Infection With
            <i>Trypanosoma cruzi</i>
            and Progression to Cardiomyopathy

Morillo, Carlos A.

doi:10.1161/circulationaha.113.000891

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…Comparing the age groups (Tables 1 and 2 ) shows that there are more older people in group A (above 70 years) and more younger people in group B (under 30 years), and that the average age of group A, 57.8 years, is significantly greater than that of group B, 49.6 years. These results are consistent, since Chagas cardiopathy requires a prolonged period to develop (Elizari 1999 ; Rassi et al 2009 ; Morillo 2013 ). In the present study, the cardiopathy increased with age.…”

Section: Discussionsupporting

confidence: 72%

Trypanosoma cruzi burden, genotypes, and clinical evaluation of Chilean patients with chronic Chagas cardiopathy

et al. 2015

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There are currently no biomarkers to assess which patients with chronic indeterminate Chagas disease will develop heart disease and which will spend their entire life in this state. We hypothetize that the parasite burden and Trypanosoma cruzi genotypes are related to the presence of heart disease in patients with Chagas disease. This study is aimed to investigate the parasite burden and T. cruzi genotypes in chagasic cardiopaths versus chagasic individuals without cardiac involvement according to the New York Heart Association. Patients with chronic Chagas disease, 50 with and 50 without cardiopathy (controls), groups A and B, respectively, were submitted to anamnesis, physical examination, and electrocardiogram. Echo-Doppler was performed for group A; all important known causes of cardiopathy were discarded. Xenodiagnosis, conventional PCR, and quantitative PCR were performed on patients of both groups. T. cruzi genotyping was done for 25 patients of group A and 20 of group B. The 50 cardiopaths had 80 electrocardiographic alterations, most of them in grade II of the New York Heart Association classification; 49 were classified in grade I by Echo-Doppler, and only one patient was in grade III. The difference in average parasitemia in patients of groups A and B was not significant. The most frequent T. cruzi DTU found was TcV. The parasite burden and genotype of the groups with and without cardiopathy were similar.Graphical abstractImagen 1 Chronic chagas cardiopathy chest X-ray heart enlargementFigure 2 Chronic Chagas cardiopathy microaneurism of left ventricle. Cineangiography

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Section: Discussionsupporting

confidence: 72%

Trypanosoma cruzi burden, genotypes, and clinical evaluation of Chilean patients with chronic Chagas cardiopathy

et al. 2015

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“…Chagas disease is a multisystemic disorder caused by Trypanosoma cruzi infection that affects more than 8 million people worldwide, being endemic in Latin America. Due to the scarcity of preventive and therapeutic tools and population at risk, it is considered as a neglected tropical disease [ 1 , 2 ]. More than 40,000 new infected people and 12,550 deaths per year are estimated.…”

Section: Introductionmentioning

confidence: 99%

Cyclooxygenase-2 and Prostaglandin E2 Signaling through Prostaglandin Receptor EP-2 Favor the Development of Myocarditis during Acute Trypanosoma cruzi Infection

et al. 2015

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Inflammation plays an important role in the pathophysiology of Chagas disease, caused by Trypanosoma cruzi. Prostanoids are regulators of homeostasis and inflammation and are produced mainly by myeloid cells, being cyclooxygenases, COX-1 and COX-2, the key enzymes in their biosynthesis from arachidonic acid (AA). Here, we have investigated the expression of enzymes involved in AA metabolism during T. cruzi infection. Our results show an increase in the expression of several of these enzymes in acute T. cruzi infected heart. Interestingly, COX-2 was expressed by CD68+ myeloid heart-infiltrating cells. In addition, infiltrating myeloid CD11b+Ly6G- cells purified from infected heart tissue express COX-2 and produce prostaglandin E2 (PGE2) ex vivo. T. cruzi infections in COX-2 or PGE2-dependent prostaglandin receptor EP-2 deficient mice indicate that both, COX-2 and EP-2 signaling contribute significantly to the heart leukocyte infiltration and to the release of chemokines and inflammatory cytokines in the heart of T. cruzi infected mice. In conclusion, COX-2 plays a detrimental role in acute Chagas disease myocarditis and points to COX-2 as a potential target for immune intervention.

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“…cruzi has two phases: acute and chronic, separated by an indeterminate period, in which the patient is relatively asymptomatic[ 7 , 8 ]. Chronically infected patients ultimately develop cardiomyopathy, which is the most important and severe manifestation of CD, and is characterized by left ventricular systolic dysfunction, wall motion abnormalities, brady and tachyarrhythmia, heart failure and sudden cardiac death[ 9 – 18 ]. CD alterations are classified in four stages A, B, C, and D. Stage A corresponds to asymptomatic patients with normal ECG, whereas presence of electrocardiographic abnormalities implies progression towards stage B and deterioration of systolic function is observed in stages C/D, associated with heart failure symptoms.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis

et al. 2018

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BackgroundChagas disease (CD) is a major public health concern in Latin America and a potentially serious emerging threat in non-endemic countries. Although the association between CD and cardiac abnormalities is widely reported, study design diversity, sample size and quality challenge the information, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected. We performed to systematically review and meta-analyze population-based studies that compared prevalence of overall and specific ECG abnormalities between CD and non-CD participants in the general population.MethodsSix databases (EMBASE, Ovid Medline, Web of Science, Cochrane Central, Google Scholar and Lilacs) were searched systematically. Observational studies were included. Odds ratios (OR) were computed using random-effects model.ResultsForty-nine studies were selected, including 34,023(12,276 CD and 21,747 non-CD). Prevalence of overall ECG abnormalities was higher in participants with CD (40.1%; 95%CIs=39.2-41.0) compared to non-CD (24.1%; 95%CIs=23.5-24.7) (OR=2.78; 95%CIs=2.37-3.26). Among specific ECG abnormalities, prevalence of complete right bundle branch block (RBBB) (OR=4.60; 95%CIs=2.97-7.11), left anterior fascicular block (LAFB) (OR=1.60; 95%CIs=1.21-2.13), combination of complete RBBB/LAFB (OR=3.34; 95%CIs=1.76-6.35), first-degree atrioventricular block (A-V B) (OR=1.71; 95%CIs=1.25-2.33), atrial fibrillation (AF) or flutter (OR=2.11; 95%CIs=1.40-3.19) and ventricular extrasystoles (VE) (OR=1.62; 95%CIs=1.14-2.30) was higher in CD compared to non-CD participants.ConclusionsThis systematic review and meta-analysis provides an update and synthesis in this field. This research of observational studies indicates a significant excess in prevalence of ECG abnormalities (40.1%) related to T. cruzi infection in the general population from Chagas endemic regions, being the most common ventricular (RBBB and LAFB), and A-V B (first-degree) node conduction abnormalities as well as arrhythmias (AF or flutter and VE). Also, prevalence of ECG alterations in children was similar to that in adults and suggests earlier onset of cardiac disease.

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Infection With Trypanosoma cruzi and Progression to Cardiomyopathy

Cited by 11 publications

References 24 publications

Trypanosoma cruzi burden, genotypes, and clinical evaluation of Chilean patients with chronic Chagas cardiopathy

Trypanosoma cruzi burden, genotypes, and clinical evaluation of Chilean patients with chronic Chagas cardiopathy

Cyclooxygenase-2 and Prostaglandin E2 Signaling through Prostaglandin Receptor EP-2 Favor the Development of Myocarditis during Acute Trypanosoma cruzi Infection

Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis

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