Clinical Outcomes of Thirteen Patients with Acute Chagas Disease Acquired through Oral Transmission from Two Urban Outbreaks in Northeastern Brazil

Chagas disease is caused by a parasitic protozoan transmitted to humans by the contaminated feces of blood-feeding assassin bugs from the Triatominae subfamily. It may also be transmitted from mother to baby during pregnancy, by breastfeeding, blood transfusion or organ transplant. In rare cases, the disease can also be caused by accidental ingestion of contaminated food (sugar cane or açaí juice, drinking water, etc.). Acute Chagas disease often presents itself as a mononucleosis-like syndrome, with symptoms including fever, lymph node enlargement and muscle pain. The mortality rate of acute Chagas disease is high, mainly due to heart failure as a consequence of cardiac fiber lesions. There are few studies describing clinical outcomes and the disease progression of patients who receive therapeutic treatment, especially with regard to cardiac exam findings. In this report, the authors describe clinical findings from two micro-outbreaks occurring in impoverished towns in northeastern Brazil. Prior to receiving treatment, patient mortality rate was 28.6% in one of the outbreaks, and one pregnant woman experienced a spontaneous abortion due to the disease in the other outbreak. Most patients complained of fever, dyspnea, myalgia and periorbital edema. After receiving a two-month course of treatment, clinical symptoms improved and the number of abnormalities in cardiac exams decreased

Serological test results from 13 patients with acute Chagas disease in two urban outbreaks Bahia, Brazil, 2006.

<p>n/a: not available.</p><p>cases 1–5: samples collected on May 5, 10 and 15, 2006 (almost 30 days after exposure); cases 6,7: no samples collected (patients died before Chagas disease was confirmed) <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Dias2" target="_blank">[8]</a>.</p><p>cases 8–13: samples collected on October, 8, 2006 (almost 60 days after exposure). Parasitological tests (thick smear or blood culture): samples processed by FIOCRUZ/Bahia and Couto Maia Hospital, Bahia, Brazil); IFAT (Indirect immunofluorescence antibody test): samples processed by LACEN-Bahia, Brazil and FUNED- Minas Gerais, Brazil; ELISA (IgM): samples processed by FUNED- Minas Gerais, Brazil; Elisa with recombinant antigens <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Houghton1" target="_blank">[20]</a>: samples processed by Edgard Santos University Hospital, Federal University of Bahia, Brazil.</p

Frequencies of signs and symptoms of thirteen patients with acute Chagas disease from Macaúbas and Ibipitanga, Bahia-Brazil.

<p>Frequencies of signs and symptoms of thirteen patients with acute Chagas disease from Macaúbas and Ibipitanga, Bahia-Brazil.</p

Clinical outcome, electrocardiogram (EKG) and Two-dimensional Doppler Echocardiography (ECHO) of thirteen patients with acute Chagas disease from Macaúbas and Ibipitanga, Bahia, Brazil, after benznidazole treatment.

<p>Patient #6 and 7 died before evaluation.</p>¥<p>performed 180 days after the end of benzonidazol treatment.</p><p>*MR = Mitral Regurgitation; PE_F = Pericardic Effusion; SD = Septum Dyskinesis; DDLV = diastolic Disfunction of Left Ventricule, RBBB = right bundle branch block, DVR = Disturbance of Ventricular Repolarization, AFib = Atrial Fibrillation, SB = Sinus Bradcardia, TI = Tricuspid Regurgitation.</p><p>EKG according the AHA/ACCF/HRS 2009 Recommendations for the Standardization and Interpretation of the Electrocardiogram <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Surawicz1" target="_blank">[21]</a> and Guidelines of the Brazilian Society of Cardiology 2009 <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Pastore1" target="_blank">[22]</a>.</p><p>ECHO according the ACC/AHA 2006 practice guidelines <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Bonow1" target="_blank">[23]</a> and ASE committee recommendations <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000711#pntd.0000711-Lang1" target="_blank">[24]</a>.</p