SUMMARY -We proposed to investigate subclinical cognitive impairment secondary to chronic Chagas' disease (CCD). No similar study was previously done. The neuropsychological performance of 45 chronic Chagasic patients and 26 matched controls (age, education place and years of residency in endemic area) was compared using the Mini Mental State Exam (MMSE), Weschler Memory Scale (WMS) and the Weschler Adult Intelligent Scale (WAIS). Non-parametric tests and Chi2 were used to compare group means and multivariate statistics in two way frequency tables for measures of independence and association of categorical variables with the disease. Results: Chagasic patients showed lower MMSE scores (p<.004), poor orientation (p<.004), and attention (p<.007). Lower WMS MQ were associated with CCD (Chi2 5.9; p<.01; Fisher test p<.02). Lower WAIS IQ were associated with CCD (Chi2 6.3, p<.01; Fisher test pcOl) being the digit symbol (pc03), picture completion (p<.03), picture arrangement (rx.01) and object assembly (pc03) subtests the most affected. The impairment in non-verbal reasoning, speed of information processing, problem solving, learning and sequencing observed in chronic Chagas disease patients resembles the cognitive dysfunction associated with white matter disease.KEY WORDS: Chagas' disease, cognitive dysfunction, cerebral white matter involvement.Disfuncion cognitiva en la enfermedad de Chagas crónica humana RESUMEN -El objetivo de esta investigación fue determinar compromiso cognitivo en pacientes con enfermedad de Chagas en estadio crónico. Se estudio el perfil cognitivo de 45 pacientes chagasicos crónicos (CC) y 26 controles apareados por edad, educación, lugar y tiempo de residencia en area endémica. El Minimental State (MMSE), 1 a escala de memoria de Weschler (WMS) y el test de Inteligencia de Weschler (WAIS) han sido utilizados para evaluar ambos grupos. Para el estudio estadístico de los datos se utilizaron pruebas no paramétricas, Chi2 y estadistica multivariada en tabla de 2 x 2 para medir la association o independencia de variables categoriales con la presencia de enfermedad. Los resultados mostraron que los pacientes alcanzaban score menor que los controles en el MMSE (p<0.004) debido basicamente a una mas pobre orientación (P<0.004) y atención (p<0.007). Cocientes bajos de memoria en el WMS se asociaron a la presencia de enfermedad (Chi2 5.9, p<0.01; test de Fisher p<0.02). Cocientes bajos de inteligencia en el WAIS se asociaron con la presencia de enfermedad (Chi2 6.3, p<0.01; test de Fisher p<0.01). Los subtests simbolos digitos (p<0.03), completamientos de figuras (p<0.03), ordenamiento de laminas (p<0.01) y rompecabezas (p<0.03) mostraron mayor compromiso. Estos resultados sugieren disfuncion del razonamiento no verbal, disminución de la velocidad de procesado de la información y dificultad en la resolución de problemas nuevos, en la habilidad de secuenciacion y en el aprendizaje. Este conjunto de hallazgos sugiere posible compromiso de la sustancia blanca subcortical en estos enfermos.PALAVRA-LLAVE:...

Autoimmune phenomena, especially occurrence of non organ-specific autoantibodies, are common in congenitally acquired HIV infection, mostly in the symptomatic stages of the disease. Anti-thyroid autoantibodies detected in adult patients represent the only type of organ-specific autoantibodies reported in HIV infection. As far as we know, occurrence of these autoantibodies has not been observed in HIV infected children. In this study thyroid biochemical pattern and possible occurrence of anti-thyroid autoantibodies were investigated in 40 vertically HIV infected, 18 seroreverted and 22 healthy children. 34% of HIV infected symptomatic children showed anti-thyroglobulin antibodies. Asymptomatic patients, seroreverted and healthy controls did not show any anti-thyroid antibodies at the time of the study. High Tg levels were observed in 38% of the 40 HIV infected patients and high TSH concentrations were found in 27.5% of the HIV children. High TSH values were more frequently observed in the infected children with moderate or severe immunocompromised status. Thyroxine binding globulin levels were high in 68% of the HIV children and in 22% of the seroreverted. The finding of anti-thyroid autoantibodies in congenital HIV infected children confirms the thyroid's involvement in HIV infection and provides more information about the wide spectrum of autoimmune phenomena observed in the infection.

SUMMARY -Thirty five patients with acute Chagas' disease who demonstrated parasitaemia at the time of the investigation were submitted to a detailed electromyographical study. With their muscles at rest, 12 patients showed fibrillation potentials and/or positive sharp waves.On volitional contraction, 7 had short duration motor unit potentials (MUPs) and low polyphasic MUPs. On motor and sensory nerve fibers conduction studies, 20 disclosed values below the lower control limit within one or more nerves. Finally, 12 patients produced a muscle, decremental response on nerve supramaximal repetitive stimulation.The findings signal that primary muscle involvement, neuropathy and impairement of the neuromuscular transmission, either isolated or combined, may be found in the acute stage of human Chagas' disease. Compromiso de la unidad motora en la fase aguda de la enfermedad de Chagas humana.RESÚMEN -Treinta y cinco pacientes con el diagnóstico de enfermedad de Chagas en su etapa aguda, todos con parasitemia positiva en el momento de la investigación, fueron sometidos a estudio electromiográfico por técnicas convencionales. En reposo, 12 de ellos mostraron fibrilaciones y/o potenciales positivos. Durante la contracción voluntaria, en 7 pacientes los potenciales de unidad motora eran bifásicos de corta duración y polifásicos de baja amplitud. En 20 se encontró disminución de la velocidad de conducción motora y/o sensitiva en uno o mas de los nervios explorados. Finalmente, 12 pacientes mostraron caida de la amplitud del potencial muscular evocado por estímulo nervioso repetitivo supramáximo. Los hallazgos hechos señalan que durante la fase aguda de la enfermedad de, Chagas en el hombre puede producirse alteración primaria del músculo, neuropatía y compromiso de la transmisión neuromuscular, en forma aislada o combinadas entre si.In the past years, the involvement of the peripheral nervous system has been extensively reported in chronic human Chagas' disease 9-u and, more recently, the same type of lesion could be demonstrated in chronic experimental models 4,8.However, only few attempts have been done looking for the eventual damage of the peripheral nervous system in the acute stage of the human disease 2 .Some experimental data obtained from the mouse support the possibility of a very early injury of the peripheral nerve 5, besides the well-known myositis 6, shortly after the inoculation of the animal.The aim of the present study, has been to make a first approach searching for the involvement of the peripheral nervous system in patients affected by acute Chagas' disease who live in an endemic area. A previous and limited account of these findings has been published elsewhere 1.

-We conducted a clinical and electromyographical study in patients with Chagas' disease in the indeterminate or chronic stages of the illness. Altogether 841 patients were examined. Only 511 were admitted within the protocol; the remainder patients were rejected because they showed other causes able to damage the nervous system. Fifty two (10.17%) out of the 511 patients showed signs and symptoms of peripheral nervous system involvement in the form of sensory impairment and diminished tendon jerks suggesting the presence of neuropathy. Forty five of them were submitted to a conventional electromyographical examination. Fifteen of mem showed normal results, while the remainder 30 disclosed a reduced interference pattern, being most of the remaining motor unit potentials fragmented or poliphasic, reduced sensory and motor conduction velocities and diminished amplitude of the sensory action potential. The findings suggest that some chagasic patients in the indeterminate or chronic stages of the disease may develop a clinical mild sensory-motor peripheral neuropathy.KEY WORDS: Chagas* disease, neuropathy, clinical assessment.Manifestaciones clinicas de compromiso del sistema nervioso periférico en el estádio crônico de la enfermedad de Chagas RESUMEN -El estúdio presente fue diseftado con ei objeto de pesquizar Ia existência de manifestaciones clinicas en pacientes afectados por enfermedad de Chagas, en estádio indeterminado o crônico, que tuviesen, ai menos, 2 reacciones serologicas positivas. En total fueron examinados 841 enfermos. De ellos solo 511 fueron admitidos en ei protocolo; los restantes fueron rechazados por mostrar Ia presencia de otras causas que hubiesen podido danar su sistema nervioso. Dentro de los 511 pacientes admitidos, 52 (10.17%) evidenciaron alteraciones objetivas y subjetivas de Ia sensibilidad y disminucion de los reflejos osteotendinosos. Estos signos y sintomas, que sugieren la presencia de neuropatia, podian combinarse de diferente manera. Como complemento dei examen clinico, se efectuo estúdio electromiografico convencional en 45 de estos pacientes. En 15 los hallazgos fueron normales, en tanto que en los restantes 30 pudo demostrarse reduccion de la capacidad de reclutamiento voluntário de unidad motora, presencia de potenciales de unidad motora fragmentados o polifasicos, reduccion de la velocidad de conduccion motora y sensitiva y disminucion de la amplitud dei potencial sensitivo. Los resultados obtenidos sefialan que una proporcion de los pacientes en el estádio indeterminado o crônico de la infeccion pueden desarrollar una moderada neuropatia sensitivo-motora con expresion clinica.

SUMMARY -Seventy five patients with the diagnosis of chronic Chagas' disease were studied by employing EPs techniques.Two of them had delayed arrival of the signal to the Erb's point and one to the spinal cord when looking at SEPs.TWo patients had increment of the time interval between waves 1st and IIIrd, when studying PEATs. These findings were interpreted as due to peripheral nerve fibers damage, a feature described in previous papers.The, most striking finding was the prolonged time interval between waves N13 and N20 (SEPs) found in two patients and between waves Illrd and Vth (PEAT) seen in 7 affected subjects.These observations suggested the development of some sort of CNS involvement, perhaps related to myelin damage, in patients who reached the chronic state of the infection. Estudio de potenciales evocados cerebrales en la enfermedad de Chagas crónica humana.RESÚMEN -Setenta y cinco pacientes con el diagnóstico de enfermedad de Chagas crónica fueron estudiados con el empleo de los potenciales evocados cerebrales. Tres de ellos tuvieron retardo del arribo de la senal a) punto de Erb ó al ingreso medular en los potenciales evocados somatosensitivos (PESS). Dos pacientes presentaron incremento del intervalo entre las ondas I y III en los potenciales evocados auditivos de tronco (PEAT).Estos hallazgos fueron interpretados como debidos al dano en la fibra nerviosa periférica, un hecho descripto en trabajos previos. El hallazgo mas sorprendente fue la prolongación del intervalo de tiempo entre las ondas N13-N20 en los PESS, hallandose en dos pacientes y entre las ondas III y V en los PEAT en 7 sujetos. Estas observaciones sugieren de algun modo, el compromiso de sistema nervioso central, quizás relacionado al daño de la mielina, en pacientes en estadio crónico de la infección. The aim of the present investigation has been to make a gross approach to the CNS of patients with chronic Chagas' disease by employing a non-invasive electrophysiological method as a first attempt for detecting eventual existing abnormalities. Nervous system damage is known to occur in chronic Chagas