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Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial
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Rassi Jr, Anis

; Marin Neto, José Antonio

; Rassi, Anis

Memórias do Instituto Oswaldo Cruz

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mar 2017, Volume 112 N. 3 Pages 224 - 235

Abstract: En | Text: En | PDF: En

Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage, immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic phase of Chagas disease could prevent complications related to the disease. However, according to the results of the BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease, and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.

https://doi.org/10.1590/0074-02760160334 2889 downloads

2 nd Brazilian Consensus on Chagas Disease, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2016, Volume 49 Suppl. 1 Pages 3 - 60

Abstract: En | Text: En | PDF: En

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 .

https://doi.org/10.1590/0037-8682-0505-2016 9267 downloads

II Consenso Brasileiro em Doença de Chagas, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia Filho, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Epidemiologia e Serviços de Saúde

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jun 2016, Volume 25 N. spe. Pages 7 - 86

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

ABSTRACT Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. 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 collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

https://doi.org/10.5123/S1679-49742016000500002 3725 downloads

II Consenso Brasileiro em Doença de Chagas, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia Filho, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Epidemiologia e Serviços de Saúde

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jun 2016, Volume 25 N. spe Pages 7 - 86

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5123/s1679-49742016000500002 63592 downloads

Adib Domingos Jatene, 1929-2014
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Rassi, Anis

Arquivos Brasileiros de Cardiologia

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mar 2015, Volume 104 N. 3 Pages 179 - 180

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20150022 1701 downloads

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant
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Rassi, Anis

; Rezende, Joffre Marcondes de

; Rassi Junior, Anis

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2012, Volume 45 N. 2 Pages 266 - 268

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Os autores relatam um caso de lactente com megaesôfago do Grupo III por doença de Chagas vetorialmente adquirida, responsável por acentuada desnutrição, da qual se recuperou com a cirurgia de Heller. Submetida em seguida a tratamento da infecção chagásica com benzonidazol, logrou cura, parasito e sorologicamente demonstrada. Seguiram-se anos sem qualquer incidente, com desenvolvimento pondo-estatural normal. Teve seu primeiro filho aos 23 anos, em quem as provas sorológicas para doença de Chagas resultaram negativas. Decorridos 30 anos após o atendimento inicial, continuava com eletrocardiograma e ecocardiograma e/ou exame radiológico do coração normais.

The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patient's electrocardiogram, echocardiogram, and chest radiography remained normal.

2377 downloads Cited 1 time in SciELO

Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I
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Rassi, Anis

; Rezende, Joffre Marcondes de

Revista da Sociedade Brasileira de Medicina Tropical

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feb 2011, Volume 44 N. 1 Pages 70 - 75

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: O esôfago e os cólons foram investigados em pacientes na fase aguda da doença de Chagas, entre 1956 e 1989. MÉTODOS: A deglutição e o exame radiológico do esôfago foram explorados em 94 (90,4%) pacientes, sendo excluídas 10 crianças em virtude de tenra idade. O enema opaco foi realizado em 59 (56,7%) pacientes. RESULTADOS: A deglutição foi referida como normal em 86 (91,5%) pacientes, 5 dos quais apresentaram aperistalse do grupo I, enquanto a disfagia incipiente foi referida por 8, dos quais 7 apresentaram exame radiológico normal e apenas um, aperistalse do grupo I. Um segundo exame radiológico, realizado em 4 dos 6 casos, 6 meses após o primeiro, mostrou-se normal em 3 e permaneceu inalterado em um, o único que recebeu tratamento (benzonidazol) e considerado como curado da infecção. O ritmo intestinal resultou normal em 96 (92,3%) pacientes, obstipado em 7 (6,7%) e diarreico em um (1%). O enema evidenciou resultado normal em 54 (91,5%) pacientes, dolicossigmoide em 4 (6,8%) e dolicorretomegassigmoide em um (1,7%), que a eletromanometria demonstrou ser de natureza funcional. CONCLUSÕES: Para explicar a regressão da aperistalse, aventaram os autores duas hipóteses que não se excluem. A primeira,é a de que o processo inflamatório intramural na fase inicial da infecção poderia interferir na motilidade esofagiana, enfraquecendo a onda peristáltica; com a regressão do processo inflamatório, o peristaltismo voltaria ao normal, desde que a desnervação fosse limitada; a segunda hipótese é a de que tenha havido real re-inervação, com recuperação normal da onda peristáltica.

INTRODUCTION: The esophagus and colons of patients with acute Chagas disease were studied. METHODS: Deglutition and radiological examination of the esophagus were assessed in 94 (90.4%) patients, 10 children were excluded due to their age. Intestinal transit was assessed in 59 (56.7%) patients. RESULTS: Deglutition was normal in 86 (91.5%) patients, 5 of whom presented aperistalsis (group I). Incipient dysphagia was reported by 8 patients, 7 of whom normal barium swallowing, while only one presented esophageal aperistalsis (group I). A second radiological examination of the esophagus was performed in 4 of the 6 cases with aperistalsis 6 months after the initial test. It was normal in 3, and showed aperistalsis in one case, the only patient who was treated with benznidazole and considered cured of the infection. Intestinal transit was normal in 96 (92.3%) patients, constipated in 7 (6.7%), and diarrheic in one (1%). Barium enema was normal in 54/59 (91.5%), showed a dolichosigmoid in 4 (6.8%) and a dolichorectomegasigmoid in one (1.7%), of functional origin, according to the electromanometric results. CONCLUSIONS: To explain the regression of aperistalsis, 2 non-excluding hypothesis were postulated: the intramural inflammatory process, established during the acute phase, could interfere with esophageal motility by weakening the peristaltic waves; with the remission of the inflammatory reaction, the peristaltic activity of the esophagus would return to normal, as long as no extensive denervation occurred; and/or a definitive reinnervation is responsible for the recuperation of the normal esophageal peristaltic activity.

3767 downloads

Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification
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Rassi Jr, Anis

; Rassi, Anis

; Marin-Neto, José Antonio

Memórias do Instituto Oswaldo Cruz

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jul 2009, Volume 104 Suppl. 1 Pages 152 - 158

Abstract: En | Text: En | PDF: En

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.

8471 downloads Cited 2 times in SciELO

The BENEFIT trial: testing the hypothesis that trypanocidal therapy is beneficial for patients with chronic Chagas heart disease
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Marin-Neto, J Antonio

; Rassi Jr, Anis

; Avezum Jr, Alvaro

; Mattos, Antonio C

; Rassi, Anis

Memórias do Instituto Oswaldo Cruz

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jul 2009, Volume 104 Suppl. 1 Pages 319 - 324

Abstract: En | Text: En | PDF: En

Among the pathophysiological derangements operating in the chronic phase of Chagas disease, parasite persistence is likely to constitute the main mechanism of myocardial injury in patients with chronic chagasic cardiomyopathy. The presence of Trypanosoma cruzi in the heart causes a low-grade, but relentless, inflammatory process and induces myocardial autoimmune injury. These facts suggest that trypanocidal therapy may positively impact the clinical course of patients with chronic Chagas heart disease. However, the experimental and clinical evidence currently available is insufficient to support the routine use of etiologic treatment in these patients. The BENEFIT project - Benznidazole Evaluation for Interrupting Trypanosomiasis - is an international, multicenter, double-blind, placebo-controlled trial of trypanocidal treatment with benznidazole in patients with chronic Chagas heart disease. This project is actually comprised of two studies. The pilot study investigates whether etiologic treatment significantly reduces parasite burden, as assessed by polymerase chain reaction-based techniques and also determines the safety and tolerability profile of the trypanocidal drug in this type of chagasic population. The full-scale study determines whether antitrypanosomal therapy with benznidazole reduces mortality and other major cardiovascular clinical outcomes in patients with chronic Chagas heart disease.

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10.

Busca retrospectiva da transmissão maternal da infecção chagásica em pacientes na fase crônica
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Rassi, Anis

; Amato Neto, Vicente

; Rassi, Gustavo Gabriel

; Amato, Valdir Sabbaga

; Rassi Júnior, Anis

; Luquetti, Alejandro O.

; Rassi, Sérgio Gabriel

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2004, Volume 37 N. 6 Pages 485 - 489

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Avaliamos a transmissão maternal do Trypanosoma cruzi em 278 filhos de 145 mães com a doença crônica causada por esse protozoário, nascidos após o estabelecimento do diagnóstico materno. Usamos, nas mães e nos filhos, provas sorológicas como base do objetivo do estudo. Verificamos que ocorreram apenas duas veiculações pela modalidade citada (2/278 = 0,7%). Como houve amamentação, não foi possível diferenciar, nesses casos, a transmissão congênita da adquirida pelo leite, mas, de qualquer forma, processou-se transmissão maternal, que constitui uma das modalidades alternativas de infecção pelo Trypanosoma cruzi. A metodologia empregada é mais uma dentre as diversas propostas para aquilatar a prevalência desse tipo de propagação do Trypanosoma cruzi. Ao lado da constatação fundamental, registramos fatos relacionados com a gestação, parto, puerpério, abortamento, prematuridade, nati-neomortalidade e aleitamento materno, que podem representar subsídios para melhores interpretações sobre o assunto.

Maternal transmission of Trypanosoma cruzi from 278 children of 145 mothers, chronically infected with this protozoan, to their offspring was investigated. This study was based upon serological tests. In only two cases (2/278 = 0.7%), such mode of transmission was demonstrated to have occurred. However, as according to extant records both patients had also been breast-fed, and the contribution of this factor could not be ruled out. In any case, maternal transmission, an alternative mode of acquiring the infection with Trypanosoma cruzi, was demonstrated. The methodology used is a further contribution to the evaluation of the prevalence of this propagating mechanism of T. cruzi; in addition to those aimed at the main objective of the investigation, records were kept about pregnancy, parturition, puerperium, abortion, prematurity, perinatal deaths and breast-feeding, which might contribute to a better interpretation of the subject.

3325 downloads Cited 7 times in SciELO

11.

Estudo clínico e epidemiológico de pacientes submetidos a implante de marcapasso cardíaco artificial permanente: comparação dos portadores da doença de Chagas com os de doenças degenerativas do sistema de condução
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Costa, Roberto

; Rassi, Anis

; Leão, Maria Inês de Paula

Brazilian Journal of Cardiovascular Surgery

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jun 2004, Volume 19 N. 2 Pages 107 - 114

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Estudar os pacientes portadores de marcapasso cardíaco artificial permanente, comparando as características clínicas e epidemiológicas dos portadores da doença de Chagas com a dos portadores de doenças degenerativas do sistema de condução. MÉTODO: Foram analisados 57.632 procedimentos cadastrados no Registro Brasileiro de Marcapassos, realizados no período de 1995 a 2003, sendo: 25.648 pacientes portadores da doença de Chagas e 31.984, de doenças degenerativas. A comparação das características dessas populações foi feita pelos testes do Qui-quadrado e t-Student com nível de significância de 5%. RESULTADOS: Houve predomínio da doença de Chagas na região Centro-Oeste, nos implantes iniciais. Nas reoperações, a população chagásica representou maioria também no Sudeste. A idade dos pacientes chagásicos foi 58,6 ± 15,3 e 59,3 ± 14,8 anos, respectivamente para implantes iniciais e reoperações, e, nos não chagásicos, 73,5 ± 12,6 e 73,7 ± 13,5. Não foi notada diferença na distribuição entre os dois sexos. Houve maior ocorrência de síncopes, pré-síncopes e bloqueio atrioventricular com QRS largo nos pacientes chagásicos e de tonturas, insuficiência cardíaca e QRS estreito nos não chagásicos. O modo de estimulação ventricular foi utilizado em 60% e 63% nos implantes iniciais e em 77% e 76% das reoperações, respectivamente para os pacientes chagásicos e não chagásicos. A depleção da bateria por desgaste normal foi o principal motivo para reoperação dos pacientes, tendo ocorrido em 76,1% e 79,6% das reoperações, respectivamente para chagásicos e não chagásicos. CONCLUSÕES: Os dados analisados demonstraram diferenças significativas nas características clínicas e demográficas das populações estudadas.

OBJECTIVE: To study patients with permanent cardiac pacemakers, comparing the clinical and epidemiological characteristics of patients with Chagas' disease versus the ones with degenerative or ischemic diseases. METHOD: 57,632 procedures performed from 1995 to 2003, registered in the Brazilian Pacemaker Register were analyzed: 25,648 patients with Chagas' disease and 31,984 with degenerative or ischemic bradiarrythmias. The comparison of the characteristics of these two populations included Chi-square and t-Student tests, with a 5% level of significance. RESULTS: There was a predominance of the Chagas' disease in the Centar-west region, in the initial implantations. In re-operations, the population with Chagas' disease represented majority in the Southeast, too. Mean age was 59.3 ± 15.3 and 58.6 ± 14.8, respectively for initial implantations and re-operations in Chagas' disease patients and 73.5 ± 12.6 and 73.7 ± 13.5, in non Chagas'disease patients. There was no difference in respect to both genders and etiology. Syncope episodes and 3rd degree AV block with wide QRS were more frequent in patients with Chagas' disease, and dizziness, heart failure and 3rd degree AV block with in the other patients. Ventricular pacing systems were used in 60% and 63% in the initial implants and 77% and 76% of the reoperations, respectively for Chagas' and non-Chagas' disease patients. The need to change the batteries was the main reason for reoperations in 76.1% and 79.6% of these procedures, respectively for patients with Chagas' disease and the other causes of bradicardia. CONCLUSIONS: The analysis of data of these two populations demonstrated significant differences in the clinical and demographic characteristics.

4084 downloads Cited 4 times in SciELO

12.

Impacto do controle químico extensivo de Triatoma infestans sobre a incidência de casos agudos e a prevalência de doença de Chagas: o exemplo de Montalvânia, Minas Gerais
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Rassi, Anis

; Luquetti, Alejandro O.

; Ornelas, José Florisval

; Ervilha, José Fernandes

; Rassi, Gustavo Gabriel

; Rassi Junior, Anis

; Azeredo, Bernardino Vaz de Mello

; Dias, João Carlos Pinto

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2003, Volume 36 N. 6 Pages 719 - 727

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A partir da emergência de um surto de casos agudos de doença de Chagas em Montalvânia, norte de Minas Gerais, Brasil, e da implantação do controle triatomínico com inseticidas, verifica-se pronta e conseqüente desaparição dos casos e redução da incidência da infecção no Município. É mostrada a evolução da implantação e do controle do Triatoma infestans em Montalvânia e a evolução da sorologia praticada na população em geral, ao longo dos últimos trinta anos.

From the emergency of acute cases of Chagas Disease in Montalvânia, Minas Gerais, Brazil, with the implementation of triatomine chemical control, the disappearing of these cases and the immediate reduction of incidence of the infection in the municipality are verified. The evolution of the dispersion and control of Triatoma infestans in Montalvânia and the evolution of the serology in general population during the last thirty years are showed.

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13.

Tratamento da fase crônica da doença de Chagas com nifurtimox associado a corticóide
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Rassi, Anis

; Amato Neto, Vicente

; Siqueira, Astolpho Ferraz de

; Ferriolli Filho, Francisco

; Amato, Valdir Sabbaga

; Rassi, Gustavo Gabriel

; Rassi Junior, Anis

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2002, Volume 35 N. 6 Pages 547 - 550

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Dez pacientes com doença de Chagas em fase crônica foram tratados durante 60 dias, com uma única exceção, por meio de nifurtimox (8 a 9mg/kg/dia) conjuntamente com betametasona (doses progressivamente decrescentes a partir de 9mg/dia). Houve intenção de utilizar a atividade antiparasitária do nifurtimox paralelamente à capacidade antiinflamatória do corticóide que, pela possibilidade de acentuar a infecção, poderia facilitar a ação do fármaco anti-Trypanosoma cruzi. Em apenas um dos casos ocorreu negatividade prolongada dos xenodiagnósticos efetuados como controles e, quanto aos demais, ficaram evidentes os insucessos terapêuticos, corroborados pela persistência da positividade das provas sorológicas. O estudo também mostrou a necessidade de adequado e duradouro seguimento pós-tratamento para a obtenção de corretas conclusões.

Ten patients with chronic Chagas' disease were treated with nifurtimox (8-9mg/kg/day) associated with betamethasone (9mg/day initially and then gradually reduced) during 60 days, with one exception. It was intended to combine the respective anti-parasitic and anti-inflammatory actions of these drugs. The expected stimulating effect of betamethasone on the infection could possibly enhance the anti-Trypanosoma cruzi action of nifurtimox. Long term persistence of negative xenodiagnosis, used to control the results, was observed in only one of the cases. Regaridng the other patients, post-treatment positivity of xenodiagnosis and serological testes attested the failure of this therapy. As this study has demonstrated, adequate and long term follow-up of treated cases is necessary to ensure correct conclusions.

7586 downloads Cited 1 time in SciELO

14.

Correlação entre a positividade do xenodiagnóstico artificial e a quantidade de sangue e triatomíneos utilizados no exame, em pacientes chagásicos crônicos
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Franco, Yara Bandeira Azevedo

; Silva, Ionizete Garcia da

; Rassi, Anis

; Rocha, Alessandra Carla Rodrigues Galvão

; Silva, Heloisa Helena Garcia da

; Rassi, Gustavo Gabriel

Revista da Sociedade Brasileira de Medicina Tropical

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feb 2002, Volume 35 N. 1 Pages 29 - 33

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Estudou-se a correlação entre a positividade do xenodiagnóstico artificial e a quantidade utilizada de sangue e de triatomíneos, em 200 pacientes na fase crônica da doença de Chagas. Colheram-se 10 ou 40ml de sangue através de tubos a vácuo, heparinizados com 20,4UI, sendo realizado com 60 e 360 triatomíneos, respectivamente. Usou-se Dipetalogaster maximus, Triatoma infestans, Triatoma vitticeps e Rhodnius neglectus, nos estádios 1°, 3°, 3° e 4°, respectivamente. A coproscopia dos triatomíneos foi realizada aos 30 e 60 dias após a aplicação. A positividade do xenodiagnóstico com o primeiro e o segundo métodos foi de 19% e 44%, respectivamente, sendo altamente significativa a correlação entre a quantidade utilizada de sangue e triatomíneos e a positividade (p<0,01). A xenopositividade nas faixas etárias variou de 9,7 a 100%, sendo maior em jovens e adultos até 34 anos, e independente em relação ao sexo dos pacientes.

The aim of this study was to verify whether the amount of blood and number of triotomines used could improve the artificial xenodiagnosis performed in 200 chronic phase infected individuals. Ten or 40ml of peripheral blood was collected in heparinized (20.4 IU) vacuum tubes, and fed to 60 and 360 triatomines, respectively. Dipetalogaster maximus (1st instar, about 15 days after eclosion), as well as 3rd instar Triatoma infestans and Triatoma vitticeps and the 4th instar of Rhodnius neglectus were used. The faecal examinations were performed 30 and 60 days after xenodiagnosis procedure. The positivity with 10ml of blood was 19% and with 40ml, 44%, from which it was concluded that a correlation existed between the amount of blood and the number of triatomines used (p < 0.01). The positivity of the xenodiagnosis ranged from 9.7 to 100%, higher in young and adults up to 34 years old, but independent in relation to the sex of the chronic chagasic individuals studied.

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15.

Sudden death in Chagas' disease
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Rassi Jr, Anis

; Rassi, Sérgio Gabriel

; Rassi, Anis

Arquivos Brasileiros de Cardiologia

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jan 2001, Volume 76 N. 1 Pages 86 - 96

Abstract: Pt | Text: Pt | PDF: Pt

4844 downloads Cited 6 times in SciELO

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