Abstract
Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is still unknown. The authors aim to describe the clinical and epidemiologic profile of children and adolescents with CD, as well as treatment and cardiac involvement during the follow-up. Methods: A descriptive cohort study was conducted from 1998 to 2013 among children and adolescents up to 18 years-old with confirmed diagnosis of CD. All participants met the criteria of CD in the acute phase. Results: A total of 126 outpatients were included and received treatment and follow-up examinations during a medium period of 10.9 years/person. Most of them (68.3%) had their diagnosis established during oral transmission outbreaks. The diagnostic method with the most positive results rate (80.9%) was the IgM class anti-T. cruzi antibody test as an acute phase marker, followed by the thick blood smears (60.8%). Acute myopericarditis was demonstrated in 18.2% of the patients, most of them with favorable evolution, though 2.4% (3/126) persisted with cardiac injury observed at the end point of the follow-up. Conclusions: Antibodies against T. cruzi persisted in 54.8% of sera from the patients without prognostic correlation with cardiac involvement. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility.
Highlights
Since 1996, there has been an increase in the number of cases of Chagas disease (CD) in Brazil, especially in the states Pará and Amapá in the Brazilian Amazon
Data from most of the endemic areas of Chagas disease in Brazil recorded the acute phase of the disease as an inapparent form among children, on contrary of those cases occurred in the Amazon region [2,3]
All participants were treated and followed up in the reference service for the follow-up of CD patients in the state of Pará, which operates according to the Clinical Protocols on Chagas Disease (PCDCha) and is located at the Unified Medical Care Service–Instituto Evandro Chagas (SOAMU/IEC)
Summary
Since 1996, there has been an increase in the number of cases of Chagas disease (CD) in Brazil, especially in the states Pará and Amapá in the Brazilian Amazon. Data from most of the endemic areas of Chagas disease in Brazil recorded the acute phase of the disease as an inapparent form among children, on contrary of those cases occurred in the Amazon region [2,3]. In Pará state, the disease has peculiarities that are expressed as a very differentiated clinical entity of chronic disease with high morbidity It is characterized by acute febrile syndrome, with manifestations of fever, chills, headache and myalgia and subcutaneous edema, in addition to reversible acute cardiac commitment, after treatment [4]. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility
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