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[Anatomo-clinical and epidemiologic study of Chagas disease]
J Milei1, R A Storino, L Matturri
1Divisione di Cardiologia, Ospedale Fernàndez, Buenos Aires.
Insights
Chagas disease, caused by Trypanosoma Cruzi, often leads to chronic cardiac issues. Advanced diagnostic tests revealed significant differences in cardiac manifestations between asymptomatic and symptomatic patients, highlighting deadly-risk indicators.
Area of Science:
- Infectious Diseases
- Cardiology
- Parasitology
Context:
- Chagas disease, caused by the parasite Trypanosoma Cruzi, is endemic to Latin America.
- Transmission occurs via hematophagous bugs, prevalent in rural areas.
- The disease progresses through acute, indeterminate, and chronic phases, with cardiac complications in the latter.
Purpose:
- To investigate and compare cardiac manifestations in patients with varying stages of Chagas disease.
- To identify significant differences in clinical and diagnostic findings among patient groups.
Summary:
- 120 patients were categorized into four groups: asymptomatic, with ECG abnormalities, with cardiomegaly, and with classic chagasic cardiomyopathy.
- Advanced diagnostic tools including Holter monitoring, echocardiography, and radionuclide ventriculography were employed.
- Significant differences (p < 0.001) were observed between asymptomatic/mildly affected groups and those with established cardiomyopathy, identifying deadly-risk indicators like bundle branch blocks and ventricular dilation.
Impact:
- This study provides crucial insights into the progression of Chagasic heart disease.
- Identifies key indicators for early detection and risk stratification.
- Autoptic findings confirmed immune complex deposition and ultrastructural changes in chronic Chagas disease.
Abstract:
Chagas' disease is a chronic form caused by a parasite, the Trypanosoma Cruzi, endemic of Latin America. The Trypanosoma Cruzi is transmitted by hematophageous bugs, particularly in dilapidated rural areas. Three phases of the disease can be distinguished: 1) acute phase, with high tissue and blood parasitic involvement; 2) undetermined phase, in which the diagnosis requires sophisticated clinical investigations; 3) chronic phase (10-30 years following the infection), characterized particularly by cardiac disease manifestations. The present 120 patients were subdivided into four groups: 1) 43 asymptomatic serum-positive subjects; 2) 25 serum-positive patients with electrocardiographic abnormalities; 3) 14 serum-positive patients with cardiomegaly; 4) 38 with classic chagasic cardiopathy. Comparative studies among these four groups were carried out employing Holter monitoring (24h), ergometric and phonomechanographic tests, M-mode and bidimensional echography and radionuclide ventriculography. A significant difference between the first 3 groups and, respectively, the fourth group (p < 0.001) was found. Deadly-risk (p < 0.001) manifestation were pointed out, such as a third tone, right bundle branch block with left anterior hemiblock and left ventricle's dilation. Autoptic controls were performed and in 4 patients the myocardial biopsy showed C3 and IgG deposition in capillaries and myocardial fibers, at electron microscopic examination, some thickening of capillary and myocytic basal membrane, interstitial collagen proliferation, besides non-specific myocellular abnormalities were detected.