Chagas: new statement from the AHA – Medical news



Evaluates the diagnosis and treatment of Chagas disease and its complications.

overview

  • Chagas disease causes severe cardiac complications in about a third of the infected, the American Heart Association emphasizes a new scientific explanation.
  • Chagas disease is caused by infection with the protozoa Trypanosoma cruzi, which can be carried by triatomine insects. Human infection usually occurs when the stool of infected insects is rubbed on bites or mucosal wounds.
  • Although triatomine insects live mainly in Latin America, they can be found in the south of the United States. UU. There are approximately 300,000 immigrants with Chagas disease in the United States. UU., Plus an "unknown number" of people who are locally infected, says the AHA.
  • The acute phase is often undiagnosed because most patients have vague or no symptoms. Left untreated, the Chagas disease remains in a chronic infection, which can lead to dilated cardiomyopathy with heart failure, ventricular arrhythmias, stroke and pulmonary embolism.
  • The AHA statement, available free of charge, discusses the diagnosis and treatment of Chagas disease and its complications.

introduction

American Trypanosomiasis or Chagas disease, caused by the protozoan Trypanosoma cruzi, is responsible for the highest disease burden of any parasitic disease in the Western Hemisphere. In the absence of a successful treatment, the infection continues to exist throughout life and causes severe heart disease in one third of the infected people.

Chagas chronic heart disease can be clinically silent at the beginning of the course of the disease, but can pass into dilated cardiomyopathy with heart failure, ventricular arrhythmias and conduction disturbances, stroke and other systemic or pulmonary disorders.

It is estimated that nearly 6 million people have Chagas disease. Although most of these infected people live in Mexico, Central America and South America, migration patterns have resulted in a large number of infected individuals in previously unaffected areas. , including Europe, Japan, Australia, Canada and the United States with around 300,000 people in the United States alone.

Chagas disease has been attacked by the Centers for Disease Control and Prevention (CDC) as one of the 5 neglected parasitic infections in the United States. The CDC provides educational resources for communities and providers and supports physicians by helping with diagnostic tests and the release of anti-pancreatic drugs.

Nevertheless, Chagas disease is still poorly recognized outside of Latin America. Most American immigrants from endemic countries have limited knowledge about Chagas disease or the risk of infection, and many have limited access to diagnostic and treatment facilities due to insurance or immigration problems.

Infected people are widely distributed in more than 40 states, making extensive assessments and screening a challenge. Most health professionals in the US. UU. They have limited knowledge and knowledge of Chagas disease and are therefore unlikely to discover any risks.

definitions

  • The term Chagas disease is used for general disease. Chagas cardiomyopathy covers all cases of Chagas disease with cardiac involvement, defined by the presence of at least one typical electrocardiogram with abnormality in patients with positive serological tests against T cruzi.
  • Chagasic dilated cardiomyopathy refers to the hemodynamic pattern of Chagas cardiomyopathy characterized by an enlargement of the left ventricle (LV) with worsening of the segmental or global systolic function, independent of the electrocardiographic findings.

epidemiology

It is responsible for 7.5 times more life years lost corrected for disability than malaria

In North and South America, Chagas disease is responsible for 7.5 times more life years adjusted for disability lost than malaria.

Strategies focused on vector control and transmission have led to a significant reduction in global prevalence, which is now estimated at 6 million people compared to 8 million in 2005 and 18 million in 1990.

Despite these improvements, in the 21 endemic countries, it is assumed that 13% of the population remains in danger.
The estimated national infection is highest in Bolivia (6.1%), followed by Argentina (3.6%) and Paraguay (2.1%), while the largest number of people with Chagas disease, 42% of all cases , They live in Brazil (almost 1.2 million people) and Argentina (1.5 million people). It is assumed that nearly 1.2 million people in these countries have Chagas cardiomyopathy.


Estimated number of cases of Chagas disease outside of Latin America.
* States with documented types of triatomines that enable the transmission of the vector. Compiled data from Bern et al, Bern and Montgomery, Gascon et al, and Navarro et al.2


Chagasic heart disease

Sudden death is the most common common cause of death

It is the main manifestation of Chagas disease, which results in the majority of Chagas disease and mortality. Although generally classified as having a hemodynamic pattern of dilated cardiomyopathy, the typical predominant distribution is fibrosis in the posterior and apical areas.

The LV region & # 39; s and the involvement of the sinus node and electrical conduction system distinguish Chagas disease from other cardiomyopathies. The clinical manifestations of Chagas heart disease are due to abnormalities in electrical conduction, contractile dysfunction of the myocardium, arrhythmia or thromboembolism.

In most studies, the sudden death it is the most common common cause of death (55% -60%), followed by heart failure (25% -30%) and embolic events (10% -15%), but the ratios vary depending on the population studied.


Illustration of the most frequent findings in patients with Chagas cardiomyopathy. PVC indicates premature ventricular contraction; RBBB, right branch block; and VT ventricular tachycardia.

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