28 research outputs found
2 nd Brazilian Consensus on Chagas Disease, 2015
Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research
Chagas Heart Disease: Pathophysiologic Mechanisms, Prognostic Factors and Risk Stratification
Chagas heart disease (CHD) results from infection with the protozoan
parasite Trypanosoma cruzi and is the leading cause of infectious
myocarditis worldwide. It poses a substantial public health burden due
to high morbidity and mortality. CHD is also the most serious and
frequent manifestation of chronic Chagas disease and appears in 20-40%
of infected individuals between 10-30 years after the original acute
infection. In recent decades, numerous clinical and experimental
investigations have shown that a low-grade but incessant parasitism,
along with an accompanying immunological response [either
parasite-driven (most likely) or autoimmune-mediated], plays an
important role in producing myocardial damage in CHD. At the same time,
primary neuronal damage and microvascular dysfunction have been
described as ancillary pathogenic mechanisms. Conduction system
disturbances, atrial and ventricular arrhythmias, congestive heart
failure, systemic and pulmonary thromboembolism and sudden cardiac
death are the most common clinical manifestations of chronic Chagas
cardiomyopathy. Management of CHD aims to relieve symptoms, identify
markers of unfavourable prognosis and treat those individuals at
increased risk of disease progression or death. This article reviews
the pathophysiology of myocardial damage, discusses the value of
current risk stratification models and proposes an algorithm to guide
mortality risk assessment and therapeutic decision-making in patients
with CHD
Chagas disease
Chagas disease is a chronic, systemic, parasitic infection caused by the protozoan Trypanosoma cruzi, and was discovered in 1909. The disease affects about 8 million people in Latin America, of whom 30-40% either have or will develop cardiomyopathy, digestive megasyndromes, or both. In the past three decades, the control and management of Chagas disease has undergone several improvements. Large-scale vector control programmes and screening of blood donors have reduced disease incidence and prevalence. Although more effective trypanocidal drugs are needed, treatment with benznidazole (or nifurtimox) is reasonably safe and effective, and is now recommended for a widened range of patients. Improved models for risk stratification are available, and certain guided treatments could halt or reverse disease progression. By contrast, some challenges remain: Chagas disease is becoming an emerging health problem in non-endemic areas because of growing population movements; early detection and treatment of asymptomatic individuals are underused; and the potential benefits of novel therapies (eg, implantable cardioverter defibrillators) need assessment in prospective randomised trials