Seroprevalence of trypanosoma cruzi infection among blood donors in the state of Bahia, Brazil

Abstract INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.

Prevalência da doença de Chagas entre doadores de sangue do Estado do Piauí, Brasil, no período de 2004 a 2013 / Prevalence of Chagas disease among blood donors in Piauí State, Brazil, from 2004 to 2013 / Prevalencia de la enfermedad de Chagas entre donadores de sangre del estado de Piauí, Brasil, durante el período de 2004 a 2013

Apesar do declínio na prevalência da doença de Chagas no Brasil, a Região Nordeste apresenta condições propícias ao seu recrudescimento. O objetivo deste estudo foi analisar a positividade por doença de Chagas entre doadores de sangue do Piauí entre 2004 e 2013. A prevalência de sorologia reagente para doenças de Chagas na triagem de doadores foi de 1%, variando de 0,4% na Regional de Saúde de Uruçuí a 2,4% na Regional de Saúde de São Raimundo Nonato. Dos 220 municípios, 58,6% apresentaram casos. Apenas 34,5% das amostras positivas na triagem foram encaminhadas para testes complementares e entre estes, 84,4% apresentaram resultados negativos. Nossos resultados indicam a possibilidade da manutenção da transmissão vetorial em áreas do Estado do Piauí e a necessidade da implantação de ações que melhorem o índice de realização dos testes complementares referentes aos casos positivos na triagem.

Despite the decline in prevalence of Chagas disease in Brazil, the Northeast region of the country has favorable conditions for its resurgence. The study aimed to analyze positive Chagas disease serology rates among blood donors in Piauí State from 2004 to 2013. Prevalence of positive Chagas disease serology in blood donor screening was 1%, ranging from 0.4% in the Uruçuí Regional Health District to 2.4% in the São Raimundo Nonato Regional Health District. Of the state's 220 municipalities, 58.6% reported cases. Only 34.5% of the positive samples in screening were referred for complementary tests, and 84.4% of these showed negative results. Our findings suggest the possibility of persistent vector-borne transmission in areas of Piauí State and the need for measures to improve complementary testing in positive cases detected by screening.

A pesar del declive en la prevalencia de la enfermedad de Chagas en Brasil, la Región Nordeste presenta condiciones propicias para su recrudecimiento. El objetivo de este estudio fue analizar la positividad por enfermedad de Chagas entre donadores de sangre de Piauí entre 2004 y 2013. La prevalencia de la serología reactiva para la enfermedad de Chagas en la clasificación de donadores fue de un 1%, variando de 0,4% en la Regional de Salud de Uruçuí, a 2,4% en la Regional de Salud de São Raimundo Nonato. De los 220 municipios, un 58,6% presentaron casos. Sólo un 34,5% de las muestras positivas en la clasificación fueron dirigidas a test complementarios y entre estos, un 84,4% presentaron resultados negativos. Nuestros resultados indican la posibilidad del mantenimiento de la transmisión vectorial en áreas del Estado de Piauí y la necesidad de la implantación de acciones que mejoren el índice de realización de los test complementarios referentes a los casos positivos en la clasificación.

Seroprevalencia de la infección por Trypanosoma cruzi en la población rural del estado Sucre, Venezuela / Seroprevalence of Trypanosoma cruzi infection in the rural population of Sucre State, Venezuela / Soroprevalência de infecção pelo Trypanosoma cruzi na população rural do Estado de Sucre, Venezuela

Resumen: El objetivo del presente estudio fue determinar la seroprevalencia de la infección por Trypanosoma cruzi en el estado Sucre (Venezuela) y su asociación con factores de riesgo epidemiológicos. El diseño muestral por conglomerados permitió seleccionar 96 centros poblados y 576 viviendas en los 15 municipios del estado. Asimismo, se evaluaron un total de 2.212 muestras de sueros, a través de las pruebas de ELISA, HAI e IFI. La seroprevalencia en el estado Sucre fue de 3,12%. Los factores de riesgo asociados a la infección por T. cruzi fueron: deposición de basura, materiales predominantes en el piso y paredes, tipo de vivienda, vivir en casas con paredes de bahareque y/o techos de palmas, vivir en casa con paredes y techos de riesgo, construcciones de riesgo y anexos de bahareque, aves dentro de la vivienda y la presencia de leña. La infección se encontró asociada a la edad de los individuos, se detectaron tres casos seropositivos en menores de 15 años. En el estado Sucre existen variables epidemiológicas que favorecen el riesgo a contraer la infección por T. cruzi.

Abstract: The current study aimed to determine the seroprevalence of Trypanosoma cruzi infection in Sucre State, Venezuela, and its association with epidemiological risk factors. The cluster sampling design allowed selecting 96 villages and 576 dwellings in the State's 15 municipalities. A total of 2,212 serum samples were analyzed by ELISA, HAI, and IFI. Seroprevalence in Sucre State was 3.12%. Risk factors associated with T. cruzi infection were: accumulated garbage, flooring and wall materials, type of dwelling, living in a house with wattle and daub walls and/or straw roofing, living in a house with risky walls and roofing, risky buildings and wattle and daub outbuildings, poultry inside the human dwelling, and presence of firewood. Infection was associated with individual age, and three seropositive cases were found in individuals less than 15 years of age. Sucre State has epidemiological factors that favor the risk of acquiring T. cruzi infection.

Resumo: O estudo teve como objetivo determinar a soroprevalência da infecção pelo Trypanosoma cruzi no Estado de Sucre, Venezuela, e a associação com fatores de risco epidemiológicos. O delineamento da amostragem em clusters permitiu a seleção de 96 vilarejos e 576 moradias nos 15 municípios do Estado. No total, 2.212 amostras de soro foram analisadas com ELISA, HAI e IFI. O estudo mostrou uma soroprevalência de 3,12% no Estado de Sucre. Os seguintes fatores de risco estiveram associados à infecção pelo T. cruzi: acúmulo de lixo, materiais de piso e paredes impróprios, tipo de moradia, moradias com paredes de pau-a-pique e/ou teto de palha, moradias em situação de risco e construções anexas feitas de pau-a-pique, aves dentro das moradias e presença de lenha. A infecção esteve associada à idade individual, e três casos soropositivos foram identificados em indivíduos com menos de 15 anos de idade. O Estado de Sucre apresenta fatores epidemiológicos que aumentam o risco de infecção pelo T. cruzi.

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Abstract INTRODUCTION In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. METHODS Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T . cruzi isolates were genotyped using three different genetic markers. RESULTS: Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T . cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. CONCLUSIONS Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.

Serological based monitoring of a cohort of patients with chronic Chagas disease treated with benznidazole in a highly endemic area of northern Argentina

This study aimed to evaluate well-documented diagnostic antigens, named B13, 1F8 and JL7 recombinant proteins, as potential markers of seroconversion in treated chagasic patients. Prospective study, involving 203 patients treated with benznidazole, was conducted from endemic areas of northern Argentina. Follow-up was possible in 107 out of them and blood samples were taken for serology and PCR assays before and 2, 3, 6, 12, 24 and 36 months after treatment initiation. Reactivity against Trypanosoma cruzi lysate and recombinant antigens was measured by ELISA. The rate of decrease of antibody titers showed nonlinear kinetics with an abrupt drop within the first three months after initiation of treatment for all studied antigens, followed by a plateau displaying a low decay until the end of follow-up. At this point, anti-B13, anti-1F8 and anti-JL7 titers were relatively close to the cut-off line, while anti-T. cruzi antibodies still remained positive. At baseline, 60.8% (45/74) of analysed patients tested positive for parasite DNA by PCR and during the follow-up period in 34 out of 45 positive samples (75.5%) could not be detected T. cruzi DNA. Our results suggest that these antigens might be useful as early markers for monitoring antiparasitic treatment in chronic Chagas disease.

Papel da galectina-3 na patogênese no tratamento da miocardiopatia chagásica crônica / Role of galectin-3 in pathogenesis in the treatment of chronic chagasic cardiomyopathy

INTRODUÇÃO: A doença de Chagas é uma relevante causa de insuficiência cardíaca na América Latina, onde cerca de 30% dos indivíduos infectados por Trypanosoma cruzi desenvolvem a cardiopatia chagásica crônica (CCC). Fatores relacionados à interação parasito-hospedeiro, resposta imune, reparo e regeneração tecidual participam da fisiopatologia da doença. A identificação de novos alvos terapêuticos depende de um melhor entendimento destes processos. Anteriormente, demonstramos que a galectina-3 (Gal-3), uma lectina com capacidade de ligação a β-galactosídeos, é superexpressa no tecido cardíaco em um modelo experimental de CCC. OBJETIVOS: O objetivo deste estudo foi investigar o papel exercido pela Gal-3 na patogênese da CCC e seu potencial uso como alvo terapêutico. MATERIAIS E MÉTODOS: A expressão de Gal-3 foi avaliada no coração de camundongos C57Bl/6...

INTRODUCTION: Chagas disease is a relevant cause of heart failure in Latin America, where about 30% of individuals infected with Trypanosoma cruzi develop chronic Chagas' disease cardiomyopathy (CCC). Several factors related to host-parasite interactions, immune response, tissue repair and regeneration participate in the pathophysiology of the disease. The identification of novel therapeutic targets relies on a better understanding of these processes. Previously, we have demonstrated that the galectin-3 (Gal-3) - a β-galactoside binding lectin - is overexpressed in the cardiac tissue in an experimental model of CCC. AIM: The aim of this study was to investigate the role of Gal-3 in the pathogenesis of CCC and its potential use as a therapeutic target. MATERIALS AND METHODS: The expression of Gal-3 was assessed in the hearts of T. cruzi infected C57BL/6...

ADENOSINE DEAMINASE ACTIVITY AND SERUM C-REACTIVE PROTEIN AS PROGNOSTIC MARKERS OF CHAGAS DISEASE SEVERITY / Atividade da adenosina deaminase e níveis de proteina C reativa sérica como marcadores de gravidade na doença de Chagas

SUMMARY Chagas disease is a public health problem worldwide. The availability of diagnostic tools to predict the development of chronic Chagas cardiomyopathy is crucial to reduce morbidity and mortality. Here we analyze the prognostic value of adenosine deaminase serum activity (ADA) and C-reactive protein serum levels (CRP) in chagasic individuals. One hundred and ten individuals, 28 healthy and 82 chagasic patients were divided according to disease severity in phase I (n = 35), II (n = 29), and III (n = 18). A complete medical history, 12-lead electrocardiogram, chest X-ray, and M-mode echocardiogram were performed on each individual. Diagnosis of Chagas disease was confirmed by ELISA and MABA using recombinant antigens; ADA was determined spectrophotometrically and CRP by ELISA. The results have shown that CRP and ADA increased linearly in relation to disease phase, CRP being significantly higher in phase III and ADA at all phases. Also, CRP and ADA were positively correlated with echocardiographic parameters of cardiac remodeling and with electrocardiographic abnormalities, and negatively with ejection fraction. CRP and ADA were higher in patients with cardiothoracic index ≥ 50%, while ADA was higher in patients with ventricular repolarization disturbances. Finally, CRP was positively correlated with ADA. In conclusion, ADA and CRP are prognostic markers of cardiac dysfunction and remodeling in Chagas disease.

Introdução e objetivo . A Doença de Chagas é um problema de saúde pública mundial. A disponibilidade de ferramentas diagnósticas para prever o desenvolvimento de miocardiopatia chagásica crônica é fundamental para reduzir a morbidade e a mortalidade. Aqui estudamos o valor prognóstico da atividade sérica da adenosina deaminase (ADA) e dos níveis de proteína C reativa (PCR) em indivíduos chagásicos. Métodos : 110 indivíduos: 28 saudáveis e 82 pacientes chagásicos foram divididos de acordo com a gravidade da doença em fase I (n = 35), II (n = 29) e III (n = 18). Para cada indivíduo foram feitos uma história médica, eletrocardiograma, radiografia de tórax e ecocardiografía transtorácica. O diagnóstico de Chagas foi confirmado por ELISA e MABA utilizando antígenos recombinantes, a atividade sérica da enzima ADA foi determinada por espectrofotometria, e os níveis séricos de PCR por ELISA. Resultados : os níveis de PCR e da atividade da ADA aumentaram linearmente em relação à fase da doença, sendo a PCR significativamente maior na fase III, e a ADA em todas as fases. Além disso, PCR e ADA foram correlacionados positivamente com parâmetros ecocardiográficos de remodelamento cardíaco e alterações eletrocardiográficas, e negativamente com a fração de ejeção. PCR e ADA foram mais elevadas em pacientes com índice cardiotorácico ≥ 50%, enquanto que a ADA foi maior em pacientes com alterações da repolarização ventricular. Finalmente, os níveis de PCR foram correlacionados positivamente com a atividade da ADA. Conclusão : ADA e PCR são marcadores prognósticos de disfunção e remodelamento cardíaco na Doença de Chagas, e devem ser incluídos na avaliação e acompanhamento dos pacientes.

Effects of vitaiin c supplementation on the chronic phase of chagas iisease / Efeitos da suplementação de vitamina C na fase crônica da doença de Chagas

Introduction: In order to examine the effectiveness of vitamin C (ascorbic acid) in combating the oxidative insult caused by Trypanosoma cruzi during the development of the chronic phase of Chagas disease, Swiss mice were infected intraperitoneally with 5.0 × 104 trypomastigotes of T. cruzi QM1strain. Methods: Mice were given supplements of two different doses of vitamin C for 180 days. Levels of lipid oxidation (as indicated by thiobarbituric acid reactive substances-TBARS), total peroxide, vitamin C, and reduced glutathione were measured in the plasma, TBARS, total peroxide and vitamin C were measured in the myocardium and histopathologic analysis was undertaken in heart, colon and skeletal muscle. Results: Animals that received a dose equivalent to 500 mg of vitamin C daily showed increased production of ROS in plasma and myocardium and a greater degree of inflammation and necrosis in skeletal muscles than those that received a lower dose or no vitamin C whatsoever. Conclusion: Although some research has shown the antioxidant effect of vitamin C, the results showed that animals subject to a 500 mg dose of vitamin C showed greater tissue damage in the chronic phase of Chagas disease, probably due to the paradoxical actions of the substance, which in this pathology, will have acted as a pro-oxidant or pro-inflammatory. .

Introdução: Para verificar a eficácia da vitamina C em combater o insulto oxidativo causado pelo Trypanosoma cruzi durante a evolução da fase crônica da doença de Chagas, camundongos Swiss foram previamente infectados via intraperitoneal com 5.0 × 104 tripomastigotas da cepa QM1 de T. cruzi. Métodos: Camundongos foram suplementados com duas diferentes doses de vitamina C por 180 dias. Foram mensurados os níveis de peroxidação lipídica (indicado por substâncias reativas ao ácido tiobarbitúrico-TBARS), peróxido total, vitamina C, e glutationa reduzida no plasma e TBARS, peróxido total e vitamina C no miocárdio, e foi realizado o estudo histopatológico em coração, cólon e músculo esquelético. Resultados: Animais que receberam diariamente uma dosagem equivalente a 500 mg de vitamina C apresentaram aumento na produção de ROS e RNS no plasma e no miocárdio e maior grau de inflamação e necrose em músculo esquelético em comparação àqueles que receberam doses menores ou nenhuma vitamina C. Conclusão: Embora muitas pesquisas tenham mostrado o efeito antioxidante da vitamina C, nossos resultados mostraram que os animais que foram expostos a 500 mg de vitamina C apresentaram maior dano tecidual na fase crônica da doença de Chagas, provavelmente devido a ações paradoxais desta substância, onde nesta patologia, poderá agir como pró-oxidante ou pró-inflamatória. .

The TcI and TcII Trypanosoma cruzi experimental infections induce distinct immune responses and cardiac fibrosis in dogs

Trypanosoma cruzi infection may be caused by different strains with distinct discrete typing units (DTUs) that can result in variable clinical forms of chronic Chagas disease. The present study evaluates the immune response and cardiac lesions in dogs experimentally infected with different T. cruzi strains with distinct DTUs, namely, the Colombian (Col) and Y strains of TcI and TcII DTU, respectively. During infection with the Col strain, increased levels of alanine aminotransferase, erythrocytes, haematocrit and haemoglobin were observed. In addition, CD8+ T-lymphocytes isolated from the peripheral blood produced higher levels of interleukin (IL)-4. The latter suggests that during the acute phase, infection with the Col strain may remain unnoticed by circulating mononuclear cells. In the chronic phase, a significant increase in the number of inflammatory cells was detected in the right atrium. Conversely, infection with the Y strain led to leucopoenia, thrombopoenia, inversion of the ratio of CD4+/CD8+ T-lymphocytes and alterations in monocyte number. The Y strain stimulated the production of interferon-γ by CD4+ and CD8+ T-lymphocytes and IL-4 by CD8+ T-cells. In the chronic phase, significant heart inflammation and fibrosis were observed, demonstrating that strains of different DTUs interact differently with the host.

Estudo do controle autonômico do coração na doença de chagas / Study of control autonômicodo heart in Chagas' disease

O comprometimento do sistema nervoso autônomo do coração na enfermidade chagasica crônica:referência ao envolvimento do sistema nervoso na Doença de Chagas foi inicialmente feita por Carlos Chagas, em 1913 ; "Relativement à la frequence des formes nerveuses de la trypanos- somiase, nous possedons des observations nombreuses, qui nous au torisent à affirmer que cette maladie est celle qui? peut-être, provoque, en pathologic humaine, la plus grand nombre d'affec tions organiques du systéme nerveux central" (01). Embora Carlos Chagas, nesta época, se referisse apenas a manifestações decorren tes do comprometimento do sistema nervoso central, ja em 1921, su geriu a possibilidade de "lesões dos nervos sensitivos intracar- díacos", ou de um "augmento do tonus sympathico", para esclarecer este "capítulo novo da pathologia humana"A relevância emprestada pelos diversos autores à lesão neuronal, como fator patogênico, tem variado bastante. Koborle (02) postulou ser a moléstia de Chagas uma enfermidade exclusiva do sistema nervoso parassimpãtico ("cardiopatia parassimpatico- priva"), em qu9 as '“patias" chagásicas —cardiopatia, bronqui- ectasia, megas etc— representariam tão-somente sequelas das lesões neuronais ocorridas na fase aguda. Por outro lado, Andrade e Andrade (0 3), embora admitindo a ocorrência de intensa destruição neuronal no coração de chagãsicos brasileiros, a qual comunicaria certas peculiaridades ã miocardiopatia em nosso meio, acreditam que a lesão autonômica não á fundamental na cardiopatia.

Aspectos nutricionais associados à infecção crônica pelo Trypanosoma cruzi (Chagas 1909) entre idosos: Projeto Bambuí / Nutritional aspects associated with chronic Trypanosoma cruzi (Chagas 1909) infection among older adults: Bambuí Project / Aspectos nutricionales asociados a la infección crónica por el Trypanosoma cruzi (Chagas 1909) entre ancianos: Proyecto Bambuí

O objetivo do estudo foi verificar os aspectos nutricionais associados à infecção crônica pelo Trypanosoma cruzi entre os participantes da linha de base da coorte de idosos de Bambuí, Minas Gerais, Brasil. A análise incluiu 84,9% (1.479) de todos os residentes com 60 anos ou mais na cidade em 1997. A infecção pelo Tr. cruzi foi avaliada por três testes sorológicos e o perfil nutricional foi caracterizado por variáveis antropométricas e bioquímicas. As associações foram avaliadas pelas razões de prevalência e intervalos de 95% de confiança, utilizando a regressão de Poisson robusta e ajustando por potenciais fatores de confusão. A infecção foi observada em 38,1% dos idosos. Todas as variáveis antropométricas apresentaram associação significativa com a infecção, evidenciando menores valores entre os idosos com sorologia positiva. As variáveis bioquímicas não foram associadas ao evento estudado. Os resultados evidenciaram a concomitância da doença de Chagas crônica e pior estado nutricional nessa população, reforçando a importância da avaliação nutricional entre idosos com infecção crônica pelo Tr. cruzi.

The aim of the study was to verify nutritional aspects associated with chronic Trypanosoma cruzi infection among baseline participants from the Bambuí cohort study on aging. The analysis included 84.9% (1,479) of residents of Bambuí, Minas Gerais State, Brazil, who were 60 years or older in 1997. T. cruzi infection was investigated by three serological tests, and nutritional status was assessed by anthropometric and biochemical variables. Associations were evaluated by prevalence ratios and confidence intervals (95%CI) using Poisson regression. T. cruzi infection was present in 38.1% of patients. All anthropometric variables were significantly associated with infection, showing lower values among patients with positive serology. No biochemical variables were associated with infection. The results showed the coexistence of chronic Chagas disease and poor nutritional status in the study population, reinforcing the importance of nutritional evaluation among elderly people presenting chronic T. cruzi infection.

El objetivo del estudio fue verificar los aspectos nutricionales asociados a la infección crónica por el Trypanosoma cruzi entre los participantes de la línea de base de una cohorte de ancianos de Bambuí, Minas Gerais, Brasil. El análisis incluyó al 84,9% (1.479) de todos los residentes con 60 años o más en la ciudad en 1997. La infección por el Tr. cruzi fue evaluada por tres testes serológicos y el perfil nutricional se caracterizó por variables antropométricas y bioquímicas. Las asociaciones se evaluaron por las razones de prevalencia e intervalos de un 95% de confianza, utilizando la regresión de Poisson robusta y ajustada por potenciales factores de confusión. La infección se observó en un 38,1% de los ancianos. Todas las variables antropométricas presentaron una asociación significativa con la infección, evidenciando menores valores entre los ancianos con serología positiva. Las variables bioquímicas no se asociaron al evento estudiado. Los resultados evidenciaron la concomitancia de la enfermedad de Chagas crónica y un peor estado nutricional en esa población, reforzando la importancia de la evaluación nutricional entre ancianos con infección crónica por el Tr. cruzi.

Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy / Avaliação das alterações anatômicas e funcionais do coto esofágico de pacientes portadores de megaesôfago avançado submetidos à esofagectomia subtotal laparoscópica

PURPOSE: Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS: Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy , were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS: It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS: The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.

OBJETIVO: Avaliar as alterações anatômicas e funcionais do coto esofágico e fundo gástrico de pacientes com megaesôfago avançado, submetidos à esofagectomia subtotal laparoscópica. MÉTODOS: Vinte pacientes com megaesôfago avançado, previamente submetidos à esofagectomia subtotal videolaparoscópica, foram avaliados. Foram realizados: avaliação radiológica do coto esofágico com o estômago transposto, eletromanometria endoscopia e exame histopatológico do coto esofágico e fundo gástrico,sem fazer tubo gástrico ou piloroplastia. RESULTADOS: Observou-se que a altura média e pressão da anastomose, na avaliação eletromanométrica, foram: 23,45cm (± 1,84cm) e 7,55mmHg (± 5,65mmHg), Em pacientes com megaesôfago III, a pressão da anastomose foi de 10,91mmHg (± 6,33mmHg), e a pressão do ESE, 31,89mmHg (±14,64mmHg) foram significativamente mais elevados do que aqueles em grau IV. A avaliação patológica detectou esofagite leve em 35% dos pacientes, moderada em 20% e acantose glicogênica em 45%. O exame do fundo gástrico mostrou que 50% dos pacientes foram infectados com Helicobacter pylori. Gastrite crônica ocorreu em 95% dos pacientes. CONCLUSÕES: A esofagectomia laparoscópica mostrou-se eficaz no tratamento de acalasia avançada. A anastomose em nível cervical tem um papel protetor para o coto esofágico ao evitar a agressão resultante de refluxo gástrico após a esofagectomia.

Seroprevalencia de la infección por Trypanosoma cruzi y factores asociados en un área endémica de Venezuela / Seroprevalence for Trypanosoma cruzi infection and associated factors in an endemic area of Venezuela

This study investigated risk factors associated with positive serological status for Trypanosoma cruzi antibodies in 26 rural communities including 905 households, 2,156 humans, and 333 dogs in Lara State, Venezuela. Serology was performed with ELISA and MABA. Data were obtained from entomological, demographic, and clinical surveys. Risk factors were determined through binary logistic regression. Seroprevalence was 7.24 percent in humans and 6.9 percent in canines. Positive serological status was positively associated with the Rhodnius prolixus vector, age, maternal history of Chagas disease, tobacco chewing, presence of mammals and birds in the household, household disarray, mud-and-wattle outbuildings, and animal nests and burrows in the peridomicile, and negatively associated with tobacco and alcohol consumption, history of cancer, and storage deposits in the peridomile. In conclusion, Chagas disease in this rural area is an old phenomenon transmitted by R. prolixus or by the transplacental route, associated with socio-cultural habits related to poverty, sylvatic surroundings, and the host's medical history.

Determinamos factores de riesgo asociados a la seropositividad para anticuerpos anti-Trypanosoma cruzi en 26 poblaciones rurales, 905 viviendas, 2.156 individuos y 333 caninos en el Estado Lara, Venezuela. La seropositividad fue determinada mediante ELISA y MABA. Los datos fueron obtenidos mediante encuestas entomológicas, demográficas y médicas. Los factores de riesgo fueron establecidos mediante regresión logística binaria. La seroprevalencia humana fue de 7,24 por ciento y la canina 6,9 por ciento. La seropositividad estuvo asociada positivamente al Rhodnius prolixus, la edad, madre con antecedentes de Chagas, consumo de chimó, presencia de mamíferos y aves en la vivienda, desorden en el domicilio, y anexos de bajareque, nidos y cuevas en el peridomicilio. Negativamente con hábitos de consumo de tabaco y alcohol, antecedentes de cáncer y a depósitos en el peridomicilio. En conclusión, la enfermedad de Chagas en el área rural estudiada es un fenómeno remoto transmitida por R. prolixus y vía transplacentaria, asociada a hábitos socioculturales relacionados con la pobreza, a entornos selváticos y antecedentes médicos del huésped.

Turbulencia de la frecuencia en pacientes portadores de chagas crónico procedentes de la zona norte del estado Anzoátegui / Heart rate variability in patients with chronic chagas disease from the northern zone of Anzoategui state

El estudio de las alteraciones en la turbulencia de la frecuencia cardíaca, como respuesta fisiológica bifásica del modo sinusal a contracciones ventriculares prematuras, es de interés como factor de riesgo en la cardiopatía isquémica. Analizar la turbulencia de la frecuencia cardíaca en pacientes chagásicos en distintos estadios de la enfermedad cardíaca. Se realizó un estudio observacional de corte transversal, con una muestra no probabilística dividida en: grupo sero-negativo a anticuerpos anti-Trypanosoma cruzi (control) y grupos sero-positivos Ch I (electrocardiograma normal), Ch II (Eelectrocardiograma anormal) y Ch III (electrocardiograma anormal e insuficiencia cardíaca). Se realizó el análisis comparativo entre los grupos para los parámetros del inicio de la turbulencia y de la pendiente de la turbulencia. El inicio de la turbulencia demostró diferencias significativas entre los grupos control (Media-3,32 IC 95%: (-4,30-2,24)) y CH III (Media:-2,24 IC 95% (-54-5), P:=,02); así también la pendiente de la turbulencia resultó estadísticamente diferente entre los grupos control (Media 14,22 IC 95%:(10,50-17,94)) y Ch III (media: 2,35 IC 95% (-2,59-7,30), P: 0,002). Aunque el análisis multivariable no demostró diferencias significativas entre los grupos de pacientes chagásicos analizados para estos dos parámetros, existió una clara tendencia a la disminución de la pendiente de la turbulencia en los estadios avanzados de la cardiomiopatía chagásica. Estos resultados revelan importantes alteraciones en la función autonómica de los pacientes con cardiopatía chagásica evaluada mediante la turbulencia de la frecuencia cardiaca, información que consideramos de interés para el análisis de los factores de riesgo y terapéutica en los estadios avanzados de la enfermedad cardíaca de estos pacientes.

Presently it is estimated that about 20 million people are infected and another 90 million are at risk of being infected with the parasite globally, thus representing the third most geographically widespread tropical illness. To estimate changes in parasymthetic control through Heart Rate Variability which is based on the two-phased response from the sinus node to premature ventricular contractions. Cross-sectional, observational study. Non probabilistic sample divided into four groups: Sero -ve or control group and sero +ve which was classified into three groups: Group 1 (Ch 1), those patients without electrical alteration. Group 2 (Ch 2), patients with alterations in their electrocardiogram and Group 3 (Ch 3), patients with an abdominal electrocardiogram and with symptoms of ICC. For the calculation of Heart Rate Variability, two paramenters were taken into consideration: Onset of the Variability and the Slope of the Variability (SV), Onset of the Variability showed no statistically significant differences when compared between patients with negative serology and Ch 1 patients. Sero-ve: 3.32 95 % CI: (-4.30-2.24) vs. Ch 1: mean -4.28. 95 % CI: (4.28-2.72). p=NS). There a statiscally significant difference between the Sero-ve mean -3.32. 95 % CI: (-4.30-2.34) vs Ch 2 mean -1.50. 95 % CI: (-2.45-0.54). P=0.02 and Ch 3 mean: -0.24 95% CI (-1.54) P=0.02. The Stope of the Variability showed no statiscally significant differences between the sero-ve vs Ch 1. Seronegative: 14.22 95 % CI: (5.25-17.17), p=NS and Ch 2 mean 6.27. 95 % CI: (2.63-9.91), p=NS and contrary to Ch 3 the means: 2.35 95 % CI (-2.59-7.30) P=o.002. Onset of the Variability as well as Slope of the Variability showed no statistically significant difference when compared with the groups of patients with chagas disease. The results reveal that patients with Chagas Disease demostrate variability in their autonomic function at intermediate stage of the illness.

Socioepidemiological screening of serologically ineligible blood donors due to Chagas disease for the definition of inconclusive cases

Epidemiological screening combined with serological tests has become an important tool at blood banks for the characterization of donors with or without Trypanosoma cruzi infection. Thus, the objective of the present study was to describe the sociodemographic and epidemiological characteristics of blood donors with non-negative serology for T. cruzito determine possible risk factors associated with serological ineligibility. Sociodemographic and epidemiological data were collected by analysis of patient histories and interviews. The data were analyzed descriptively using absolute and relative frequencies and odds ratio (OR) evaluation. The frequency of serological ineligibility was 0.28 percent, with a predominance of inconclusive reactions (52 percent) and seropositivity among first-time donors (OR = 607), donors older than 30 years (OR = 3.7), females (OR = 1.9), donors from risk areas (OR = 4) and subjects living in rural areas (OR = 1.7). The risk of seropositivity was higher among donors who had contact with the triatomine vector (OR = 11.7) and those with a family history of Chagas disease (OR = 4.8). The results demonstrate the value of detailed clinical-epidemiological screening as an auxiliary tool for serological definition that, together with more specific and more sensitive laboratory methods, will guarantee a higher efficacy in the selection of donors at blood centres.

Associação entre os níveis plasmáticos de TNF-α, IFN-γ, IL-10, óxido nítrico e os isotipos de IgG específicos nas formas clínicas da doença de Chagas crônica / Association between the plasma levels of TNF-α, IFN-γ, IL-10, nitric oxide and specific IgG isotypes in the clinical forms of chronic Chagas disease

A doença de Chagas é uma importante doença parasitária crônica, que acomete cerca de 9-11 milhões de pessoas na América Latina. Provavelmente, uma combinação de fatores relacionados ao parasito e ao hospedeiro podem ser os responsáveis pela patogênese na fase crônica da doença. Dentre os fatores relacionados ao hospedeiro, a resposta imunológica é um parâmetro de especial interesse. Objetivamos avaliar os níveis plasmáticos das citocinas interferon gama, interleucina 10, fator de necrose tumoral alfa e das imunoglobulinas G total, 3 e 4, por ELISA e do óxido nítrico, pela reação de Griess, entre indivíduos soronegativos e soropositivos para Trypanosoma cruzi, com as formas clínicas cardíaca, indeterminada e digestiva. Os indivíduos soropositivos para Trypanosoma cruzi produziram níveis significativamente mais elevados de imunoglobulinas G total e G3. Indivíduos com a forma digestiva apresentam níveis mais elevados de imunoglobulina G4 e interleucina 10. Entretanto, tais indivíduos apresentaram menores níveis de óxido nítrico do que controles. Os resultados sugerem que os maiores níveis de IL-10 observados nos indivíduos com a forma digestiva poderiam contribuir com os maiores níveis de IgG4 específicos observados.

Chagas disease is an important chronic parasitic disease that affects around 9-11 million people in Latin America. A combination of parasite and host-related factors are probably responsible for pathogenesis in the chronic phase of the disease. Among the host-related factors, the immunological response is a parameter of special interest. Our aim here was to evaluate the plasma levels of the cytokines interferon gamma, interleukin 10 and tumor necrosis factor alpha and the immunoglobulins total IgG and its subclasses 3 and 4, by means of ELISA, and the levels of nitric oxide by means of the Griess reaction, among individuals who were seropositive for Trypanosoma cruzi, presenting the cardiac, indeterminate and digestive clinical forms of the disease, and among seronegative individuals. The seropositive individuals produced significantly higher levels of total IgG and IgG-3. Individuals with the digestive form presented higher levels of IgG-4 and interleukin 10. However, these individuals presented lower levels of nitric oxide than the controls did. The results suggest that the higher levels of interleukin 10 observed among individuals with the digestive form may contribute towards the higher levels of the specific IgG-4 that were seen.

Trypanosoma cruzi infection induces up-regulation of cardiac muscarinic acetylcholine receptors in vivo and in vitro

The pathogenesis of chagasic cardiomyopathy is not completely understood, but it has been correlated with parasympathetic denervation (neurogenic theory) and inflammatory activity (immunogenic theory) that could affect heart muscarinic acetylcholine receptor (mAChR) expression. In order to further understand whether neurogenic and/or immunogenic alterations are related to changes in mAChR expression, we studied two models of Trypanosoma cruzi infection: 1) in 3-week-old male Sprague Dawley rats chronically infected with T. cruzi and 2) isolated primary cardiomyocytes co-cultured with T. cruzi and peripheral blood mononuclear cells (PBMC). Using [³H]-quinuclidinylbenzilate ([³H]-QNB) binding assays, we evaluated mAChR expression in homogenates from selected cardiac regions, PBMC, and cultured cardiomyocytes. We also determined in vitro protein expression and pro-inflammatory cytokine expression in serum and cell culture medium by ELISA. Our results showed that: 1) mAChR were significantly (P < 0.05) up-regulated in right ventricular myocardium (means ± SEM; control: 58.69 ± 5.54, N = 29; Chagas: 72.29 ± 5.79 fmol/mg, N = 34) and PBMC (control: 12.88 ± 2.45, N = 18; Chagas: 20.22 ± 1.82 fmol/mg, N = 19), as well as in cardiomyocyte transmembranes cultured with either PBMC/T. cruzi co-cultures (control: 24.33 ± 3.83; Chagas: 43.62 ± 5.08 fmol/mg, N = 7 for both) or their conditioned medium (control: 37.84 ± 3.84, N = 4; Chagas: 54.38 ± 6.28 fmol/mg, N = 20); 2) [³H]-leucine uptake was increased in cardiomyocytes co-cultured with PBMC/T. cruzi-conditioned medium (Chagas: 21,030 ± 2321; control 10,940 ± 2385 dpm, N = 7 for both; P < 0.05); 3) plasma IL-6 was increased in chagasic rats, IL-1â, was increased in both plasma of chagasic rats and in the culture medium, and TNF-á level was decreased in the culture medium. In conclusion, our results suggest that cytokines are involved in the up-regulation of mAChR in chronic Chagas disease.

Clinical and nutritional profile of individuals with chagas disease

Chagas disease (CD), caused by the protozoan Trypanossoma cruzi, affects approximately 18 million individuals in the Americas, 5 million of which live in Brazil. Most chronic sufferers have either the indeterminate form of the disease, without organic compromise, or the cardiac or digestive forms. Despite the importance of this disease, there is no information on the effect of nutrition on CD evolution. We evaluated the clinical-nutritional profile of individuals with CD treated at the Tropical Diseases Nutrition Out-Patient Clinic of the Botucatu School of Medicine, UNESP. A retrospective cohort study was performed between 2002 and 2006, on 66 patients with serum and parasitological diagnosis of CD. Epidemiological, clinical, nutritional, and biochemical data were collected, including gender, age, skin color, smoking, alcoholism, physical activity, weight, stature, body mass index, abdominal circumference, glycemia, and lipid profile. Fifty-three percent were male and 47 percent female; 96 percent were white skinned. Mean age was 49.6±6.36 years. The predominant form was indeterminate in 71 percent; smoking and drinking were recorded in 23 percent and 17 percent, respectively. Sedentariness predominated in 83 percent, and 55 percent presented increased abdominal circumference. Most, 94 percent, were overweight or obese. The biochemical exams revealed hyperglycemia in 12 percent and dyslipidemia in 74 percent. These findings suggest that the Chagas population presents co-morbidities and risk factors for developing chronic non-transmissible diseases, including cardiovascular diseases, making CD evolution even worse.

Trypanocide treatment among adults with chronic Chagas disease living in Santa Fe city (Argentina), over a mean follow-up of 21 years: parasitological, serological and clinical evolution

The efficacy of treatment with nifurtimox and/or benznidazole among adults with chronic Chagas disease with no previous electrocardiographic disturbances was evaluated over a mean follow-up of 21 years, by means of conventional serology, xenodiagnosis, clinical examination, electrocardiograms and chest X-ray. One hundred and eleven patients, between 17 and 46 years old, were studied: 54 underwent treatment (nifurtimox 27, benznidazole 27) and 57 remained untreated (control group). Xenodiagnosis was performed on 65 percent of them: 36/38 of the treated and 9/34 of the untreated patients had previous positive xenodiagnosis. Post-treatment, 133 xenodiagnoses were performed on 41 patients, all resulting negative. In the control group, 29 xenodiagnoses were performed on 14 patients; 2 resulted positive. Sera stored during the follow-up were simultaneously analyzed through conventional serology tests (IHA; DA-2ME; IIF). The serological evolution in the treated group was: a) 37 percent underwent negative seroconversion (nifurtimox 11, benznidazole 9); b) 27.8 percent decreased titers (nifurtimox 9, benznidazole 6), 9 showed inconclusive final serology (nifurtimox 7, benznidazole 2); c) 35.2 percent remained positive with constant titers (nifurtimox 7; benznidazole 12). The control group conserved the initial antibody levels during the follow-up. In the clinical evolution, 2/54 (3.7 percent) of the treated and 9/57 (15.8 percent) of the untreated patients showed electrocardiographic disturbances attributable to Chagas myocardiopathy, with a statistically relevant difference (p<0.05). Treatment caused deparasitation in at least 37 percent of the chronically infected adults and a protective effect on their clinical evolution.

Avaliamos a eficácia do nifurtimox e/ou benznidazol, durante 21 anos em média, em adultos chagásicos crônicos sem alterações eletrocardiográficas iniciais, mediante sorologia convencional, xenodiagnóstico, exames clínicos, eletrocardiográficos e radiografia do tórax. Estudamos 111 pacientes (17 a 46 anos): 54 foram tratados (27 com nifurtimox e 27 com benznidazol) e 57 formaram o grupo controle. Foram submetidos ao xenodiagnóstico 65 por cento dos pacientes estudados: 36/38 tratados e 9/34 do grupo controle com xenodiagnóstico positivo prévio. Após tratamento, foram realizados 133 xenodiagnósticos em 41 pacientes, sendo todos negativos. Foram realizados 29 xenodiagnósticos em 14 pacientes do grupo controle, 2 foram positivos. A sorologia convencional foi realizada em soros estocados durante o seguimento. Evolução sorológica. Grupo tratado: a) 37 por cento negativaram (nifurtimox 11, benznidazol 9); b) 27,8 por cento diminuíram a titulação (nifurtimox 9, benznidazol 6), 9 deles apresentaram sorologia final discordante (nifurtimox 7, benznidazol 2; c) 35,2 por cento permaneceram positivos com titulação constante (nifurtimox 7, benznidazol 12). Grupo controle: conservou os níveis iniciais de anticorpos durante o seguimento. Evolução clínica: 2/54 (3,7 por cento) pacientes tratados e 9/57 não tratados apresentaram alterações eletrocardiográficas atribuíveis a miocardiopatia chagásica. Diferenças estatisticamente significantes (p<0,05). O tratamento produziu efeito de combate ao parasita em pelo menos 37 por cento dos infetados crônicos adultos e efeito protetor na evolução clínica.

Avaliação de pacientes assintomáticos com forma crônica da doença de Chagas através da análise do eletrocardiograma dinâmico, ecocardiograma e do peptídeo natriurético tipo B / Evaluation of asymptomatic patients with chronic Chagas' disease through ambulatory electrocardiogram, echocardiogram and B-Type natriuretic peptide analyses / Evaluation of asymptomatic patients with chronic Chagas' disease through ambulatory electrocardiogram, echocardiogram and B-Type natriuretic peptide analyses

OBJETIVO: Avaliar pacientes assintomáticos com forma crônica da doença de Chagas em relação a prevalência de arritmias ventriculares, disfunção ventricular esquerda e níveis plasmáticos do peptídeo natriurético tipo B (BNP). MÉTODOS: Avaliação clínica, eletrocardiograma (ECG), índice cardiotorácico (ICT), eletrocardiograma dinâmico, ecocardiograma e dosagem BNP foram realizados em 106 pacientes do Ambulatório de Doença de Chagas, distribuídos em três grupos: GI (50-ECG normal), GIIA (31-ECG com alterações características de doença de Chagas) e GIIB (25-ECG com outras alterações). RESULTADOS: Alterações eletrocardiográficas mais prevalentes no GIIA: bloqueio completo do ramo direito, bloqueio divisional ântero-superior esquerdo (35 por cento cada) e áreas inativas (32 por cento), GIIB: alteração da repolarização inferolateral (28 por cento) e sobrecarga ventricular esquerda (24 por cento). Os valores médios do ICT foram semelhantes (p = 0,383). A prevalência de arritmia ventricular foi maior nos grupos GIIA (77 por cento) e GIIB (75 por cento) do que no GI (46 por cento) (p = 0,002). A disfunção ventricular foi mais prevalente no GIIA (52 por cento) e GIIB (32 por cento) do que no GI (14 por cento) (p = 0,001). A disfunção sistólica foi mais prevalente no GIIA (29 por cento) do que no GIIB (20 por cento) e GI (2 por cento) (p < 0,001). A disfunção diastólica foi mais prevalente no GIIA (42 por cento) e no GIIB (28 por cento) do que no GI (12 por cento) (p = 0,005). Os valores médios do peptídeo natriurético tipo B foram, respectivamente, 30 ± 88 pg/ml no GI, 66 ± 194 no GIIA e 24 ± 82 no GIIB (p = 0,121). CONCLUSÃO: Pacientes assintomáticos com forma crônica da doença de Chagas e ECG alterado têm maior prevalência de arritmias e disfunção ventricular esquerda do que pacientes com ECG normal. Os níveis plasmáticos do BNP foram semelhantes entre os grupos.

OBJECTIVE: To evaluate asymptomatic patients with chronic Chagas' disease to determine prevalence of ventricular arrhythmias, left ventricular dysfunction, and B-type natriuretic peptide (BNP) plasma levels. METHODS: One hundred and six patients from the Chagas' disease outpatient clinic underwent clinical evaluation, electrocardiogram (ECG), cardiothoracic index (CTI), ambulatory electrocardiogram (Holter monitoring), echocardiogram, and BNP measurement and then were distributed into three groups: GI, with normal ECG (n = 50); GIIA, with ECG changes characteristic of Chagas' disease (n = 31); and GIIB, with other ECG changes (n = 25). RESULTS: The most common electrocardiographic changes were the following. GIIA: complete right bundle branch block (35 percent), left anterior hemiblock (35 percent), and electrically inactive areas (32 percent); GIIB: inferolateral repolarization change (28 percent), and left ventricular overload (24 percent). Mean CTI index values were similar (p = 0.383). Ventricular arrhythmia prevalence was higher in the GIIA (77 percent) and GIIB (75 percent) groups than in the GI group (46 percent) (p = 0.002). Ventricular dysfunction was more prevalent in the GIIA (52 percent) and GIIB (32 percent) groups than in the GI group (14 percent) (p = 0.001). Systolic dysfunction was more prevalent in the GIIA group (29 percent) than in the GIIB (20 percent) and GI groups (2 percent) (p < 0.001). Diastolic dysfunction was more prevalent in the GIIA (42 percent) and GIIB (28 percent) groups than in the GI group (12 percent) (p = 0.005). Mean B-type natriuretic peptide levels were 30 ± 88 pg/mL in the GI group, 66 ± 194 in the GIIA group and 24 ± 82 for the GIIB group (p = 0.121), respectively. CONCLUSION: Arrhythmias and left ventricular dysfunction are more prevalent in asymptomatic patients with chronic Chagas' disease and abnormal ECG than in patients with normal ECG. Plasma BNP levels were similar among the groups.