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1.
World J Urol ; 37(7): 1395-1402, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30302592

RESUMO

PURPOSE: To describe and give an estimation of the prevalence of urinary disorders in chronic Chagas disease, since most clinical research has been centered on the description of the cardiac and digestive forms. METHODS: To explore this topic, a cross-sectional study was conducted in 137 Bolivian adults of both sexes suffering from symptomatic chronic Chagas disease. All patients presenting confirmed chagasic cardiomyopathy, megacolon or both underwent a urologic symptom questionnaire, uroflowmetry, urinary tract ultrasonography and a creatinine assay. When urinary abnormality was detected, a complete urodynamic study was proposed including cystometry, pressure-flow studies and urethral pressure profile. RESULTS: Out of all study patients, 35 (26%) had a Chagas cardiomyopathy, 81 (59%) a megacolon, and 21 (15%) a megacolon associated with cardiomyopathy. In all, 63% presented urinary disorders defined by IPSS > 7 and/or ICIQ SF > 1. Among them, 62% were incontinent, mainly by bladder overactivity, and 45% presented grade 2 or 3 renal insufficiency. Of 49 patients, the urodynamic study identified 34 patients with detrusor overactivity (69%), mostly in those with Chagas megacolon. Median bladder functional capacity, urethral closure pressure and bladder compliance had normal values. Moreover, 36% of these patients presented moderate hypocontractility, without significant post-void residual. CONCLUSIONS: This study evidenced lower urinary tract dysfunction in a majority of chronic chagasic patients; those presenting megacolon were more likely to suffer from urinary incontinence. These results strongly suggest including routine urological clinical investigation in chronic Chagas patients, as urinary incontinence due to overactive bladder is frequently observed in this population.


Assuntos
Doença de Chagas/epidemiologia , Megacolo/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Bexiga Urinária Hiperativa/epidemiologia , Incontinência Urinária/epidemiologia , Adulto , Bolívia/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Urodinâmica
2.
Circulation ; 139(6): 730-743, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30586738

RESUMO

BACKGROUND: Poor glycemic control is associated with increased risk of cardiovascular disease (CVD) in type 1 diabetes mellitus (T1DM); however, little is known about mechanisms specific to T1DM. In T1DM, myocardial injury can induce persistent cardiac autoimmunity. Chronic hyperglycemia causes myocardial injury, raising the possibility that hyperglycemia-induced cardiac autoimmunity could contribute to long-term CVD complications in T1DM. METHODS: We measured the prevalence and profiles of cardiac autoantibodies (AAbs) in longitudinal samples from the DCCT (Diabetes Control and Complications Trial) in participants with mean hemoglobin A1c (HbA1c) ≥9.0% (n=83) and ≤7.0% (n=83) during DCCT. We assessed subsequent coronary artery calcification (measured once during years 7-9 in the post-DCCT EDIC [Epidemiology of Diabetes Interventions and Complications] observational study), high-sensitivity C-reactive protein (measured during EDIC years 4-6), and CVD events (defined as nonfatal myocardial infarction, stroke, death resulting from CVD, heart failure, or coronary artery bypass graft) over a 26-year median follow-up. Cardiac AAbs were also measured in matched patients with type 2 diabetes mellitus with HbA1c ≥9.0% (n=70) and ≤7.0% (n=140) and, as a control for cardiac autoimmunity, patients with Chagas cardiomyopathy (n=51). RESULTS: Apart from HbA1c levels, the DCCT groups shared similar CVD risk factors at the beginning and end of DCCT. The DCCT HbA1c ≥9.0% group showed markedly higher cardiac AAb levels than the HbA1c ≤7.0% group during DCCT, with a progressive increase and decrease in AAb levels over time in the 2 groups, respectively ( P<0.001). In the HbA1c ≥9.0% group, 46%, 22%, and 11% tested positive for ≥1, ≥2, and ≥3 different cardiac AAb types, respectively, similar to patients with Chagas cardiomyopathy, compared with 2%, 1%, and 0% in the HbA1c ≤7.0% group. Glycemic control was not associated with AAb prevalence in type 2 diabetes mellitus. Positivity for ≥2 AAbs during DCCT was associated with increased risk of CVD events (4 of 6; hazard ratio, 16.1; 95% CI, 3.0-88.2) and, in multivariable analyses, with detectable coronary artery calcification (13 of 31; odds ratio, 60.1; 95% CI, 8.4-410.0). Patients with ≥2 AAbs subsequently also showed elevated high-sensitivity C-reactive protein levels (6.0 mg/L versus 1.4 mg/L in patients with ≤1 AAbs; P=0.003). CONCLUSIONS: Poor glycemic control is associated with cardiac autoimmunity in T1DM. Furthermore, cardiac AAb positivity is associated with an increased risk of CVD decades later, suggesting a role for autoimmune mechanisms in the development of CVD in T1DM, possibly through inflammatory pathways.


Assuntos
Cardiomiopatia Chagásica/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Hiperglicemia/epidemiologia , Miocárdio/imunologia , Adulto , Autoanticorpos/sangue , Autoimunidade , Brasil/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Antígenos HLA/genética , Humanos , Masculino , Prevalência , Risco , Fatores de Tempo , Adulto Jovem
3.
Circulation ; 138(12): e169-e209, 2018 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-30354432

RESUMO

BACKGROUND: Chagas disease, resulting from the protozoan Trypanosoma cruzi, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission. METHODS AND RESULTS: The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of T cruzi infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease. CONCLUSIONS: This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.


Assuntos
Cardiomiopatia Chagásica/terapia , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/efeitos dos fármacos , American Heart Association , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/parasitologia , Humanos , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Resultado do Tratamento , Tripanossomicidas/efeitos adversos , Trypanosoma cruzi/isolamento & purificação , Estados Unidos
4.
Curr Cardiol Rep ; 20(12): 131, 2018 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-30311008

RESUMO

PURPOSE OF REVIEW: Chagas cardiomyopathy is an emerging form of non-ischemic cardiomyopathy in the USA. This review aims to summarize current concepts in pathophysiology, disease transmission, medical therapy, and heart transplantation for patients with chronic Chagas cardiomyopathy. RECENT FINDINGS: The incidence of Chagas cardiomyopathy is increasing in the USA, driven mainly by immigration from countries where Chagas disease is endemic. Chagas cardiomyopathy is a chronic, progressive myocarditis, with hallmark features of biventricular dysfunction, ventricular arrhythmias, thromboembolic complications, and a high risk of mortality. Currently, there is no effective treatment for chronic Chagas cardiomyopathy. Heart transplantation is the only treatment for patients with end-stage Chagas cardiomyopathy, but is associated with unique challenges including risk of reactivation. As the prevalence of Chagas cardiomyopathy increases in the USA, practitioners must be aware of the unique challenges in diagnosis and management that Chagas cardiomyopathy presents.


Assuntos
Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/terapia , Trypanosoma cruzi/isolamento & purificação , Fármacos Cardiovasculares/uso terapêutico , Doença de Chagas/epidemiologia , Transplante de Coração/efeitos adversos , Humanos , Miocardite/etiologia , Fatores de Risco , Resultado do Tratamento , Tripanossomicidas/uso terapêutico , Estados Unidos/epidemiologia
5.
Transpl Infect Dis ; 20(6): e12996, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30204269

RESUMO

BACKGROUND: Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries. METHODS: We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule. RESULTS: Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks). CONCLUSIONS: Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed.


Assuntos
Cardiomiopatia Chagásica/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Imunossupressão/efeitos adversos , Trypanosoma cruzi/isolamento & purificação , Adulto , Idoso , Aloenxertos/parasitologia , Aloenxertos/patologia , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/parasitologia , Cardiomiopatia Chagásica/patologia , Feminino , Seguimentos , Coração/parasitologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/parasitologia , Insuficiência Cardíaca/patologia , Humanos , Imunossupressão/métodos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Recidiva , Fatores de Risco , Estados Unidos/epidemiologia
6.
Vector Borne Zoonotic Dis ; 18(8): 417-423, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29768103

RESUMO

Chagas disease is a lingering Public Health problem in Latin America with ∼5.7 million people infected with Trypanosoma cruzi. Transmission is still taking place in most countries of the Americas, including the United States. Dogs are frequently infected with T. cruzi and its high infection prevalence is associated with increased risk of Chagas disease in humans. The city of Mérida in the Yucatan peninsula is endemic for Chagas disease and canines are frequently infected with T. cruzi. The objective of this study was to evaluate the performance of a qualitative point of care (POC) molecular test (RPA-LF, recombinase polymerase amplification-lateral flow) developed in our laboratory for identifying infected dogs. We used retrospective samples of dogs that came for consultation because of cardiac alterations and proved to be infected with T. cruzi as determined by enzyme-linked immunosorbent assay (ELISA), Western blot, and quantitative PCR (qPCR). The analytical sensitivity indicated that RPA-LF amplified T. cruzi DNA in samples containing almost equal to one to two parasites per reaction. Serial twofold dilutions of T. cruzi epimastigotes showed that the test had 95% (19/20) repeatability at concentrations of two parasites per reaction. The test showed no cross reactivity with human DNA or other protozoan parasites (Trypanosoma rangeli, Leishmania spp., and Plasmodium spp.). RPA-LF had the capacity to amplify all discrete typing units (DTUs I-VI) of T. cruzi that circulate in domestic or extradomestic environments. The RPA-LF had 93.2% (95% confidence interval 87.2-98.1) sensitivity and excellent agreement with qPCR used as gold standard (Cohen's Kappa test = 0.963). ELISA was positive in 96.6% (85/88) of dogs, which together with the molecular tests confirmed the frequent contact with infected triatomine bugs in the city of Mérida. These preliminary results on the diagnostic efficacy of the RPA-LF deserve further large-scale field testing of this POC test for T. cruzi infection in endemic areas.


Assuntos
Cardiomiopatia Chagásica/veterinária , Doenças do Cão/parasitologia , Reação em Cadeia da Polimerase/veterinária , Trypanosoma cruzi/genética , Animais , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/parasitologia , DNA de Cinetoplasto/genética , DNA de Protozoário/genética , Doenças do Cão/patologia , Cães , Ensaio de Imunoadsorção Enzimática/veterinária , México/epidemiologia , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos
7.
Heart ; 104(18): 1522-1528, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523589

RESUMO

BACKGROUND: Chagas cardiomyopathy (ChC) prevalence is decreasing in Brazil and medical therapies for heart failure (HF) have improved in the last decade. Whether these changes modified the prognosis of ChC relative to non-Chagas cardiomyopathies (NChC) remains unknown. This study evaluated the temporal trends in population attributable risk (PAR) of ChC for 2-year mortality among patients with HF enrolled at years 2002-2004 (era 1) and 2012-2014 (era 2) in a Brazilian university hospital. METHODS: We prospectively studied 362 (15% with ChC) and 582 (18% with ChC) HF patients with ejection fraction ≤50% in eras 1 and 2, respectively and estimated the PAR of ChC for 2-year mortality. RESULTS: There were 145 deaths (29 in ChC) in era 1 and 85 deaths (26 in ChC) in era 2. In multivariable Cox-regression analysis adjusted for age, sex, ejection fraction, heart rate, body mass index, hypertension, diabetes mellitus, systolic blood pressure and ischaemic/valvar aetiology, ChC was associated with higher risk of death in era 1 (HR (95% CI)=1.92 (1.00 to 3.71), p=0.05) and era 2 (HR (95% CI)=3.51 (1.94 to 6.36), p<0.001). In fully adjusted analysis, the PAR of ChC for mortality increased twofold from era 1 (PAR (95% CI)=11.0 (2.8 to 18.5)%) to era 2 (PAR (95% CI)=21.9 (16.5 to 26.9)%; p=0.023 versus era 1). CONCLUSION: Although the absolute death rates decreased over time in the ChC and NChC groups, the PAR of ChC for mortality increased among patients with HF, driven by increases in the HR associated with ChC. Our results highlight the need for additional efforts aiming to prevent and treat ChC.


Assuntos
Cardiomiopatia Chagásica/complicações , Insuficiência Cardíaca/mortalidade , Medição de Risco/métodos , Volume Sistólico/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem
8.
Circ Res ; 121(7): 803-818, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28912184

RESUMO

Inflammatory activation occurs in nearly all forms of myocardial injury. In contrast, inflammatory cardiomyopathies refer to a diverse group of disorders in which inflammation of the heart (or myocarditis) is the proximate cause of myocardial dysfunction, causing injury that can range from a fully recoverable syndrome to one that leads to chronic remodeling and dilated cardiomyopathy. The most common cause of inflammatory cardiomyopathies in developed countries is lymphocytic myocarditis most commonly caused by a viral pathogenesis. In Latin America, cardiomyopathy caused by Chagas disease is endemic. The true incidence of myocarditis is unknown to the limited utilization and the poor sensitivity of endomyocardial biopsies (especially for patchy diseases such as lymphocytic myocarditis and sarcoidosis) using the gold-standard Dallas criteria. Emerging immunohistochemistry criteria and molecular diagnostic techniques are being developed that will improve diagnostic yield, provide additional clues into the pathophysiology, and offer an application of precision medicine to these important syndromes. Immunosuppression is recommended for patients with cardiac sarcoidosis, giant cell myocarditis, and myocarditis associated with connective tissue disorders and may be beneficial in chronic viral myocarditis once virus is cleared. Further trials of immunosuppression, antiviral, and immunomodulating therapies are needed. Together, with new molecular-based diagnostics and therapies tailored to specific pathogeneses, the outcome of patients with these disorders may improve.


Assuntos
Autoimunidade , Cardiomiopatias/imunologia , Mediadores da Inflamação/imunologia , Miocardite/imunologia , Miocárdio/imunologia , Animais , Antivirais/uso terapêutico , Biópsia , Técnicas de Imagem Cardíaca , Cardiomiopatias/diagnóstico , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/epidemiologia , Cardiomiopatia Dilatada/epidemiologia , Cardiomiopatia Dilatada/imunologia , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/imunologia , Fibrose , Humanos , Hipersensibilidade/epidemiologia , Hipersensibilidade/imunologia , Imunossupressores/uso terapêutico , Técnicas de Diagnóstico Molecular , Miocardite/diagnóstico , Miocardite/tratamento farmacológico , Miocardite/epidemiologia , Miocárdio/patologia , Prognóstico , Fatores de Risco , Sarcoidose/epidemiologia , Sarcoidose/imunologia , Viroses/epidemiologia , Viroses/imunologia
9.
J Stroke Cerebrovasc Dis ; 26(12): 2864-2869, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28844546

RESUMO

BACKGROUND: Cardioembolism is considered a major pathophysiological mechanism in patients with ischemic stroke (IS) and Chagas disease (CD). However, a previous study reported that other stroke subtypes are present in more than 40% of CD patients according to the TOAST classification. Therefore, the aim of our study was to evaluate the etiologic classification of stroke in patients with CD using the Causative Classification System (CCS), the ASCOD, and the TOAST classifications in a prospective cohort of patients. METHODS: Patients evaluated in our outpatient clinic from 2012 to 2015 with IS and CD were included and underwent full investigation for stroke etiology. TOAST, CCS TOAST, and the ASCOD classifications were compared. FINDINGS: We Included 32 patients (18 men; mean age 62.7 +/-10.1 years). A total of 93.8% had at least 1 vascular risk factor; the most frequent was hypertension (87.5%). According to TOAST, we defined 87.5% as having cardioembolic stroke, being 9.4% as large-artery atherosclerotic (LAA) and 3.1% as undetermined cause. Using the CCS TOAST, 62.5% were classified as cardioaortic embolism evident and 15.6% as possible, 6.3% as small artery occlusion evident and 3.1% as probable, and 12.5% as LAA evident. When ASCOD phenotyping was applied, atherosclerosis was present in 50.1% of patients (A1 = 6.3%, A3 = 43.8%), cardiac pathology in 84.4% (C1 = 62.5%, C2 = 15.6%, C3 = 6.3%), and small-vessel disease in 66% (S1 = 9.4%, S2 = 3.1%, S3 = 3.1%). FINDINGS: In conclusion, the use of the CCS and the ASCOD phenotyping in patients with CD confirmed a high frequency of cardioembolic IS but also showed that other etiologies are prevalent, such as large-artery atherosclerosis and small-vessel occlusion.


Assuntos
Cardiomiopatia Chagásica/epidemiologia , Técnicas de Apoio para a Decisão , Embolia Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Brasil/epidemiologia , Cardiomiopatia Chagásica/diagnóstico , Feminino , Humanos , Embolia Intracraniana/classificação , Embolia Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Fenótipo , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnóstico por imagem , Fatores de Tempo
10.
Arq Bras Cardiol ; 108(6): 546-551, 2017 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28699977

RESUMO

Background:: Chagas disease continues to be a serious public health problem, and accounts for 25-30% of the indications for cardiac stimulation in Brazil. Objective:: To assess clinical and epidemiological characteristics of patients with Chagas disease, younger than 18 years, who had undergone pacemaker implantation in Brazil between 1994 and 2011, and its temporal trend. Methods:: This was a cross-sectional analysis of data from the Brazilian Pacemaker Registry database. The following variables were analyzed: year when pacemaker was implanted, location, age, sex, ethnic group, functional class and the main electrocardiographic findings at baseline. Results:: In a total of 183,123 implants performed between 1994 and 2011, 214 implants of cardiac stimulation device in Chagas disease patients aged younger than 18 years were identified. Mean age at implantation was 5.6 ± 6.2 years. Second- and third-degree atrioventricular blocks corresponded to 71% of indications for pacemaker implantation. Fifty-six percent of the procedures were performed in the southeast region. Regarding the total number of pacemaker implants per year, there was a remarkable increase in the implants for all causes. However, time series analysis of the implants in Chagas disease patients younger than 18 years revealed a significant reduction in the annual number of implants. Conclusion:: There has been an important reduction in the number of pacemaker implantations among children and adolescents with Chagas disease, suggesting a reduction in the vertical transmission of the parasite. Fundamento:: A doença de Chagas mantém-se como sério problema de saúde pública e tem sido responsável por aproximadamente 25% a 30% das indicações de estimulação cardíaca no Brasil. Objetivo:: Estudar as características clínicas e epidemiológicas dos pacientes menores de 18 anos portadores de doença de Chagas submetidos a implante de marca-passo no território brasileiro entre 1994 e 2011, e sua tendência temporal. Métodos:: Trata-se de um estudo retrospectivo que utilizou informações coletadas pelo Registro Brasileiro de Marca-passo. As variáveis analisadas foram: ano do implante, localidade, idade, sexo, grupo étnico dos pacientes; classificação funcional e os principais achados eletrocardiográficos de base. Resultados:: Em um total de 183 123 implantes realizados entre 1994 e 2011, foram identificados 214 implantes de dispositivos de estimulação cardíaca em portadores de doença de Chagas com idade inferior a 18 anos. A média de idade no momento do implante foi de 5,6 ± 6,2 anos. Bloqueios atrioventriculares de 2º e 3º graus foram responsáveis por 71% das indicações. Dos procedimentos, 55,6% foram realizados na região sudeste. Em relação ao total de implantes de marca-passo por ano, observamos um aumento importante e significante de implante por todas as causas. Entretanto, quando avaliamos a série temporal de implantes em pacientes com doença de Chagas menores que 18 anos, observamos uma redução expressiva e significativa no número anual de implantes. Conclusão:: Observa-se uma redução importante do número de implantes de marca-passo em crianças e adolescente chagásicos, o que sugere uma redução da transmissão vertical do parasita.


Assuntos
Cardiomiopatia Chagásica/terapia , Marca-Passo Artificial , Adolescente , Brasil/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Criança , Estudos Transversais , Humanos , Incidência , Marca-Passo Artificial/estatística & dados numéricos , Fatores Socioeconômicos , Resultado do Tratamento
11.
Rev. cuba. med ; 56(1): 50-68, ene.-mar. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-901265

RESUMO

Introducción: la enfermedad de Chagas es de etiología parasitaria generalmente crónica. Es una de las enfermedades más desatendidas del mundo. Constituye un problema de salud, social y económico en muchos países latinoamericanos. Objetivo: se revisaron 35 bibliografías con el objetivo de describir las características clínicas, diagnósticas y terapéuticas de la Enfermedad de Chagas. Desarrollo: esta entidad, generalmente afecta el tracto gastrointestinal o al corazón. La cardiopatía chagásica crónica es la forma más grave de la enfermedad y se asocia a una alta mortalidad. Los principales elementos para el diagnóstico de la enfermedad son el antecedente epidemiológico compatible y demostrar la presencia del parásito. El tratamiento médico en la fase crónica es el correspondiente a una miocardiopatía dilatada, no se recomenda el tratamiento antiparasitario en la fase crónica de la enfermedad. Conclusiones: es una causa frecuente de insuficiencia cardiaca en Latinoamérica. Afecta fundamentalmente a jóvenes y no tiene un tratamiento específico que mejore la supervivencia(AU)


Introduction: Chagas disease has generally chronic parasitic etiology. It is one of the most neglected diseases worldwide. It is a health, social and economic concern in many Latin American countries. Objective: 35 bibliographies were reviewed with the aim at describing the clinical, diagnostic and therapeutic characteristics of Chagas disease. Development: This entity usually affects the gastrointestinal tract or the heart. Chronic Chagas' heart disease is the disease's most severe form and is associated with high mortality. The main elements for the diagnosis of the disease are the compatible epidemiological antecedent and demonstration of the parasite presence. The medical treatment in the chronic phase corresponds to a dilated cardiomyopathy, without the recommended antiparasitic treatment in the chronic phase of the disease. Conclusions: Tt is a frequent cause of heart failure in Latin America. It affects mainly young people and does not have a specific treatment that improves survival(AU)


Assuntos
Humanos , Masculino , Feminino , Cardiomiopatia Chagásica/epidemiologia , Doença de Chagas/epidemiologia , Insuficiência Cardíaca/diagnóstico
12.
Rev. cuba. med ; 56(1): 50-68, ene.-mar. 2017. ilus, tab
Artigo em Espanhol | CUMED | ID: cum-73106

RESUMO

Introducción: la enfermedad de Chagas es de etiología parasitaria generalmente crónica. Es una de las enfermedades más desatendidas del mundo. Constituye un problema de salud, social y económico en muchos países latinoamericanos. Objetivo: se revisaron 35 bibliografías con el objetivo de describir las características clínicas, diagnósticas y terapéuticas de la Enfermedad de Chagas. Desarrollo: esta entidad, generalmente afecta el tracto gastrointestinal o al corazón. La cardiopatía chagásica crónica es la forma más grave de la enfermedad y se asocia a una alta mortalidad. Los principales elementos para el diagnóstico de la enfermedad son el antecedente epidemiológico compatible y demostrar la presencia del parásito. El tratamiento médico en la fase crónica es el correspondiente a una miocardiopatía dilatada, no se recomenda el tratamiento antiparasitario en la fase crónica de la enfermedad. Conclusiones: es una causa frecuente de insuficiencia cardiaca en Latinoamérica. Afecta fundamentalmente a jóvenes y no tiene un tratamiento específico que mejore la supervivencia(AU)


Introduction: Chagas disease has generally chronic parasitic etiology. It is one of the most neglected diseases worldwide. It is a health, social and economic concern in many Latin American countries. Objective: 35 bibliographies were reviewed with the aim at describing the clinical, diagnostic and therapeutic characteristics of Chagas disease. Development: This entity usually affects the gastrointestinal tract or the heart. Chronic Chagas' heart disease is the disease's most severe form and is associated with high mortality. The main elements for the diagnosis of the disease are the compatible epidemiological antecedent and demonstration of the parasite presence. The medical treatment in the chronic phase corresponds to a dilated cardiomyopathy, without the recommended antiparasitic treatment in the chronic phase of the disease. Conclusions: Tt is a frequent cause of heart failure in Latin America. It affects mainly young people and does not have a specific treatment that improves survival(AU)


Assuntos
Humanos , Masculino , Feminino , Cardiomiopatia Chagásica/epidemiologia , Doença de Chagas/epidemiologia , Insuficiência Cardíaca/diagnóstico
14.
Rev Assoc Med Bras (1992) ; 63(1): 57-63, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28225875

RESUMO

OBJECTIVE: To evaluate clinical and epidemiological characteristics and clinical outcomes in patients hospitalized with decompensated heart failure (DHF), with a comparison between Chagas and non-Chagas disease. METHOD: This is a retrospective cohort study involving 136 patients consecutively admitted with DHF between January 1 and December 31, 2011, with the following outcomes: acute renal failure, cardiogenic shock, rehospitalization, and hospital death. Individuals aged ≥ 18 years with DHF were included while those with more than 10% of missing data regarding outcomes were excluded. Statistical analysis was performed using SPSS version 17.0. Chi-squared test was used to compare proportions. Student's T test was used to compare means. Kaplan-Meier and log-rank tests were used to compare rehospitalization rates between the two groups over time. RESULTS: Chagasic and non-chagasic patients were compared. The first had lower mean systolic blood pressure (111.8±18.4 versus 128.8±24.4, p<0.01), lower mean diastolic blood pressure (74.5±13.6 versus 82.0±15.2, p<0.01) and lower left ventricular ejection fraction (26.5±6.2 versus 41.5±18.9, p<0.01). In all, 20 patients with Chagas (50.1%) were rehospitalized, compared to 35 patients in the non-Chagas group (35.4%, p=0.04). Log rank test = 4.5 (p<0.01) showed that rehospitalization rates between the two groups over time (Kaplan-Meier curves) differed. CONCLUSION: Chagas disease was associated with lower systolic and diastolic blood pressure and lower left ventricular ejection fraction. The rehospitalization rate was higher in Chagas disease.


Assuntos
Cardiomiopatia Chagásica , Insuficiência Cardíaca , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/fisiopatologia , Cardiomiopatia Chagásica/terapia , Estudos de Coortes , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
15.
Med. clín (Ed. impr.) ; 148(3): 125-131, feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-160055

RESUMO

La enfermedad de Chagas es una zoonosis causada por el parásito protozoario Trypanosoma cruzi, transmitido con mayor frecuencia por vía vectorial. En los últimos años, sin embargo, se está observando un aumento marcado de la transmisión de la enfermedad por vía oral, asociada al consumo de bebidas preparadas a base de frutas u otros vegetales contaminados con las heces de triatominos o secreciones de mamíferos infectados. Después de un período de latencia de 3-22 días, a partir de la ingestión, la infección oral se caracteriza por manifestaciones más graves que la vectorial: fiebre prolongada, miocarditis aguda con insuficiencia cardíaca y en algunos casos meningoencefalitis. La mortalidad puede llegar hasta un 33% de los infectados. El objetivo de este trabajo es realizar una revisión del fenómeno y promover prácticas de prevención (AU)


Chagas disease is a zoonosis caused by protozoan parasite Trypanosoma cruzi, which is most frequently associated with a vectorial transmission. However, in recent years we have observed a significant increase in the oral transmission of the disease, associated mainly with the consumption of drinks made from fruit or other vegetables contaminated with triatomine faeces or secretions from infected mammals. After a latency period of 3 to 22 days after ingestion, the oral infection is characterized by more severe manifestations than those associated with vectorial transmission: prolonged fever, acute myocarditis with heart failure and, in some cases, meningoencephalitis. Mortality can reach up to 33% of those infected. The aim of this paper is to review this matter and to promote prevention practices (AU)


Assuntos
Humanos , Masculino , Feminino , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Surtos de Doenças/prevenção & controle , Trypanosoma cruzi/isolamento & purificação , Trypanosoma cruzi/microbiologia , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/prevenção & controle , Doença de Chagas/mortalidade , Doença de Chagas/prevenção & controle , Técnica Indireta de Fluorescência para Anticorpo/métodos , Nifurtimox/uso terapêutico
16.
Infect Genet Evol ; 49: 151-156, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28095298

RESUMO

The parasitic protozoan Trypanosoma cruzi, the causative agent of Chagas disease, is widely distributed throughout the Americas, from the southern United States (US) to northern Argentina, and infects at least 6 million people in endemic areas. Much remains unknown about the dynamics of T. cruzi transmission among mammals and triatomine vectors in sylvatic and peridomestic eco-epidemiological cycles, as well as of the risk of transmission to humans in the US. Identification of T. cruzi DTUs among locally-acquired cases is necessary for enhancing our diagnostic and clinical prognostic capacities, as well as to understand parasite transmission cycles. Blood samples from a cohort of 15 confirmed locally-acquired Chagas disease patients from Texas were used for genotyping T. cruzi. Conventional PCR using primers specific for the minicircle variable region of the kinetoplastid DNA (kDNA) and the highly repetitive genomic satellite DNA (satDNA) confirmed the presence of T. cruzi in 12/15 patients. Genotyping was based on the amplification of the intergenic region of the miniexon gene of T. cruzi and sequencing. Sequences were analyzed by BLAST and phylogenetic analysis by Maximum Likelihood method allowed the identification of non-TcI DTUs infection in six patients, which corresponded to DTUs TcII, TcV or TcVI, but not to TcIII or TcIV. Two of these six patients were also infected with a TcI DTU, indicating mixed infections in those individuals. Electrocardiographic abnormalities were seen among patients with single non-TcI and mixed infections of non-TcI and TcI DTUs. Our results indicate a greater diversity of T. cruzi DTUs circulating among autochthonous human Chagas disease cases in the southern US, including for the first time DTUs from the TcII-TcV-TcVI group. Furthermore, the DTUs infecting human patients in the US are capable of causing Chagasic cardiac disease, highlighting the importance of parasite detection in the population.


Assuntos
Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/transmissão , DNA de Cinetoplasto/genética , Insetos Vetores/parasitologia , Filogenia , Triatoma/parasitologia , Trypanosoma cruzi/genética , Animais , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/parasitologia , Estudos de Coortes , DNA Intergênico/genética , DNA Satélite/genética , Eletrocardiografia , Técnicas de Genotipagem , Humanos , Texas/epidemiologia , Trypanosoma cruzi/classificação
17.
Cardiol Clin ; 35(1): 31-47, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27886788

RESUMO

The initial infection of Chagas disease is typically asymptomatic, but approximately 30% of people will progress to a chronic cardiac form, and others develop the gastrointestinal form. Death is often sudden due to arrhythmias or progressive heart failure. Prevention through vector control programs and blood bank screening, along with strengthened surveillance systems and rapid information sharing, are key to decreasing disease burden globally. The epidemiology, diagnostic evaluation, diagnosis, and treatment of acute and chronic Chagas cardiac disease are discussed with focus on educating the primary care professionals and general cardiologists in nonendemic areas who have limited experience treating this disease.


Assuntos
Cardiomiopatia Chagásica , Gerenciamento Clínico , Américas/epidemiologia , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/epidemiologia , Cardiomiopatia Chagásica/terapia , Humanos , Morbidade/tendências
18.
Tohoku J Exp Med ; 240(3): 243-249, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27890871

RESUMO

Chagas disease is a parasitic infection mainly found in Latin America; it is transmitted by a triatomine, also known as assassin bug or kissing bug. In humans, the parasite causes mostly cardiac disorders. Two-thirds of the Mexican territory are regarded as risk areas for vector transmission of Trypanosoma cruzi, the causal agent. The parasite can be found as a blood-borne trypomastigote or as an intracellular amastigote. The progression and severity of lesions could be due to frequent reinfections or to infection by highly virulent strains. A total of 3,327 individuals younger than 18 years old, living in risk areas for this disease in the rural setting of the States of Queretaro, San Luis Potosi, and Veracruz, underwent a seroepidemiological study. Among them, 37 subjects were seropositive for T. cruzi, and were studied to look for signs of cardiac pathology, which has only been reported in adults. A clinical record was prepared for all included individuals, and electrocardiography (ECG) and echocardiography (ECHO) studies were performed; 25 cases showed lesions compatible with the onset of Chagas cardiomyopathy. The other 12 patients showed either normal ECG and ECHO data or showed abnormal parameters that were not regarded as significant. Lesions found in the onset of Chagas cardiomyopathy in children are herein reported, along with 14 cases of cardiac pathology compatible with Chagas disease. Our results indicate that patients younger than 18 years can show a cardiac pathology similar to that observed in adults.


Assuntos
Cardiomiopatia Chagásica/epidemiologia , Adolescente , Cardiomiopatia Chagásica/diagnóstico por imagem , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Feminino , Geografia , Humanos , Masculino , México/epidemiologia
19.
PLoS One ; 11(11): e0165950, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27855177

RESUMO

Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies.


Assuntos
Cardiomiopatia Chagásica/tratamento farmacológico , Cardiomiopatia Chagásica/epidemiologia , Nitroimidazóis/uso terapêutico , Idoso , Brasil/epidemiologia , Cardiomiopatia Chagásica/diagnóstico , Doença Crônica , Comorbidade , Estudos Transversais , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Tripanossomicidas/uso terapêutico
20.
Pathog Glob Health ; 110(6): 228-232, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27666187

RESUMO

Chagas disease, which is caused by Trypanosoma cruzi, is transmitted primarily by triatomine bugs, although the incidence of new cases has decreased as a result of vector control. In Brazil, most of those affected have the chronic form of the disease and are generally elderly individuals who require appropriate clinical follow-up. In this work, we undertook a descriptive study in which 85 patients were interviewed and blood samples were collected for molecular analyses based on the amplification of parasite satellite DNA. The cardiac form of the disease was the most prevalent among the patients and hypertension was the most frequent comorbidity; polypharmacy was detected in 34% of the cases. Serological tests were positive in 95% of cases while 36% were positive in nested-polymerase chain reaction. These findings indicate an increased use of medications and a larger number of age-related diseases in elderly patients with Chagas disease, even in patients with low parasitemia. We conclude that elderly patients with Chagas disease require special attention and that further studies should be done with elderly individuals who carry this disease.


Assuntos
Doença de Chagas/diagnóstico , Trypanosoma cruzi/isolamento & purificação , Idoso , Animais , Brasil/epidemiologia , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/epidemiologia , Doença de Chagas/epidemiologia , Comorbidade , DNA de Protozoário/genética , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Polimedicação , Testes Sorológicos/métodos , Trypanosoma cruzi/genética
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