Chagas disease: don't forget it in Latin American patients with heart block!

Chagas disease is caused by the parasite Trypanosoma cruzi, and mostly affects poor rural populations of central and south America. It is mainly acquired by bugs (triatoma) but also by ingestion of the parasite (fresh fruit juices) or by foetal-maternal blood passing. Despite an important decrease in transmission during the last decades in several countries, millions of patients are still chronically infected and most of them are asymptomatic. In 2012-2013, two cases were admitted in our cardiac intensive care unit (ICU) with heart block due to Chagas cardiomyopathy. Diagnosis was established by echocardiography and positive serological results for Trypanosoma cruzi. This report underlines that in cases of heart failure and conduction abnormalities of unclear aetiology, Chagas disease should be taken into consideration, even in patients originating from non-endemic countries.

ELISA seroprevalence of Trypanosoma cruzi in a cohort of heart disease patients.

INTRODUCTION: Chagas disease is the most important parasitic disease in El Salvador and Latin America. The disease has two phases: acute and chronic, with an intermediate unspecified phase. The chronic phase develops in 30% of infected persons and its most common manifestation is cardiac disease. This study aimed to obtain reference data for the prevalence of T. cruzi seropositivity in a cohort of cardiac patients. METHODOLOGY: A cross-sectional study involving consecutive heart disease patients consulting at the National Hospital Rosales was conducted over a six-month period. Congenital heart disease patients were excluded. A survey, file review, and ELISA serological test were conducted for each subject. RESULTS: Out of 455 subjects, 76 were seropositive for T. cruzi, giving a seropositivity prevalence of 16.7%. The average age of the patients was 58.09 years and the female:male ratio was 2.79:1. No significant difference was found between T. cruzi seropositive and seronegative patients in terms of age and gender. No association between T. cruzi serological status and either area of residence or seeing vectors in the house was found. However, living in the Salvadoran western region during childhood was significantly associated with seropositivity (p = 0.003). Other factors associated with T. cruzi seropositivity included: clinical diagnosis of cardiac Chagas disease; electrocardiographic (ECG) findings of a permanent pacemaker, all atrioventricular (AV) blocks and right bundle branch block; and grade III-IV radiological cardiomegaly. CONCLUSIONS: T. cruzi seropositivity prevalence was found to be 16.7% among heart disease patients in a public reference hospital.

A rare form of trifascicular block with intermittent complete atrioventricular block in a patient with Chagas disease.

Trifascicular block, which consists of impaired conduction in the three main fascicles of the ventricular conduction system, may progress to high-grade or complete atrioventricular block. Exceptionally, it is possible to register in the same patient paroxysmal alternating atrioventricular block and bilateral bundle branch block. This is the electrocardiogram of a male, 60 year-old patient coming from an endemic area, with positive serology for Chagas disease, with the exclusively dromotropic form (there are no signs of cardiac muscle involvement), manifest by repetitive pre-syncope and syncope episodes.

Heart involvement in disseminated cysticercosis- a case report and review of literature.

Heart involvement in cysticercosis is uncommon but is well described in literature. Most of the reports are in the form of autopsy studies. Here we describe a young female with asymptomatic involvement of the heart, diagnosed by echocardiography.

Chronic myocardial damage in experimental T. cruzi infection of a new world primate, Cebus sp. monkey

Dezoito macacos Cebus apella (jovens e adultos de ambos os sexos) foram inoculados há 5 anos atrás, com 3 cepas de T. cruzi (CA1, n=10; Colombiana, n=4 e Tulahuen, n=4) seja por via conjuntiva ou intraperitonial, uma única vez ou repetidamente. Os achados parasitológicos, hematológicos, sorológicos, enzimáticos, radiográficos, eletro e ecocardiográficos foram anteriormente publicados e säo semelhantes aqueles vistos no homem. O achado eletrocardiográfico mais freqüente foi o bloqueio do ramo direito. Seis animais, escolhidos ao acaso, foram sacrficados. Aqueles sacrificados 20 e 25 meses após a primeira inoculaçäo mostraram acúmulos focais de leucócitos com miocitólise. Focos de fibrose intersticial difusa com pequeno infiltrado de leucócitos entre as fibras foram observados em animais sacrificados 36 a 47 meses após a inoculaçäo. Näo foram encontrados parasitas. As lesöes foram mais proeminentes nas paredes ventrículares e no septo. O achado de infiltrados predominantemente, nos animais sacrificados em tempo mais curto em relaçäo à primeira inoculaçäo e a fibrose mais severa naqueles sacrificados após um tempo maior sugere que existe uma progressäo das lesöes infiltrativas até a fibrose, com atividade leucocítica indicativa de fase crônica