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Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological
H Parada1, H A Carrasco, N Añez
1Hospital Luis Razetti, Barinas, Venezuela.
Insights
This study on acute Chagas
Area of Science:
- Infectious Diseases
- Cardiology
- Parasitology
Background:
- Chagas' disease is a significant public health concern in endemic areas.
- Acute Chagas' disease presents with systemic symptoms and parasitic infection.
- Myocarditis is a frequent complication, even in early stages.
Purpose of the Study:
- To analyze clinical features, treatment outcomes, and cardiac involvement in acute Chagas' disease.
- To evaluate the efficacy of benznidazole in acute cases.
- To understand the impact of treatment on parasitemia, serology, and myocarditis.
Main Methods:
- Retrospective study of 58 acute Chagas' disease cases.
- Clinical evaluation, laboratory tests (parasitemia, serology), myocardial biopsies, and necropsy.
- Cardiac assessment using chest X-ray, 2D echocardiography, resting ECG, and clinical findings.
Main Results:
- Fever (98%) and parasitemia (100%) were prevalent; mortality was 8.6%.
- Acute myocarditis was universally found, often subclinical (36%), with cardiomegaly primarily due to pericardial effusion.
- Benznidazole eliminated parasitemia but only 20% achieved seronegativity; treatment showed limited impact on myocarditis.
Conclusions:
- Acute Chagas' disease requires prompt diagnosis and treatment.
- Current benznidazole therapy effectively clears parasitemia but has minimal effect on established myocarditis.
- Improved therapeutic strategies are needed to prevent chronic cardiac complications by addressing immunologic and microcirculatory damage.
Abstract:
During the last 8 years 58 acute cases of Chagas' disease were studied. Patients from an endemic area of the state of Barinas, Venezuela, showed fever (98%) and circulating forms of T. cruzi (100%), and were treated with oral benznidazole. The recorded mortality was 8.6%. Acute myocarditis was constantly found either in myocardial biopsies or at necropsy, even in patients without any other sign of cardiac compromise (36%), which was detected by chest X-ray in 58%, by 2D echocardiography in 52%, by resting ECG in 41% and by clinical findings in 27.5% of the patients. Cardiomegaly was due to pericardial effusion rather than ventricular dilatation in most instances. Treatment eliminated parasitemia but negativized serology in only 20% of patients. It also appeared to have little influence on the ongoing myocarditic process, emphasizing the need for better therapeutic schedules, able to avoid or control the early appearance of immunologic mechanisms and microcirculatory damage involved in the future development of chronic chagasic myocarditis.