Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Abstract INTRODUCTION Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil. METHODS We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR. RESULTS Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients. CONCLUSIONS: Chagas disease affected mostly women, with the indeterminate chronic form of the disease.

Avaliação do eletrocardiograma de pacientes com leishmaniose tegumentar americana tratados com antimonial pentavalente (glucantime) / Electrocardiographic assessment of patients with american cutaneous leihmaniasis treated with pentavalent antimonial (glucantime)

Os antimoniais pentavalentes (Antimoniato de N-metilglumina – Glucantime®) são fármacosde primeira escolha no tratamento da leishmaniose tegumentar americana (LTA). Apresentama cardiotoxicidade como importante efeito adverso e é evidenciada por alterações noeletrocardiograma de repouso (ECG). O alargamento do intervalo QT corrigido (QTc) é a principale potencialmente mais grave delas. O presente estudo teve como objetivo avaliar as alteraçõesno ECG e sua frequência nos pacientes com LTA tratados com Glucantime® no Serviço deDermatologia de nossa instituição. Para isso, um cardiologista avaliou os ECGs de 15 pacientes entre 18 e 59 anos de idade diagnosticados com LTA. Os exames foram realizados imediatamenteantes, no 7º, 14º e 21º dias do tratamento. Desses pacientes, cinco (33 por cento) desenvolveram algumdistúrbio no eletrocardiograma, cuja frequência foi diretamente proporcional ao tempo de uso dofármaco. Bradicardia sinusal nova foi o mais comum (5/15 pacientes), seguida por alargamento dointervalo QTc (2/15 pacientes, os quais também apresentaram bradicardia). Não houve registro decomplicações graves e nenhum paciente desenvolveu sintomatologia cardiovascular. Em apenasum caso foi necessária a interrupção do tratamento. A frequência de alterações no ECG observada écompatível com a relatada por estudos anteriores sobre o tema. Concluímos que a cardiotoxicidadedos antimoniais pentavalentes se manifestou de forma insidiosa, cumulativa, em proporçãocompatível com os relatos da literatura e sem repercussões clínicas.

The pentavalent antimonial compounds (Meglumine Antimoniate – Glucantime®) are thecornerstone for the treatment of American Cutaneous Leishmaniasis (ACL). Cardiotoxicity is theirprincipal adverse effect, which becomes evident as abnormalities in the resting Electrocardiogram(ECG), the prolongation of the corrected QT interval (QTc) being the most important and potentiallyhazardous of them. The purpose of this study was to evaluate the disturbances on ECG and theirfrequency in patients diagnosed with ACL and treated with Glucantime® at our Institution. Fifteenpatients between 18 and 59 years had their ECGs assessed by a senior cardiologist. The tests wereperformed prior to treatment, as well as on its 7th, 14th and 21st day. Five patients (33 percent) developed anabnormality not previously observed, and frequency correlated with the duration of the treatment.The most common was sinus bradycardia (5 of 15 patients), followed by prolongation of the QTcinterval (2 of 15 patients; both also had sinus bradycardia). No major cardiovascular symptomsor complications were reported. Only one patient had to interrupt the treatment. This proportionof ECG disturbances is consistent with previous studies on the subject. We conclude that thecardiotoxicity of the pentavalent antimonial drugs occurred insidiously in a percentage of patientscompatible with the literature, and was not associated with major clinical complications.

Aneurisma da parte torácica da aorta em paciente com lúpus eritematoso sistêmico / Aortic aneurysm in a patient with systemic lupus erythematosus

O lúpus eritematoso sistêmico está frequentemente associado a lesões cardiovasculares, mas os aneurismas de aorta, incluindo-se sua ruptura e dissecção, são complicações incomuns. Relata-se o caso de uma paciente de 22 anos, com diagnóstico de lúpus eritematoso sistêmico em tratamento com corticosteroide havia nove anos, com insuficiência renal crônica e hipertensão arterial sistêmica havia sete anos. Teve dor torácica por um mês antes da admissão. A tomografia computadorizada evidenciou aneurisma na parte torácica descendente da aorta, que se rompeu sete meses após o diagnóstico. A doente foi submetida a correção cirúrgica de urgência, com boa evolução pós-operatória. A patogênese da formação do aneurisma nos pacientes com lúpus eritematoso sistêmico pode serdecorrente do uso prolongado de esteroides, associado a vasculite. O diagnóstico dessa condição deve ser lembrado em assistidos com lúpus eritematoso sistêmico, principalmente naqueles submetidos à terapia estrogênica crônica com hipertensão arterial associada.

Systemic lupus erythematosus is frequently associated with cardiovascular manifestations, but aortic aneurysms including rupture and dissection are uncommon complications. The authors report a case of a 22-year-old female patient with a 9-year history of systemic lupus erythematosus and steroid therapy, and a 7-year history of chronic renal failure and systemic hypertension. She had suffered from chest pain for one month before admission. A computed tomography scan demonstrated aneurysm of the descending thoracic aorta, which was ruptured sevenmonths after diagnosis. The patient underwent urgent surgical repair and had satisfactory postoperative recovery. The pathogenesis of aneurysm formation in systemic lupus erythematosus patients may be due to prolonged steroid therapy, associated with the presence of vasculitis. The diagnosis of this condition should be considered in individuals with systemic lupus erythematosus, especially those who have a history of prolonged steroid use and systemic hypertension.