Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological study

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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.

Introduction

American Trypanosomiasis (Chagas' disease), first described in 1909 [1], has been considered since then a public health problem in Latin America and an increasing medical threat in the United States of America [2]. Over the last 80 years the clinical manifestations, prognostic factors, complications and many other aspects of the chronic phase of the disease have been studied 3, 4. However, we noticed with concern that at the end of the 20th century, instead of achieving control or eradication of the disease, there are in several Latin American countries as many acute cases as those reported at the beginning of the century. This article deals with the description of clinical and paraclinical manifestations of acute Chagas' disease, observed in an outbreak detected during the last 8 years in the state of Barinas, Venezuela.

Section snippets

Materials and methods

From January 1989 to December 1996, 58 patients were evaluated at the out-patient clinic of the Luis Razetti Hospital (Barinas, Venezuela). In most cases diagnosis of acute Chagas' disease was demonstrated by the presence of circulating Trypanosoma cruzi, and the most common vector found was Rhodnius Prolixus. After providing informed consent, patients were submitted to a study plan which included clinical examination, routine laboratory, resting and 24-h continuous ECG, chest X-rays and

Clinical findings

The observed male:female ratio was 1.4 and the average age was 17 years (range: 5 months to 50 years). The presumptive diagnosis was established by the presence of a febrile illness in all but one patient coming from endemic areas, lasting 21 days (2–60) in the 36 adults and 15 days (4–20) in the 21 children under 12 years of age, being the only symptom noticed in 20/57 patients (35%). In 26 cases (45%) the site of entry, particularly the Romaña sign (23/58: 40%), was in evidence. Sixteen

Discussion

Aside from some clinical differences such as adult and male predominance, milder symptomatic course in pediatric patients and lower prevalence of signs of entry (45 vs. 80%), our study showed a proportion of cardiac failure (27.5%), hepatomegaly (10.3%), radiological cardiomegaly (58%), abnormal ECG (41%) and mortality (8.6%) similar to that reported previously 10, 11, 12, 13(Fig. 1 and Fig. 2).

The echocardiographic results deserve a separate discussion since there is scarce information

Acknowledgements

We are indebted to the paramedical personnel at the Hospitals of Mérida and Barinas, to the technicians at the division of Rural Endemics in Barinas and to the staff of the Center for Parasitologic Research at the Faculty of Science, Universidad de los Andes, Mérida, Venezuela. This study was supported by grants C-743-95-AA, M-379 CDCHT-ULA and CONICIT-SI-95000899.

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