esophagus would return to normal, as long as no extensive denervation occurred; and/or a definitive reinnervation is responsible for the recuperation of the normal esophageal peristaltic activity.

Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I / Clinical and radiological evaluation of the esophagus and colon in the acute phase of Chagas disease with Report of three cases of spontaneous remission of esophageal group I aperistalsis

INTRODUÇÃO: O esôfago e os cólons foram investigados em pacientes na fase aguda da doença de Chagas, entre 1956 e 1989. MÉTODOS: A deglutição e o exame radiológico do esôfago foram explorados em 94 (90,4 por cento) pacientes, sendo excluídas 10 crianças em virtude de tenra idade. O enema opaco foi realizado em 59 (56,7 por cento) pacientes. RESULTADOS: A deglutição foi referida como normal em 86 (91,5 por cento) pacientes, 5 dos quais apresentaram aperistalse do grupo I, enquanto a disfagia incipiente foi referida por 8, dos quais 7 apresentaram exame radiológico normal e apenas um, aperistalse do grupo I. Um segundo exame radiológico, realizado em 4 dos 6 casos, 6 meses após o primeiro, mostrou-se normal em 3 e permaneceu inalterado em um, o único que recebeu tratamento (benzonidazol) e considerado como curado da infecção. O ritmo intestinal resultou normal em 96 (92,3 por cento) pacientes, obstipado em 7 (6,7 por cento) e diarreico em um (1 por cento). O enema evidenciou resultado normal em 54 (91,5 por cento) pacientes, dolicossigmoide em 4 (6,8 por cento) e dolicorretomegassigmoide em um (1,7 por cento), que a eletromanometria demonstrou ser de natureza funcional. CONCLUSÕES: Para explicar a regressão da aperistalse, aventaram os autores duas hipóteses que não se excluem. A primeira,é a de que o processo inflamatório intramural na fase inicial da infecção poderia interferir na motilidade esofagiana, enfraquecendo a onda peristáltica; com a regressão do processo inflamatório, o peristaltismo voltaria ao normal, desde que a desnervação fosse limitada; a segunda hipótese é a de que tenha havido real re-inervação, com recuperação normal da onda peristáltica.

INTRODUCTION: The esophagus and colons of patients with acute Chagas disease were studied. METHODS: Deglutition and radiological examination of the esophagus were assessed in 94 (90.4 percent) patients, 10 children were excluded due to their age. Intestinal transit was assessed in 59 (56.7 percent) patients. RESULTS: Deglutition was normal in 86 (91.5 percent) patients, 5 of whom presented aperistalsis (group I). Incipient dysphagia was reported by 8 patients, 7 of whom normal barium swallowing, while only one presented esophageal aperistalsis (group I). A second radiological examination of the esophagus was performed in 4 of the 6 cases with aperistalsis 6 months after the initial test. It was normal in 3, and showed aperistalsis in one case, the only patient who was treated with benznidazole and considered cured of the infection. Intestinal transit was normal in 96 (92.3 percent) patients, constipated in 7 (6.7 percent), and diarrheic in one (1 percent). Barium enema was normal in 54/59 (91.5 percent), showed a dolichosigmoid in 4 (6.8 percent) and a dolichorectomegasigmoid in one (1.7 percent), of functional origin, according to the electromanometric results. CONCLUSIONS: To explain the regression of aperistalsis, 2 non-excluding hypothesis were postulated: the intramural inflammatory process, established during the acute phase, could interfere with esophageal motility by weakening the peristaltic waves; with the remission of the inflammatory reaction, the peristaltic activity of the esophagus would return to normal, as long as no extensive denervation occurred; and/or a definitive reinnervation is responsible for the recuperation of the normal esophageal peristaltic activity.

Megaesôfago por doença de Chagas / Megaesophagus due to Chagas disease

Revisões históricas aos avanços científicos para o controle da doença, o Simpósio Internacional Comemorativo do Centenário da Descoberta da Doença de Chagas (1909-2009).

Participação de Carlos Chagas e seus colaboradores no conhecimento e reconhecimento do megaesôfago de etiologia chagásica / Participation of Carlos Chagas and his collaborators in the knowledge and recognition of the mega oesophagus of chagasic aetiology

Revê-se a participação de Carlos Chagas e colaboradores mais próximos no reconhecimento e detecção do megaesôfago chagásico, através de registros feitos em alguns trabalhos pioneiros. A disperistalse é claramente mencionada e bem descrita em observações originais por eles realizadas em áreas endêmicas e material hospitalar. Revê-se a indagação de Chagas quanto à possibilidade da etiologia esquizotripanósica do agravo, em 1916, assunto que não retoma em trabalhos posteriores. Na oportunidade, são discutidos alguns fatos eventualmente explicativos a respeito desta história.

New evidence of spontaneous cure in human Chagas' disease

A new case of spontaneous cure of human Chagas' disease is described in Uruguay. An 87-year-old man who had a typical acute phase of Trypanosoma cruzi infection in 1947 and never received specific treatment against the disease, when examined in 1998 revealed several completely negative parasitological and serological tests, including traditional serology, PCR and flow cytometry. As a whole, such findings fulfill the current criteria to define the cure of Chagas' disease. Clinical data suggest the possibility of a benign evolution of Chagas' disease in this case, but the basic findings (slight cardiac and esophageal impairment) could also be due to the advanced age of the patient

Um nome que faltava na história do megaesôfago chagásico: Joseph Cooper Reinhardt (1809/10-1873) / A missing name in the history of chagasic megaesophagus: Joseph Cooper Reinhardt (1809/10-1873)

No livro "Brazil and the Brazilians" escrito pelos reverendos Kidder e Fletcher, publicado nos Estados Unidos em primeira ediçao em 1857 e que relata viagens destes dois missionários pelo Brasil, há um sub-capítulo intitulado "A new disease". Ali sao revelados dados do quadro clínico, da evoluçao, da endemicidade e da distribuiçao geográfica de doença comum nos sertoes brasileiros e que era conhecida como mal de engasgo. As informaçoes sobre a doença foram prestadas a Fletcher, em 1855, em Limeira (SP), por um médico norte-americano mantido no anonimato na obra citada, designado apenas como Dr. -. Os autores relatam as investigaçoes conduzidas no sentido de identificar o Dr. - e revelam provas documentais que demonstram, cabalmente, ter sido ele o Dr. Joseph Cooper Reinhardt (1809/10-1873). Este médico clinicou, por muitos anos, nas cidades de Limeira (SP) e Campinas (SP). As informaçoes que deu a Fletcher denotam que ele tinha notável conhecimento sobre as características da doença que, cerca de 100 anos mais tarde, seria conhecida como megaesôfago chagásico. Os autores opinam que, doravente, este nome deve ser mençao indispensável quando se contar a história do megaesôfago chagásico.

Correlaçäo entre a sintomatologia e a evoluçäo do mesaesôfago / Correlation between the symptoms and the stage of the megaesophagus

Em um estudo prospectivo de 500 casos de mesaesofago, os autores analisaram a correlaçäo existente entre a sintomatologia e a evoluçäo desta afecçäo, tomando por base o seu estadiamento em 4 grupos radiológicos, de acordo com a classificaçäo de Rezende e cols. Dos 500 pacientes, 280 (56 por cento) eram do sexo masculino e 220 (44 por cento) do sexo feminino. As idades variaram de 7 a 82 anos (média de 45,1, mediana de 45 anos) com sorologia positiva em 453 pacientes (90,6 por cento). Foram analisados os seguintes sintomas: disfagia presente em 96,6 por cento dos pacientes; regurgitaçäo em 65,2 por cento; dor esofagiana em 59,3 por cento; odinofagia em 56,2 por cento; pirose em 32,2 por cento e obstipaçäo intestinal em 51 por cento. Foram ainda avaliados o déficit ponderal como indicador do estado nutricional e a hiportrofia das parótidas...