Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

Abstract INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.

Soroepidemiologia da hepatite B e C em índios Kaingang do Sul do Brasil / Seroepidemiology of hepatitis B and C in Kaingang Indians in the South of Brazil

OBJETIVO: Investigar a prevalência de infecção pelo vírus da hepatite B e C na população indígena Kaingang da reserva de Mangueirinha, no Estado do Paraná, Brasil. MÉTODO: A presença dos marcadores sorológicos anti-HBc, anti-HBs, AgHBs e anti-VHC foi investigada em amostras de sangue de 214 voluntários (81 do sexo masculino e 133 do sexo feminino) usando técnicas imunoenzimáticas. Os participantes responderam a um questionário sobre os aspectos sociodemográficos, as condições de vida, os hábitos e o histórico de doenças e de vacinação. RESULTADOS: A média de idade foi de 29,85 anos (1 a 90 anos). Foi observada uma positividade de 71,02 por cento para o marcador anti-HBs e de 15,42 por cento para o anti-HBc. Nenhum caso foi positivo para o marcador AgHBs. Somente um participante, uma mulher de 30 anos, apresentou positividade para anti-VHC. CONCLUSÃO: Os resultados mostram baixa prevalência de infecção pelo VHB e pelo VHC na população Kaingang estudada. A alta prevalência de anti-HBs nas faixas etárias mais baixas indica uma boa abrangência da imunização ativa artificial. Na população adulta, é provável que a imunidade contra o VHB tenha sido adquirida principalmente de forma natural, pelo contato com o vírus.

OBJECTIVE: To investigate the prevalence of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) among Kaingang Indians living on the Mangueirinha reservation in the state of Paraná, Brazil. METHODS: The presence of viral markers was investigated in blood samples from 214 volunteers (81 males, 133 females), using immunoenzymatic techniques. The viral markers studied were: antibody to hepatitis B core antigen (anti-HBc), antibody to hepatitis B surface antigen (anti-HBs), hepatitis B surface antigen (HBsAg), and antibody to hepatitis C virus (anti-HCV). The participants answered a questionnaire on their sociodemographic characteristics, living conditions, personal habits (such as smoking and consuming alcohol or illicit drugs), and history of disease and of vaccination. RESULTS: The respondents ranged in age from 1 to 90 years; their mean age was 29.85 years. Positivity for anti-HBs was 71.02 percent, and for anti-HBc it was 15.42 percent. None of the individuals was positive for HBsAg. Anti-HCV was detected in only one participant, a 30-year-old woman. CONCLUSIONS: There were low prevalences of HBV and HCV infection in the Kaingang population studied. The high prevalence of anti-HBs in younger individuals indicates good immunization coverage. In the adult population, immunity against HBV was probably acquired mainly by contact with the virus.