Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease

Abstract INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.

Avaliação dos perfis sorológico e sócio-demográfico dos receptores de sangue do Hospital Universitário Oswaldo Cruz da Universidade de Pernambuco-UPE / Evaluation of the profiles sorologic and partner-demographic of the receivers of blood of the Hospitals, University Oswaldo Cruz of the University of Pernambuco-UPE

(...) O objetivo do trabalho foi avaliar os perfis sorológico e sóciodemográfico dos receptores de sangue (RS) internados no Hospital Universitário Oswaldo Cruz (HUOC) da Universidade de Pernambuco-UPE. O estudo foi realizado nos RS (n=172) no período de fevereiro a maio de 2003, quando os pacientes foram submetidos ao instrumento de coleta de dados. O trabalho foi aprovado pela Comissão de Ética do Centro de Pesquisas Aggeu Magalhães-CPqAM. A sorologia foi realizada na Fundação Hemope, e as amostras foram submetidas aos mesmos testes utilizados para triagem dos doadores de sangue (T. pallidum, T. cruzi, HIV, HCV, HBV e HTLV I/II). Os RS que apresentaram reação positiva foram divididos em três grupos: grupo 1 (G1), nunca receberam sangue; grupo 2 (G2), politransfundidos; e grupo 3 (G3), receptores eventuais de sangue. O perfil sócio-demografifico de 172 receptores de sangue do HUOC mostrou que a idade média foi de 32,2 anos, 46,5 por cento do sexo masculino e 53,5 por cento feminino, 43 por cento casados, 37 por cento solteiros, 20,0 por cento outros. Quanto ao grau de escolaridade, 65,3 por cento tinham ensino fundamental. Apenas 22,6 por cento residiam na cidade do Recife e 49,1 por cento eram oriundos de outros municípios e estados do Brasil, e 57,2 por cento não estavam exercendo atividade trabalhista. O estudo sorológico pré-transfusional, realizado em 159 RS, mostrou que 62 desses indivíduos apresentaram reatividade para uma ou mais das doenças transmissíveis por sangue - 10 (13,3 por cento) foram positivos para T. pallidum, 4 (5,3 por cento ) para T. cruzi, 23 (30,7 por cento para HIV, 7 (9,3 por cento) para HCV e 31 (41,4 por cento) para HBV. Nenhuma reação foi observada para HTLV I/II. A positividade para os grupos foi: 38 (62,3 por cento) do G1, 2 (3,3 por cento) do G2 e 21 (34,4 por cento) do grupo G3. Vários RS (n=33) não tinham conhecimento do seu estado sorológico prévio à transfusão: 19 (57,6 por cento) do G1, 2 (100 por cento) do G2, e 12 (63,2 por cento) do G3. Estes fatos apontam para a necessidade da criação de mecanismos capazes de detectar nos receptores, antes da transfusão, a presença de agentes patógenos transmissíveis por sangue. Isso minimizaria o risco de co-morbidade e respaldaria o Estado e os serviços de hemoterapia quanto à presença desses agentes nos receptores, anteriores a transfusão