Abstract
American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53-3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11-0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03-2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.
Highlights
There are circa 7 million persons infected by Trypanosoma cruzi, the agent of Chagas disease (CD) [1]
In Brazil, especially in the Northern macro-region vector-borne disease transmitted by Triatomineae (“kissing bugs”), CD has been associated with poor housing conditions in rural areas [2]
We studied a cohort of patients with CD (ICF) admitted over two decades to an outpatient clinic in inner São Paulo State, Brazil
Summary
There are circa 7 million persons infected by Trypanosoma cruzi, the agent of Chagas disease (CD) [1]. In Brazil, especially in the Northern macro-region vector-borne disease transmitted by Triatomineae (“kissing bugs”), CD has been associated with poor housing conditions in rural areas [2]. That form of transmission has decreased as quality of housing improved in the country. The oral transmission (associated with ingesting the vector smashed alongside with acaı or sugarcane juices) has been increasingly reported. CD may be transmitted through blood transfusion and vertically. European and North American countries are at risk due to migration from endemic areas [1,3,4,5,6]
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