Chagas Disease in Mexico: Report of 14 Cases of Chagasic Cardiomyopathy in Children

Abstract

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.

Oral Trypanosoma cruzi Transmission Resulting in Advanced Chagasic Cardiomyopathy in an 11-Month-Old Male

“…A 7-year-old child with vectoral transmission developed Chagas cardiomyopathy 3 months after a known triatomine exposure (chagoma presence); however, the exact timing of initial T. cruzi infection was unknown and speculated to have previously occurred due to epidemiologic family data [ 20 ]. A surveillance study in Mexico identified 14 cases aged 5–18 years with a history of vectoral transmission that presented with cardiomyopathy [ 21 ], providing further evidence that children can develop cardiomegaly within a short duration after infection. Lastly, a Bolivian congenital transmission study identified 11% of T. cruzi -positive newborns had cardiomegaly noted by chest radiography [ 22 ].…”

Caracterización molecular de aislados de Trypanosoma cruzi de triatominos recolectados en los municipios del Estado de Hidalgo, México

“…Vivas et al, 2018). Sin embargo, hace falta hacer estudios más minuciosos acerca de la epidemiología molecular de T. cruzi en humanos ya que estos linajes no se han reportado en pacientes chagásicos en México (Salazar-Schettino et al, 2016). Por lo que queda como una asignatura pendiente, el determinar la frecuencia con la que los diferentes linajes de T. cruzi encontrados en México están produciendo infecciones en humanos.…”

Acquired heart disease in low-income and middle-income countries

“…Although usually observed in chronic disease 10–20 years after initial infection, a recent epidemiological study of more than 3000 children in Mexico identified 14 children with presymptomatic chagasic cardiomyopathy 30. It is unclear if antiparasitic treatment improves the prognosis once the disease has developed 31…”