Abstract
This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). This cross-sectional study included 186 adults who were evaluated using electrocardiography, echocardiography, chest radiography, and contrast radiography of the esophagus and colon. A clinical-epidemiological questionnaire was also used. The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Heart failure (functional classes I-IV) was detected in 7.5% (14/186) of the participants, and 36.4% (24/66), 30.3% (20/66), 15.2% (10/66), 13.6% (9/66), and 4.5% (3/66) of the patients were at stage A, B1, B2, C, and D, respectively. Dilated cardiomyopathy and electrocardiographic changes were detected in 10.2% (19/186) and 48.1% (91/186) of the participants, respectively. Apical aneurysm was diagnosed in 10.8% (20/186) of the participants, and other changes in the segmental myocardial contractility of the left ventricle were diagnosed in 33.9% (63/186) of the participants. Megaesophagus (groups I-IV) was observed in 7% (13/186) of the participants, megacolon (grades 1-3) was detected in 12.9% (24/186) of the participants, and both organs were affected in 29.2% (7/24) of the megacolon cases. We detected various clinical forms of Chagas disease (including the digestive form). Our findings indicate that clinical symptoms alone may not be sufficient to exclude or confirm cardiac and/or digestive damage, and the number of patients with symptomatic clinical forms may be underestimated.
Highlights
This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil)
Chagas disease (ChD) remains a major public health challenge in Latin America, where it currently affects 5.7 million individuals, with the largest numbers observed in Argentina, Brazil, and Mexico(1).The clinical manifestations of ChD exhibit regional variations that are associated with different factors and are related to the parasite and/or host as the main cause of the chronic phase of the disease(2).The digestive form is considered common in central Brazil and Chile, it is practically non-existent in Venezuela and Central America(3)
Studies regarding chronic ChD in endemic areas have typically been conducted by stratifying the clinical forms using the patients’ clinical symptoms, and without the use of contrast radiography. This is the first study to characterize the clinical forms of ChD and the severity of its clinical manifestations among patients with chronic infection in Western Rio Grande do Norte (RN)
Summary
This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). Results: The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Chagas disease (ChD) remains a major public health challenge in Latin America, where it currently affects 5.7 million individuals, with the largest numbers observed in Argentina, Brazil, and Mexico(1).The clinical manifestations of ChD exhibit regional variations that are associated with different factors and are related to the parasite and/or host as the main cause of the chronic phase of the disease(2).The digestive form is considered common in central Brazil and Chile, it is practically non-existent in Venezuela and Central America(3). The indeterminate form is characterized by the absence of symptoms that are compatible with ChD, and common diagnostic testing is not normally performed, such as conventional serology,12-lead electrocardiography, and radiography of the chest, esophagus, and colon(5). The high mortality rateis due to chronic ChD cardiomyopathy (CCC), which is characterized by manifestations that include complex arrhythmias, heart failure, and thromboembolic
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