Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil

ABSTRACT This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Increased angiogenesis parallels cardiac tissue remodelling in experimental acute Trypanosoma cruzi infection

BACKGROUND Angiogenesis has been implicated in tissue injury in several noninfectious diseases, but its role in Chagas disease (CD) physiopathology is unclear. OBJECTIVES The present study aimed to investigate the effect of Trypanosoma cruzi infection on cardiac angiogenesis during the acute phase of experimental CD. METHODS The signalling pathway involved in blood vessel formation and cardiac remodelling was evaluated in Swiss Webster mice infected with the Y strain of T. cruzi. The levels of molecules involved in the regulation of angiogenesis, such as vascular endothelial growth factor-A (VEGF-A), Flk-1, phosphorylated extracellular-signal-regulated protein kinase (pERK), hypoxia-inducible factor-1α (HIF-1α), CD31, α-smooth muscle actin (α-SMA) and also the blood vessel growth were analysed during T. cruzi infection. Hearts were analysed using conventional histopathology, immunohistochemistry and western blotting. FINDINGS In this study, our data demonstrate that T. cruzi acute infection in mice induces exacerbated angiogenesis in the heart and parallels cardiac remodelling. In comparison with noninfected controls, the cardiac tissue of T. cruzi-infected mice presented higher levels of (i) HIF-1α, VEGF-A, Flk-1 and pERK; (ii) angiogenesis; (iii) α-SMA+ cells in the tissue; and (iv) collagen -1 deposition around blood vessels and infiltrating throughout the myocardium. MAIN CONCLUSIONS We observed cardiac angiogenesis during acute experimental T. cruzi infection parallels cardiac inflammation and remodelling.

Atrial fibrillation in acute Chagas disease acquired via oral transmission: a case report

Abstract Atrial fibrillation (AF), a type of supraventricular arrhythmia increases the risk of thromboembolism. Chagas disease has been reported in the Brazilian Amazon region over approximately 20 years. Cardiac abnormalities are recorded in at least 50% of patients and among these, 3.3% develop AF. We describe a case of a 41-year-old man from Muaná, Pará State, who reported a 30-day history of a febrile illness. Acute Chagas disease was confirmed, and an electrocardiogram revealed AF. He was treated with antiparasitic and anti-arrhythmic drugs, beta blockers, and anticoagulants. Reversion to sinus rhythm was observed at his 9-month follow-up.

Acute Chagas disease in the state of Pará, Amazon Region: is it increasing?

Acute Chagas disease (ACD) has a distinct epidemiological profile in the Amazon Region, with cases and outbreaks of Trypanosoma cruzi infection being possibly related to the ingestion of contaminated food. Data on ACD in the state of Pará retrieved from 2000 to 2016 from the Brazilian Notifiable Diseases Information System (SINAN) were evaluated. During this period, 2,030 of the 16,807 reported cases were confirmed, with a higher incidence between the months of August and December, thus characterising a seasonal pattern of acute infection, and coinciding with the higher production of "açaí", one fruit likely involved in the oral transmission of the disease. Evaluation of the absolute numbers of confirmed ACD cases secondary to oral infection suggests that infection through this route increased during the 2010-2016 period, differing from what was recorded in terms of vectorial or other infection routes. These findings point to the need of intensifying strategies to prevent or substantially reduce oral transmission.

Uneventful benznidazole treatment of acute Chagas disease during pregnancy: a case report

This report describes the case of a patient with acute Chagas disease in Tocantins, Brazil, who was unaware of her pregnancy during benznidazole treatment. She presented with impaired cardiac function during the acute phase (pericarditis and incomplete right bundle-branch block) that resolved favorably after benznidazole therapy. Serological results also became negative, as determined by hemagglutination assays, enzyme-linked immunosorbent assays, and immunofluorescence assays. The child was born without sequelae and showed no evidence of congenital Trypanosoma cruzi infection at birth or 24 days later.

Electrocardiography repolarization abnormalities are characteristic signs of acute chagasic cardiomyopathy / Los trastornos de la repolarización ventricular son signos característicos de la cardiomiopatía chagásica aguda

Chagas disease is a tropical parasitic disease caused by the protozoan Trypanosoma cruzi (T. cruzi), whose reemergence as oral outbreaks is currently a public health problem in Venezuela. T. cruzi infection induces myocardial damage; which according to the microvascular theory, is derived from parasite-mediated disruption of the endothelium, inducing platelet aggregation and ischemia. In order to determine whether ventricular repolarization disorders observed in human patients are characteristic signs of the disease that can be reproduced in NMRI mice; we studied 12 patients with a well documented diagnosis of acute Chagas disease, based on epidemiological, clinical, parasitological and molecular data. Also, T. cruzi isolates from the blood of human patients from other Venezuelan geographical regions were characterized and inoculated in albino NMRI mice. A standard 12-lead and bipolar electrocardiogram configuration were done in human patients during the acute phase of the disease and in mice, after three weeks of infection. Results in human showed repolarization disorders, characterized by: negative, bimodal or biphasic T waves, ST segment depression or elevation and early repolarization. In mice a significant increase in T wave amplitude, increased QT interval duration and elevation or depression of ST segment were observed. These findings were evidenced in all infected mice, suggesting that electrocardiographic repolarization abnormalities in a well documented clinical and epidemiological context are signs that increase the sensitivity for the diagnosis of acute Chagas´ disease.

La enfermedad de Chagas es una hemoparasitosis causada por Trypanosoma cruzi (T. cruzi), cuya re-emergencia como epidemias por contaminación oral es actualmente un problema de salud pública en Venezuela. La infección por T. cruzi causa miocarditis; que de acuerdo con la teoría microvascular deriva del daño del endotelio vascular, al inducir agregación plaquetaria e isquemia. Con el objetivo de demostrar que los trastornos de repolarización son signos propios de la miocarditis chagásica aguda (MChA) reproducibles en modelos animales, estudiamos 12 pacientes humanos con diagnostico bien documentado de MChA, basado en datos epidemiológicos, clínicos, parasitológicos y moleculares. A partir de la sangre de los pacientes obtuvimos los aislados de T cruzi, los caracterizamos molecularmente y los inoculamos en ratones albinos NMRI; paralelamente, aislados de T cruzi provenientes de otras regiones de Venezuela fueron también ensayados. Tanto en los pacientes humanos como en los ratones con Chagas agudo, se realizaron estudios electrocardiográficos en 12 derivaciones estándares y en configuración bipolar, respectivamente. En humanos observamos trastornos de la repolarización ventricular caracterizados por: onda T negativa, bimodal o bifásica; elevación o depresión del segmento ST y despolarizaciones tempranas. En ratones observamos incrementos en la amplitud de la onda T, aumento en la duración del intervalo QT y elevación o depresión del segmento ST. Estos hallazgos fueron evidenciados en todos los ratones infectados con los diferentes aislados, sugiriendo que los trastornos de repolarización, en un adecuado y bien documentado contexto epidemiológico y clínico, son signos que aumentan la sensibilidad para el diagnóstico de MChA.

Transmisión oral de la enfermedad de chagas: con especial referencia a la patología de los casos del año 2009 / Oral transmission of chagas disease due to oral: with special reference to the pathology of the cases from the year 2009

La transmisión oral de la enfermedad de Chagas habitual en el ciclo selvático es una forma rará en el ser humano. En este último, se debe a la contaminación de las heces con Trypanosoma cruzi (Tcruzi) en los alimentos o a la manipulación infectada de los mismos. Más raramente a la ingesta de carne de reservorios infectados. En esta comunicación, se ponen en el tapete, los trabajos experimentales y naturales del investigador Díaz-Ungría quien demostró el importante papel que juega la mosca doméstica en la contaminación de los alimentos con las heces infectadas de los vectores. Igualmente, se destaca la importancia del perro como reservorio doméstico, todos los cuales podrían ser factores determinantes en la causa de los brotes agudos presentados en los dos últimos años en nuestro país. Se exponen las características de la miocarditis aguda chagásica como la expresión más constante de la forma aguda de la enfermedad por transmisión oral. Se destacan las medidas de prevención efectuadas por las autoridades sanitarias en estas circunstancias

Oral transmission of Chagas disease is common in the forest'cycle and is a rare form in humans. In the human is due to contamination of the stool with T.cruzi in food or infected by their manipulation. More rarely due to reservoirs infected T.cruzi meat intake. In this communication we described the natural and experimental works of the Díaz-Ungría researcher who demonstrated the important role played bi the house fly in the contamination of food with vectors infected faeces. It also highlights the importance of the dog as domestic reservoir, all of which could be determining factors in the cause of acute outbreaks in the past two years in our country. The features of acute Chagasic'myocarditis are exposed as the constant expression of the acute form of the disease by oral transmission. The prevention measures carried out by the health authorities in these circunstances are high lighted

On an acute case of Chagas disease in a region under vector control in the state of São Paulo, Brazil / Sobre caso de doença de Chagas aguda em região de vetores controlados no Estado de São Paulo, Brasil

No vector transmitted cases of Chagas disease had been notified in the state of São Paulo since the 1970s. However, in March, 2006, the death of a six-year-old boy from the municipality of Itaporanga was notified to the Center for Epidemiological Survey of the São Paulo State Health Secretariat: an autochthonous case of acute Chagas disease. The postmortem histopathological examination performed in the Hospital das Clínicas of the Botucatu School of Medicine confirmed the diagnosis. Reference to hospital records, consultation with the health professionals involved in the case and interviews with members of the patient's family supplied the basis for this study. We investigated parasite route of transmission, probable local reservoirs and vectors. No further human cases of acute Chagas disease were diagnosed. No locally captured vectors or reservoirs were found infected with Trypanosoma cruzi. Alternative transmission hypotheses - such as the possible ingestion of foods contaminated with vector excreta - are discussed, as well as the need to keep previously endemic regions and infested houses under close surveillance. Clinicians should give due attention to such signs as uni- or bilateral palpebral edema, cardiac failure, myocarditis, pericarditis, anasarca and atypical signs of nephrotic syndrome or nephritis and consider the diagnostic hypothesis of Chagas disease.

Desde a década de 1970 não se notificavam casos autóctones de doença de Chagas aguda em São Paulo. Em março de 2006 a Vigilância Epidemiológica registrou óbito por doença de Chagas aguda, em Itaporanga, de paciente de seis anos de idade. Exame histopatológico post mortem realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu confirmou o diagnóstico. Consultamos prontuários de hospitais e entrevistamos profissionais de saúde envolvidos além de familiares do paciente. Descrevemos medidas adotadas in loco para identificar a via de transmissão, reservatórios e vetores. Discutimos as possíveis fontes de infecção. Na região não foram identificados outros casos humanos, vetores ou reservatórios vertebrados infectados por Trypanosoma cruzi. Salientamos a importância de manter a vigilância, mesmo em áreas onde a transmissão de doença de Chagas está interrompida e naquelas ainda infestadas por triatomíneos. Deve-se admitir a hipótese diagnóstica de doença de Chagas quando observados: edema palpebral (uni ou bilateral), insuficiência cardíaca, miocardite, pericardite, anasarca, quadros similares aos de síndrome nefrótica ou glomerulonefrite sem causas outras aparentes, em pacientes com dados epidemiológicos positivos. Encontro, mesmo em raras ocasiões, de triatomíneos na região ou ainda contato com alimento contaminável com formas infectantes de T. cruzi.

Efecto de la infección aguda con Trypanosoma cruzi sobre el sistema nervioso central de rata gestante / Effect of acute infection with Trypanosoma cruzi on the central nervous system in pregnant rats

Este estudio analizó el efecto de la infección aguda con Trypanosoma cruzi sobre la histología del sistema nervioso central de ratas durante la gestación. Las ratas Wistar fueron infectadas por inoculación intraperitoneal de 5x10(4) tripanosomas sanguícolas de la cepa M/HOM/Bra/53/Y. Para obtener la preñez durante el ascenso de la parasitemia, las ratas en estrus del ciclo menstrual fueron apareadas con los machos a los 12 días posinfección (pi). Ratas vírgenes/infectadas, vírgenes/sanas y sanas/preñadas fueron usadas como controles. Altos niveles de parasitemia patente (PP), de 36 ± 2,9 a 55 ± 3,0 tripanosomas/mm³ de sangre en las ratas con 16 y 22 días de infección y con 6 y 12 días de gestación respectivamente fueron observados. La comparación de la PP entre las ratas infectadas/preñadas y vírgenes/infectadas fue significativa al 1 por ciento. A los 30 días pi las ratas fueron sacrificadas y el cerebro (C) y las regiones cervical (RC), torácica (RT), lumbar (RL) y sacra (RS) de la ME fueron fijadas en formalina al 10 por ciento, deshidratadas e incluidas con Paraplast. Los cortes de 7 μm coloreados con hematoxilina y eosina mostraron reacción inflamatoria de células polimorfonucleares, mononucleares y plasmocitos en contacto con los cuerpos neuronales del C de las ratas infectadas/preñadas. La comparación entre el número de linfocitos en los hemisferios derecho (HD) e izquierdo (HI) de 65 ± 6,3 y 48 ± 4,5 linfocitos en las ratas infectadas/preñadas y de 20 ± 2,0 y 13 ± 1,1 linfocitos en las ratas sanas/preñadas fue significativa (P<0,05). La comparación del número de linfocitos en los HD y HI de las ratas vírgenes/sanas vírgenes/infectadas no reveló diferencias. La disminución de motoneuronas (MN) de 35 ± 3,4 a 16 ± 1,7 en la RC, de 33 ± 3,1 a 21 ± 3,0 en la RT y de 31± 3,8 a 10 ± 1,8 en la RL, de la ME de las ratas infectadas/preñadas fue significativa (P<0,05) en comparación con el número de MN en la ME de las ratas sanas/preñadas....

This study analyzed the effect of acute infection with Trypanosoma cruzi on the histology of Central Nervous System (CNS) of rats during pregnancy. Wistar rats were infected by intraperitonealy inoculation of 5x10(4) blood trypomastigotes of the M/HOM/Bra/53/Y strain. To obtain pregnancies during the ascending phase of parasitemia, rats in estrus of its menstrual cycle were matched with males at days 12 after infection (pi). Virgin/infected, virgin/healthy and healthy/pregnant rats were used as controls. High levels of patent parasitemia (PP) of 36 ± 2.9 to 55 ± 3.0 tripanosomas/mm³ blood, were observed in rats between 16 and 22 infection days and between 6 and 12 pregnancy days respectively. The comparison of the PP between infected/ pregnant rats and virgin/infected rats was significant at 1 percent. At the 30 days pi rats were sacrificed. Brain (B) and regions cervical (CR), thoracic (TR), lumbar (LR) and sacra (SR) of Spinal cord (SC) samples were obtained and fixed in formalin to 10 percent, dehydrated and embedded in Paraplast. The sections (7 μm) stained with Hematoxylin and Eosin showed inflammatory reaction of polymorphonuclear and mononuclear cells and plasmocytes in contact with neurons of B of the infected/pregnant rats. The comparison between lymphocytes number in the right (HR) (65 ± 6.3) and left (HL) (48 ± 4.5) cerebral hemispheres of infected/pregnant rats and of 20 ± 2.0 and 13 ± 1.1 lymphocytes in healthy/pregnant rats was significant (P<0.05). The comparison between lymphocyte number in the HR y HL of the virgin/healthy rats and virgin/infected rats not showed differences. Motoneurons (MN) reduction of 35 ± 3.4 to 16 ± 1.7 in CR, of 33 ± 3.1 to 21 ± 3.0 in TR and of 31± 3.8 to 10 ± 1.8 in LR of the SC of infected/pregnant rats was significant (P<0.05), when they were compared with MN number in SC of healthy/pregnant rats. Reduction of MN of 53 ± 4.9 to 35 ± 3.4 in the CR and of 37 ± 3.3 to 22 ± 1.9 in the SR...

Acute Chagas disease outbreak associated with oral transmission / Surto de doença de Chagas aguda associada à transmissão oral

Seven individuals living in a town in the Southwest of Bahia developed sudden signs of cardiac and systemic impairment, with lethality of 28.6 percent. Serological tests were positive at least in one test in the five patients examined. Forty percent of the Triatoma sordida mynphs found inside or around Trypanosoma cruzi were found by blood culturig in there out five cases the homes of these cases were positive for Trypanosoma cruzi. Transmission probably occurred through consumption of water contaminated with triatomine feces. These findings emphasize the necessity to evaluation the importance of vectors like Triatoma sordida in maintaining the endemicity of this disease.

Sete indivíduos que viviam em uma cidade do sudoeste da Bahia desenvolveram sinais súbitos de envolvimento cardíaco e sistêmico com letalidade de 28,6 por cento Trypanosoma cruzi foi isolado por hemocultura em três de cinco casos examinados. Testes sorológicos foram positivos em mais de um teste nos cinco pacientes, que os realizaram. Qinquenta por cento dos Triatoma sordida encontrados na residência ou no peridomicilio dos casos estavam positivos para Trypanosoma cruzi. A transmissão provavelmente foi devido à ingestão de água contaminada por fezes de triatomíneos. Estes achados enfatizam a necessidade de se avaliar a importância de vetores como Triatoma sordida na manutenção da endemicidade da doença.

Doença de Chagas aguda grave autóctone da Amazônia Brasileira / Serious acute Chagas Disease authoctonous from Brazilian Amazon

Objetivo: analisar o quadro clinico-laboratorial de casos de Doença de Chagas aguda autóctone da Amazônia brasileira avaliados sob regime hospitalar, enfatizando a síndrome febril e sinais potenciais de comprometimento cardíaco futuro. Método: estudo transversal de casos de Doença de Chagas aguda, internados no Hospital Universitário João de Barros Barreto, de janeiro de 1990 a outubro de 2003. Resultados: em 20 casos estudados encontramos febre em 95% deles, sendo metade do tipo recorrente, dispnéia (75%), astenia (65%), edema de membros inferiores (65%) e cefaléia (60%). As principais alterações eletrocardiográficas foram: taquicardia sinusal, alterações difusas da repolarização ventricular e complexo QRS de baixa voltagem. Observou-se derrame pericárdico em 35% dos ecocardiogramas realizados. Conclusõe. a elevada freqüência da síndrome febril na doença de Chagas aguda expressa a importância do correto diagnóstico diferencial com as demais endemiasfebris da Amazônia. As alterações eletrocardiográficas e ecocardiográficas encontradas podem sugerir forma clínica de transição para cronicidade, além de indicar gravidade.

Objective: To analyze clinical and laboratorial findings of authoctononus acute Chagas disease from Brazilian Amazon, evaluated under hospital regimen, emphasizing feverish syndrome observations and potential signs of future cardiac commitment. Method: Transversal study of acute Chagas disease in patients from University Hospital João de Barros Barreto, within jan 1990 to at 2003. Results: In a total of 20 studied cases we found predominant symptoms: fever (95%), dyspnea (75%), asthenia (65%), edema of lower members (65%) and headache (60%). Main abnonnalities found in electrocardiograms were: sinusal tachycardia, diffuse ventricular repolarization abnormalities and low voltage of QRS. We demonstrated 35% with pericardial effusion show in echocardiograms. Conclusions: Raised frequency of feverish syndrome in acute Chagas disease shows the importance of the correct distinguishing diagnosis with others febrile endemic diseases occurred in Amazon. The electrocardiographics and echocardiographics abnormalíties found could suggest clínical form of transition for chronicity, besides expressing gravity.

Gastrocnemius skeletal muscle microvasculature and neuromuscular junction alterations in mice with experimental acute chagas infection / Alteraciones en la microvasculatura y unión neuromuscular del músculo esquelético Gastrocnemius de ratones con infección experimental de Chagas agudo

A light and transmission electron microscopy study was performed in skeletal muscles (SM) Gastrocnemius (G) from mice experimentally infected with Trypanosoma cruzi to determine changes on microvessels (MV) and neuromuscular junction (NMJ) of G. In this study 10 male (mus musculus) (20 g) were infected subcutaneally with 1.10(4) bloodstream trypomastigotes M/DID/Ve/02/DSM strain. Five mice were kept as uninfected controls. The parasites induced a complete paralysis of the rear limbs and death while still in the acute Chagas´disease. The histopathology of SM showed inflammatory cell infiltration by mononuclear and polymorphonuclear leukocytes associated with marked parasitism in the muscle fibers of G. Indirect immunofluorescence revealed interstitial IgG deposit as bands regularly spaced along the nerve terminals at 40 days post-infection (pi). At this time T. cruzi antigens and intracellular amastigotes nests were also observed. The marked inflammatory response and morphological changes in the SM were confirmed by transmission electron microscopy. Capillary ultrastructure was seen to be altered, with points of cell cytoplasm discontinuity that appear to represent holes in the microvessel walls. This finding coincided with amastigote nests in myofibers, close contacts between trypomastigotes and endothelial cells and marked thickening of the basement membrane of the muscle vessels. Loss of capillary lumen and a process of ischemia also were observed in the SM of infected mice. The neuromuscular junction showed degeneration of intramuscular nerve fibers, reduction in the axon caliber, swollen mitochondrial, increase in the actin filaments and microtubules in the axoplasm, and swelling of the Schwann cells. Increase in the nerve terminal perimeter and most of the synaptic vesicles were localized near the presynaptic active zones and scarces in the axoplasm. At this stage of infection the changes findings in MV and NMJ of G infected with ...

Un estudio con microscopía de luz y electrónica de transmisión fue realizado en muestras del músculo esquelético (ME) Gastrocnemius (G) de ratones experimentalmente infectados con Trypanosoma cruzi, a fin de determinar las alteraciones en la microvasculatura y unión neuromuscular (UNM) de G durante la infección chagásica aguda. Un grupo de 10 ratones machos (mus musculus) NMRI (20 g), fueron infectados subcutáneamente con 1,10(4) tripomastigotes sanguícolas de la cepa M/DID/Ve/02/DSM. Cinco ratones NMRI no infectados fueron usados como control. Estos parásitos produjeron completa parálisis de las patas posteriores y muerte de los ratones durante la infección aguda. La histopatología del ME mostró infiltración de células mononucleares y leucocitos polimorfonucleares asociados con marcado parasitismo en la fibra muscular de G. La inmunofluorescencia indirecta reveló IgG a manera de bandas sobre el nervio terminal a los 40 días post-infección (pi). En este tiempo, antígeno y grupos de amastigotes de T. cruzi fueron observados en los cortes del ME. La marcada respuesta inflamatoria y las alteraciones morfológicas en el tejido muscular fueron verificadas por microscopía electrónica de transmisión. La ultraestructura de los capilares estuvo relacionada con puntos de discontinuidad en la microvasculatura. Este encuentro coincidió con la presencia de grupos de amastigotes dentro de las miofibrillas, estrecho contacto entre los tripomastigotes y las células endoteliales y marcado adelgazamiento de la membrana basal de los vasos sanguíneos. La pérdida del lumen capilar y un proceso de ischemia también fue observado en el G de los ratones infectados. La unión neuromuscular mostró degeneración de la fibra nerviosa intramuscular, reducción en el calibre del axón del nervio motor determinada por una retracción de la vaina de mielina, inflamación mitocondrial, aumento en los filamentos de actina y microtúbulos en el axoplasma e inflamación de las células ...

Cecílio Romaña, o sinal de Romaña e a doença de Chagas / Cecílio Romaña, Romaña's sign and Chagas' disease

Recentemente falecido em Barcelona, Cecílio Romaña foi um importante tropicologista argentino com muitas contribuições à clínica, ao controle e à patologia da doença de Chagas entre 1930 e 1960. Em 1935, Romaña tornou-se famoso por sua precisa descrição do complexo oftalmo-ganglionar, o mais típico dos sinais de porta de entrada da doença de Chagas humana, sinal este que logo ficou conhecido em toda a América Latina com o nome de "sinal de Romaña", por proposição de dois pesquisadores brasileiros, Emmanuel Dias e Evandro Chagas. O achado de Romaña causou enorme polêmica com o grande Salvador Mazza, que não reconheceu a especificidade do sinal e, muito menos, aceitou a proposta nomenclatura. Estes fatos são relatados no presente artigo, que homenageia Cecílio Romaña e destaca o enorme impacto de sua descoberta para o conhecimento da doença de Chagas aguda em toda sua área endêmica

Cecílio Romaña was an important Argentinean researcher dedicated to tropical diseases in the period 1930-1960, recently died in Barcelona. Working mainly on the epidemiological, clinical and pathological aspects of American trypanosomiasis, Romaña became very famous in 1935 when he accurately described the most typical portal recognized in all the endemic area with the cognomen of [quot ]Romaña sign[quot ]. This description caused an enormous polemic with Romaña's then director, the great Salvador Mazza, who never accepted the specificity of the sign and, much less, its popular name (which was proposed by the Brazilian researchers Emmanuel Dias and Evandro Chagas). This history is briefly summarized in the present article, as well as the great impact of Romaña's discovery in the recognition of the acute Chagas' disease in all the endemic area.

Doença de Chagas: revisäo de 8 casos simultâneos de miocardite aguda chagásica; 25 anos após / Chagas disease: review of 8 simultaneous cases of acute Chagas myocarditis; 25 years after

Objetivo - Relatar a evoluçäo de pacientes após 25 anos após uma miciroepidemia de doença de Chagas, surgida em Teotônia-RS em 1965 e discutir a importância da transnissäo via oral (VO) como porta de entrada. Métodos - Oito pacientes de um grupo de 17 pessoas acometidas de infecçäo chagásica aguda, em 1965, estäo fichadas no IC/FUC do RS com diagnóstico de doença de Chagas. Foram examinadas clinicamente e se submeteram a exames laboratoriais de rotina, provas específicas para o Trypanozoma cruzi, eletrocardiograma (ECG), radiografia de tórax (RX) e ecocardiograma (ECO) em 1991. Resultados - Nenhum dos 8 pacientes apresentou manifestaçöes orgânicas da doença de Chagas, os exames laboratoriais, ECG, RX e ECO foram normais. Na imunofluorescência somente um paciente apresentou indice 1/20. Conclusäo - 1) A evoluçäo dos oito casos nestes 25 anos foi benigna, näo apresentando nenhum sinal ou manifestaçäo orgânica de doença de Chagas e, especificamente, sem miocardiopatia; 2) a transmissäo VO deve ser considerada definitivamente como porta de entrada para a doença de Chagas e, provavelmente, influi na evoluçäo da fase crônica

Purpose - To analyse the evolution of 8 cases of Chagas' disease after a microepidemy of 17 cases which ocurred in Teotonia - RS - in 1965 and to discuss the importance of oral contamination in Chagas' disease. Methods - All 8 patients are followed at the IC/ FUC - RS - Brazil since 1980. Clinical examinations, blood tests, ECG, Cx-Ray and Echo were made in 1991. Results - None of the eight cases presented any sign of chronic Chagas' disease manifestation. The blood tests, ECG, Cx-Ray and Echo were normais. Only one case showed a imunofluorescence of 1/20. Conclusion - 1) The follow-up after 25 years in all the 8 cases did not show clinical alterations or any chronic manifestation of Chagas' disease. All the tests performed had normal results; 2) the oral transmission must be considered definitive in Chagas' disease