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Guías clínicas de la enfermedad de Chagas 2006: Parte V. Diagnóstico de laboratorio Guidelines for the Chagas disease: Part V. Laboratory diagnosis of Chagas disease
Werner Apt B,Ingrid Heitmann G,M. Isabel Jercic L,Leonor Jofré M
Revista chilena de infectología , 2008,
Abstract: En esta quinta parte de las Guías Clínicas de enfermedad de Chagas, se revisa el diagnóstico de la infección por Trypanosona cruzi en humanos, la interpretación de los resultados y un algoritmo de diagnóstico de laboratorio en inmunocompetentes. La enfermedad de Chagas se puede diagnosticar por medio de tres tipos de técnicas: directas, que permiten evidenciar la presencia del parásito en diferentes tipos de muestras; indirectas, que corresponden a la búsqueda de anticuerpos específicos contra antígenos de T. cruzi y moleculares, basadas en la detección del material genético del parásito. Las técnicas directas se emplean, de preferencia, en la fase aguda de la enfermedad, donde es posible detectar al parásito circulando en el torrente sanguíneo de la persona infectada. Estas técnicas no requieren ser confirmadas por otros métodos. Para la fase crónica indeterminada y para la fase sintomática es recomendado el uso de las técnicas indirectas; generalmente se emplean técnicas de inmuno ensayo (ELISA) que detectan anticuerpos de tipo IgG contra antígenos de T. cruzi. Por la posibilidad de reacciones falsas positivas, la recomendación es que los resultados positivos o indeterminados sean confirmados con, a lo menos, otra técnica diferente (inmunofluorescencia indirecta o hemaglutinación indirecta). En Chile la confirmación es realizada por el Laboratorio Nacional de Referencia del Instituto de Salud Pública y los centros autorizados por éste. Los métodos moleculares pueden ser empleados para el diagnóstico en fase aguda o crónica, teniendo mayor rendimiento en la primera, y su uso es recomendado principalmente como apoyo para la pesquisa de hijos de madres infectadas en la transmisión transplacentaria de la infección donde el diagnóstico precoz aumenta las posibilidades de cura del ni o y es un buen marcador para evaluar el éxito del tratamiento. In this fifth part of Guidelines for Chagas disease, diagnostic techniques for Trypanosoma cruzi infection in humans are reviewed, the interpretation of laboratory results and an algorithm for laboratory diagnosis in immunocompetent hosts are presented. Chagas disease may be diagnosed by three kinds of techniques: direct, which allow detect the presence of the parasite in different kind of samples; indirect, based on the search of immune specific response against T. cruzi antigens and molecular, which detect parasite genetic material. Direct techniques are utilized mamly in acute phase of disease, as the parasite is present in blood of infected host. These techniques do not require be confirmed by other methods. For
Autoimmunity in Chagas' heart disease
Cunha-Neto, Edécio;Kalil, Jorge;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000200005
Abstract: the time scale dissociation between high parasitemia and tissue pathology, allied to the absence of parasites in the heart lesions of chronic chagas' disease cardiopathy, casted doubt on the direct participation of trypanosoma cruzi in tissue lesions. moreover, the heart tissue lesions in chronic chagas' disease cardiopathy are associated to an inflammatory mononuclear cell infiltrate, presumably the ultimate effectors of tissue damage. it has been hypothesized that the inflammatory cell infiltrate could mediate a delayed hypersensitivity process directed to the heart tissue components, an autoimmune response triggered by immunological cross-reactivity in the course of a protective immune response against some t.cruzi antigen homologous to heart proteins. however, little is known about the efector role of the t cells in the infiltrate, or about the nature of the antigen that lead to their accumulation in tissue. in this paper, we will review the published evidence on autoimmunity and immunological cross-reactivity between t. cruzi and the mammalian host, along with data generated in our laboratory. the definition of the precise role played by autoimmunity in the pathogenesis of chagas' disease cardiopathy may have important consequences both for immunoprophylaxis and for the therapeutic approach of chronic chagas' disease.
Magnetic resonance imaging in Chagas' heart disease
Kalil Filho, Roberto;Albuquerque, Cicero Piva de;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000200022
Abstract: many important aspects of chagas' heart disease can be successfully assessed using magnetic resonance imaging of the heart. it is possible to obtain with great detail the anatomic characterization of the cardiac chambers as well as important information of the functional or metabolic status of the heart. magnetic resonance imaging after gadolinium infusion seems also a promising technique to obtain a better regional characterization of myocardial tissue, and may be important in the non-invasive diagnosis of active myocarditis in patients with chagas' heart disease.
Inquérito s?bre a doen?a de Chagas no hospital da Santa Casa de Misericórdia de Belo Horizonte (Minas Gerais, Brasil)
Pellegrino, J.;Borrotchin, M.;
Memórias do Instituto Oswaldo Cruz , 1948, DOI: 10.1590/S0074-02761948000200004
Abstract: results of a survey on the occurence of chagas' disease in patients of the hospital "santa casa de misericórdia" in belo horizonte, minas geraes, brazil, are reported. 181 unselected patients have been examined. the following methods have been used: a) general clinical examination and special examination of the circulatory apparatus; b) electrocardiogram; c) complement-fixation test for chagas's disease (schizotrypanum cruzi culture antigen); d) wassermann test; e) xenodiagnosis and x-ray pictures of patients with positive complement-fixation test for chagas's disease or with heart troubles of any kind. 37 out of the 181 (20.44%) patients examined had positive laboratory tests for chagas' disease. 49 (27,07%) had heart troubles with the following etiology: chagas' disease (18 cases); arteriosclerosis (13 cases); hypertension (12 cases); syphilis (6 cases); rheumatic fever (3 cases); congenital heart disease (1 case); chronic cor pulmonale (1 case). .18 pit of 34 chagas' disease patients (52,95%) showed evidences of myocardial damage. the most frequent electrocardiographic changes were right bundle branch block, ventricular premature beats, alterations of qrs (single or associated to alterations of t wave), auriculo-ventricular blocks. these findings are similar to those previously described in chronic chagas' heart disease by laranja et al. (13,26). the most frequent electrocardiographic changes found in the group of patients with negative tests for chagas' disease were those showing left ventricular strain, primary alterations of t wave and ventricular premature beats. 50.0 per cent of the patients with chronic chagas' heart disease were under 30 years of age and 80,33 per of the patients with heart lesion from other causes than chagas' disease were over 30 years. the complement-fixation test (schizotrypanum cruzi culture antigen) owing to its specificity and sensibility proved to be very useful for the laboratory diagnosis of chronic chagas' disease. xenodiagnosis
Evolu??o tardia do transplante cardíaco na doen?a de Chagas: long-term evolution in cardiac transplantation
Fiorelli, Alfredo I;Stolf, Noedir A. G;Bocchi, Edmar A;Seferian, Pedro;Higushi, Lourdes;David, Uip;Strabelli, Tania;Kalil, Jorge;Newman, Jorge;Jatene, Fábio B;Pomerantzeff, Pablo M. A;Lemos, Pedro Carlos P;Pereira-Barreto, Antonio C;Bellotti, Giovanni;Jatene, Adib D;
Revista Brasileira de Cirurgia Cardiovascular , 1990, DOI: 10.1590/S0102-76381990000200007
Abstract: in the cardiac forms of chagas' disease that develop with refractory cardiac failure under clinical treatment, the transplant is the only alternative along with the cardiomyoplasty. the authors present the six patient late evolution with terminal chagasic myocardiopathy submitted under on orthopic heart transplantation. the average period of observation was of 25.2 months. the diagnosis of chagas' disease reativation relies on the clinical observation, laboratory investigation of parasito, endomyocardial biopsy and subcutaneous nodules. the analyses of the results show that: 1) the laboratory exams were useless in the diagnosis of the disease reativation, but the biopsy presented hight positivity; 2) the pulse therapy with steroid predisposes the reativation; 3) the lymphoproliferative disease presents hight incidence in the chagas' disease which is the main late complication; possibly the benzonidazol shows its potentially oncogenic effect. having in mind the endemic character of the disease, the lack of alternative therapy becomes compulsory the analysis of immunosuppressive therapy, reativation treatment and increases the clinical experience to more defined position.
Ventricular function in Chagas' heart disease
Maciel, Benedito Carlos;Almeida Filho, Oswaldo César de;Schmidt, André;Marin-Neto, José Antonio;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000200012
Abstract: invasive and noninvasive methods used to evaluate ventricular function in chagas's disease are reviewed. the traditional indices of overall ventricular performance reflect interaction of preload, contractility, afterload and heart rate. therefore, they are unable to distinguish changes in contractility from modifications of loading conditions. the role of ventricular function as a predictor of mortality in chronic chagas' heart disease is discussed. ventricular function abnormalities in patients with indeterminate and digestive forms of chagas' disease are especially emphasized. finally, the evidence of early impairment of diastolic performance in patients with chagas' disease is presented.
Electrocardiography in Chagas' heart disease
Garzon, Sérgio A.C.;Lorga, Adalberto M.;Nicolau, José Carlos;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000200011
Abstract: conventional ecg still plays an important role in the overall knowledge of chagas' cardiopathy, because of its importance in longitudinal and epidemiological studies, its diagnostic value, and its utility in prognostic evaluation. the authors discuss these aspects, as well as the use of ecg in the acute phase and the significance of a normal ecg in chagas' disease. correlations were made between ecg and hemodynamic/angiographic variables among 1010 patients with positive laboratory tests for chagas' disease: a) in the group with normal ecg there were no significant differences between symptomatic and non-symptomatic patients with regard to ejection fraction and angiographic abnormalities; b) slight abnormalities on the ecg corresponded to an intermediate level of severity of the disease, that is, between normal ecg and ecg with significant abnormalities; c) fibrosis on the ecg was not predictive of akinesia in the related area on the angiography; d) combined ecg abnormalities generally correlated with greater myocardial compromise compared to isolated abnormalities; e) under multiple regression analysis the ecg abnormalities that independently correlated with depressed ejection fraction were: premature ventricular beats, ventricular tachycardia, left bundle branch block, atrial fibrillation, complete av block, and anterior and inferior fibrosis. male sex, cardiac insufficiency and cardiomegaly on the thorax radiography were also significantly related.
HEART ANEURYSM IN CHAGAS' DISEASE
OLIVEIRA, José Alberto Mello de;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1998, DOI: 10.1590/S0036-46651998000500007
Abstract: this prospective study on 41 autopsy collected human hearts concerns the "apical" lesion in chagas' disease. previous report did not show a correlation between lesion frequency and heart weight then discarding a vascular factor in its pathogenesis. the present paper involves other variables besides the heart weight to evaluate the relative coronary insufficiency. distinct colored gel (green and red) injected through the capillary beds of both coronary arteries defined the extent of both vessels before separating the atria and removing the sub-epicardium fat. the right ventricle (rv) and left ventricle (lv) free walls furnished the rv/lv mass ratio. the myocardium mass colored green (right coronary artery - rc) and the whole ventricular weight (vw) determined the rc/vw mass ratio. the heart weight plus these mass ratios, graded and added, composed a score inversely proportional to the myocardium irrigation condition. it intended to be a more sensitive morphologic evaluation of the relative ischaemia to correlate to the apical lesion. this study showed a right deviation for the relative accumulated frequency of lesions plotted as a score function and a significant difference for higher scores in hearts with aneurysm. it suggests a ischaemic factor intervening in the apical lesion pathogenesis in chagas' cardiopathy.
HEART ANEURYSM IN CHAGAS' DISEASE  [cached]
OLIVEIRA José Alberto Mello de
Revista do Instituto de Medicina Tropical de S?o Paulo , 1998,
Abstract: This prospective study on 41 autopsy collected human hearts concerns the "apical" lesion in Chagas' disease. Previous report did not show a correlation between lesion frequency and heart weight then discarding a vascular factor in its pathogenesis. The present paper involves other variables besides the heart weight to evaluate the relative coronary insufficiency. Distinct colored gel (green and red) injected through the capillary beds of both coronary arteries defined the extent of both vessels before separating the atria and removing the sub-epicardium fat. The Right Ventricle (RV) and Left Ventricle (LV) free walls furnished the RV/LV mass ratio. The myocardium mass colored green (right coronary artery - RC) and the whole Ventricular Weight (VW) determined the RC/VW mass ratio. The heart weight plus these mass ratios, graded and added, composed a score inversely proportional to the myocardium irrigation condition. It intended to be a more sensitive morphologic evaluation of the relative ischaemia to correlate to the apical lesion. This study showed a right deviation for the relative accumulated frequency of lesions plotted as a score function and a significant difference for higher scores in hearts with aneurysm. It suggests a ischaemic factor intervening in the apical lesion pathogenesis in Chagas' cardiopathy.
Thromboembolism in chronic Chagas' heart disease
Braga, Jo?o Carlos;Labrunie, André;Villa?a, Fábio;Nascimento, Ezilaine do;Quijada, Luiz;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000200019
Abstract: thromboembolic episodes are particularly important in chronic chagas' heart disease. systemic and pulmonary embolic phenomena are important complications of the disease. prophylaxis of the thromboembolic phenomena with anticoagulant therapy should be considered in several clinical forms of the disease. further studies will have to address the stratification risk issue.
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