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Indeterminate form of Chagas disease: historical, conceptual, clinical, and prognostic aspects
Alejandro Marcel Hasslocher-Moreno1, Sergio Salles Xavier1, Roberto Magalhães Saraiva1
1Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil.
Insights
Chagas disease indeterminate form (IF) is a common chronic stage. Etiological treatment in younger patients may reduce long-term cardiac complications, though aging populations present new challenges.
Area of Science:
- * Infectious Diseases
- * Tropical Medicine
- * Cardiology
Background:
- * Chagas disease (CD) is a significant public health issue in Latin America, with increasing global prevalence due to migration.
- * The indeterminate form (IF) of CD, characterized by positive serology for Trypanosoma cruzi and absence of clinical symptoms or ECG abnormalities, is the most common chronic presentation.
- * Historically, the IF was recognized later than other forms of CD, with its definition solidified in the mid-20th century.
Purpose of the Study:
- * To review the current understanding of Chagas disease indeterminate form (IF).
- * To discuss the benefits of etiological treatment for IF patients, particularly in younger demographics.
- * To highlight the evolving clinical considerations for IF patients, including age-related comorbidities.
Main Methods:
- * Literature review of Chagas disease and its indeterminate form.
- * Analysis of historical data regarding the classification and understanding of IF.
- * Examination of current treatment strategies and long-term outcomes for IF patients.
Main Results:
- * Etiological treatment in children, adolescents, and young adults with IF is associated with reduced progression to cardiac disease compared to untreated individuals.
- * The prognosis for IF patients is generally favorable, comparable to healthy individuals with normal ECGs.
- * An aging IF population now presents with comorbidities requiring integrated healthcare management.
Conclusions:
- * Early etiological treatment for Chagas disease indeterminate form offers long-term cardiovascular benefits.
- * While IF is often benign, the aging of affected populations necessitates proactive management of comorbidities.
- * Continued research and public health strategies are crucial for addressing the evolving challenges of Chagas disease globally.
Abstract:
Chagas disease (CD) remains a serious endemic disease in Latin America and a major public health problem. Because of globalization, the disease has spread to non-endemic areas in the northern hemisphere. In the chronic phase of the disease, most patients present with the indeterminate form (IF), characterized by positive serology for Trypanosoma cruzi, absence of clinical findings, and normal findings in electrocardiogram (ECG). IF was not recognized as a clinical entity until decades after the discovery of the disease, and only in the 1940-50s, it was categorized as a form of CD, and its conceptual definition was ratified in the 1980s. Children, adolescents, and young adults with the IF benefit from etiological treatment and tend to have less progression to heart disease in the long term than the untreated ones. IF patients have an essentially benign clinical condition, and their prognosis can be compared to that of healthy individuals with normal ECG findings. Currently, because of aging, patients with the IF have comorbidities that require attention in health services.
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