Cardiopatia chagásica crônica no Rio Negro, Estado do Amazonas. Relato de três novos casos autóctones, comprovados por exames sorológicos, clínicos, radiográficos do tórax, eletro e ecocardiográficos

We report three new autochthonous cases of chronic chagasic cardiomyopathy from Rio Negro, Amazon State, confirmed by serology (indirect immunofluorescence, ELISA and Western-blot for Trypanosoma cruzi infection), clinical examination, chest X-rays, electro- and echocardiography. The three patients were born and lived all their lives in the Rio Negro region working as piacaba gatherers, where they were bitten several times by sylvatic triatomine bugs. The clinical feature was congestive heart failure and intraventricular conduction impairment in the three cases (right bundle branch block with left anterior hemiblock in two cases, left bundle branch block of 3rd degree in one), polimorphic ventricular extrasystoles in two cases and primary T wave inversion in another one. The echocardiographic evaluation showed a significant increasing of the left ventricular diameters with ejection fraction lesser than 36%, and myocardial segmental impairment pattern, including apical aneruysm and postero-inferior akinesia in the three patients. These are the first autochthonous cases of chronic Chagasic cardiomyopathy from the Brazilian Amazon state with echocardiographic pattern suggestive of Chagas' disease.

[1]  T. Nunes.  Second school education. , 2000, Memórias do Instituto Oswaldo Cruz.

[2]  Sebastião Aldo da Silva Valente,et al.  Acometimento cardíaco em pacientes com doença de Chagas aguda em microepidemia familiar, em Abaetetuba, na Amazônia Brasileira , 2001 .

[3]  H. F. Neto,et al.  Considerations on the epidemiology and transmission of Chagas disease in the Brazilian Amazon. , 1999, Memorias do Instituto Oswaldo Cruz.

[4]  Enio Roberto Pietra Pedroso,et al.  Patologia da forma aguda, toxêmica, da esquistossomose mansoni , 1986 .

[5]  A. Voller,et al.  MICROPLATE ENZYME-LINKED IMMUNOSORBENT ASSAY FOR CHAGAS' DISEASE , 1975, The Lancet.

[6]  Sérgio Salles Xavier,et al.  Doença de Chagas em Virgem da Lapa, Minas Gerais, Brasil. IV. Aspectos clínicos e epidemiológicos do aneurisma ventricular esquerdo , 1998 .

[7]  H. Schenone,et al.  [Value of xenodiagnosis in chronic Chagasic infection]. , 1968, Boletin chileno de parasitologia.

[8]  P. Wincker,et al.  A simple protocol for the physical cleavage of Trypanosoma cruzi kinetoplast DNA present in blood samples and its use in polymerase chain reaction (PCR)-based diagnosis of chronic Chagas disease. , 1993, Memorias do Instituto Oswaldo Cruz.

[9]  A. Fm,et al.  Apical lesion of the left ventricle in clinical evolution of chronic Chagas cardiopathy , 1991 .

[10]  J. R. Coura,et al.  Miocardiopatia dilatada em pacientes com infecção chagásica crônica: relato de dois casos fatais autóctones do Rio Negro, Estado do Amazonas , 2003 .

[11]  Camargo Me.  Fluorescent antibody test for the serodiagnosis of American trypanosomiasis. Technical modification employing preserved culture forms of Trypanosoma cruzi in a slide test. , 1966 .

[12]  N. Schiller,et al.  M-mode and two-dimensional echocardiography in chronic Chages' heart disease. A clinical and pathologic study. , 1980, Circulation.

[13]  J. Maguire,et al.  Cardiac morbidity and mortality due to Chagas' disease: prospective electrocardiographic study of a Brazilian community. , 1987, Circulation.

[14]  R. Schwartz,et al.  Superiority of visual versus computerized echocardiographic estimation of radionuclide left ventricular ejection fraction. , 1989, American heart journal.

[15]  R Gorlin,et al.  Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. , 1976, The American journal of cardiology.

[16]  O. Fernandes,et al.  Emerging Chagas disease in Amazonian Brazil. , 2002, Trends in parasitology.

[17]  O. Fernandes,et al.  Chagas' disease in the Brazilian Amazon. III. A cross-sectional study (1). , 1995, Revista do Instituto de Medicina Tropical de Sao Paulo.

[18]  R. Lainson,et al.  Considerações sobre a epidemiologia dos primeiros casos autóctones de doença de Chagas registrados em Belém, Pará, Brasil , 1969 .

[19]  H. Moreira,et al.  Chagasic megaesophagus and megacolon. Historical review and present concepts. , 1988, Arquivos de gastroenterologia.

[20]  G. Silva,et al.  Inquérito sorológico da prevalência de infecção chagásica no Brasil, 1975/1980 , 1984 .

[21]  J. Dias,et al.  The prognostic value of the electrocardiographic features of chronic Chagas' disease. , 1968, Revista do Instituto de Medicina Tropical de Sao Paulo.

[22]  S. Goldenberg,et al.  Use of recombinant antigens for the diagnosis of Chagas disease and blood bank screening. , 1990, Memorias do Instituto Oswaldo Cruz.

[23]  J. C. P. Dias,et al.  Nota sobre uma nova técnica de hemocultura para diagnóstico parasitológico na doença de chagas na sua fase crônica , 1975 .

[24]  E. Barrero,et al.  Detection of anti-pili antibodies of gonococcus using an enzyme-linked immunosorbent assay. , 1999, Memorias do Instituto Oswaldo Cruz.

[25]  O. Fernandes,et al.  Chagas disease in the Brazilian Amazon: IV. a new cross-sectional study. , 2002, Revista do Instituto de Medicina Tropical de Sao Paulo.

[26]  J. Coura,et al.  Immunoblot assay using excreted-secreted antigens of Trypanosoma cruzi in serodiagnosis of congenital, acute, and chronic Chagas' disease , 1996, Journal of clinical microbiology.