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1.
Rev Soc Bras Med Trop ; 50(3): 296-300, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28700045

RESUMO

After more than one century since its discovery, Chagas disease is still extremely prevalent in 21 Latin American countries. Chagas disease is one of the most concerning public health problems in Latin America; the overall cost of CD treatment is approximately 7 billion United States dollars per year and it has a strong social impact on populations. Little progress has been made regarding the access to diagnosis and treatment at the primary health care level, calling into question the current policies to ensure the right to health and access to essential medications. In this article, diverse dimensions of access to treatment for Chagas disease are reviewed, illustrating the present state of benznidazole medication in relation to global production capacity, costs, and needs. The findings are based on an investigation requested by Médecins Sans Frontières Brazil through a consultancy in 2015, aiming to estimate the current costs of benznidazole production.


Assuntos
Doença de Chagas/tratamento farmacológico , Custos de Medicamentos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Brasil , Doença de Chagas/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , América Latina , Nitroimidazóis/economia , Tripanossomicidas/economia
2.
J Antimicrob Chemother ; 72(9): 2596-2601, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28645201

RESUMO

Background: Up to half of patients with Chagas' disease under benznidazole treatment present adverse drug reactions (ADRs) and up to one-third do not complete standard treatment. Objectives: To verify the incidence and possible factors associated with the suspension of benznidazole treatment in a large cohort of patients. Methods: We included 2075 patients treated with benznidazole during the projects managed by the medical humanitarian organization Doctors Without Borders (Médecins Sans Frontières) in Bolivia from 2009 to 2013. Benznidazole treatment was provided two or three times per day for ∼60 days at 5-7.5 mg/kg/day. A multiple logistic regression model was developed to evaluate the factors associated with permanent suspension of benznidazole treatment. Results: Permanent benznidazole treatment suspension occurred in 211 patients (10.2%) and the average time until permanent treatment suspension was 23 days. Multifactorial analysis revealed that female sex (adjusted OR = 1.70), moderate ADRs (adjusted OR = 10.57), mild ADRs (adjusted OR = 1.69) and skin disorders (adjusted OR = 4.18) were significantly associated with the permanent suspension of benznidazole treatment. Women with mild or moderate skin ADRs presented a probability of treatment interruption of 18.6% and 59.0%, respectively. Conclusions: Benznidazole treatment was safe and a large proportion of patients were able to complete a full course of benznidazole treatment under close treatment surveillance. Female sex, skin disorders and mild and moderate ADRs were independently associated with the permanent suspension of benznidazole treatment. In particular, women with moderate skin ADRs had the highest risk of benznidazole treatment interruption.


Assuntos
Doença de Chagas/tratamento farmacológico , Nitroimidazóis/efeitos adversos , Tripanossomicidas/administração & dosagem , Adulto , Bolívia/epidemiologia , Doença de Chagas/epidemiologia , Doença de Chagas/etnologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nitroimidazóis/administração & dosagem , Nitroimidazóis/uso terapêutico , Cooperação do Paciente/etnologia , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/efeitos dos fármacos
3.
Rev. Soc. Bras. Med. Trop ; 50(3): 296-300, May-June 2017. tab
Artigo em Inglês | LILACS | ID: biblio-896973

RESUMO

Abstract After more than one century since its discovery, Chagas disease is still extremely prevalent in 21 Latin American countries. Chagas disease is one of the most concerning public health problems in Latin America; the overall cost of CD treatment is approximately 7 billion United States dollars per year and it has a strong social impact on populations. Little progress has been made regarding the access to diagnosis and treatment at the primary health care level, calling into question the current policies to ensure the right to health and access to essential medications. In this article, diverse dimensions of access to treatment for Chagas disease are reviewed, illustrating the present state of benznidazole medication in relation to global production capacity, costs, and needs. The findings are based on an investigation requested by Médecins Sans Frontières Brazil through a consultancy in 2015, aiming to estimate the current costs of benznidazole production.


Assuntos
Humanos , Tripanossomicidas/uso terapêutico , Custos de Medicamentos/estatística & dados numéricos , Doença de Chagas/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Nitroimidazóis/uso terapêutico , Tripanossomicidas/economia , Brasil , Doença de Chagas/economia , Necessidades e Demandas de Serviços de Saúde , América Latina , Nitroimidazóis/economia
4.
Rev Soc Bras Med Trop ; 49(6): 721-727, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28001219

RESUMO

INTRODUCTION:: Geographical, epidemiological, and environmental differences associated with therapeutic response to Chagas etiological treatment have been previously discussed. This study describes high seroconversion rates 72 months after benznidazole treatment in patients under 16 years from a project implemented by Doctors without Borders in Guatemala. METHODS:: An enzyme-linked immunosorbent assay was used to detect Trypanosoma cruzi IgG antibodies in capillary blood samples from patients 72 months after treatment. Fisher's exact test was used to establish association between characteristics, such as sex, age, and origin of patients, and final seroconversion. Kappa index determined concordance between laboratory tests. The level of significance was set to 5%. RESULTS:: Ninety-eight patients, aged 6 months to 16 years, were available for follow-up. Sex and origin were not associated with seroconversion. Individuals older than 13 were more prone to maintain a positive result 72 months after treatment, although results were not highly significant. Laboratory tests presented elevated Kappa concordance (95% CI) = 0.8290 (0.4955-1), as well as high (97%) seroconversion rates. CONCLUSIONS:: The high seroconversion rate found in this study emphasizes the importance of access to diagnosis, treatment, and follow-up of individuals affected by Chagas disease. Moreover, it contradicts the idea that it is not possible to achieve a cure with the currently available drugs. This study strongly supports expanding programs for patients infected with T. cruzi in endemic and non-endemic countries.


Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/imunologia , Adolescente , Doença de Chagas/imunologia , Criança , Pré-Escolar , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Feminino , Guatemala , Humanos , Lactente , Masculino , Soroconversão , Resultado do Tratamento
5.
Rev. Soc. Bras. Med. Trop ; 49(6): 721-727, Dec. 2016. tab, graf
Artigo em Inglês | LILACS | ID: biblio-829672

RESUMO

Abstract INTRODUCTION: Geographical, epidemiological, and environmental differences associated with therapeutic response to Chagas etiological treatment have been previously discussed. This study describes high seroconversion rates 72 months after benznidazole treatment in patients under 16 years from a project implemented by Doctors without Borders in Guatemala. METHODS: An enzyme-linked immunosorbent assay was used to detect Trypanosoma cruzi IgG antibodies in capillary blood samples from patients 72 months after treatment. Fisher's exact test was used to establish association between characteristics, such as sex, age, and origin of patients, and final seroconversion. Kappa index determined concordance between laboratory tests. The level of significance was set to 5%. RESULTS: Ninety-eight patients, aged 6 months to 16 years, were available for follow-up. Sex and origin were not associated with seroconversion. Individuals older than 13 were more prone to maintain a positive result 72 months after treatment, although results were not highly significant. Laboratory tests presented elevated Kappa concordance (95% CI) = 0.8290 (0.4955-1), as well as high (97%) seroconversion rates. CONCLUSIONS: The high seroconversion rate found in this study emphasizes the importance of access to diagnosis, treatment, and follow-up of individuals affected by Chagas disease. Moreover, it contradicts the idea that it is not possible to achieve a cure with the currently available drugs. This study strongly supports expanding programs for patients infected with T. cruzi in endemic and non-endemic countries.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/imunologia , Anticorpos Antiprotozoários/sangue , Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Ensaio de Imunoadsorção Enzimática , Doença Crônica , Resultado do Tratamento , Doença de Chagas/imunologia , Soroconversão , Guatemala
6.
Mem. Inst. Oswaldo Cruz ; 108(8): 1009-1013, 6/dez. 2013. tab, graf
Artigo em Inglês | LILACS | ID: lil-697154

RESUMO

A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals.


Assuntos
Animais , Humanos , Cardiomiopatia Chagásica/diagnóstico , Brasil/epidemiologia , Estudos de Casos e Controles , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/epidemiologia , Ecocardiografia , Eletrocardiografia , Insetos Vetores/classificação , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia
7.
Mem Inst Oswaldo Cruz ; 108(8): 1009-13, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24402153

RESUMO

A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals.


Assuntos
Cardiomiopatia Chagásica/diagnóstico , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/epidemiologia , Ecocardiografia , Eletrocardiografia , Humanos , Insetos Vetores/classificação , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia
8.
Rev Soc Bras Med Trop ; 43(2): 170-7, 2010.
Artigo em Português | MEDLINE | ID: mdl-20464148

RESUMO

INTRODUCTION: A seroepidemiological and clinical study was conducted on 152 autochthonous individuals living in the district of Barcelos, State of Amazonas, to evaluate the seroprevalence of Chagas infection and morbidity of Chagas disease. METHODS: The serological tests used were indirect immunofluorescence, conventional and recombinant ELISA and immunoblot (Tesa-blot). Thirty-eight patients were considered seropositive; 31 were considered serodoubtful; and 83 were considered seronegative. The 38 seropositive cases were paired with 38 seronegative controls of the same age and sex, and underwent epidemiological and clinical evaluations, electrocardiograms and echocardiograms. Twenty-nine pairs underwent radiological examinations of the esophagus. RESULTS: Seropositivity was 19.9 times more frequent among workers gathering plant materials from the forests and 10.4 times more frequent among piassaba gatherers. Eighty six point seven percent of the seropositive individuals recognized the genus Rhodnius as the local vector, while only 34.2% of the seronegative individuals recognized this. The EKG was abnormal in 36.8% of the seropositive individuals and in 21.5% of the seronegative individuals, while the echocardiogram showed abnormalities in 31.6% of the seropositive and 18.4% of the seronegative individuals. Precordialgia and palpitation were more frequent among the seropositive individuals. Clinical evaluation on the digestive system and X-ray on the esophagus did not show significant abnormalities. CONCLUSIONS: Chagas disease in the study region can be considered to be an occupational disease.


Assuntos
Doença de Chagas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Criança , Doença Crônica , Ecocardiografia , Eletrocardiografia , Ensaio de Imunoadsorção Enzimática , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Insetos Vetores , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/parasitologia , Rhodnius , Estudos Soroepidemiológicos , Adulto Jovem
9.
Rev. Soc. Bras. Med. Trop ; 43(2): 170-177, Mar.-Apr. 2010. ilus, tab
Artigo em Português | LILACS | ID: lil-545772

RESUMO

INTRODUÇÃO: Foi realizado um estudo soroepidemiológico e clínico em 152 indivíduos residentes no município de Barcelos, Estado do Amazonas. Avaliou-se a soroprevalência da infecção chagásica e a morbidade da doença de Chagas. MÉTODOS: Os testes sorológicos foram a imunofluorescência indireta, ELISA convencional e recombinante e o Tesa-blot. Foram considerados soropositivos 38 pacientes, duvidosos 31 e soronegativos negativos 83. Os 38 casos soropositivos foram pareados com 38 controles soronegativos da mesma idade, sexo e submetidos à avaliação epidemiológica, clínica, eletro e ecocardiográfica, sendo que, 29 pares fizeram exame radiológico do esôfago. RESULTADOS: A soropositividade foi 19,9 vezes mais frequente nos trabalhadores do extrativismo em geral e 10,4 vezes mais frequente no extrativismo da piaçaba. Aplicou-se o teste de reconhecimento com o vetor local do gênero Rhodnius e 86,7 por cento dos pacientes soropositivos o reconheceram, enquanto somente 34,2 por cento dos soronegativos o fizeram. O ECG mostrou-se alterado em 36,8 por cento nos soropositivos e em 21,5 por cento nos soronegativos, enquanto o ecocardiograma mostrou alterações em 31,6 por cento nos soropositivos e 18,4 por cento nos soronegativos. Precordialgia e palpitações foram mais frequentes nos soropositivos. O estudo clínico do aparelho digestivo e radiológico do esôfago não mostrou alterações significativas. CONCLUSÕES. A doença de Chagas na região estudada pode ser considerada uma doença ocupacional.


INTRODUCTION: A seroepidemiological and clinical study was conducted on 152 autochthonous individuals living in the district of Barcelos, State of Amazonas, to evaluate the seroprevalence of Chagas infection and morbidity of Chagas disease. METHODS: The serological tests used were indirect immunofluorescence, conventional and recombinant ELISA and immunoblot (Tesa-blot). Thirty-eight patients were considered seropositive; 31 were considered serodoubtful; and 83 were considered seronegative. The 38 seropositive cases were paired with 38 seronegative controls of the same age and sex, and underwent epidemiological and clinical evaluations, electrocardiograms and echocardiograms. Twenty-nine pairs underwent radiological examinations of the esophagus. RESULTS: Seropositivity was 19.9 times more frequent among workers gathering plant materials from the forests and 10.4 times more frequent among piassaba gatherers. Eighty six point seven percent of the seropositive individuals recognized the genus Rhodnius as the local vector, while only 34.2 percent of the seronegative individuals recognized this. The EKG was abnormal in 36.8 percent of the seropositive individuals and in 21.5 percent of the seronegative individuals, while the echocardiogram showed abnormalities in 31.6 percent of the seropositive and 18.4 percent of the seronegative individuals. Precordialgia and palpitation were more frequent among the seropositive individuals. Clinical evaluation on the digestive system and X-ray on the esophagus did not show significant abnormalities. CONCLUSIONS: Chagas disease in the study region can be considered to be an occupational disease.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Doença de Chagas/diagnóstico , Brasil/epidemiologia , Estudos de Casos e Controles , Doença Crônica , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Ecocardiografia , Eletrocardiografia , Ensaio de Imunoadsorção Enzimática , Técnica Indireta de Fluorescência para Anticorpo , Insetos Vetores , Doenças Profissionais/epidemiologia , Doenças Profissionais/parasitologia , Rhodnius , Estudos Soroepidemiológicos , Adulto Jovem
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