Doença de Chagas aguda: vias de transmissão, aspectos clínicos e resposta à terapêutica específica em casos diagnosticados em um centro urbano

Abstract

The authors report clinical features and therapeutic response of 24 outpatients with acute Chagas' disease, and 3 in the initial chronic phase, referred to the Clinic for Infectious and Parasitic Diseases of the FMUSP "Clínicas" Hospital between 1974 and 1987. The following transmission routes were involved: triatominae in 7 cases, blood transfusion in 9, kidney transplantation and/or blood transfusion in 4, accidental in 1, oral route in 3, probably breast feeding in 1, congenital or breast feeding in 1, and congenital or blood transfusion in 1. Six patients infected by triatominac acquired the disease between 1974 and 1980 and one in 1987. The blood transfusion infected patients acquired the disease in Greater São Paulo, seven of whom after 1983. The acute phase Chagas' disease was oligosymptomatic in 4 patients: three of such patients being immunocompromised by drugs or other diseases. Another two adult immunocompromised patients developed myocarditis and congestive heart failure. Clinical features were severe in 5 from 6 children under two years, irrespective of the transmission route. Evaluation of the acute phase patients treated with benznidazol (4-10 mg/kg/day) showed: therapeutic failure in 4/16 (25.0%); possible cure in 9/16 (53.2%) and inconclusive results in 3/16 (18.8%). The antibody and complement-mediated lysis reaction was in keeping with the xenodiagnosis in 18/22 cases, having shown negative results after treatment earlier than classical serological reactions. One aplastic anaemia patient receiving corticosteroid presented lymphoproliferative disease 6 years after being treated with benznidazol for acute Chagas' disease.

La enfermedad de Chagas en las Américas: una perspectiva de ecosalud

“…Los enfermos de las zonas urbanas son fundamentalmente los inmigrantes de las zonas rurales, antiguos campesinos que llegaron a la ciudad para emplearse como mano de obra en los oficios urbanos 67 . Hay otro tipo de pacientes, los menos, que contrajeron la enfermedad en la ciudad por la transfusión sanguínea y nunca vivieron en áreas endémicas, ni tuvieron contacto con un vector.…”

Chagas' disease

“…Myocarditis may be clinically evident and may include tachycardia, congestive heart failure, and cardiomegaly (206,215,237). In some patients, the electrocardiogram (ECG) may reveal prolongation of the P-R interval, nonspecific T-wave changes, and low voltage.…”

Hematological alterations during experimental canine infection by Trypanosoma cruzi

“…Chagas disease in humans induces anemia, thrombocytopenia and leukocytosis, mainly during the acute phase of disease (SHIKANAI-YASUDA et al, 1990). TNF-α can modulate myelopoiesis, erythropoiesis, lymphopoiesis and thrombocytopoiesis (ULICH et al, 1990).…”