Abstract
Background: Chronic Chagas disease (CChD), one of the infectious parasitic diseases with the greatest social and economic impact upon a large part of the American continent, has distinct clinical manifestations in humans (cardiac, digestive, or mixed clinical forms). The mechanisms underlying the development of the most common and ominous clinical form, the chronic Chagas cardiomyopathy (CCC) have not been completely elucidated, despite the fact that a high intensity of parasite persistence in the myocardium is deemed responsible for an untoward evolution of the disease. The present study aimed to assess the parasite load CCC and its relation to left ventricular ejection fraction (LVEF), a definite prognostic marker in patients with CCC.Methods: Patients with CCC were clinically evaluated using 12-lead-electrocardiogram, echocardiogram, chest X-ray. Peripheral blood sampling (5 ml of venous blood in guanidine/EDTA) was collected from each patient for subsequent DNA extraction and the quantification of the parasite load using real-time PCR.Results: One-hundred and eighty-one patients with CCC were evaluated. A total of 140 (77.3%) had preserved left ventricular ejection fraction (of ≥40%), and 41 individuals had LV dysfunction (LVEF of <40%). A wide variation in parasite load was observed with a, mean of 1.3460 ± 2.0593 (0.01 to 12.3830) par. Eq./mL. The mean ± SD of the parasite load was 0.6768 ± 0.9874 par. Eq./mL and 3.6312 ± 2.9414 par. Eq./mL in the patients with LVEF ≥ 40% and <40%, respectively.Conclusion: The blood parasite load is highly variable and seems to be directly related to the reduction of LVEF, an important prognostic factor in CCC patients.
Highlights
Chagas disease (ChD) is caused by the hemoflagellate protozoan Trypanosoma cruzi [1]
Since the intensity of tissue inflammation and the evolution of chronic Chagas cardiomyopathy (CCC) are thought to be dependent upon the parasite persistence and multiplication in the myocardium that may be reflected by the parasite burden as assessed with blood real-time Quantitative real-time PCR (qPCR), in the present study we evaluated the relation between the parasite load in the peripheral blood of patients with CCC and its relation to one of the most important prognostic factors for such patients, the left ventricular systolic function
This study evaluated 181 patients who were managed at the Chagas Disease Outpatient Clinic, Division of Cardiology, Ribeirão Preto Medical School, University of São Paulo (FMRPUSP) between 2012 and 2018
Summary
Chagas disease (ChD) is caused by the hemoflagellate protozoan Trypanosoma cruzi [1]. The endemic area of ChD is relatively wide, extending from the southern United States to Argentina [3]. This disease is still one of the infectious and parasitic diseases with the greatest social and economic impact upon much of the American continent, due to its high transmission rates mainly in the Andean countries [4] and to the large bulk of infected individuals in most Latin American countries where disease control is not properly carried out [5, 6]. The pathological changes causing megaesophagus and/or megacolon are deemed to be mainly associated with the extensive destruction of the intramural autonomic system, especially of the Auerbach and Meisner myenteric plexuses of patients chronically infected with the T. cruzi [10, 11]. The present study aimed to assess the parasite load CCC and its relation to left ventricular ejection fraction (LVEF), a definite prognostic marker in patients with CCC
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