Terapêutica da forma crônica da doença de chagas. É eficaz o tratamento etiológico?

Ianni, Bárbara Maria; Mady, Charles

doi:10.1590/s0066-782x1998000100012

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…However, other studies are contradictory and indicate that when treatment is administered during the chronic phase of the disease, the parasite is not eliminated, the progress of the disease is not interrupted; therefore, the complications of the infection are not prevented (Ianni et al . 1993, Amato Neto 1998, Ianni & Mady 1998, Braga et al . 2000, Lauria-Pires et al .…”

Section: Discussionmentioning

confidence: 99%

A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention

Machado-de-Assis

Diniz

Montoya

et al. 2013

Mem. Inst. Oswaldo Cruz

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The etiological treatment of Chagas disease is recommended for all patients with acute or recent chronic infection, but controversies remain regarding the benefit of chemotherapy and interpretations of the parasitological cure after etiological treatment. This study compares the laboratory and clinical evaluations of Chagas disease patients who were diagnosed 13 years earlier. Fifty-eight Chagas disease patients (29 treated with benznidazole and 29 untreated) were matched at the time of treatment based on several variables. Conventional serology revealed the absence of seroconversion in all patients. However, lower serological titres were verified in the treated group, primarily among patients who had the indeterminate form of the disease. Haemoculture performed 13 years after the intervention was positive for 6.9% and 27.6% of the treated and untreated patients, respectively. Polymerase chain reaction tests were positive for 44.8% and 13.8% of the treated and untreated patients, respectively. Patients who presented with the indeterminate form of the disease at the beginning of the study exhibited less clinical progression (17.4%) compared with the untreated group (56.5%). Therefore, this global analysis revealed that etiological treatment with benznidazole may benefit patients with respect to the clinical progression of Chagas disease and the prognosis, particularly when administered to patients with the indeterminate form of the disease.

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Section: Discussionmentioning

confidence: 99%

A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention

Machado-de-Assis

Diniz

Montoya

et al. 2013

Mem. Inst. Oswaldo Cruz

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“…If these individuals undergo stress testing, subclinical dysfunctions will be detected. Even today, only one drug is available to specifically treat this disease, and even so its positive results have not yet been duly proven, in addition, it causes a high incidence of side effects 17 . Efforts have been driven toward the search of new parasiticides 18 .…”

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confidence: 99%

Situação atual do tratamento da insuficiência cardíaca no Brasil

Mady¹

2007

Arq. Bras. Cardiol.

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Heart failure has been addressed with increasingly frequency in symposia, congresses and researches because of its very high incidence, morbidity and mortality. The number of individuals with heart failure is about 23 million worldwide, with two million new cases each year. In Brazil, according to the IBGE (Instituto Brasileiro de Geografia e Estatística -Brazilian Institute of Geography and Statistics), the population in 2007 will be of almost 190 million, seven million of which with this syndrome 1 . The number of new patients has been growing despite the increasingly greater advances in treatment. And what would be the causes to explain this fact? There are attempts to explain it by the increase in population survival, as well as by the increase in industrialization and urbanization of countries in constant development. As a consequence, there is a deterioration of eating habits and an increase in the incidence of sedentary lifestyle, stress and smoking, thus leading to an increased incidence of artery diseases, diabetes mellitus and hypertension, which are potential causes of heart failure. To make this situation even worse, high rates of individuals with Chagas disease and rheumatic disease are still seen in our country. In parallel, there is a decrease in the number of hospital admissions and an increase in in-hospital deaths, facts that are explained by a decrease in hospital bed supply and increased severity of cases hospitalized [2][3][4] . For decades, researchers have struggled to diminish morbidity, mortality and costs of this syndrome. New agents, surgical therapeutic approaches, devices, and multiprofessional clinics have been introduced in the clinical practice. What are the results of this huge endeavor, and what is the cost-benefit ratio for society?When the impact of the use of medications on mortality is analyzed, the conclusion is not favorable. The new agents available in the market had positive results on death rates, albeit modest. This was predictable. For instance, the analysis of the original graphs of the CONSENSUS study (Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study 5 ), published two decades ago, shows an evident drop in mortality in the group treated; however, when we pay attention to the values and compare the treatment group with the placebo group, the numerical difference is small.The use of angiotensin converting enzyme inhibitors brought an unquestionable benefit, but unfortunately the cost-benefit ratio was not as favorable.We addressed this issue at that time in several symposia and lectures, and the discussions were always heated; there was great resistance to accept this argument. It was the beginning of a new stage in the treatment of heart failure, in which the neurohormonal axis was being directly approached. Studies conducted later corroborated these results. The RALES 6 study, which showed a drop in mortality of patients with heart failure receiving spironolactone, was also q...

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“…Chagas, e pode levar à insuficiência cardíaca, eventos tromboembólicos e a morte súbita, sendo que se encontra nesta forma 30% dos indivíduos com a DCH (Mady et al, 1994;Arteaga, 1989;Lanni, 1997), ocorrendo após um período de latência de até 20 anos (Coura, 2003). Assim, a cardiopatia chagásica crônica (CCC) constitui forma clínica tardia da infecção pelo T. cruzi, resultando em dano ao miocárdio, levando à miocardiopatia dilatada.…”

Section: Introductionunclassified

Avaliação da concentração serica da proteina C-reativa na forma cardiaca da Doença de Chagas

Silva¹

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Chagas disease, caused by protozoan Trypanossoma cruzi (T.cruzi), still remains a major public health problem in developing countries of Latin America. Only 20-30 % of the infected patients have heart disease or megas syndrome. The World Health Organization indicates a prevalence of 16 million people infected by the parasite T. cruzi in America and more than 40 million people at risk of contracting the disease. In Brazil, current estimates suggest the existence of 2 to 3 million of infected people. This study aimed to establish the relationship between the clinical cardiac form and average concentration of serum levels of C-reactive protein as a possible indicator of inflammation and progression of Chagas disease. And compounds analyzed in serum by 136 individuals assessed by the StudyGroup on Chagas disease (GEDoCh) initially divided into five pre-established groups between the clinical forms of Chagas disease. The CRP was measured by the method immunonefelometria, using highly sensitive kit was used as statistical methods Mann-Whitney for comparison of variables between groups and Kruskal-Wallis test. For numerical analysis was calculated from was calculated for numerical analysis the correlation of Spearman. The results showed that the non-chagasic cardiopathy group and chagasic severe cardiopathy group had significantly higher levels of CRP than the other groups. Concluded that CRP can be considered as a marker of the evolution of Chagas disease to the chronic cardiac form.

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Terapêutica da forma crônica da doença de chagas. É eficaz o tratamento etiológico?

Cited by 6 publications

References 5 publications

A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention

A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention

Situação atual do tratamento da insuficiência cardíaca no Brasil

Avaliação da concentração serica da proteina C-reativa na forma cardiaca da Doença de Chagas

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