Evolution and pathology in Chagas disease: a review

Teixeira, Antônio R. L.; Nascimento, Rubens J.; Sturm, Nancy R.

doi:10.1590/s0074-02762006000500001

Cited by 195 publications

(227 citation statements)

References 190 publications

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“…It is particularly interesting to note that palpitations, a symptom commonly related to arrhythmia, have been considered to be a possible indication of adverse outcome in Chagas' disease (22), and conduction delay, on the other hand, reported in 5.8 to 20.2% of subjects with chronic Chagas' cardiomyopathy (23), has been regarded as a degenerative disturbance and a consequence of conduction system fibrosis (24).…”

Section: Discussionmentioning

confidence: 99%

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

Benchimol-Barbosa

Barbosa-Filho

2009

Braz J Med Biol Res

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Atrial fibrillation (AF) affects subjects with Chagas' disease and is an indicator of poor prognosis. We investigated clinical, echocardiographic and electrocardiographic variables of Chagas' disease in a long-term longitudinal study as predictors of a new-onset AF episode lasting >24 h, nonfatal embolic stroke and cardiac death. Fifty adult outpatients (34 to 74 years old, 62% females) staged according to the Los Andes classification were enrolled. During a follow-up of (mean ± SD) 84.2 ± 39.0 months, 9 subjects developed AF (incidence: 3.3 ± 1.0%/year), 5 had nonfatal stroke (incidence: 1.3 ± 1.0%/year), and nine died (mortality rate: 2.3 ± 0.8%/year). The progression rate of left ventricular mass and left ventricular ejection fraction was significantly greater in subjects who experienced AF (16.4 ± 20.0 g/year and -8.6 ± 7.6%/year, respectively) than in those who did not (8.2 ± 8.4 g/year; P = 0.03, and -3.0 ± 2.5%/year; P = 0.04, respectively). In univariate analysis, left atrial diameter ≥3.2 cm (P = 0.002), pulmonary arterial hypertension (P = 0.035), frequent premature supraventricular and ventricular contraction counts/ 24 h (P = 0.005 and P = 0.007, respectively), ventricular couplets/24 h (P = 0.002), and ventricular tachycardia (P = 0.004) were long-term predictors of AF. P-wave signal-averaged ECG revealed a limited long-term predictive value for AF. In chronic Chagas' disease, large left atrial diameter, pulmonary arterial hypertension, frequent supraventricular and ventricular premature beats, and ventricular tachycardia are long-term predictors of AF. The rate of left ventricular mass enlargement and systolic function deterioration impact AF incidence in this population.

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Section: Discussionmentioning

confidence: 99%

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

Benchimol-Barbosa

Barbosa-Filho

2009

Braz J Med Biol Res

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“…According to Köberle hipothesis 13 megaesopgagus, megacolon and cardiac conduction disturbances in Chagas disease are consequence of the desnervation of the parasympathetic autonomous system. Prata 14 , Teixeira et al 11 and other considerer that the neuron destruction in the heart, esophagus, colon and other hollow viscera may be explained both by direct inflammatory phenomena and by imumunological mechanism that results in the cardiopathy, megaesophagus, megacolon and other visceral alargements seen in Chagas disease.…”

Section: Introduction Pathogenesis and Evolution Of Infection By Trypmentioning

confidence: 99%

“…However, Tarleton 10 questioned the autoimmunity mechanism, emphasizing the role of parasite persistence in the pathogenesis of Chagas disease. Teixeira et al 11 On the other hand Higushi 12 state that sensitivity of TCD4 + and TCD8 + lymphocytes by T. cruzi, with development of anti-myocardial cells, associated with migration and activation of macrophages and the release of platelet aggregation factors, there by respectively inducing chronic Chagas myocarditis and myocardial ischemic lesions, may explain the findings encountered in cases of chronic myocardiophaty, but in agreement with Tarleton 10 the pathogenesis of chronic myocarditis in Chagas disease is directly related with the presence of T. cruzi). According to Köberle hipothesis 13 megaesopgagus, megacolon and cardiac conduction disturbances in Chagas disease are consequence of the desnervation of the parasympathetic autonomous system.…”

Section: Introduction Pathogenesis and Evolution Of Infection By Trypmentioning

confidence: 99%

Chagas disease: What is known and what should be improved: a systemic review

Coura

Borges-Pereira

2012

Rev. Soc. Bras. Med. Trop.

118

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This study consists of a broad review on what is known and what should be improved regarding knowledge of Chagas disease, not only through analysis on the main studies published on the topics discussed, but to a large extent based on experience of this subject, acquired over the past 50 years (1961-2011). Among the subjects covered, we highlight the pathogenesis and evolution of infection by Trypanosoma cruzi, drugs in use and new strategies for treating Chagas disease; the serological tests for the diagnosis and the controls of cure the infection; the regional variations in prevalence, morbidity and response to treatment of the disease; the importance of metacyclogenesis of T. cruzi in different species of triatomines and its capacity to transmit Chagas infection; the risks of adaptation of wild triatomines to human dwellings; the morbidity and need for a surveillance and control program for Chagas disease in the Amazon region and the need to prioritize initiatives for controlling Chagas disease in Latin America and Mexico and in non-endemic countries, which is today a major international dilemma. Finally, we raise the need for to create a new initiative for controlling Chagas disease in the Gran Chaco, which involves parts of Argentina, Bolivia and Paraguay.

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“…The main pathogenic mechanisms mediated by the parasite, including autonomic disorders, alteration of the humoral and cellular immune response, and microvascular disorders, are shown in Fig. 1 (Teixeira et al 2006;Marin-Neto et al 2007;Marin-Neto and Rassi 2009;Rassi and Marin-Neto 2010).…”

Section: Introductionmentioning

confidence: 99%

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

Salazar-Schettino

Cabrera-Bravo

Vázquez-Antona

et al. 2016

Tohoku J. Exp. Med.

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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.

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Evolution and pathology in Chagas disease: a review

Cited by 195 publications

References 190 publications

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

Chagas disease: What is known and what should be improved: a systemic review

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

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