Abstract
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.
Highlights
In the Brazilian Amazon, Chagas disease has always been considered an enzootic disease of wild animals since Carlos Chagas (1924) first confirmed that the parasites found in Saimiri sciureus monkeys were Trypanosoma cruzi
José Rodrigues Coura et al Four epidemiological profiles for Chagas disease can be observed in the Amazon Region: (i) enzootic disease of wild animals throughout the region, (ii) anthropozoonosis, i.e., accidental human infection by T. cruzi when man invades the wild ecotope or when triatomines and wild reservoirs of T. cruzi invade human homes, (iii) acute disease caused by oral transmission of T. cruzi through ingestion of food contaminated with the faeces and/or urine of wild triatomines or with the odoriferous secretions of marsupials, causing epidemic outbreaks of acute Chagas disease and (iv) professional disease from plant extraction workers, especially those who work with piassava fibre
A case-control study was conducted to assess the morbidity of Chagas heart disease in 106 patients who were serologically positive for T. cruzi infection with confirmation from at least two techniques with different principles (IIF, conventional ELISA, recombinant ELISA and/or TESA-blot)
Summary
In the Brazilian Amazon, Chagas disease has always been considered an enzootic disease of wild animals since Carlos Chagas (1924) first confirmed that the parasites found in Saimiri sciureus monkeys were Trypanosoma cruzi. A case-control study was conducted to assess the morbidity of Chagas heart disease in 106 patients who were serologically positive for T. cruzi infection with confirmation from at least two techniques with different principles (IIF, conventional ELISA, recombinant ELISA and/or TESA-blot). This sample included patients from all the studies conducted in the area over the past 20 years who presented confirmed serological reactions and for whom clinical, electrocardiographic and echocardiographic examinations were available. Fig. 1: location of the municipality of Barcelos in the microregion of the Negro River, state of Amazonas
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