Hidatidosis cardíaca: tratamiento quirúrgico para recidiva de quiste hidatídico en ventrículo izquierdo / Cardiac hydatid disease: surgical treatment for recurrent hydatid cyst in the left ventricle

INTRODUCCIÓN: El quiste hidatídico cardiaco es una patología infrecuente, producida por la llegada de Equinococcus granulosus a la circulación coronaria. MATERIALES Y MÉTODO: Hombre de 52 años, con antecedente de quiste hidatídico cardiaco operado hace 27 años, insuficiencia cardiaca y enfermedad coronaria. Presentó disnea progresiva de un año de evolución. Estudio con radiografía de tórax, ecocardiografía y tomografía computada que mostró imagen compatible con hidatidosis cardiaca recidivada en el ventrículo izquierdo, arteria pulmonar e hilio pulmonar izquierdo, rodeando por completo el tronco coronario común izquierdo y parte proximal de la arteria descendente anterior. Se constató fracción de eyección de ventrículo izquierdo aproximadamente de 30%. No se encontró evidencia de enfermedad hidatídica extracardiaca. Se decidió tratamiento quirúrgico. Se abordó por esternotomía media y en circulación extracorpórea, se observaron lesiones compatibles con quiste hidatídico multiloculado de ubicación miocárdica en ventrículo izquierdo, con incontables vesículas hijas. Se realizó quistectomía más periquistectomía hidatídica sin incidentes. Presentó hemorragia postoperatoria por lo que requirió reintervención quirúrgica precoz. Evolucionó favorablemente y fue dado de alta sin complicaciones. A seis años de seguimiento se encuentra asintomático, sin evidencia tomográfica y ecocardiográfica de recidiva. DISCUSIÓN: La hidatidosis es una zoonosis endémica en Chile. La ubicación cardiaca es infrecuente, correspondiendo al 0,5 al 2% de los casos. Suele asociarse a la presencia de quistes extracardiacos. La ubicación más frecuente es la pared libre del ventrículo izquierdo a nivel intramiocárdico. El tratamiento médico suele ser insuficiente, por lo que se recomienda la resección quirúrgica.

INTRODUCTION: Cardiac hydatid cyst is a rare disease caused by Echinococcus granulosus arrival of the coronary circulation. MATERIAL AND METHOD: 52 years old man with a history of cardiac hydatid cyst operated 27 years ago, heart failure and coronary artery disease. He presented with a history of one year of progressive dyspnoea. Study with chest radiography, echocardiography and computed tomography showed an image compatible with cardiac hydatid disease recurrence in relation to the left ventricle, pulmonary artery and anterior descending artery. Ejection fraction of the left ventricle was approximately 30%. No evidence of extracardiac hydatid disease was found and surgical treatment was decided. Addressed by median sternotomy and extracorporeal circulation, a multiloculated myocardial hydatid cyst, with hundreds of daughter vesicles of different size was found. Pericystectomy of the hydatid cyst was performed without incident. The patient presented postoperative bleeding which required early reoperation. Posteriorly, was discharged without complications. DISCUSSION: Hydatid disease is an endemic zoonosis in Chile. Heart location is infrecuent and correspond to 0.5 to 2% of the cases, usually associated with the presence of extracardiac cysts. The most common location is the free wall of the left ventricle at intramyocardial level. Medical treatment is often inadequate and surgical resection is recommended.

Embolismo arterial agudo como forma de presentación clínica inicial de una hidatidosis diseminada: reporte de un caso / Acute arterial embolism as the clinical presentation of a disseminated hydatidosis: case report

La hidatidosis es una zoonosis producida por el parásito Echinococcus granulosus. En el ciclo zoonótico del parásito, el hombre es un huésped intermediario y sufre la enfermedad tras la ingesta de alimentos y agua contaminados por la materia fecal de animales infectados. En Argentina, la enfermedad constituye un problema importante de salud pública. Suele manifestarse con compromiso hepático y pulmonar. La afectación de otros órganos, que incluyen el corazón, es infrecuente.

Hydatidosis is a parasitic infection caused by the Echinococcus granulosus larvae, transmitted by the ingestion of infected food, characterized by the formation of cysts in vital organs. In Argentina, the disease is spread throughout the territory, constituting an important public health issue. The disease usually affects the liver and lungs. The affection of other organs is rare, and even more uncommon the affection of the heart. We present the case of a disseminated hydatidosis in a pediatric patient, whose initial clinical manifestation was an acute arterial embolism of the right limb caused by the rupture of a hydatidic cardiac cyst.

Hidatidosis Cardiaca Primaria / Primary cardiac hydatidosis

Cardiac hydatidosis without involvement of extracardiac organs is an uncommun condition. We report a case of a 20 years old female without any prior disease, she consult for progressive dyspnea and palpitations. Echocardiogram and cardiac MRI shows cystic lesion in apical intraventricular septum suggestive of hydatid cyst. No other organs were affected. The patient underwent surgery with successful removal of hydatid cyst and medical treatment with Albendazole, after that, the patient remains asymptomatic.

Cardiac hydatid cyst revealed by ventricular tachycardia

Hydatid disease is a human parasitic infestation caused by the larval stage of Echinococcus Granulosus. The liver and the lungs are the most common locations. Cardiac involvement is rare and accounts for 0.5-2% of all hydatid disease. We report an unusual presentation of cardiac hydatid cyst revealed by ventricular tachycardia in a patient with a history of cerebral hydatid cyst

Caracterização clínica e laboratorial de cães naturalmente infectados com Trypanosoma cruzi no semiárido nordestino / Clinical and laboratorial characterization of naturally infected Trypanosoma cruzi dogs in the northeastern semi-arid

Objetivou-se, com este estudo, evidenciar os sinais clínicos e laboratoriais desta enfermidade para auxiliar na caracterização da doença de forma natural na área semi-árida da região nordeste. Foram avaliados 10 cães positivos para Trypanosoma cruzi, identificados mediante análises sorológicas de reação de imunofluorescência indireta (RIFI) e enzyme linked immunosorbent assay (ELISA); análise molecular pela Reação em Cadeia Polimerase (PCR), microscopia direta e hemocultura. Os cães chagásicos foram submetidos à avaliação física, verificação da pressão arterial, exames eletrocardiográficos, radiográficos, hematológicos (eritrograma e leucograma) e bioquímicos (ureia, creatinina, ALT, AST, PT, albumina, globulina, CK, CK-MB e cTnI). O exame físico e os valores das pressões arteriais dos cães apresentaram dentro dos parâmetros de normalidade, enquanto que na eletrocardiografia observou-se FC normal com ritmo sinusal, com exceção de um cão, que apresentou taquicardia sinusal (168 bat/min). No ECG de oito cães houve aumento da duração de P (47±6,5ms) sugestivo de aumento atrial, não confirmado radiograficamente. Foi observado supradesnivelamento do segmento ST em um cão. Nos resultados hematológicos constatou-se trombocitopenia (187,4x10³ ±137,2x10³) e anemia (5,0x10(6) ±1,39x10(6)/uL). Os valores médios da hemoglobina (11±2,7g/dL) e do hematócrito (34±10,5%) estavam abaixo dos limites de normalidade. A série branca apresentou-se dentro dos limites de normalidade, com exceção da eosinofilia observada em três cães. Individualmente, registrou-se em dois cães, leucocitose, linfocitose e neutrofilia. Na avaliação bioquímica, registrou-se hiperproteinemia (7,2±0,9g/dL), hipoalbuminemia (2,2±0,4g/dL), hiperglobulinemia (5,1±1,0g/dL) e aumento da CK (196±171U/L). Não houve alteração nas enzimas ALT e AST. A isoenzima CK-MB e o cTnI alteraram somente em três cães. Os cães infectados naturalmente no semiárido nordestino apresentam características relacionáveis à forma crônica indeterminada, ou seja, cães assintomáticos. A identificação dos cães infectados naturalmente sem características patognomônicas da doença de Chagas ressalta a importância desta enfermidade no processo diagnóstico com as demais que manifestam perfis inespecíficos associados ou não às doenças cardiovasculares.

This study aimed to evidence the clinical and laboratorial signs of this disease to help characterize this illness in a natural way in the semiarid in the northeastern region. We evaluated 10 positive for Trypanosoma cruzi dogs, that were identified by serological analysis of immunofluorescence assay (RIFI) and enzyme linked immunosorbent assay (ELISA); molecular analysis by polymerase chain reaction (PCR), direct microscopy and blood culture. The chagasic dogs underwent physical examination, electrocardiographic, radiographic, blood pressure, hematology (erythrocyte and leukocyte count) and biochemical exams (urea, creatinine, ALT, AST, PT, albumin, globulin, CK, CK-MB, and cTnl). The physical examination and the blood pressure were presented within the normal range, while in the electrocardiography the FC was observed as normal with a sinus rhythm, with the exception of one dog that presented a sinus tachycardia (168 bat/min). In the ECG of eight dogs there was increase of duration of P (47±6.5ms) suggestive to atrial enlargement, not confirmed in the radiography. A supraunlevelling was observed in the ST segment in one dog. In the hematological results, thrombocytopenia (187.4x10³ ±137.2x10³) and anemia (5.0x10(6) ±1.39x10(6)/ul) were noted. The mean hemoglobin (11 ±2.7g/dL), hematocrit (34±10.5%) were below normal limits. The white series were within normal variation, with the exception of eosinophilia observed in three dogs. Individually, there were two dogs which registered leukocytosis, lymphocytosis and neutrophilia. In the biochemical evaluation there was hyperproteinemia PT=7.2 ±0.9g/dL, hypoalbuminemia (2.2±0.4g/dL), hyperglobulinemia (5.1±1.0g/dL), increased of CK (196+171 U/L) and there was no alteration on ALT and AST enzymes. The CK-MB isoenzymes and cTnI did not change, except in three dogs. We conclude that dogs naturally infected in the northeastern semiarid present characteristics related to indeterminate chronic form (asymptomatic dogs) and that the identification of the naturally infected dogs with no pathognomonic characteristics of the Chagas disease underscores the importance of this illness in the diagnostic process with the other profiles that show nonspecific or not associated to cardiovascular disease.

Cardiac markers: profile in rats experimentally infected with Toxocara canis / Marcadores cardíacos: perfil em ratos infectados experimentalmente com Toxocara canis

The aim of this study was to evaluate the profile of the enzymes creatine kinase (CK), creatine kinase MB (CK-MB) and lactate dehydrogenase (LDH) in Wistar rats infected with 250 (GI, n = 24) or 1000 (GII, n = 24) Toxocara canis eggs. Animals were evaluated on days 7, 15, 30, 60, 120 and 180 post-infection (DPI). Only the GI rats showed an increase in CK and CK-MB, at 15 and 30 DPI, respectively. Anti-Toxocara spp. antibodies were detected by ELISA in infected animals. Despite of the presence of eosinophilic infiltrate in the heart of three infected animals, none larva was recovered from the organ neither by acid digestion nor by Baermann procedure. Eosinophilia was observed in both groups but there was no significant difference in the eosinophil counts between GI and GII (p = 0.2239). It is possible to consider that cardiac lesion is an eventual finding in murine model for toxocariasis

O objetivo do presente estudo foi avaliar o perfil das enzimas creatinoquinase (CK), creatinoquinase-MB (CK-MB) e lactato desidrogenase (LDH) em ratos Wistar infectados com 250 (GI, n = 24) ou 1000 (GII, n = 24) ovos de Toxocara canis. Os animais foram avaliados nos dias 7, 15, 30, 60, 120 e 180 pós-infecção (DPI). Observou-se que apenas os animais do GI apresentaram aumento da atividade de CK e CK-MB aos 15 e 30 DPI, respectivamente. Anticorpos anti-T. canis foram detectados por ELISA nos animais infectados. Apesar da presença de infiltrado eosinofílico em três animais infectados, nenhuma larva foi recuperada do coração pela digestão ácida ou pela técnica de Baermann. Eosinofilia foi observada em todos os momentos em GI e GII, sem diferença significativa entre os grupos (p = 0,2239). Pode-se considerar que as lesões cardíacas foram um achado eventual no modelo murino para toxocaríase.

Hydatid cyst of the left ventricle of the heart

The present study involves a 47-year-old male patient from Jordan that presented with a history of progressive shortness of breath and chest tightness. Cardiac hydatidosis was diagnosed based on typical radiological findings and a positive serology test. Intra-operatively, there was a mass of a hydatid cyst located in the left ventricle and interventricular septum with no other organs involved. The patient was treated by a surgical excision and albendazole without any complications

Stroke: a rare presentation of cardiac hydatidosis.

A 13-year-old boy presented with acute stroke leading to right-sided hemiparesis. A contrast CT scan of the brain showed a hemorrhagic infarct in the left basal ganglia region with surrounding edema. Echocardiography showed a hydatid cyst in the right atrial chamber extending into the left atrium. A single hepatic hydatid was also seen.

Infarto agudo del miocardio de probable etiología viral: presentación de un caso / Acute myocardial infaction of probable viral etiology

La gran mayoría de los infartos agudos del miocardio es de etiología aterosclerótica. La edad de presentación se ubica más en la sexta década de la vida. Infartos agudos del micardio en pacientes jovénes indican otras posibilidades etiológicas. Aquí se presenta un cuadro clínico de probable etiología viral

Cardiac B-receptors in experimental Chagas`disease

Estudaram-se os receptores beta cardiacos de camundongos infectados pelo Trypanosoma cruzi na fase pos-aguda da doenca de Chagas para estabelecer em que medida os mesmos contribuem a gerar respostas anomalas as catecolaminas observadas nestes miocardios. Utilizara-se 3-H/DHA para a marcacao dos receptores beta cardiacos dos camundongos normais e dos infectados na fase pos-aguda (45 a 90 dias pos-infeccao). O numero dos sitios de fixacao foi similar nos dois grupos, 78.591 ñ 3.125 fmol/mg. Proteina no grupo controle. Em vez disso, a afinidade verificou-se significamente diminuida no grupo chagasico (Kd = 7.299 ñ 0.212 nM) p < 0.001. Os resultados obtidos demonstraram que as modificacoes observadas na estimulacao adrenergica do miocardio chagasico se correlacionam com a menor afinidade dos receptores beta cardiacos e que estas alteracoes exerceriam uma parte determinante para as consequencias funcionais que sao detectadas na fase cronica.

Secondary hydatid cyst of the brain: a case report

A fifteen year old boy is reported with one month history of headache, dysphasia and right sided weakness which were due to progressive growth of more than fifteen hydatid cysts spread in both cerebral hemispheres. Echocardiography proved the origin of the cysts from the heart

Cardiopatia Chagasica, caracteristica clinicas electrocardiografica / Cardiopaty Chagasic, Charatericty clinics electrocardiografic

Se estudiaron 503 pacientes del consultorio externo del CENETROP con diagnostico de infeccion chagasica. La edad promedio del grupo fue de 38.34 anos. 216 eran del sexo masculino con una edad promedio de 38.0+- 13.7 y 287 del sexo femenino con edad promedio de 38.5+- 13.6. La prevalencia de miocardiopatia chagasica fue del 37.7 por ciento. La edad promedio de los pacientes con miocardiopatia fue de 44.5 anos y la de los pacientes con ECG normal fue de 34.6 anos(p=0.0001). Del total de anormalidades electrocardiograficas el 55.2 por ciento eran debidas a trastornos de de la conduccion intraventricular, con un 39.9 por ciento de afeccion de la rama derecha del haz de his ya sea solo (7.4 por ciento), o asociado al hemibloqueo anterior izquierdo (14.7 por ciento). El bloque completo de la rama izquierda se obserbo solo en el 1.6 por ciento de los casos