TY - JOUR T1 - Circulating plasma MicroRNA-208a as potential biomarker of chronic indeterminate phase of Chagas disease A1 - Linhares-Lacerda, Leandra A1 - Granato, Alessandra A1 - Gomes-Neto, João Francisco A1 - Conde, Luciana A1 - Freire-de-Lima, Leonardo A1 - de Freitas, Elisangela O. A1 - Freire-de-Lima, Celio G. A1 - Barroso, Shana P.Coutinho A1 - Guerra, Rodrigo Jorge de Alcântara A1 - Pedrosa, Roberto C. A1 - Savino, Wilson A1 - Morrot, Alexandre Y1 - 2018/// KW - Chagas disease KW - Disease biomarkers KW - Infectious heart disease KW - MicroRNA KW - Trypanosoma cruzi JF - Frontiers in Microbiology VL - 9 IS - MAR SP - 1 EP - 9 DO - 10.3389/fmicb.2018.00269 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Linhares-Lacerda et al. - 2018 - Circulating plasma MicroRNA-208a as potential biomarker of chronic indeterminate phase of Chagas diseas.pdf N2 - Chagas cardiomyopathy is the most severe clinical manifestation of chronic Chagas disease. The disease affects most of the Latin American countries, being considered one of the leading causes of morbidity and death in the continent. The pathogenesis of Chagas cardiomyopathy is very complex, with mechanisms involving parasite-dependent cytopathy, immune-mediated myocardial damage and neurogenic disturbances. These pathological changes eventually result in cardiac myocyte hypertrophy, arrhythmias, congestive heart failure and stroke during chronic infection phase. Herein, we show that miR-208a, a microRNA that is a key factor in promoting cardiovascular dysfunction during cardiac hypertrophy processes of heart failure, has its circulating levels increased during chronic indeterminate phase when compared to cardiac (CARD) clinical forms in patients with Chagas disease. In contrast, we have not found altered serum levels of miR-34a, a microRNA known to promote pro-apoptotic role in myocardial infarction during degenerative process of cardiac injuries thus indicating intrinsic differences in the nature of the mechanisms underlying the heart failure triggered by Trypanosoma cruzi infection. Our findings support that the chronic indeterminate phase is a progressive phase involved in the genesis of chagasic cardiopathy and point out the use of plasma levels of miR-208a as candidate biomarker in risk-prediction score for the clinical prognosis of Chagas disease. ER - TY - JOUR T1 - Echocardiography in Chagas heart disease A1 - Acquatella, Harry Y1 - 2007/// KW - Cardiomyopathy KW - Chagas disease KW - Echocardiography KW - Echocardiography, Doppler KW - Heart failure KW - Survival JF - Circulation VL - 115 IS - 9 SP - 1124 EP - 1131 DO - 10.1161/CIRCULATIONAHA.106.627323 L1 - file:///C:/Users/NATALI/Downloads/echocardiograph in chagas disease.pdf N2 - BACKGROUND - Chagas heart disease is a frequent cause of morbidity and mortality in Latin America. Echocardiography provides useful diagnostic and prognostic information and is an important tool in the management of patients with Chagas disease. METHODS AND RESULTS - A search for relevant publications was obtained from MEDLINE, LILACS, and SCIELO sources. Acute Chagas myocarditis is a rare disorder in which pericardial effusion is frequent. Echocardiography may exclude pericardial tamponade in case of heart failure. Chronic Chagas cardiomyopathy evolves for several decades after the infection. Epidemiological history, positive serology, and suggestive clinical and ECG abnormalities establish the diagnosis. About three quarters of chronic Chagas cardiomyopathy subjects remain asymptomatic with normal (indeterminate form) or abnormal ECGs. Early Doppler abnormalities includes prolongation of isovolumic contraction and relaxation times. Systolic function frequently is normal, but dysfunction may be elicited by stress tests. Half or more of symptomatic patients have a left ventricular apical aneurysm and other segmental contractile abnormalities similar to those seen in coronary heart disease. The dilated nonsegmental form is indistinguishable from dilated cardiomyopathy. Results from univariate and multivariate Cox survival analyses indicate that impaired systolic function and increased ventricular dimensions have significant value in predicting cardiac morbidity and mortality. Cardiac ultrasound commonly is used in the follow-up of patients and in the assessment of various therapeutic modalities. CONCLUSIONS - Echocardiographic and Doppler techniques provide useful structural and functional information in the detection of early myocardial damage, risk assessment of prognosis, disease progression, and management of patients with Chagas disease. © 2007 American Heart Association, Inc. ER - TY - JOUR T1 - Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais , Brazil , before and nine years after aetiological treatment A1 - Lana, Marta De A1 - Lopes, Leonardo A A1 - Martins, Helen R A1 - Bahia, Maria T A1 - Machado-de-assis, Girley F A1 - Wendling, Ana P A1 - Martins-filho, Olindo A A1 - Montoya, Roberto A A1 - Dias, João C P A1 - Albajar-viñas, Pedro A1 - Coura, José R Y1 - 2009/// KW - brought under control in KW - chagas disease - aetiological KW - chagas disease has been KW - clinical-laboratorial evaluation - clinical KW - due to successive vec- KW - evolution KW - several latin american countries KW - tor control programs along KW - treatment - benznidazole - KW - with successful blood trans- VL - 104 IS - December SP - 1139 EP - 1147 L1 - file:///C:/Users/NATALI/Downloads/Clinical and laboratory status of patients with chronic Chagas disease living in a vector controlled area in minas gerais brazil before and nine years after aetiological treatment.pdf ER - TY - JOUR T1 - Clinical course of chagas' heart disease: A comparison with dilated cardiomyopathy A1 - Bestetti, Reinaldo B. A1 - Muccillo, Gerson Y1 - 1997/// KW - Cardiomyopathy KW - Chagas' cardiomyopathy KW - Dilated KW - Heart failure KW - South America KW - Trypanosomiasis JF - International Journal of Cardiology VL - 60 IS - 2 SP - 187 EP - 193 DO - 10.1016/S0167-5273(97)00083-1 L1 - file:///C:/Users/NATALI/Downloads/Clinical course of Chagas’ heart disease a comparison with dilated cardiomyopathy.pdf N2 - This investigation was carried out to compare the clinical course of patients with chronic Chagas' heart disease with that of patients with dilated cardiomyopathy. A total of 125 patients (75 chagasic and 50 nonchagasic) prospectively followed up at the Cardiomyopathy clinic of Santa Casa Hospital from January 1990 to June 1993 entered the study. Patients underwent clinical history, physical examination, serological tests, resting electrocardiogram, chest X-ray and two-dimensional echocardiography. In nonchagasic patients, hypertensive cardiomyopathy was found in 17 of 50 (34%) patients, idiopathic dilated cardiomyopathy in 16 (32%), the association of hypertension and coronary artery disease in 12 (24%) and ischemic cardiomyopathy in two (4%). Twenty-one (23%) chagasic and three (6%) nonchagasic patients died during the study period (P=0.02). Sudden cardiac death occurred in eight (38%) chagasic patients, pump failure death was detected in 10 (47%) and the mode of death could not be determined in three (14%) patients with chronic Chagas' heart disease. Thus, patients with chronic Chagas' heart disease have a clinical course worse than that of patients with nonchagasic dilated cardiomyopathy. This fact may be ascribed to the electrocardiographic and morphological peculiarities usually found in chronic Chagas' heart disease. ER - TY - JOUR T1 - Trypanosoma cruzi clonal diversity and the epidemiology of Chagas' disease A1 - Buscaglia, Carlos A. A1 - Di Noia, Javier M. Y1 - 2003/// KW - Chagas' disease KW - Clonality KW - Epidemiology KW - TSSA KW - Trypanosoma cruzi JF - Microbes and Infection VL - 5 IS - 5 SP - 419 EP - 427 DO - 10.1016/S1286-4579(03)00050-9 L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruzi clonal diversity and the epidemiology of chagas disease.pdf N2 - Chagas' disease is caused by the protozoan Trypanosoma cruzi and it has a variable clinical outcome. The basis for this variability relies in part on the complexity of the parasite population consisting of multiple clones displaying distinct biological properties. A major current challenge is to correlate parasite genetic variability with pathogenesis. © 2003 Éditions scientifiques et médicales Elsevier SAS. All rights reserved. ER - TY - JOUR T1 - Chagas Disease Prevalence in Colombia: A Meta-Analysis and Systematic Review A1 - Anthoni F. Llau, Carlos Espinal Tejada, Nasar U. Ahmed Y1 - 2018/// KW - chagas disease KW - colombia KW - meta-analysis KW - prevalence KW - trypanosoma cruzi SP - 1 EP - 9 DO - 10.1089/vbz.2018.2308 L1 - file:///C:/Users/NATALI/Downloads/Chagas Disease Prevalence in Colombia a meta analysis and systematic review.pdf ER - TY - JOUR T1 - Trypanosoma cruzi: Genetic structure of populations and relevance of genetic variability to the pathogenesis of chagas disease A1 - Macedo, Andréa M. A1 - Machado, Carlos R. A1 - Oliveira, Riva P. A1 - Pena, Sérgio D.J. Y1 - 2004/// KW - Chagas disease KW - Genetic variability KW - Mismatch repair KW - Pathogenesis KW - Population structure KW - Trypanosoma cruzi JF - Memorias do Instituto Oswaldo Cruz VL - 99 IS - 1 SP - 1 EP - 12 DO - 10.1590/S0074-02762004000100001 L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruzi Genetic Structure of Populations and relevance of genetic variability to the pathogenesis of chagas disease.pdf N2 - Chagas disease, caused by the protozoan Trypanosoma cruzi, has a variable clinical course, ranging from symptomless infection to severe chronic disease with cardiovascular or gastrointestinal involvement or, occasionally, overwhelming acute episodes. The factors influencing this clinical variability have not been elucidated, but it is likely that the genetic variability of both the host and the parasite are of importance. In this work we review the the genetic structure of T. cruzi populations and analyze the importance of genetic variation of the parasite in the pathogenesis of the disease under the light of the histotropic-clonal model. ER - TY - JOUR T1 - The revised Trypanosoma cruzi subspecific nomenclature: Rationale, epidemiological relevance and research applications A1 - Zingales, Bianca A1 - Miles, Michael A. A1 - Campbell, David A. A1 - Tibayrenc, Michel A1 - Macedo, Andrea M. A1 - Teixeira, Marta M.G. A1 - Schijman, Alejandro G. A1 - Llewellyn, Martin S. A1 - Lages-Silva, Eliane A1 - Machado, Carlos R. A1 - Andrade, Sonia G. A1 - Sturm, Nancy R. Y1 - 2012/// KW - Discrete typing unit KW - Genotyping KW - Hybridization KW - Pathology KW - Phylogeography KW - Trypanosoma cruzi strains PB - Elsevier B.V. JF - Infection, Genetics and Evolution VL - 12 IS - 2 SP - 240 EP - 253 DO - 10.1016/j.meegid.2011.12.009 UR - http://dx.doi.org/10.1016/j.meegid.2011.12.009 L1 - file:///C:/Users/NATALI/Downloads/the revised Trypanosoma cruzi subspecific nomenclature rationale epidemiological relevance and research applications.pdf N2 - The protozoan Trypanosoma cruzi, its mammalian reservoirs, and vectors have existed in nature for millions of years. The human infection, named Chagas disease, is a major public health problem for Latin America. T. cruzi is genetically highly diverse and the understanding of the population structure of this parasite is critical because of the links to transmission cycles and disease. At present, T. cruzi is partitioned into six discrete typing units (DTUs), TcI-TcVI. Here we focus on the current status of taxonomy-related areas such as population structure, phylogeographical and eco-epidemiological features, and the correlation of DTU with natural and experimental infection. We also summarize methods for DTU genotyping, available for widespread use in endemic areas. For the immediate future multilocus sequence typing is likely to be the gold standard for population studies. We conclude that greater advances in our knowledge on pathogenic and epidemiological features of these parasites are expected in the coming decade through the comparative analysis of the genomes from isolates of various DTUs. © 2012 Elsevier B.V. ER - TY - JOUR T1 - Retrospective distribution of Trypanosoma cruzi I genotypes in Colombia A1 - León, Cielo M. A1 - Hernández, Carolina A1 - Montilla, Marleny A1 - Ramírez, Juan David Y1 - 2015/// KW - Chagas disease KW - Domestic cycle KW - Genotypes KW - Sylvatic cycle JF - Memorias do Instituto Oswaldo Cruz VL - 110 IS - 3 SP - 387 EP - 393 DO - 10.1590/0074-02760140402 L1 - file:///C:/Users/NATALI/Downloads/Retrospective_distribution_of_Trypanosoma_cruzi_I_genotypes_in_Colombia.pdf N2 - Trypanosoma cruzi is the aetiological agent of Chagas disease, which affects approximately eight million people in the Americas. This parasite exhibits genetic variability, with at least six discrete typing units broadly distributed in the American continent. T. cruzi I (TcI) shows remarkable genetic diversity; a genotype linked to human infections and a domestic cycle of transmission have recently been identified, hence, this strain was named TcIDom. The aim of this work was to describe the spatiotemporal distribution of TcI subpopulations across humans, insect vectors and mammalian reservoirs in Colombia by means of molecular typing targeting the spliced leader intergenic region of mini-exon gene. We analysed 101 TcI isolates and observed a distribution of sylvatic TcI in 70% and TcIDom in 30%. In humans, the ratio was sylvatic TcI in 60% and TcIDom in 40%. In mammal reservoirs, the distribution corresponded to sylvatic TcI in 96% and TcIDom in 4%. Among insect vectors, sylvatic TcI was observed in 48% and TcIDom in 52%. In conclusion, the circulation of TcIDom is emerging in Colombia and this genotype is still adapting to the domestic cycle of transmission. The epidemiological and clinical implications of these findings are discussed herein. ER - TY - JOUR T1 - The Determinants of Chagas Disease: Connecting Parasite and Host Genetics A1 - Campbell, David A1 - Westenberger, Scott A1 - Sturm, Nancy Y1 - 2005/// KW - dimorphism KW - genetic variation KW - group KW - hybrid KW - molecular marker KW - snp KW - subgroup KW - zymodeme JF - Current Molecular Medicine VL - 4 IS - 6 SP - 549 EP - 562 DO - 10.2174/1566524043360249 L1 - file:///C:/Users/NATALI/Downloads/The Determinants of Chagas Disease Connecting Parasite and host genetics.pdf N2 - As a consequence of infection by Trypanosoma cruzi, 30% of victims may develop chronic Chagas disease, which presents a spectrum of pathology including cardiomyopathy, megacolon and megaesophagus. The outcome of infection in a particular individual is the result of a set of complex interactions among the host genetic background, environmental and social factors, and the genetic composition of the parasite, all of which can be complicated by mixed infections and re-infections. Initially we consider what is known about the genetic structure and biological properties of the protozoan. Currently, six distinct subgroups have been characterized by different combinations of four distinct genotypic classes. The recent demonstration of genetic exchange via non-meiotic cell fusion illustrates a mechanism by which maintained heterogeneous polyploidy may have been generated in these parasites. Subsequently, we consider factors in humans and in experimental mouse-infection and tissue culture models that have contributed to our understanding of the host's susceptibility or resistance to disease. Identification of the direct players in host-pathogen interactions at the establishment and chronic phases of the disease is perhaps the best hope of a clinical handle for treatment. At some point in the future, these disparate areas of study will have to come together. It is to be hoped that this scientific fusion will result in better prognosis and treatment of Chagas disease. ER - TY - JOUR T1 - Control of Chagas disease A1 - World Health Organization[WHO] Y1 - 2002/// DO - 10.1016/s0035-9203(02)90338-x L1 - file:///C:/Users/NATALI/Downloads/WHO control of chagas disease.pdf ER - TY - JOUR T1 - Lineamiento para la vigilancia por laboratorio de la enfermedad de Chagas en fase aguda . A1 - Instituto Nacional de Salud Y1 - 2012/// L1 - file:///C:/Users/NATALI/Downloads/Lineamientos para la vigilancia por laboratorio de la Enfermedad de Chagas fase aguda.pdf ER - TY - JOUR T1 - Environmental determinants of the distribution of chagas disease vector triatoma dimidiata in Colombia A1 - Parra-Henao, Gabriel A1 - Quirós-Gómez, Oscar A1 - Jaramillo-O, Nicolas A1 - Cardona, Ángela Segura Y1 - 2016/// JF - American Journal of Tropical Medicine and Hygiene VL - 94 IS - 4 SP - 767 EP - 774 DO - 10.4269/ajtmh.15-0197 L1 - file:///C:/Users/NATALI/Downloads/Environmental Determinants of the Distribution of Chagas Disease Vector triatoma dimidiata in Colombia.pdf N2 - Triatoma dimidiata (Hemiptera: Reduviidae) is a secondary vector of Trypanosoma cruzi in Colombia and represents an important epidemiological risk mainly in the central and oriental regions of the country where it occupies sylvatic, peridomestic, and intradomestic ecotopes, and because of this complex distribution, its distribution and abundance could be conditioned by environmental factors. In this work, we explored the relationship between T. dimidiata distribution and environmental factors in the northwest, northeast, and central zones of Colombia and developed predictive models of infestation in the country. The associations between the presence of T. dimidiata and environmental variables were studied using logistic regression models and ecological niche modeling for a sample of villages in Colombia. The analysis was based on the information collected in field about the presence of T. dimidiata and the environmental data for each village extracted from remote sensing images. The presence of Triatoma dimidiata (Latreille, 1811) was found to be significantly associated with the maximum vegetation index, minimum land surface temperature (LST), and the digital elevation for the statistical model. Temperature seasonality, annual precipitation, and vegetation index were the variables that most influenced the ecological niche model of T. dimidiata distribution. The logistic regression model showed a good fit and predicted suitable habitats in the Andean and Caribbean regions, which agrees with the known distribution of the species, but predicted suitable habitats in the Pacific and Orinoco regions proposing new areas of research. Improved models to predict suitable habitats for T. dimidiata hold promise for spatial targeting of integrated vector management. ER - TY - JOUR T1 - Sudden death in chagas' disease A1 - Rassi, Anis A1 - Rassi, Sérgio Gabriel A1 - Rassi, Anis Y1 - 2001/// JF - Arquivos Brasileiros de Cardiologia VL - 76 IS - 1 SP - 86 EP - 96 DO - 10.1590/s0066-782x2001000100008 L1 - file:///C:/Users/NATALI/Downloads/Sudden Death in Chagas’ Disease.pdf ER - TY - JOUR T1 - Diagnosis and management of Chagas disease and cardiomyopathy A1 - Ribeiro, Antonio L. A1 - Nunes, Maria P. A1 - Teixeira, Mauro M. A1 - Rocha, Manoel O.C. Y1 - 2012/// PB - Nature Publishing Group JF - Nature Reviews Cardiology VL - 9 IS - 10 SP - 576 EP - 589 DO - 10.1038/nrcardio.2012.109 L1 - file:///C:/Users/NATALI/Downloads/Diagnosis and management of Chagas disease and cardiomyopathy.pdf N2 - Chagas cardiomyopathy is the most severe and life-threatening manifestation of human Chagas disease-A 'neglected' tropical disease caused by the protozoan parasite Trypanosoma cruzi. The disease is endemic in all continental Latin American countries, but has become a worldwide problem because of migration of infected individuals to developed countries, mainly in Europe and North America. Chagas cardiomyopathy results from the combined effects of persistent parasitism, parasite-driven tissue inflammation, microvascular and neurogenic dysfunction, and autoimmune responses triggered by the infection. Clinical presentation varies widely according to the extent of myocardial damage, and manifests mainly as three basic syndromes that can coexist in an individual patient: heart failure, cardiac arrhythmia, and thromboembolism. NYHA functional class, left ventricular systolic function, and nonsustained ventricular tachycardia are important prognostic markers of the risk of death. Management of Chagas cardiomyopathy focuses on the treatment of the three main syndromes. The use of β-blockers in patients with Chagas disease and heart failure is safe, well tolerated, and should be encouraged. Most specialists and international institutions now recommend specific antitrypanosomal treatment of patients with chronic Chagas disease, even in the absence of evidence obtained from randomized clinical trials. Further research on the management of patients with Chagas cardiomyopathy is necessary. © 2012 Macmillan Publishers Limited. All rights reserved. ER - TY - JOUR T1 - Chagas disease in Latin America: an epidemiological update based on 2010 estimates A1 - World Health Organization[WHO] Y1 - 2015/// JF - Relevé épidémiologique hebdomadaire / Section d'hygiène du Secrétariat de la Société des Nations = Weekly epidemiological record / Health Section of the Secretariat of the League of Nations VL - 90 IS - 6 SP - 33 EP - 43 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/World Health OrganizationWHO - 2015 - Chagas disease in Latin America an epidemiological update based on 2010 estimates.pdf ER - TY - JOUR T1 - 2nd Brazilian Consensus on Chagas disease, 2015 A1 - Dias, João Carlos Pinto A1 - Ramos, Alberto Novaes A1 - Gontijo, Eliane Dias A1 - Luquetti, Alejandro A1 - Shikanai-Yasuda, Maria Aparecida A1 - Coura, José Rodrigues A1 - Torres, Rosália Morais A1 - Melo, José Renan Da Cunha A1 - De Almeida, Eros Antonio A1 - De Oliveira Junior, Wilson A1 - Silveira, Antônio Carlos A1 - De Rezende, Joffre Marcondes A1 - Pinto, Fabiane Scalabrini A1 - Ferreira, Antonio Walter A1 - Rassi, Anis A1 - Fragata Filho, Abílio Augusto A1 - De Sousa, Andréa Silvestre A1 - Correia, Dalmo A1 - Jansen, Ana Maria A1 - Andrade, Glaucia Manzan Queiroz A1 - De Paoli de Carvalho Britto, Constança Felícia A1 - Pinto, Ana Yecê Das Neves A1 - Rassi Junior, Anis A1 - Campos, Dayse Elisabeth A1 - Abad-Franch, Fernando A1 - Santos, Silvana Eloi A1 - Chiari, Egler A1 - Hasslocher-Moreno, Alejandro Marcel A1 - Moreira, Eliane Furtado A1 - Marques, Divina Seila De Oliveira A1 - Silva, Eliane Lages A1 - Marin-Neto, José Antonio A1 - Galvão, Lúcia Maria Da Cunha A1 - Xavier, Sergio Salles A1 - Valente, Sebastião Aldo Da Silva A1 - Carvalho, Noêmia Barbosa A1 - Cardoso, Alessandra Viana A1 - E Silva, Rafaella Albuquerque A1 - Da Costa, Veruska Maia A1 - Vivaldini, Simone Monzani A1 - Oliveira, Suelene Mamede A1 - Valente, Vera Da Costa A1 - Lima, Mayara Maia A1 - Alves, Renato Vieira Y1 - 2016/// KW - Brazil KW - Chagas disease KW - Consensus KW - Control KW - Diagnosis KW - Epidemiology KW - Health care KW - Treatment JF - Revista da Sociedade Brasileira de Medicina Tropical VL - 49 IS - December SP - 3 EP - 60 DO - 10.1590/0037-8682-0505-2016 L1 - file:///C:/Users/NATALI/Downloads/2nd Brazilian Consensus on Chagas Disease, 2015.pdf N2 - 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. ER - TY - JOUR T1 - Diagnóstico, manejo y tratamiento de la cardiopatía chagásica crónica en áreas donde la infección por Trypanosoma cruzi no es endémica A1 - Gascón, Joaquim A1 - Albajar, Pedro A1 - Cañas, Elías A1 - Flores, María A1 - Prat, Jordi Gómez A1 - Herrera, Ramón N. A1 - Lafuente, Carlos A. A1 - Luciardi, Héctor L. A1 - Moncayo, Álvaro A1 - Molina, Lluís A1 - Muñoz, José A1 - Puente, Sabino A1 - Sanz, Ginés A1 - Treviño, Begoña A1 - Sergio-Salles, Xavier Y1 - 2008/// KW - Arrhythmia KW - Chagas' disease KW - Heart disease KW - Sudden death JF - Enfermedades Infecciosas y Microbiologia Clinica VL - 26 IS - 2 SP - 99 EP - 106 DO - 10.1157/13115545 L1 - file:///C:/Users/NATALI/Downloads/Diagnóstico, manejo y tratamiento de la cardiopatíachagásica crónica en áreas donde la infecciónporTrypanosoma cruzi no es endémica.pdf N2 - Chagas' disease, or American trypanosomiasis, is a parasitic zoonosis found only in the Americas. Under natural conditions, Trypanosoma cruzi is transmitted by insects belonging to different species of Triatoma. However, several routes of transmission that do not involve insect vectors have also been described, such as transmission via blood products or transplantation of infected organs, and vertical transmission. At present, the number of people infected with Chagas' disease worldwide is estimated to be about 10-12 million. The process of urbanization in Latin America and migratory population movements from endemic countries have led to the disease being diagnosed in non-endemic areas. It is estimated that 20-30% of individuals infected with T. cruzi will develop symptomatic heart disease at some point during their lives. The specific differential characteristics of chronic chagasic cardiopathy, lack of knowledge of the disease among many healthcare workers, and the fact that arrhythmia or sudden death is frequently the first manifestation of disease all make it essential that diagnostic and therapeutic protocols for the disease are developed and disseminated. The aim should be to improve patient care by increasing understanding of the condition by physicians and other healthcare professionals who may be involved in its detection and treatment. ER - TY - JOUR T1 - Clinical and morphological characteristics associated with sudden cardiac death in patients with Chagas' disease A1 - Bestetti, R. B. A1 - Freitas, O. C. A1 - Muccillo, G. A1 - Oliveira, J. S.M. Y1 - 1993/// KW - Chagas' cardiomyopathy KW - Sudden death KW - Trypanosomiasis (South American) KW - Ventriculal aneurysm JF - European Heart Journal VL - 14 IS - 12 SP - 1610 EP - 1614 DO - 10.1093/eurheartj/14.12.1610 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Bestetti et al. - 1993 - Clinical and morphological characteristics associated with sudden cardiac death in patients with Chagas' diseas.pdf N2 - The medical records of 24 patients with Chagas disease who died suddenly; between 1982 and 1988, were examined in an attempt to determine the clinical profile of sudden death in Chagas disease Patient age ranged from 33 to 72 years (average: 51). Seventeen (70%) were male. Five (20%) were asymptomatic. Dyspnoea at rest was observed in l6 (66%) and palpitations in eight (33%). On physical examination, arrhythmias were observed in 14 (58%) ankle swelling in 13 (54%) and liver enlargement in 12 (50%) patients. Twenty-three (95%) patients had an abnormal resting electrocardiogram: ventricular premature contractions were observed in l9 patients (79%) and a left anterior fascicular block in 14 (58%). The chest X-ray revealed cardiomegaly in 20 patients (82%), which was moderate in three (13%) and severe in 11 (45%). At autopsy mean heart weight was 496g. Dilatation of all cardiac chambers was detected in 22 (91%), and apical aneurysm in 19 (79%) patients. When compared with symptomatic patients asymptomatic patients with Chagas disease had a higher frequency of normal physical examination (3/5vs1/19, P< 0.004), normal chest X-ray (3/5 vs1/19, P< 0.01), and a lower heartweight (400 + 43 g vs 521.58 + 146.26 g, P< 0.03). The majority of patients with Chagas disease who die suddenly have severe underlying myocardial disease. In some of them, however, sudden cardiac death may occur in the presence of minimal, if any heart involvement. ER - TY - JOUR T1 - Noninvasive prognostic markers for cardiac death and ventricular arrhythmia in long-term follow-up of subjects with chronic Chagas' disease A1 - Benchimol Barbosa, P. R. Y1 - 2007/// KW - Cardiomyopathy KW - Chagas' disease KW - Echocardiography KW - Electrocardiography KW - Long-term follow-up study KW - Noninvasive prognostic assessment JF - Brazilian Journal of Medical and Biological Research VL - 40 IS - 2 SP - 167 EP - 178 DO - 10.1590/S0100-879X2006005000061 L1 - file:///C:/Users/NATALI/Downloads/Noninvasive prognostic markers for cardiac death and ventricular arrhythmia in long term follow up of subjects with chronic chagas diasease.pdf N2 - The objective of the present study was to investigate clinical, echocardiographic and electrocardiographic (12-lead resting ECG, 24-h ambulatory ECG monitoring and signal-averaged ECG (SAECG)) parameters in subjects with chronic Chagas' disease in a long-term follow-up as prognostic markers for adverse outcomes. Fifty adult outpatients (34 to 74 years old, 31 females) staged according to Los Andes class I, II or III and complaining of palpitation were enrolled in a longitudinal study. SAECG was analyzed in time and frequency domains and the endpoint was a composite of cardiac death and ventricular tachycardia. During a follow-up of 84.2 ± 39.0 months, 34.0% of the patients developed adverse outcomes (9 cardiac deaths and 11 episodes of ventricular tachycardia). After optimal dichotomization, in a stepwise multivariate Cox-hazard regression model, apical aneurysm (HR = 3.7; 95% CI = 1.2-1.3; P = 0.02), left ventricular ejection fraction <62% (HR = 4.60; 95% CI = 1.39-15.24; P = 0.01) and incidence of ventricular premature contractions >614 per 24 h (hazard ratio = 6.1; 95% CI = 1.7-22.6; P = 0.006) were independent predictors of the composite endpoint. Although a high frequency content in SAECG demonstrated association with the presence of left ventricular dysfunction and myocardial fibrosis, its predictive value for the composite endpoint was not significant. Apical aneurysms, reduced left ventricular function and a high incidence of ventricular ectopic beats over a 24-h period have a strong predictive value for a composite endpoint of cardiac death and ventricular tachycardia in subjects with chronic Chagas' disease. ER - TY - JOUR T1 - Indicadores clínicos de progresión de la miocarditis chagásica crónica A1 - Viotti, Rodolfo A1 - Vigliano, Carlos A1 - Lococo, Bruno A1 - Petti, Marcos A1 - Bertocchi, Graciela A1 - Álvarez, María G. A1 - Armenti, Alejandro Y1 - 2005/// KW - Cardiac disease KW - Cardiopathy KW - Heart failure KW - Prognosis PB - Elsevier JF - Revista Espanola de Cardiologia VL - 58 IS - 9 SP - 1037 EP - 1044 DO - 10.1157/13078551 UR - http://dx.doi.org/10.1157/13078551 L1 - file:///C:/Users/NATALI/Downloads/Indicadores clínicos de progresión de la miocarditis chagásica cronica.pdf N2 - Introduction and objectives. Previous prognostic studies of Chagas' disease have focused on mortality associated with end-stage cardiopathy (i.e., heart failure). Our aim was to identify indicators of progression in early-stage Chagas' heart disease. Matherial and method. The study included 856 patients with 3 positive anti-Trypanosoma cruzi test results. Those with heart failure were excluded. Patients were divided into 3 clinical groups: those without heart disease (Group I); those with heart disease but without left ventricular enlargement (Group II); and those with left ventricular enlargement but without heart failure (Group III). The endpoint was progression to a more severe clinical stage or death due to cardiovascular disease. A Cox regression model was used to derive a clinical risk score from clinical, electrocardiographic and echocardiographic variables. Results. At study entry, the patients' mean age was 43.7 years. They were followed up for a mean of 8 years. The following were predictors of heart disease progression: age at entry (HR=1.05; 95% CI, 1.02-1.07; P<.001), left ventricular systolic diameter (HR=1.06; 95% CI, 1.04-1.09; P<.001), intraventricular conduction abnormalities (HR=1.85; 95% CI, 1.02-3.36; P=.04), and sustained ventricular tachycardia (HR=3.97; 95% CI, 1.65-9.58; P=.002). Treatment with benznidazole reduced the risk of progression (HR=0.40; 95% CI, 0.23-0.72; P=.002). The devised clinical risk score was effective in stratifying the likelihood of cardiopathy progression. Conclusions. Specific clinical indicators and a derived clinical risk score can be used to predict the progression of chronic chagasic myocarditis in patients without heart failure. ER - TY - JOUR T1 - Long term evaluation of etiological treatment of Chagas disease with benznidazole A1 - Cançado, J. Romeu Y1 - 2002/// KW - Benznidazole KW - Chagas disease KW - Cure KW - Side-effects KW - Therapeutic schedule KW - Treatment KW - Trypanosoma cruzi JF - Revista do Instituto de Medicina Tropical de Sao Paulo VL - 44 IS - 1 SP - 29 EP - 37 DO - 10.1590/S0036-46652002000100006 L1 - file:///C:/Users/NATALI/Downloads/Long term evaluation of etiological treatment of chagas disease with benznidazole.pdf N2 - The aim of this article is to present an investigation of cure rate, after long follow up, of specific chemotherapy with benznidazole in patients with both acute and chronic Chagas disease, applying quantitative conventional serological tests as the base of the criterion of cure. Twenty one patients with the acute form and 113 with one or other of the various chronic clinical forms of the disease were evaluated, after a follow up period of 13 to 21 years, for the acute, and 6 to 18 years, for the chronic patients. The duration of the acute as well as the chronic disease, a condition which influences the results of the treatment, was determined. The therapeutic schedule was presented, with emphasis on the correlation between adverse reactions and the total dose of 18 grams, approximately, as well as taking into consideration precautions to assure the safety of the treatment. Quantitative serological reactions consisting of complement fixation, indirect immunofluorescence, indirect hemagglutination, and, occasionally, ELISA, were used. Cure was found in 76 per cent of the acute patients but only in 8 per cent of those with chronic forms of the disease. In the light of such contrasting results, fundamentals of the etiological therapy of Chagas disease were discussed, like the criterion of cure, the pathogenesis and the role of immunosuppression showing tissue parasitism in long standing chronic disease, in support of the concept that post-therapeutic consistently positive serological reactions mean the presence of the parasite in the patient's tissues. In relation to the life-cycle of T. cruzi in vertebrate host, there are still some obscure and controversial points, though there is no proof of the existence of resistant or latent forms. However, the finding over the last 15 years, that immunosuppression brings about the reappearance of acute disease in long stand chronic patients justifies a revision of the matter. Facts were quoted in favor of the treatment of chronic patients. ER - TY - JOUR T1 - Cardiovascular comorbidities in patients with chronic Chagas disease A1 - Oliveira Junior, Luiz Roberto A1 - Carvalho, Thaysa Buss A1 - da Costa, Érika Alessandra Pellison Nunes A1 - Pereira, Paulo Câmara Marques A1 - Kurokawa, Cilmery Suemi Y1 - 2018/// KW - 01 KW - 04 july 2018 KW - 07 KW - 10 KW - 20 june 2018 KW - 2018 KW - 21037 KW - 27 july 2018 KW - accepted KW - amj KW - cardiovascular comorbidities KW - cd KW - chagas disease KW - chronic cd KW - chronic chagas disease KW - doi KW - dx KW - http KW - org KW - published KW - received KW - view this article at JF - AME Medical Journal VL - 3 SP - 79 EP - 79 DO - 10.21037/amj.2018.07.01 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Oliveira Junior et al. - 2018 - Cardiovascular comorbidities in patients with chronic Chagas disease.pdf ER - TY - JOUR T1 - Enfermedad de Chagas. Memorias A1 - Maldonado, Jorge E A1 - Villa, Sergio Isaza Y1 - 2013/// JF - Ministerio de Salud y Protección Social SP - 1 EP - 34 UR - http://www.facmed.unam.mx/deptos/microbiologia/parasitologia/trypanosomosis.html L1 - file:///C:/Users/NATALI/Downloads/Memorias_chagas.pdf N2 - La enfermedad de Chagas es una de las enfermedades transmitidas por vectores de mayor importancia en salud pública en el país, principalmente por las manifestaciones de la fase crónica representadas en la cardiomiopatía. Además, por tratarse de una patología con una historia natural compleja, con frecuencia se manejan conceptos equivocados que dentro de esta unidad se van a definir, explicar y unificar. La detección oportuna y el manejo adecuado de la enfer- medad de Chagas en el país requieren de una difusión amplia de los conceptos y recomendaciones, la adopción de protocolos de atención adecuados y una intensa ges- tión con los diferentes actores del sistema que contribuyan a mejorar la calidad de vida de las personas infectadas con el Trypanosoma cruzi. La Unidad de Enfermedad de Chagas es una adaptación pedagógica e interactiva de la Guía desarrollada por el Ministerio de Salud y la Protección Social, con el apo- yo de la Organización Panamericana de la Salud y con participación de expertos nacionales, y del Protocolo de Vigilancia de la Enfermedad de Chagas elaborado por el Instituto Nacional de Salud. ER - TY - JOUR T1 - Chagas disease A1 - Pérez-Molina, José A. A1 - Molina, Israel Y1 - 2018/// JF - The Lancet VL - 391 IS - 10115 SP - 82 EP - 94 DO - 10.1016/S0140-6736(17)31612-4 L1 - file:///C:/Users/NATALI/Downloads/Chagas disease review the lancet.pdf N2 - Chagas disease is an anthropozoonosis from the American continent that has spread from its original boundaries through migration. It is caused by the protozoan Trypanosoma cruzi, which was identified in the first decade of the 20th century. Once acute infection resolves, patients can develop chronic disease, which in up to 30–40% of cases is characterised by cardiomyopathy, arrhythmias, megaviscera, and, more rarely, polyneuropathy and stroke. Even after more than a century, many challenges remain unresolved, since epidemiological control and diagnostic, therapeutic, and prognostic methods must be improved. In particular, the efficacy and tolerability profile of therapeutic agents is far from ideal. Furthermore, the population affected is older and more complex (eg, immunosuppressed patients and patients with cancer). Nevertheless, in recent years, our knowledge of Chagas disease has expanded, and the international networking needed to change the course of this deadly disease during the 21st century has begun. ER - TY - JOUR T1 - Chagas disease A1 - Teixeira, A. R.L. A1 - Nitz, N. A1 - Guimaro, M. C. A1 - Gomes, C. A1 - Santos-Buch, C. A. Y1 - 2006/// JF - Postgraduate Medical Journal VL - 82 IS - 974 SP - 788 EP - 798 DO - 10.1136/pgmj.2006.047357 L1 - file:///C:/Users/NATALI/Downloads/chagas disease review pmj.bmj.pdf N2 - Chagas disease is the clinical condition triggered by infection with the protozoan Trypanosoma cruzi. The infection is transmitted by triatomine insects while blood feeding on a human host. Field studies predict that one third of an estimated 18 million T cruzi-infected humans in Latin America will die of Chagas disease. Acute infections are usually asymptomatic, but the ensuing chronic T cruzi infections have been associated with high ratios of morbidity and mortality: Chagas heart disease leads to unexpected death in 37.5% of patients, 58% develop heart failure and die and megacolon or megaoesophagus has been associated with death in 4.5%. The pathogenesis of Chagas disease appears to be related to a parasite-induced mutation of the vertebrate genome. Currently, treatment is unsatisfactory. ER - TY - BOOK T1 - Manual de procedimientos para la toma, conservación y envío de muestras al Laboratorio Nacional de Referencia A1 - Instituto Nacional de Salud Y1 - 2020/// CY - Bogotá SN - 9789587591590 L1 - file:///C:/Users/NATALI/Downloads/Manual para obtención y envío de muestras para eventos de interes en salud publica INS.pdf N2 - PAGINA: 1 de 86 PRESENTACIÓN El examen del parcial de orina es un método complementario de la historia clínica del paciente, que como tal orienta al profesional médico a completar la información o evidencia con el propósito de confirmar un diagnóstico o de rechazar la hipótesis planteada. El profesional de la salud encargado de hacer el proceso de recolectar la información, debe tener presente que sus conocimientos de base, están orientados en reconocer los parámetros de funcionamiento normal del riñón o fisiología renal, y al mismo tiempo comprender la fisiopatología del mismo; igualmente se debe de tener un conocimiento integrado de fisiopatología general y especializada, puesto que ello permitirá ordenar el examen específico del estudio de la excreción renal, o simplemente una observación generalizado de funcionamiento de la filtración reabsorción y eliminación de sustancias toxicas del organismo. Observamos por lo tanto que el análisis y estudio de los exámenes correspondientes al funcionamiento renal, no solo identifica patologías de funcionamiento del órgano como tal, sino además podemos observar el funcionamiento de otros órganos en forma indirecta como el endocrino, el enzimático, metabólico nervioso, etc. Lo anterior nos lleva a realizar un mejoramiento de los procesos en la forma y el contexto, por parte de los diferentes actores que participan en el manejo integral no solo de la muestra a examinar, además es la del usuario quien es el que se beneficia del acto médico. El proceso de la garantía de la calidad, es por lo tanto estandarizar los procesos, para llegar a unificar criterios y minimizar los errores con el propósito de cumplir con el objetivo de ofrecer una atención medica integral y mejorar la ER - TY - JOUR T1 - Guía para la vigilancia por laboratorio del Trypanosoma cruzi en Colombia A1 - Instituto Nacional de Salud Y1 - 2017/// SP - 1 EP - 36 L1 - file:///C:/Users/NATALI/Downloads/guia para la vigilancia por laboratorio del trypanosoma cruzi.pdf N2 - La presente guía aplica para la vigilancia por laboratorio del Trypanosoma cruzi en diferentes matrices y métodos con los cuales se detectan en el laboratorio nacional de referencia del INS. ER - TY - JOUR T1 - Trypanosoma cruzi genetic diversity: Something new for something known about Chagas disease manifestations, serodiagnosis and drug sensitivity A1 - Zingales, Bianca Y1 - 2018/// KW - Chagas disease pathology KW - Chemotherapy KW - Hybridization KW - Serological diagnosis KW - Trypanosoma cruzi discrete typing units KW - immune response PB - Elsevier B.V. JF - Acta Tropica VL - 184 SP - 38 EP - 52 DO - 10.1016/j.actatropica.2017.09.017 UR - http://dx.doi.org/10.1016/j.actatropica.2017.09.017 L1 - file:///C:/Users/NATALI/Downloads/Zingales, B. (2018). Trypanosoma cruzi genetic diversity Something new for something known about Chagas disease manifestations, serodiagnosis and drug sensitivity .pdf N2 - The genetic diversity of Trypanosoma cruzi, the protozoan agent of Chagas disease, is widely recognized. At present, T. cruzi is partitioned into seven discrete typing units (DTUs), TcI–TcVI and Tcbat. This article reviews the present knowledge on the parasite population structure, the evolutionary relationships among DTUs and their distinct, but not exclusive ecological and epidemiological associations. Different models for the origin of hybrid DTUs are examined, which agree that genetic exchange among T. cruzi populations is frequent and has contributed to the present parasite population structure. The geographic distribution of the prevalent DTUs in humans from the southern United States to Argentina is here presented and the circumstantial evidence of a possible association between T. cruzi genotype and Chagas disease manifestations is discussed. The available information suggests that parasite strains detected in patients, regardless of the clinical presentation, reflect the principal DTU circulating in the domestic transmission cycles of a particular region. In contrast, in several orally transmitted outbreaks, sylvatic strains are implicated. As a consequence of the genotypic and phenotypic differences of T. cruzi strains and the differential geographic distribution of DTUs in humans, regional variations in the sensitivity of the serological tests are verified. The natural resistance to benznidazole and nifurtimox, verified in vivo and in vitro for some parasite stocks, is not associated with any particular DTU, and does not explain the marked difference in the anti-parasitic efficacy of both drugs in the acute and chronic phases of Chagas disease. Throughout this review, it is emphasized that the interplay between parasite and host genetics should have an important role in the definition of Chagas disease pathogenesis, anti-T. cruzi immune response and chemotherapy outcome and should be considered in future investigations. ER - TY - JOUR T1 - Retrospective molecular integrated epidemiology of Chagas disease in Colombia A1 - Guhl, Felipe A1 - Ramírez, Juan David Y1 - 2013/// KW - Chagas disease KW - Discrete typing units KW - Disease ecology KW - Genotypes KW - Trypanosoma cruzi PB - Elsevier B.V. JF - Infection, Genetics and Evolution VL - 20 SP - 148 EP - 154 DO - 10.1016/j.meegid.2013.08.028 UR - http://dx.doi.org/10.1016/j.meegid.2013.08.028 L1 - file:///C:/Users/NATALI/Downloads/Retrospective molecular integrated epidemiology of Chagas disease in Colombia.pdf N2 - American trypanosomiasis is a very complex zoonosis that is present throughout South America, Central America, and Mexico and continues to represent a serious threat to the health of countries in the region. The parasite infects 150 species from 24 families of domestic and wild mammals and shows remarkable genetic variability evinced in at least seven discrete typing units (DTU's) named TcI-TcVI with the presence of a novel genotype associated with bats named TcBat. These DTUs show a wide range of geographical and host distributions. Our study aimed to establish the relationship between the genetic diversity of Trypanosoma cruzi and the diverse clinical manifestations of infected patients and unravel the molecular eco-epidemiology in the epizootic and enzootic scenarios in Colombia. We undertook intensive sampling in 17 departments of Colombia among 11 triatomine species, 9 mammalian reservoir species and humans and obtained 637 biological clones that were subsequently analyzed using nuclear and mitochondrial molecular markers. TcI was the most prevalent (80.7%) followed by TcII (7.2%), TcIII (3.9%), TcIV (5%), TcV (0.8%), TcVI (1.6%) and TcBat (0.8%). Within domestic foci, TcI (70%) was the most prevalent, followed by TcII (20%), TcIII (1.6%), TcIV (3.6%), TcV (2.2%) and TcVI (2,6%); within sylvatic foci, TcI (85%) was the most prevalent, followed by TcII (0.3%), TcIII (5.5%), TcIV (7%), TcVI (1.1%) and TcBat (1.1%). The results suggest the occurrence of the seven DTUs and strict associations of independent DTUs with the host and environment in Colombia. The implications are discussed herein. © 2013. ER - TY - JOUR T1 - Between a bug and a hard place: Trypanosoma cruzi genetic diversity and the clinical outcomes of Chagas disease A1 - Messenger, Louisa A. A1 - Miles, Michael A. A1 - Bern, Caryn Y1 - 2015/// KW - Chagas disease KW - cardiomyopathy KW - congenital transmission KW - diagnostics KW - genetic diversity KW - oral outbreaks KW - reactivation KW - treatment PB - Informa UK, Ltd. JF - Expert Review of Anti-Infective Therapy VL - 13 IS - 8 SP - 995 EP - 1029 DO - 10.1586/14787210.2015.1056158 UR - http://dx.doi.org/10.1586/14787210.2015.1056158 L1 - file:///C:/Users/NATALI/Downloads/Between a bug and a hard place trypanosoma cruzi gentic diversity and the clinical outcomes of chagas disease.pdf N2 - Over the last 30 years, concomitant with successful transnational disease control programs across Latin America, Chagas disease has expanded from a neglected, endemic parasitic infection of the rural poor to an urbanized chronic disease, and now a potentially emergent global health problem. Trypanosoma cruzi infection has a highly variable clinical course, ranging from complete absence of symptoms to severe and often fatal cardiovascular and/or gastrointestinal manifestations. To date, few correlates of clinical disease progression have been identified. Elucidating a putative role for T. cruzi strain diversity in Chagas disease pathogenesis is complicated by the scarcity of parasites in clinical specimens and the limitations of our contemporary genotyping techniques. This article systematically reviews the historical literature, given our current understanding of parasite genetic diversity, to evaluate the evidence for any association between T. cruzi genotype and chronic clinical outcome, risk of congenital transmission or reactivation and orally transmitted outbreaks. ER - TY - JOUR T1 - Boletín epidemiológico semanal Enfermedad de Chagas En busqueda de la sostenibilidad A1 - Instituto Nacional de Salud Y1 - 2021/// L1 - file:///C:/Users/NATALI/Downloads/2021_Boletin_epidemiologico_semana_14.pdf ER - TY - JOUR T1 - Seroprevalence of Chagas disease in Southern Brazilian cardiac patients and their knowledge about the parasitosis and vectors A1 - Dutra, A S A1 - Stauffert, D A1 - Bianchi, T F A1 - Ribeiro, D R P A1 - Villela, M M Y1 - 2021/// KW - brasil e seu conhecimento KW - cardiopathy KW - chagas em pacientes cardíacos KW - do sul do KW - knowledge KW - sobre a parasitose e KW - soroprevalência da doença de KW - triatomines KW - vetores VL - 6984 IS - 2014 SP - 867 EP - 871 L1 - file:///C:/Users/NATALI/Downloads/Seroprevalence of Chagas disease in Southern Brazilian cardiac patients and their knowledge about the parasitosis and vectors.pdf ER - TY - JOUR T1 - Chagas disease : Historic perspective A1 - Chen Chao, José L Leone, Carlos A Vigliano Y1 - 2020/// KW - chagas disease - trypanosoma KW - cruzi JF - BBA Molecular Bases of Disease DO - 10.1016/j.bbadis.2020.165689 L1 - file:///C:/Users/NATALI/Downloads/chagas disease historic perspective.pdf ER - TY - JOUR T1 - Increasing access to comprehensive care for Chagas disease : development of a patient-centered model in Colombia A1 - Marchiol, Andrea A1 - Forsyth, Colin A1 - Bernal, Oscar A1 - Hernández, Carlos Valencia A1 - Cucunubá, Zulma A1 - Abril, Eduin Pachón A1 - Javier, Mauricio A1 - Soto, Vera Y1 - 2017/// JF - Revista Panamericana de Salud Pública SP - 1 EP - 9 DO - 10.26633/RPSP.2017.153 L1 - file:///C:/Users/NATALI/Downloads/Increasing access to comprehensive care for chagas disease development of a patient centered model in colombia.pdf ER - TY - JOUR T1 - Integrated control of Chagas disease for its elimination as public health problem - A Review A1 - Sosa-Estani, Sergio A1 - Segura, Elsa Leonor Y1 - 2015/// JF - Memórias do Instituto Oswaldo Cruz VL - 110 IS - May SP - 289 EP - 298 DO - 10.1590/0074-02760140408 L1 - file:///C:/Users/NATALI/Downloads/Integrated control of Chagas disease for its elimination as public health problem a review.pdf ER - TY - JOUR T1 - Acta Tropica Interventions to bring comprehensive care to people with Chagas disease : Experiences in Bolivia , Argentina and Colombia A1 - Jesús, Maria A1 - Pereiro, Ana A1 - Herazo, Rafael A1 - Chopita, Marina A1 - Forsyth, Colin A1 - Lenardón, Mabel A1 - Losada, Irene A1 - Torrico, Faustino A1 - Marchiol, Andrea A1 - Vera, Mauricio Y1 - 2020/// KW - Access to medicine KW - Chagas disease KW - Neglected tropical diseases KW - Trypanosoma cruzi PB - Elsevier JF - Acta Tropica VL - 203 IS - March 2019 SP - 105290 EP - 105290 DO - 10.1016/j.actatropica.2019.105290 UR - https://doi.org/10.1016/j.actatropica.2019.105290 L1 - file:///C:/Users/NATALI/Downloads/interventions to bring comprehensive care to people with chagas diasease experiences in bolivia, argentina and colombia.pdf ER - TY - JOUR T1 - Trypanosoma cruzi in the chicken model: Chagas-like heart disease in the absence of parasitism A1 - Teixeira, Antonio R.L. A1 - Gomes, Clever A1 - Nitz, Nadjar A1 - Sousa, Alessandro O. A1 - Alves, Rozeneide M. A1 - Guimaro, Maria C. A1 - Cordeiro, Ciro A1 - Bernal, Francisco M. A1 - Rosa, Ana C. A1 - Hejnar, Jiri A1 - Leonardecz, Eduardo A1 - Hecht, Mariana M. Y1 - 2011/// JF - PLoS Neglected Tropical Diseases VL - 5 IS - 3 DO - 10.1371/journal.pntd.0001000 L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruzi in the Chicken Model Chagas-Like heart disease in the absence of parasitism.pdf N2 - Background: The administration of anti-trypanosome nitroderivatives curtails Trypanosoma cruzi infection in Chagas disease patients, but does not prevent destructive lesions in the heart. This observation suggests that an effective treatment for the disease requires understanding its pathogenesis. Methodology/Principal Findings: To understand the origin of clinical manifestations of the heart disease we used a chicken model system in which infection can be initiated in the egg, but parasite persistence is precluded. T. cruzi inoculation into the air chamber of embryonated chicken eggs generated chicks that retained only the parasite mitochondrial kinetoplast DNA minicircle in their genome after eight days of gestation. Crossbreeding showed that minicircles were transferred vertically via the germ line to chicken progeny. Minicircle integration in coding regions was shown by targeted-primer thermal asymmetric interlaced PCR, and detected by direct genomic analysis. The kDNA-mutated chickens died with arrhythmias, shortness of breath, cyanosis and heart failure. These chickens with cardiomyopathy had rupture of the dystrophin and other genes that regulate cell growth and differentiation. Tissue pathology revealed inflammatory dilated cardiomegaly whereby immune system mononuclear cells lyse parasite-free target heart fibers. The heart cell destruction implicated a thymus-dependent, autoimmune; self-tissue rejection carried out by CD45+, CD8γδ+, and CD8α lymphocytes. Conclusions/Significance: These results suggest that genetic alterations resulting from kDNA integration in the host genome lead to autoimmune-mediated destruction of heart tissue in the absence of T. cruzi parasites. © 2011 Teixeira et al. ER - TY - JOUR T1 - Chagas disease: Pregnancy and congenital transmission A1 - Cevallos, Ana María A1 - Hernández, Roberto Y1 - 2014/// JF - BioMed Research International VL - 2014 DO - 10.1155/2014/401864 L1 - file:///C:/Users/NATALI/Downloads/401864.pdf N2 - Chagas disease is a chronic infection that kills approximately 12,000 people a year. Mass migration of chronically infected and asymptomatic persons has caused globalization of Chagas disease and has made nonvectorial infection, including vertical and blood-borne transmission, more of a threat to human communities than vectorial infection. To control transmission, it is essential to test all pregnant women living in endemic countries and all pregnant women having migrated from, or having lived in, endemic countries. All children born to seropositive mothers should be tested not only within the first month of life but also at 6 months and 12 months of age. The diagnosis is made by identification of the parasite in blood before the age of 6 months and by identification of the parasite in blood and/or positive serology after 10 months of age. Follow up for a year is essential as a significant proportion of cases are initially negative and are only detected at a later stage. If the condition is diagnosed and treated early, the clinical response is excellent and the majority of cases are cured. © 2014 Ana María Cevallos and Roberto Hernández. ER - TY - JOUR T1 - Prevalence of Chagas disease in Colombia: A systematic review and meta-analysis A1 - Olivera, Mario J. A1 - Fory, Johana A. A1 - Porras, Julián F. A1 - Buitrago, Giancarlo Y1 - 2019/// JF - PLoS ONE VL - 14 IS - 1 SP - 1 EP - 18 SN - 1111111111 DO - 10.1371/journal.pone.0210156 L1 - file:///C:/Users/NATALI/Downloads/pevalence of chagas disease in colombia a systematic review and metaanalysis.pdf N2 - Background Despite the adoption of campaigns to interrupt the main vector and to detect Trypanosoma cruzi in blood banks, millions of people are still chronically infected; however, the prevalence data are limited, and the epidemiology of Chagas disease has not been systematically evaluated. This study aimed to estimate the prevalence of Chagas disease in Colombia. Methods A systematic literature review and meta-analysis was conducted to select all observational studies reporting the prevalence of Chagas disease in Colombia, based on serological diagnosis in participants of any age and published between January 2007 and November 2017. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random-effects models. In addition, the I2 statistic was calculated. Results The literature search yielded a total of 1,510 studies; sixteen articles with relevant prevalence data were included in the systematic review. Of these, only 12 articles were included for entry in the meta-analysis. The pooled prevalence of Chagas disease across studies was 2.0% (95% CI: 1.0–4.0). A high degree of heterogeneity was found among studies (I2 > 75%; p < 0.001). The publication bias was not statistically significant (Egger’s test, p = 0.078). The highest pooled prevalences were found in the adult population (3.0%, 95% CI: 1.0–4.0), pregnant women (3.0%, 95% CI: 3.0–4.0) and the Orinoco region (7.0%, 95% CI: 2.2–12.6). Conclusions The results indicate that the T. cruzi-infected population is aging, the adult population, pregnant women and that the Orinoco region (department of Casanare) have the highest prevalences. These results highlight the need to maintain screening and surveillance programs to identify people with chronic T. cruzi infections. ER - TY - JOUR T1 - Prevalência de anticorpos contra Trypanosoma cruzi em mulheres grávidas de zonas endémicas do Departamento de Boyacá, Colômbia A1 - Suescún-Carrero, Sandra Helena A1 - García-Artunduaga, Claudia A1 - Valdivieso-Bohórquez, Silvia Y1 - 2017/// KW - Chagas Disease KW - Colombia KW - Pregnant Women KW - Prevalence JF - Iatreia VL - 30 IS - 4 SP - 361 EP - 368 DO - 10.17533/udea.iatreia.v30n4a01 L1 - file:///C:/Users/NATALI/Downloads/anticuerpos chagas embarazada boyaca.pdf N2 - Objective: To determine the prevalence of antibodies against Trypanosoma cruzi in pregnant women in endemic areas of Boyacá, Colombia, in 2012 and 2013. Materials and methods: Cross-sectional study of 566 pregnant women from endemic municipalities of Boyacá. Samples were analyzed by means of serological tests for Chagas, namely: IgG ELISA, indirect immunofluorescence and indirect hemagglutination. Cases with positive results in two tests were considered as confirmed. Results: The overall prevalence of antibodies against Trypanosoma cruzi was 2.5 % (14/566). Municipalities with the highest prevalence were Chitaraque (8.3 %), and Soatá (3.3 %). Average age of positive women was 32.6 years, and their gestational period, 18.1 weeks. We found a statistically significant association between age and the presence of antibodies against Trypanosoma cruzi. Conclusion: Prevalence of antibodies against T. cruzi in pregnant women demonstrates the importance of the monitoring program for Chagas disease in pregnancy, as a method for congenital disease control. ER - TY - JOUR T1 - I diretriz latino-americana para o diagnóstico e tratamento da cardiopatia chagásica A1 - Castro, Iran A1 - de Andrade, Jadelson Pinheiro A1 - de Paola, Angelo Amato Vincenzo A1 - Vilas-Boas, Fábio A1 - Oliveira, Gláucia Maria Moraes A1 - Marin Neto, José Antônio A1 - Chagas, Antônio Carlos Palandri A1 - Vilas-Boas, Fábio A1 - Rocha, Eduardo Augusto Victor A1 - Oliveira, Gláucia Maria Moraes A1 - de Andrade, Jadelson Pinheiro A1 - Zimerman, Leandro Ioschpe A1 - de Almeida Campos, Luiz Antonio A1 - Montera, Marcelo Westerlund A1 - de Melo Barbosa, Márcia A1 - Guimarães, Jorge Ilha A1 - Morillo, Carlos A1 - Acquatella, Harry A1 - Mitelman, Jorge A1 - Moreno, Juan Bautista Gonzalez A1 - Gimenez, Luisa A1 - Dones, Wistremundo A1 - Filho Fragata, Abílio Augusto A1 - de Paola, Angelo Amato Vincenzo A1 - Almeida, Dirceu Rodrigues A1 - Bocchi, Edimar Alcides A1 - Vilas-Boas, Fábio A1 - Bacal, Fernando A1 - Dias, João Carlos Pinto A1 - Neto, José Antônio Marin A1 - Moreira, Maria da Consolação Vieira A1 - Xavier, Sérgio Salles A1 - de Oliveira, Wilson Alves Y1 - 2011/// KW - cardiomyopathy KW - chagas KW - complications KW - diagnosis KW - epidemiology KW - guidelines KW - history KW - latin america KW - mortality KW - pathophysiology KW - therapy KW - trend JF - Arquivos Brasileiros de Cardiologia VL - 97 IS - 2 SUPPL. 1 SP - 1 EP - 53 DO - 10.1590/s0066-782x2011001600001 L1 - file:///C:/Users/NATALI/Downloads/Latin American Guidelines for the Diagnosis and Treatment of Chagas heart disease. Executive summary.pdf ER - TY - JOUR T1 - Evolution of anti-Trypanosoma cruzi antibody production in patients with chronic Chagas disease: Correlation between antibody titers and development of cardiac disease severity A1 - Georg, Ingebourg A1 - Hasslocher-Moreno, Alejandro Marcel A1 - Xavier, Sergio Salles A1 - Holanda, Marcelo Teixeira de A1 - Roma, Eric Henrique A1 - Bonecini-Almeida, Maria da Gloria Y1 - 2017/// JF - PLoS Neglected Tropical Diseases VL - 11 IS - 7 SP - 1 EP - 22 SN - 1111111111 DO - 10.1371/journal.pntd.0005796 L1 - file:///C:/Users/NATALI/Downloads/Evolution of antiTrypanosoma cruzi antibody PRODUCTION IN PATINENTS WITH CHRONIC CHAGAS DISEASE CORRELATION BETWEEN ANTIBODY TITER AND DEVELOPMENT OF CARDIAC DISEASE SEVERITY.pdf N2 - Chagas disease is one of the most important endemic infections in Latin America affecting around 6–7 million people. About 30–50% of patients develop the cardiac form of the disease, which can lead to severe cardiac dysfunction and death. In this scenario, the identification of immunological markers of disease progression would be a valuable tool for early treatment and reduction of death rates. In this observational study, the production of anti-Trypanosoma cruzi antibodies through a retrospective longitudinal follow-up in chronic Chagas disease patients´ cohort and its correlation with disease progression and heart commitment was evaluated. Strong inverse correlation (ρ = -0.6375, p = 0.0005) between anti-T. cruzi IgG1titers and left ventricular ejection fraction (LVEF) in chronic Chagas cardiomyopathy (CCC) patients were observed after disease progression. Elevated levels of anti-T. cruzi IgG3titers were detected in all T. cruzi-infected patients, indicating a lack of correlation of this IgG isotype with disease progression. Furthermore, low levels of anti-T. cruzi IgG2, IgG4, and IgA were detected in all patients through the follow-up. Although without statistical significance anti-T. cruzi IgE tends to be more reactive in patients with the indeterminate form (IND) of the disease (p = 0.0637). As this study was conducted in patients with many years of chronic disease no anti-T. cruzi IgM was detected. Taken together, these results indicate that the levels of anti-T. cruzi IgG1could be considered to seek for promising biomarkers to predict the severity of chronic Chagas disease cardiomyopathy. ER - TY - JOUR T1 - Natural populations of Trypanosoma cruzi, the agent of Chagas disease, have a complex multiclonal structure A1 - Tibayrenc, M. A1 - Ward, P. A1 - Moya, A. A1 - Ayala, F. J. Y1 - 1986/// JF - Proceedings of the National Academy of Sciences of the United States of America VL - 83 IS - 1 SP - 115 EP - 119 DO - 10.1073/pnas.83.1.115 L1 - file:///C:/Users/NATALI/Downloads/Natural populations of Trypanosoma cruzi, the agent of Chagas disease, have a complex multiclonal structure.pdf N2 - We have studied 15 gene loci coding for enzymes in 121 Trypanosoma cruzi stocks from a wide geographic range - from the United States and Mexico to Chile and southern Brazil. T.cruzi is diploid but reproduction is basically clonal, with very little if any sexuality remaining at present. We have identified 43 different clones by their genetic composition; the same genetic clone is often found in very distant places and in diverse hosts. There is much genetic heterogeneity among the different clones, and they cannot be readily classified into a few discrete groups that might represent natural taxa. These findings imply that the biological and medical characteristics need to be ascertained separately for each natural clone. The evidence indicates that clonal evolution is very ancient in T.cruzi. We propose two alternative hypotheses concerning the relationship between the biochemical diversity and the heterogeneity in other biological and medical characteristics of T. cruzi. One hypothesis is that the degree of diversity between strains simply reflects the time elapsed since their last common ancestor. The second hypothesis is that biological and medical heterogeneity is recent and reflects adaptation to different transmission cycles. A decision between the two hypotheses can be reached with appropriate studies, with important medical consequences. ER - TY - JOUR T1 - A new consensus for Trypanosoma cruzi intraspecific nomenclature: second revision meeting recommends TcI to TcVI A1 - Zingales B, SG Andrade, MRS Briones, DA Campbell, E Chiari, O Fernandes, F Guhl, E Lages-Silva, AM Macedo, CR Machado, MA Miles, AJ Romanha, NR Sturm, M Tibayrenc, AG Schijman Y1 - 2009/// KW - Chagas disease - Trypanosoma cruzi strains - taxon JF - Mem Inst Oswaldo Cruz VL - 104 IS - 7 SP - 1051 EP - 1054 L1 - file:///C:/Users/NATALI/Downloads/A new consensus for Trypanosoma cruzi intraspecific nomenclature second revision meeting recommends TcI to TcVI.pdf ER - TY - JOUR T1 - Association between Trypanosoma cruzi DTU TcII and chronic Chagas disease clinical presentation and outcome in an urban cohort in Brazil A1 - Nielebock, Marco Antonio Prates A1 - Moreira, Otacílio C. A1 - das Chagas Xavier, Samanta Cristina A1 - de Freitas Campos Miranda, Luciana A1 - de Lima, Ana Carolina Bastos A1 - de Jesus Sales Pereira, Thayanne Oliveira A1 - Hasslocher-Moreno, Alejandro Marcel A1 - Britto, Constança A1 - Sangenis, Luiz Henrique Conde A1 - Saraiva, Roberto Magalhães Y1 - 2020/// JF - PLoS ONE VL - 15 IS - 12 December SP - 1 EP - 15 SN - 1111111111 DO - 10.1371/journal.pone.0243008 L1 - file:///C:/Users/NATALI/Downloads/Association between Trypanosoma cruzi DTU TcII and chronic chagas disease clinical presentation and outcome in an urban cohort in brazil.pdf N2 - Background The specific roles of parasite characteristics and immunological factors of the host in Chagas disease progression and prognosis are still under debate. Trypanosoma cruzi genotype may be an important determinant of the clinical chronic Chagas disease form and prognosis. This study aimed to identify the potential association between T. cruzi genotypes and the clinical presentations of chronic Chagas disease. Methodology/principal findings This is a retrospective study using T. cruzi isolated from blood culture samples of 43 patients with chronic Chagas disease. From 43 patients, 42 were born in Brazil, mainly in Southeast and Northeast Brazilian regions, and one patient was born in Bolivia. Their mean age at the time of blood collection was 52.4±13.2 years. The clinical presentation was as follows 51.1% cardiac form, 25.6% indeterminate form, and 23.3% cardiodigestive form. Discrete typing unit (DTU) was determined by multilocus conventional PCR. TcII (n = 40) and TcVI (n = 2) were the DTUs identified. DTU was unidentifiable in one patient. The average follow-up time after blood culture was 5.7±4.4 years. A total of 14 patients (32.5%) died and one patient underwent heart transplantation. The cause of death was sudden cardiac arrest in six patients, heart failure in five patients, not related to Chagas disease in one patient, and ignored in two patients. A total of 8 patients (18.6%) progressed, all of them within the cardiac or cardiodigestive forms. Conclusions/significance TcII was the main T. cruzi DTU identified in chronic Chagas disease Brazilian patients (92.9%) with either cardiac, indeterminate or cardiodigestive forms, born at Southeast and Northeast regions. Other DTU found in much less frequency was TcVI (4.8%). TcII was also associated to patients that evolved with heart failure or sudden cardiac arrest, the two most common and ominous consequences of the cardiac form of Chagas disease. ER - TY - JOUR T1 - Ecological , Social and Biological Risk Factors for Continued Trypanosoma cruzi Transmission by Triatoma dimidiata in Guatemala A1 - Bustamante DM, De Urioste-Stone SM, Juárez JG, Pennington PM Y1 - 2014/// VL - 9 IS - 8 DO - 10.1371/journal.pone.0104599 L1 - file:///C:/Users/NATALI/Downloads/Ecological, Social and Biological Risk Factors for continued trypanosoma cruzi transmission by triatoma diamidiata in Guatemala.pdf ER - TY - JOUR T1 - Identification of novel mammalian hosts and Brazilian biome geographic distribution of Trypanosoma cruzi TcIII and TcIV A1 - Barros, Juliana Helena S. A1 - Xavier, Samanta Cristina C. A1 - Bilac, Daniele A1 - Lima, Valdirene Santos A1 - Dario, Maria Augusta A1 - Jansen, Ana Maria Y1 - 2017/// KW - DTU KW - Mammals KW - Reservoir KW - Triatomines KW - Wild PB - Elsevier JF - Acta Tropica VL - 172 IS - October 2016 SP - 173 EP - 179 DO - 10.1016/j.actatropica.2017.05.003 UR - http://dx.doi.org/10.1016/j.actatropica.2017.05.003 L1 - file:///C:/Users/NATALI/Downloads/Identification of novel mammalian hosts and Brazilian biome geographic ditribution of trypanosoma cruzi TcIII and TcIV.pdf N2 - Trypanosoma cruzi is a parasitic protozoan responsible for Chagas disease. Seven different Discrete Typing Units (DTUs) of T. cruzi are currently identified in nature: TcI−TcVI, and TcBat whose distribution patterns in nature, hosts/reservoirs and eco-epidemiological importance are still little known. Here, we present novel data on the geographic distribution and diversity of mammalian hosts and vectors of T. cruzi DTUs TcIII and TcIV. In this study, we analyzed 61 T. cruzi isolates obtained from 18 species of mammals (five orders) and two Hemiptera genera. Samples were collected from five Brazilian biomes (Pantanal, Caatinga, Cerrado, Atlantic Rainforest, and Amazon) previously characterized as Z3 or mixed infection (TcI-Z3) by mini-exon gene PCR. To identify TcIII and TcIV genotypes, we applied restriction fragment length polymorphism analysis to the PCR-amplified histone 3 gene. DTUs TcIII and TcIV were identified in single and mixed infections from wide dispersion throughout five Brazilian biomes studied, with TcIV being the most common. Pantanal was the biome that displayed the largest number of samples characterized as TcIII and TcIV in single and mixed infections, followed by Atlantic Rainforest and Amazon. Species from the Didelphimorphia order displayed the highest frequency of infection and were found in all five biomes. We report, for the first time, the infection of a species of the Artiodactyla order by DTU TcIII. In addition, we describe new host species: five mammals (marsupials and rodents) and two genera of Hemiptera. Our data indicate that DTUs TcIII and TcIV are more widespread and infect a larger number of mammalian species than previously thought. In addition, they are transmitted in restricted foci and cycles, but in different microhabitats and areas with distinct ecological profiles. Finally, we show that DTUs TcIII and TcIV do not present any specific association with biomes or host species. ER - TY - JOUR T1 - Trypanosoma cruzi I genotypes in different geographic regions and transmission cycles based on a microsatellite motif of the intergenic spacer of spliced leader genes A1 - Cura CI, Mejía-Jaramillo AM, Duffy T, Burgos JM, Rodriguero M, Cardinal MV, Kjos S, Gurgel-Gonçalves R, Blanchet D, De Pablos LM, Tomasini N, da Silva A, Russomando G, Cuba CA, Aznar C, Abate T, Levin MJ, Osuna A, Gürtler RE, Diosque P, Solari A, Triana-C, Schijman AG. Y1 - 2010/// KW - epiblast KW - gfp fusion KW - histone h2b- KW - icm KW - lineage specification KW - live imaging KW - mouse blastocyst KW - pdgfr α KW - primitive endoderm JF - Int J Parasitol. VL - 40 IS - 14 SP - 1599 EP - 1607 SN - 6176321972 DO - 10.1016/j.ijpara.2010.06.006.Trypanosoma L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruzi I genotypes in different geographic regions and transmission cycles based on a microsatellite motif of the intergenic spacer of spliced leader genes.pdf ER - TY - JOUR T1 - Molecular identification of trypanosoma cruzi discrete typing units in end-stage chronic chagas heart disease and reactivation after heart transplantation A1 - Burgos, Juan Miguel A1 - Diez, Mirta A1 - Vigliano, Carlos A1 - Bisio, Margarita A1 - Risso, Marikena A1 - Duffy, Tomás A1 - Cura, Carolina A1 - Brusses, Betina A1 - Favaloro, Liliana A1 - Leguizamon, María Susana A1 - Lucero, Raul Horacio A1 - Laguens, Ruben A1 - Levin, Mariano Jorge A1 - Favaloro, Roberto A1 - Schijman, Alejandro Gabriel Y1 - 2010/// JF - Clinical Infectious Diseases VL - 51 IS - 5 SP - 485 EP - 495 DO - 10.1086/655680 L1 - file:///C:/Users/NATALI/Downloads/Molecular Identification of Trypanosoma cruzi DTU in end stage chronic chagas heart disease and reactivation after heart transplantation.pdf N2 - Background. One hundred years after the discovery of Chagas disease, it remains a major neglected tropical disease. Chronic Chagas heart disease (cChHD) is the most severe manifestation. Heart transplantation is the proper treatment for end-stage heart failure, although reactivation of disease may result after receipt of immunosuppressive therapy. T. cruzi strains cluster into 6 discrete typing units (DTUs; I-VI) associated with different geographical distribution, transmission cycles and varying disease symptoms. In the southern cone of South America, T. cruzi II, V, and VI populations appear to be associated with Chagas disease and T. cruzi I with sylvatic cycles. Methods. Molecular characterization of DTUs, T. cruzi I genotypes (on the basis of spliced-leader gene polymorphisms), and minicircle signatures was conducted using cardiac explant specimens and blood samples obtained from a cohort of 16 Argentinean patients with cChHD who underwent heart transplantation and from lesion samples obtained from 6 of these patients who presented with clinical reactivation of Chagas disease. Results. Parasite persistence was associated with myocarditis progression, revealing T. cruzi I (genotype Id) in 3 explant samples and T. cruzi II, V, or VI in 5 explant samples. Post-heart transplantation follow-up examination of bloodstream DTUs identified T. cruzi I in 5 patients (genotypes Ia or Id) and T. cruzi II, V, or VI in 7 patients. T. cruzi I, V, and VI were detected in skin chagoma specimens, and T. cruzi V and VI were detected in samples obtained from patients with myocarditis reactivations. Multiple DTUs or genotypes at diverse body sites and polymorphic minicircle signatures at different cardiac regions revealed parasite histotropism. T. cruzi I infections clustered in northern Argentina (latitude, 23°S-27°S), whereas T. cruzi II, V, or VI DTUs were more ubiquitous. Conclusions. Multiple DTUs coexist in patients with Chagas disease. The frequent finding of T. cruzi I associated with cardiac damage was astounding, revealing its pathogenic role in cChHD at the southern cone. © 2010 by the Infectious Diseases Society of America. ER - TY - JOUR T1 - Chagas cardiomyopathy manifestations and trypanosoma cruzi genotypes circulating in chronic chagasic patients A1 - Ramírez, Juan David A1 - Guhl, Felipe A1 - Rendón, Lina Maŕa A1 - Rosas, Fernando A1 - Marin-Neto, Jose A. A1 - Morillo, Carlos A. Y1 - 2010/// JF - PLoS Neglected Tropical Diseases VL - 4 IS - 11 SP - 1 EP - 9 DO - 10.1371/journal.pntd.0000899 L1 - file:///C:/Users/NATALI/Downloads/Chagas Cardiomyopathy Manifestations and trypanosoma cruzi genotypes circulating in chronic chagasic patients.pdf N2 - Chagas disease caused by Trypanosoma cruzi is a complex disease that is endemic and an important problem in public health in Latin America. The T. cruzi parasite is classified into six discrete taxonomic units (DTUs) based on the recently proposed nomenclature (TcI, TcII, TcIII, TcIV, TcV and TcVI). The discovery of genetic variability within TcI showed the presence of five genotypes (Ia, Ib, Ic, Id and Ie) related to the transmission cycle of Chagas disease. In Colombia, TcI is more prevalent but TcII has also been reported, as has mixed infection by both TcI and TcII in the same Chagasic patient. The objectives of this study were to determine the T. cruzi DTUs that are circulating in Colombian chronic Chagasic patients and to obtain more information about the molecular epidemiology of Chagas disease in Colombia. We also assessed the presence of electrocardiographic, radiologic and echocardiographic abnormalities with the purpose of correlating T. cruzi genetic variability and cardiac disease. Molecular characterization was performed in Colombian adult chronic Chagasic patients based on the intergenic region of the mini-exon gene, the 24Sa and 18S regions of rDNA and the variable region of satellite DNA, whereby the presence of T.cruzi I, II, III and IV was detected. In our population, mixed infections also occurred, with TcI-TcII, TcI-TcIII and TcI-TcIV, as well as the existence of the TcI genotypes showing the presence of genotypes Ia and Id. Patients infected with TcI demonstrated a higher prevalence of cardiac alterations than those infected with TcII. These results corroborate the predominance of TcI in Colombia and show the first report of TcIII and TcIV in Colombian Chagasic patients. Findings also indicate that Chagas cardiomyopathy manifestations are more correlated with TcI than with TcII in Colombia. © 2010 Rami{dotless} ́rez et al. ER - TY - JOUR T1 - Epidemiology, Biochemistry and Evolution of Trypanosoma cruzi Lineages Based on Ribosomal RNA Sequences A1 - Zingales, Bianca A1 - Stolf, Beatriz S. A1 - Souto, Ricardo P. A1 - Fernandes, Octavio A1 - Briones, Marcelo R.S. Y1 - 1999/// KW - Major lineages KW - Molecular epidemiology KW - Phylogeny KW - Ribosomal RNA KW - Trypanosoma cruzi JF - Memorias do Instituto Oswaldo Cruz VL - 94 IS - SUPPL. 1 SP - 159 EP - 164 DO - 10.1590/S0074-02761999000700020 L1 - file:///C:/Users/NATALI/Downloads/Epidemiology, Biochemistry and Evolution of Trypanosoma cruzi lineages based on ribosomal rna sequences.pdf ER - TY - JOUR T1 - Genetic characterization of Trypanosoma cruzi directly from tissues of patients with chronic chagas disease: Differential distribution of genetic types into diverse organs A1 - Vago, Annamaria R. A1 - Andrade, Luciana O. A1 - Leite, Adriana A. A1 - d’Ávila Reis, D#x00E9;bora A1 - Macedo, Andrea M. A1 - Adad, Sheila J. A1 - Tostes, Sebasti#x00E3;o A1 - Moreira, Maria da Consolaçao V. A1 - Filho, Geraldo Brasileiro A1 - Pena, Sérgio D.J. Y1 - 2000/// JF - American Journal of Pathology VL - 156 IS - 5 SP - 1805 EP - 1809 DO - 10.1016/S0002-9440(10)65052-3 L1 - file:///C:/Users/NATALI/Downloads/Genetic Characterization of Trypanosoma cruzi directly from tissues of patients with chronic chagas disease.pdf N2 - We have previously shown that a low-stringency single-specific primer-polymerase chain reaction (LSSP-PCR) is a highly sensitive and reproducible technique for the genetic profiling of Trypanosoma cruzi parasites directly in tissues from infected animals and humans. By applying LSSP-PCR to the study of the variable region of kinetoplast minicircle from T. cruzi, the intraspecific polymorphism of the kinetoplast-deoxyribonucleic acid (kDNA) sequence can be translated into individual kDNA signatures. In the present article, we report on our success using the LSSP-PCR technique in profiling the T. cruzi parasites present in the hearts of 13 patients with chagasic cardiopathy and in the esophagi of four patients (three of them with chagasic megaesophagus). In two patients, one with the cardiodigestive clinical form of Chagas disease and the other with cardiopathy and an esophageal inflammatory process, we could study both heart and esophagus and we detected distinct kDNA signatures in the two organs. This provides evidence of a differential tissue distribution of genetically diverse T. cruzi populations in chronic Chagas disease, suggesting that the genetic variability of the parasite is one of the determining factors of the clinical form of the disease. ER - TY - JOUR T1 - Differential tissue distribution of diverse clones of Trypanosoma cruzi in infected mice A1 - Andrade, Luciana O. A1 - Machado, Conceição R.S. A1 - Chiari, Egler A1 - Pena, Sérgio D.J. A1 - Macedo, Andrea M. Y1 - 1999/// KW - Clonal-histotropic hypothesis KW - Inflammation KW - LSSP-PCR KW - Tissue parasitism KW - kDNA minicircle JF - Molecular and Biochemical Parasitology VL - 100 IS - 2 SP - 163 EP - 172 SN - 5531499264 DO - 10.1016/S0166-6851(99)90035-X L1 - file:///C:/Users/NATALI/Downloads/Differential tissue distribution of diverse clones of Trypanosoma cruzi in infected mice.pdf N2 - Chagas disease, caused by the protozoan Trypanosoma cruzi, presents variable clinical course but the phenomena underlying this variability remain largely unknown. T. cruzi has a clonal population structure and infecting strains are often multiclonal. T. cruzi genetic variability could be a determinant of differential tissue tropism or distribution and consequently of the clinical forms of the disease. We tested this hypothesis by using low-stringency single specific primer polymerase chain reaction (LSSP-PCR) to type genetically the parasites in tissues of experimental infected mice. BALB/c mice were simultaneously inoculated with two different T. cruzi populations (JG strain and Col1.7G2 clone). Doubly infected animals showed clear differential tissue distribution for the two populations (chronic phase). Our results indicate a significant influence of the genetic polymorphism of infecting T. cruzi populations in the pathogenesis of chronic Chagas disease. Copyright (C) 1999 Elsevier Science B.V. ER - TY - JOUR T1 - Trypanosoma cruzi TcIII/Z3 genotype as agent of an outbreak of Chagas disease in the Brazilian Western Amazonia: Short Communication A1 - Monteiro, Wuelton M. A1 - Magalhães, Laylah K. A1 - Santana Filho, Franklin S. A1 - Borborema, Maurício A1 - Silveira, Henrique A1 - Barbosa, Maria Das Graças V. Y1 - 2010/// KW - Trypanossoma cruzi KW - acute Chagas disease KW - genotype KW - outbreak JF - Tropical Medicine and International Health VL - 15 IS - 9 SP - 1049 EP - 1051 DO - 10.1111/j.1365-3156.2010.02577.x L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruziTcIII⁄Z3 genotype as agent of an outbreak ofChagas disease in the Brazilian Western Amazonia.pdf N2 - Chagas' disease is an emerging and neglected disease in the Brazilian Amazon region, where T. cruzi I predominates among the acute cases of the disease; and T. cruzi III/Z3, a population cluster from sylvatic areas of the Amazon basin, is rarely associated with human infections. On 23rd April 2007, the Foundation for Health Surveillance of the State of Amazonas, Brazil reported an outbreak of acute Chagas disease in the municipality of Coari on the Solimões River banks. Fresh blood examination confirmed the infection in 25 patients. Parasite culture in LIT medium was successful for 18 isolates. Molecular characterization was performed by PCR of the non-transcribed spacer of the mini-exon and by sequencing of the mitochondrial cytochrome c oxidase subunit II (COII) gene. The T. cruzi isolates were all from genotype Z3, and sequencing revealed that all isolates had equal COII sequences compatible with TcIII type, suggesting a single source of infection. To our knowledge, this is the first outbreak of acute cases caused uniquely by the genotype TcIII/Z3. Wild vectors harbouring TcIII stocks contribute to transmission when the triatomine species reaches human food chain or when humans invade the forest environment, where sylvatic cycle constitutes a reservoir of parasites that might be associated with specific epidemiological and clinical traits of the emergent Chagas disease in the Amazon. © 2010 Blackwell Publishing Ltd. ER - TY - JOUR T1 - Trypanosoma cruzi IV causing outbreaks of acute chagas disease and infections by different haplotypes in the Western Brazilian Amazonia A1 - Monteiro, Wuelton Marcelo A1 - Magalhães, Laylah Kelre Costa A1 - de Sá, Amanda Regina Nichi A1 - Gomes, Mônica Lúcia A1 - Toledo, Max Jean de Ornelas A1 - Borges, Lara A1 - Pires, Isa A1 - Guerra, Jorge Augusto de Oliveira A1 - Silveira, Henrique A1 - Barbosa, Maria das Graças Vale Y1 - 2012/// JF - PLoS ONE VL - 7 IS - 7 DO - 10.1371/journal.pone.0041284 L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruzi IV Causing Outbreaks of Acute chgas disease and infections by different haplotypes in the western brazilian amazonia.pdf N2 - Background: Chagas disease is an emergent tropical disease in the Brazilian Amazon Region, with an increasing number of cases in recent decades. In this region, the sylvatic cycle of Trypanosoma cruzi transmission, which constitutes a reservoir of parasites that might be associated with specific molecular, epidemiological and clinical traits, has been little explored. The objective of this work is to genetically characterize stocks of T. cruzi from human cases, triatomines and reservoir mammals in the State of Amazonas, in the Western Brazilian Amazon. Methodology/Principal Findings: We analyzed 96 T. cruzi samples from four municipalities in distant locations of the State of Amazonas. Molecular characterization of isolated parasites from cultures in LIT medium or directly from vectors or whole human blood was performed by PCR of the non-transcribed spacer of the mini-exon and of the 24 S alfa ribosomal RNA gene, RFLP and sequencing of the mitochondrial cytochrome c oxidase subunit II (COII) gene, and by sequencing of the glucose-phosphate isomerase gene. The T. cruzi parasites from two outbreaks of acute disease were all typed as TcIV. One of the outbreaks was triggered by several haplotypes of the same DTU. TcIV also occurred in isolated cases and in Rhodnius robustus. Incongruence between mitochondrial and nuclear phylogenies is likely to be indicative of historical genetic exchange events resulting in mitochondrial introgression between TcIII and TcIV DTUs from Western Brazilian Amazon. TcI predominated among triatomines and was the unique DTU infecting marsupials. Conclusion/Significance: DTU TcIV, rarely associated with human Chagas disease in other areas of the Amazon basin, is the major strain responsible for the human infections in the Western Brazilian Amazon, occurring in outbreaks as single or mixed infections by different haplotypes. © 2012 Monteiro et al. ER - TY - JOUR T1 - Recognizing and reducing the risks of Chagas disease (American Trypanosomiasis) in travelers A1 - Diaz, James H. Y1 - 2008/// JF - Journal of Travel Medicine VL - 15 IS - 3 SP - 184 EP - 195 DO - 10.1111/j.1708-8305.2008.00205.x L1 - file:///C:/Users/NATALI/Downloads/Recognizing and Reducing the Risks of Chagas Disease in travelers.pdf ER - TY - JOUR T1 - Prevention of Transfusional Trypanosoma cruzi Infection in Latin America A1 - Schmunis, Gabriel A. Y1 - 1999/// KW - Blood transfusion KW - Chagas disease KW - Donors screening KW - Latin America KW - Prevention KW - Serology KW - Trypanosoma cruzi JF - Memorias do Instituto Oswaldo Cruz VL - 94 IS - SUPPL. 1 SP - 93 EP - 101 DO - 10.1590/S0074-02761999000700010 L1 - file:///C:/Users/NATALI/Downloads/Prevention of Transfusional Trypanosoma cruzi Infection in latin america.pdf N2 - Trypanosoma cruzi is a protozoan infection widely spread in Latin America, from Mexico in the north to Argentina and Chile in the south. The second most important way of acquiring the infection is by blood transfusion. Even if most countries of Latin America have law/decree/norms, that make mandatory the screening of blood donors for infectious diseases, including T. cruzi (El Salvador and Nicaragua do not have laws on the subject), there is usually no enforcement or it is very lax. Analysis of published serologic surveys of T. cruzi antibodies in blood donors done in 1993, indicating the number of donors and screening coverage for T. cruzi in ten countries of Central and South America indicated that the probability of receiving a potentially infected transfusion unit in each country varied from 1,096 per 10,000 transfusions in Bolivia, the highest, to 13.02 or 13.86 per 10,000 transfusions in Honduras and Venezuela respectively, where screening coverage was 100%. On the other hand the probability of transmitting a T. cruzi infected unit was 219/10,000 in Bolivia, 24/10,000 in Colombia, 17/10,000 in El Salvador, and around 2-12/10,000 for the seven other countries. Infectivity risks defined as the likelihood of being infected when receiving an infected transfusion unit were assumed to be 20% for T. cruzi. Based on this, estimates of the absolute number of infections induced by transfusion indicated that they were 832, 236, and 875 in Bolivia, Chile and Colombia respectively. In all the other countries varied from seven in Honduras to 85 in El Salvador. Since 1993, the situation has improved. At that time only Honduras and Venezuela screened 100% of donors, while seven countries, Argentina, Colombia, El Salvador, Honduras, Paraguay, Uruguay and Venezuela, did the same in 1996. In Central America, without information from Guatemala, the screening of donors for T. cruzi prevented the transfusion of 1,481 infected units and the potential infection of 300 individuals in 1996. In the same year, in seven countries of South America, the screening prevented the transfusion of 36,017 infected units and 7,201 potential cases of transfusional injection. ER - TY - JOUR T1 - Oral transmission of chagas disease by consumption of Açaí palm fruit, Brazil A1 - Nóbrega, Aglaêr A. A1 - Garcia, Marcio H. A1 - Tatto, Erica A1 - Obara, Marcos T. A1 - Costa, Elenild A1 - Sobel, Jeremy A1 - Araujo, Wildo N. Y1 - 2009/// JF - Emerging Infectious Diseases VL - 15 IS - 4 SP - 653 EP - 655 DO - 10.3201/eid1504.081450 L1 - file:///C:/Users/NATALI/Downloads/Oral Transmission of chagas disease by consumption of acai palm fruit.pdf N2 - In 2006, a total of 178 cases of acute Chagas disease were reported from the Amazonian state of Para, Brazil. Eleven occurred in Barcarena and were confirmed by visualization of parasites on blood smears. Using cohort and case-control studies, we implicated oral transmission by consumption of açaí palm fruit. ER - TY - JOUR T1 - The impact of climate change on the geographical distribution of two vectors of chagas disease: Implications for the force of infection A1 - Medone, Paula A1 - Ceccarelli, Soledad A1 - Parham, Paul E. A1 - Figuera, Andreìna A1 - Rabinovich, Jorge E. Y1 - 2015/// KW - Chagas disease KW - Climate change KW - Climatic modelling KW - Force of infection KW - Rhodnius prolixus KW - Triatoma infestans JF - Philosophical Transactions of the Royal Society B: Biological Sciences VL - 370 IS - 1665 SP - 1 EP - 12 DO - 10.1098/rstb.2013.0560 L1 - file:///C:/Users/NATALI/Downloads/The impact of climate change on the geographical distribution of two vectors of chagas disease implications for the force of infection.pdf N2 - Chagas disease, caused by the parasite Trypanosoma cruzi, is the most important vector-borne disease in Latin America. The vectors are insects belonging to the Triatominae (Hemiptera, Reduviidae), and are widely distributed in the Americas. Here, we assess the implications of climatic projections for 2050 on the geographical footprint of two of the main Chagas disease vectors: Rhodnius prolixus (tropical species) and Triatoma infestans (temperate species).We estimated the epidemiological implications of current to future transitions in the climatic niche in terms of changes in the force of infection (FOI) on the rural population of two countries: Venezuela (tropical) and Argentina (temperate). The climatic projections for 2050 showed heterogeneous impact on the climatic niches of both vector species, with a decreasing trend of suitability of areas that are currently at high-to-moderate transmission risk. Consequently, climatic projections affected differently the FOI for Chagas disease in Venezuela and Argentina. Despite the heterogeneous results, our main conclusions point out a decreasing trend in the number of new cases of Tr. cruzi human infections per year between current and future conditions using a climatic niche approach. ER - TY - JOUR T1 - Persistent infections in chronic Chagas' disease patients treated with anti-Trypanosoma cruzi nitroderivatives A1 - M S Braga, L Lauria-Pires, E R Argañaraz, R J Nascimento, A R Teixeira Y1 - 2000/// KW - benznidazole KW - chagas KW - disease KW - nifurtimox KW - treatment KW - trypanosoma cruzi VL - 42 IS - 3 SP - 157 EP - 161 L1 - file:///C:/Users/NATALI/Downloads/PERSISTENT INFECTIONS IN CHRONIC CHAGAS’ DISEASE PATIENTS TREATED WITH anti trypanosoma cruzi nitroderivatives.pdf ER - TY - JOUR T1 - Evaluation of Parasiticide Treatment with Benznidazol in the Electrocardiographic, Clinical, and Serological Evolution of Chagas Disease A1 - Fragata-Filho, Abilio Augusto A1 - França, Francisco Faustino A1 - Fragata, Claudia da Silva A1 - Lourenço, Angela Maria A1 - Faccini, Cristiane Castro A1 - Costa, Cristiane Aparecida de Jesus Y1 - 2016/// JF - PLoS Neglected Tropical Diseases VL - 10 IS - 3 SP - 1 EP - 12 DO - 10.1371/journal.pntd.0004508 L1 - file:///C:/Users/NATALI/Downloads/Evaluation of Parasiticide Treatment with benznidazol in the ecg clinical and serological evolution of chagas disease.pdf N2 - Introduction: Chagas disease is one of the most important endemic parasitic diseases in Latin America. In its chronic phase, progression to cardiomyopathy has high morbidity and mortality. The persistence of a normal electrocardiogram (ECG) provides a similar prognosis to that of a non-diseased population. Benznidazole (BNZ) is the only drug with trypanocidal action available in Brazil. Materials/Methods/Results: A group of 310 patients with chronic Chagas disease who had normal ECGs at the first medical visit performed before 2002 were included. There were 263 patients treated with BNZ and 47 untreated. The follow-up period was 19.59 years. Univariate analyses showed that those treated were younger and predominantly male. As many as 79.08% of those treated and 46.81% of those untreated continued with normal electrocardiograms (p <0.0001). The occurrence of electrocardiographic abnormalities and relevant clinical events (heart failure, stroke, total mortality, and cardiovascular death) was less prevalent in treated patients (p <0.001, p: 0.022, p: 0.047 respectively). In multivariate analyses, the parasiticide treatment was an independent variable for persistence of a normal ECG pattern, which was an independent variable in the prevention of significant clinical events. The immunofluorescence titers decreased with the parasitological treatment. However, the small number of tests in untreated patients did not allow the correlation of the decrease of these titers with electrocardiographic alterations. Conclusion: These data suggest that treatment with benznidazole prevents the occurrence of electrocardiographic alterations. On the other hand, patients who develop ECG abnormalities present with more significant clinical events. ER - TY - JOUR T1 - A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention A1 - Machado-de-Assis, Girley Francisco A1 - Diniz, Glaucia Alessio A1 - Montoya, Roberto Araújo A1 - Dias, João Carlos Pinto A1 - Coura, José Rodrigues A1 - Machado-Coelho, George Luiz Lins A1 - Albajar-Viñas, Pedro A1 - Torres, Rosália Morais A1 - de Lana, Marta Y1 - 2013/// KW - Benznidazole KW - Chagas disease KW - Etiological treatment KW - Serological and clinical evaluation KW - Trypanosoma cruzi JF - Memorias do Instituto Oswaldo Cruz VL - 108 IS - 7 SP - 873 EP - 880 DO - 10.1590/0074-0276130122 L1 - file:///C:/Users/NATALI/Downloads/A serological, parasitological and clinical evaluation of untreated chagas disease patients and those tresated with benznidazole before and thirteen years after intervention.pdf N2 - The etiological treatment of Chagas disease is recommended for all patients with acute or recent chronic infection, but controversies remain regarding the benefit of chemotherapy and interpretations of the parasitological cure after etiological treatment. This study compares the laboratory and clinical evaluations of Chagas disease patients who were diagnosed 13 years earlier. Fifty-eight Chagas disease patients (29 treated with benznidazole and 29 untreated) were matched at the time of treatment based on several variables. Conventional serology revealed the absence of seroconversion in all patients. However, lower serological titres were verified in the treated group, primarily among patients who had the indeterminate form of the disease. Haemoculture performed 13 years after the intervention was positive for 6.9% and 27.6% of the treated and untreated patients, respectively. Polymerase chain reaction tests were positive for 44.8% and 13.8% of the treated and untreated patients, respectively. Patients who presented with the indeterminate form of the disease at the beginning of the study exhibited less clinical progression (17.4%) compared with the untreated group (56.5%). Therefore, this global analysis revealed that etiological treatment with benznidazole may benefit patients with respect to the clinical progression of Chagas disease and the prognosis, particularly when administered to patients with the indeterminate form of the disease. ER - TY - JOUR T1 - Parasite persistence correlates with disease severity and localization in chronic Chagas' disease A1 - Zhang, L. A1 - Tarleton, Rick L. Y1 - 1999/// JF - Journal of Infectious Diseases VL - 180 IS - 2 SP - 480 EP - 486 DO - 10.1086/314889 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Zhang, Tarleton - 1999 - Parasite persistence correlates with disease severity and localization in chronic Chagas' disease.pdf N2 - The protozoan parasite Trypanosoma cruzi infects up to 20 million people in Latin America, and the resulting disease (Chagas' disease) is a leading cause of heart disease and death in young adults in areas endemic for the parasite. The clinical symptoms of Chagas' disease have been attributed to autoimmune reactivity to antigens shared by the parasite and host muscle or neuronal tissue. In the present study, in situ polymerase chain reaction analysis was used in murine models of Chagas' disease to demonstrate an absolute correlation between the persistence of parasites and the presence of disease in muscle tissue. Clearance of parasites from tissues, presumably by immunologic mechanisms, correlated with the abatement of inflammatory responses and the resolution of disease. These data provide strong evidence for parasite persistence as a primary cause of Chagas' disease and argue for efforts to eliminate T. cruzi from the host as a means for prevention and treatment of Chagas' disease. ER - TY - JOUR T1 - Different parasite inocula determine the modulation of the immune response and outcome of experimental Trypanosoma cruzi infection A1 - Borges, Diego C. A1 - Araújo, Natalia M. A1 - Cardoso, Cristina R. A1 - Lazo Chica, Javier E. Y1 - 2013/// KW - Immune response KW - Inflammation KW - Parasite inocula KW - Regulatory T cells KW - Trypanosoma cruzi JF - Immunology VL - 138 IS - 2 SP - 145 EP - 156 DO - 10.1111/imm.12022 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Borges et al. - 2013 - Different parasite inocula determine the modulation of the immune response and outcome of experimental Trypanosom.pdf N2 - During infection, the host response develops effector mechanisms to combat the parasite. However, this response can become uncontrolled or regulated by mechanisms that modulate the inflammatory reaction. The number of parasites that infects the host, such as trypomastigotes in Chagas disease, may also influence immune activation and disease pathology. We evaluated the inflammation and immune regulation that follows Trypanosoma cruzi infection with low (300), intermediate (3000) or high (30 000) parasite loads. Our results showed that the load of parasite inoculum influenced disease outcome: the higher the number of parasites in the inoculum, the lower were the survival rates. There was a strong association between parasitism and inflammatory infiltrate in the heart and the parasite inoculum determined cytokine interplay in this tissue, as shown by increased interferon-γ, tumour necrosis factor-α, interleukin-17 (IL-17) and IL-23 in the 300 and 30 000 inoculum groups, higher IL-4 and IL-10 in the intermediate-inoculum mice, and elevated IL-6 production in the heart of mice in the 3000 and 30 000 groups. The number of T cells and antigen-presenting cells was augmented in the infected groups, especially for the splenic CD4+ CD25+ regulatory T cells expressing CD45RBlow, GITR, PD-1 and FoxP3 in the group with the highest inoculum. Interestingly, these mice also presented an apparent decrease in CD4+ CD25+ FoxP3+ cells in the cardiac infiltrate, in contrast to the intermediate inoculum group, which showed elevated numbers of these regulatory leucocytes in the heart. Finally, our results demonstrated that parasite load during T. cruzi infection is linked to the response pattern that will result in parasite/inflammation control or tissue damage. © 2012 Blackwell Publishing Ltd. ER - TY - JOUR T1 - Cardiac gene expression profiling provides evidence for cytokinopathy as a molecular mechanism in Chagas' disease cardiomyopathy A1 - Cunha-Neto, Edecio A1 - Dzau, Victor J. A1 - Allen, Paul D. A1 - Stamatiou, Dimitri A1 - Benvenutti, Luiz A1 - Higuchi, M. Lourdes A1 - Koyama, Natalia S. A1 - Silva, Joao S. A1 - Kalil, Jorge A1 - Liew, Choong Chin Y1 - 2005/// PB - American Society for Investigative Pathology JF - American Journal of Pathology VL - 167 IS - 2 SP - 305 EP - 313 DO - 10.1016/S0002-9440(10)62976-8 UR - http://dx.doi.org/10.1016/S0002-9440(10)62976-8 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Cunha-Neto et al. - 2005 - Cardiac gene expression profiling provides evidence for cytokinopathy as a molecular mechanism in Chagas' dis.pdf N2 - Chronic Chagas' disease cardiomyopathy is a leading cause of congestive heart failure in Latin America, affecting more than 3 million people. Chagas' cardiomyopathy is more aggressive than other cardiomyopathies, but little is known of the molecular mechanisms responsible for its severity. We characterized gene expression profiles of human Chagas' cardiomyopathy and dilated cardiomyopathy to identify selective disease pathways and potential therapeutic targets. Both our customized cDNA microarray (Cardiochip) and real-time reverse transcriptase-polymerase chain reaction analysis showed that immune response, lipid metabolism, and mitochondrial oxidative phosphorylation genes were selectively up-regulated in myocardial tissue of the tested Chagas' cardiomyopathy patients. Interferon (IFN)-γ-inducible genes represented 15% of genes specifically up-regulated in Chagas' cardiomyopathy myocardial tissue, indicating the importance of IFN-γ signaling. To assess whether IFN-γ can directly modulate cardiomyocyte gene expression, we exposed fetal murine cardiomyocytes to IFN-γ and the IFN-γ-inducible chemokine monocyte chemoattractant protein-1. Atrial natriuretic factor expression increased 15-fold in response to IFN-γ whereas combined IFN-γ and monocyte chemoattractant protein-1 increased atrial natriuretic factor expression 400-fold. Our results suggest IFN-γ and chemokine signaling may directly up-regulate cardiomyocyte expression of genes involved in pathological hypertrophy, which may lead to heart failure. IFN-γ and other cytokine pathways may thus be novel therapeutic targets in Chagas' cardiomyopathy. Copyright © American Society for Investigative Pathology. ER - TY - JOUR T1 - Pivotal role for TGF-β in infectious heart disease: The case of Trypanosoma cruzi infection and consequent Chagasic myocardiopathy A1 - Araújo-Jorge, Tania C. A1 - Waghabi, Mariana C. A1 - Soeiro, Maria de Nazaré C. A1 - Keramidas, Michelle A1 - Bailly, Sabine A1 - Feige, Jean Jacques Y1 - 2008/// KW - Cardiac fibrosis KW - Chagas disease KW - TGF-β KW - Trypanosoma cruzi JF - Cytokine and Growth Factor Reviews VL - 19 IS - 5-6 SP - 405 EP - 413 DO - 10.1016/j.cytogfr.2008.08.002 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Araújo-Jorge et al. - 2008 - Pivotal role for TGF-β in infectious heart disease The case of Trypanosoma cruzi infection and consequent C.pdf N2 - This paper summarizes recent data from the literature suggesting that transforming growth factor-β (TGF-β) participates at least in four different processes influencing development of myocardiopathy in Chagas disease, a major parasitic illness caused by Trypanosoma cruzi infection: (a) invasion of cardiac fibroblasts and myocytes; (b) intracellular parasite cycle; (c) regulation of inflammation and immune response; (d) fibrosis and heart remodeling during acute and chronic disease. All these effects point to an important role of TGF-β in Chagas disease myocardiopathy and suggest that monitoring the circulating levels of this cytokine could be of help in clinical prognosis and management of patients. Moreover, TGF-β-interfering therapies appear as interesting adjuvant interventions during acute and chronic phases of T. cruzi infection. © 2008 Elsevier Ltd. All rights reserved. ER - TY - JOUR T1 - Anatomopathological aspects of acute chagas myocarditis by oral transmission A1 - de Souza, Dilma do Socorro Moraes A1 - Araujo, Marialva T.F. A1 - Garcez, Paulo da Silva A1 - Furtado, Julio Cesar Branco A1 - Figueiredo, Maria Tereza Sanches A1 - Povoa, Rui M.S. Y1 - 2016/// KW - Chagas cardiomyopathy / pathology KW - Chagas disease / transmission KW - Food parasitology KW - Trypanosoma cruzi JF - Arquivos Brasileiros de Cardiologia VL - 107 IS - 1 SP - 77 EP - 80 DO - 10.5935/abc.20160110 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/de Souza et al. - 2016 - Anatomopathological aspects of acute chagas myocarditis by oral transmission.pdf ER - TY - JOUR T1 - Pathology of chronic chagas cardiomyopathy in the United States: A detailed review of 13 cardiectomy cases A1 - Kransdorf, Evan P. A1 - Fishbein, Mike C. A1 - Czer, Lawrence S.C. A1 - Patel, Jignesh K. A1 - Velleca, Angela A1 - Tazelaar, Henry D. A1 - Roy, R. Raina A1 - Steidley, D. Eric A1 - Kobashigawa, Jon A. A1 - Luthringer, Daniel J. Y1 - 2016/// KW - Chagas cardiomyopathy KW - Chagas disease KW - Heart transplantation KW - Surgical pathology KW - Trypanosoma cruzi JF - American Journal of Clinical Pathology VL - 146 IS - 2 SP - 191 EP - 198 DO - 10.1093/ajcp/aqw098 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kransdorf et al. - 2016 - Pathology of chronic chagas cardiomyopathy in the United States A detailed review of 13 cardiectomy cases.pdf N2 - Objectives: The pathologic features of chronic Chagas cardiomyopathy may not be widely appreciated in the United States. We sought to describe the gross, microscopic, immunohistochemical, and molecular pathology features useful to diagnose chronic Chagas cardiomyopathy. Methods: The features from a case series of cardiectomy specimens of patients undergoing heart transplantation (12 patients) or mechanical circulatory support device implantation (one patient) for chronic Chagas cardiomyopathy at three institutions in the United States are reported and analyzed. Results: Gross findings included enlarged and dilated ventricles (100% of cases), mural thrombi (54%), epicardial plaques (42%), and left ventricular aneurysm (36%). Microscopic evaluation revealed myocarditis (100% of cases) characterized by mononuclear cell infiltration, fibrosis (100%), nonnecrotizing granulomas (62%), and giant cells (38%). Two specimens (15%) showed rare intracellular amastigotes. Immunohistochemical assays for Trypanosoma cruzi organisms were negative in all cardiectomy specimens, whereas tissue polymerase chain reaction was positive in six (54%) of 11 cases. Conclusions: The gross and microscopic features of chronic Chagas cardiomyopathy in the United States appear similar to those reported in endemic countries. Importantly, tissue polymerase chain reaction may be useful to confirm the diagnosis. ER - TY - JOUR T1 - A Critical Review on Chagas Disease Chemotherapy A1 - Coura, José Rodrigues A1 - Castro, Solange L De Y1 - 2002/// KW - chagas disease - chemotherapy KW - drug development - clinical KW - review - trypanosoma cruzi KW - treatment VL - 97 IS - January SP - 3 EP - 24 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Coura, Castro - 2002 - A Critical Review on Chagas Disease Chemotherapy.pdf ER - TY - JOUR T1 - Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia A1 - Kaplinski, Michelle A1 - Jois, Malasa A1 - Galdos-cardenas, Gerson A1 - Rendell, Victoria R A1 - Shah, Vishal A1 - Do, Rose Q A1 - Marcus, Rachel A1 - Pena, Melissa S Burroughs A1 - Abasto, Carmen A1 - Lafuente, Carlos A1 - Bozo, Ricardo A1 - Valencia, Edward A1 - Verastegui, Manuela A1 - Colanzi, Rony A1 - Gilman, Robert H A1 - Bern, Caryn A1 - Group, Working Y1 - 2015/// KW - 1 KW - an estimated 6 million KW - cardiomyopathy KW - chagas disease KW - infectious disease transmission KW - lost than malaria KW - more disability-adjusted life years KW - of whom KW - people are infected KW - trypanosoma cruzi KW - vertical SP - 1 EP - 9 DO - 10.1093/cid/civ446 L1 - file:///C:/Users/NATALI/Downloads/Sustained Domestic Vector Exposure Is associated with increased chagas cardiomyopathy risk but decreased parasitemia and congenital transmission risk among young women in bolivia.pdf ER - TY - JOUR T1 - Chronic Chagas Heart Disease Management From Etiology to Cardiomyopathy Treatment A1 - Bocchi EA, Bestetti RB, Scanavacca MI, Cunha Neto E, Issa VS Y1 - 2017/// VL - 70 IS - 12 SP - 1510 EP - 1524 DO - 10.1016/j.jacc.2017.08.004 L1 - file:///C:/Users/NATALI/Downloads/Chronic Chagas HeartDisease ManagementFrom Etiology to Cardiomyopathy Treatment.pdf ER - TY - JOUR T1 - Mortality indicators among chronic Chagas patients living in an endemic area A1 - Geraldo, José A1 - Gonçalves, Ferreira A1 - José, Valdo A1 - Silva, Dias A1 - Cândida, Maria A1 - Borges, Calzada A1 - Prata, Aluízio A1 - Correia, Dalmo Y1 - 2010/// KW - arrhythmias KW - chagas disease KW - endemic area KW - longitudinal study KW - mortality indicators PB - Elsevier Ireland Ltd JF - International Journal of Cardiology VL - 143 IS - 3 SP - 235 EP - 242 DO - 10.1016/j.ijcard.2009.02.011 UR - http://dx.doi.org/10.1016/j.ijcard.2009.02.011 L1 - file:///C:/Users/NATALI/Downloads/Mortality indicators among chronic Chagas patients living in an endemic area.pdf ER - TY - JOUR T1 - Etiopatogenia e historia natural da doenca de Chagas humana. A1 - Pinto Dias, José Carlos Y1 - 1983/// JF - Boliv. Inform. Cenetrop. in Rev. patol. trop;14(1):17-29, jan.-jun. 1985. tab VL - 14 IS - 9 SP - 28. EP - 28. L1 - file:///C:/Users/NATALI/Downloads/etiopatogenia e historia natural da doenca de chagas humana.pdf ER - TY - JOUR T1 - Survival of Trypanosoma cruzi in sugar cane used to prepare juice A1 - Cardoso, Adriana V.N. A1 - Lescano, Susana A.Z. A1 - Amato Neto, Vicente A1 - Gakiya, Érika A1 - Santos, Sérgio V. Y1 - 2006/// KW - Experimental infection KW - Sugar cane juice KW - Trypanosoma cruzi JF - Revista do Instituto de Medicina Tropical de Sao Paulo VL - 48 IS - 5 SP - 287 EP - 289 DO - 10.1590/s0036-46652006000500009 L1 - file:///C:/Users/NATALI/Downloads/SURVIVAL OF Trypanosoma cruzi IN SUGAR CANE USED TO PREPARE JUICE.pdf N2 - Chagas disease can be transmitted to man by many different means, including contact with infected triatomine feces, blood transfusion, laboratory accidents, organ transplants, and congenital or oral routes. The latter mode has received considerable attention recently. In this assay, we evaluate the survival of Trypanosoma cruzi contaminating sugar cane used to prepare juice, as well as the viability and capacity for infection by the parasite after recovery. Thirty triatomines were contaminated with T. cruzi Y strain and 45 days later pieces of sugar cane were contaminated with the intestinal contents of the insects. The pieces were ground at different intervals after contamination (time = 0, 1, 4, 6, 12 and 24 hours) and the juice extracted and analyzed. Different methods were used to show T. cruzi in the juice: direct analysis, hematocrit tube centrifugation and QBC, and experimental inoculation in 47 female BALB/c mice (five control mice and seven mice for each interval examined (five inoculated orally and two intraperitoneally). Positive results were found using the direct analysis and QBC methods for juice prepared up to 12 hours after initial contamination. However, by the centrifugation technique, positivity was found only up to four hours after contamination of the sugar cane. Inoculated animals showed parasitemia during a 14 day observation period, demonstrating the high survival rate of T. cruzi in sugar cane. ER - TY - JOUR T1 - Electrocardiogram in chagas disease A1 - Brito, Bruno Oliveira de Figueiredo A1 - Ribeiro, Antônio Luiz Pinho Y1 - 2018/// KW - Chagas disease KW - Death KW - Electrocardiogram KW - Heart failure KW - Prognosis KW - Stroke JF - Revista da Sociedade Brasileira de Medicina Tropical VL - 51 IS - 5 SP - 570 EP - 577 DO - 10.1590/0037-8682-0184-2018 L1 - file:///C:/Users/NATALI/Downloads/electrocardiogram in chagas disease sept 2018.pdf N2 - Since the initial descriptions of Chagas cardiomyopathy (ChCM), the electrocardiography has played a key role in patient evaluations. The diagnostic criterion of chronic ChCM is the presence of characteristic electrocardiographic (ECG) abnormalities in seropositive individuals, regardless of the presence of symptoms. However, these ECG abnormalities are rarely specific to ChCM and, particularly among the elderly, can be caused by other simultaneous cardiomyopathies. ECG abnormalities can predict the occurrence of heart failure, stroke, and even death. Nevertheless, most prognostic studies have included Chagas disease (ChD) populations and, not exclusively, ChCM. Thus, more studies are required to evaluate the efficacy of ECG in predicting reliable prognoses in established chronic ChCM. This review exclusively discusses the role of the 12-lead ECG in the clinical evaluation of chronic ChD. ER - TY - JOUR T1 - Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction A1 - A L Basquiera, A Sembaj, A M Aguerri, M Omelianiuk, S Guzmán, J Moreno Barral, T F Caeiro, R J Madoery, O A Salomone Y1 - 2003/// JF - Heart VL - 89 SP - 1186 EP - 1190 L1 - file:///C:/Users/NATALI/Downloads/Risk progression to chronic Chagas cardiomyopathy influence of male sex and of parasitaemia detected by polymerase chain reaction.pdf ER - TY - JOUR T1 - Chagas heart disease: Pathophysiologic mechanisms, prognostic factors and risk stratification A1 - Rassi, Anis A1 - Rassi, Anis A1 - Marin-Neto, José Antonio Y1 - 2009/// KW - Chagas disease KW - Chagas heart disease KW - Pathogenesis KW - Pathophysiology KW - Prognostic factors KW - Rrisk stratification JF - Memorias do Instituto Oswaldo Cruz VL - 104 IS - SUPPL. 1 SP - 152 EP - 158 DO - 10.1590/s0074-02762009000900021 L1 - file:///C:/Users/NATALI/Downloads/Chagas heart disease pathophysiologic mechanisms, prognostic factors and risk stratification.pdf N2 - 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. ER - TY - JOUR T1 - Chagas disease A1 - Rassi, Anis A1 - Rassi, Anis A1 - Marin-Neto, José Antonio Y1 - 2010/// PB - Elsevier Ltd JF - The Lancet VL - 375 IS - 9723 SP - 1388 EP - 1402 DO - 10.1016/S0140-6736(10)60061-X UR - http://dx.doi.org/10.1016/S0140-6736(10)60061-X L1 - file:///C:/Users/NATALI/Downloads/rassi chagas disease.pdf N2 - 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. © 2010 Elsevier Ltd. All rights reserved. ER - TY - JOUR T1 - Risk of Chronic Cardiomyopathy Among Patients With the Acute Phase or Indeterminate Form of Chagas Disease: A Systematic Review and Meta-analysis A1 - Chadalawada, Sindhu A1 - Sillau, Stefan A1 - Archuleta, Solana A1 - Mundo, William A1 - Bandali, Mehdi A1 - Parra-Henao, Gabriel A1 - Rodriguez-Morales, Alfonso J. A1 - Villamil-Gomez, Wilmer E. A1 - Suárez, José Antonio A1 - Shapiro, Leland A1 - Hotez, Peter J. A1 - Woc-Colburn, Laila A1 - DeSanto, Kristen A1 - Rassi, Anis A1 - Franco-Paredes, Carlos A1 - Henao-Martínez, Andrés F. Y1 - 2020/// JF - JAMA network open VL - 3 IS - 8 SP - e2015072 EP - e2015072 DO - 10.1001/jamanetworkopen.2020.15072 L1 - file:///C:/Users/NATALI/Downloads/Risk of Chronic Cardiomyopathy Among Patients With the Acute Phase or indeterminate form of chagas diasease.pdf N2 - Importance: Chagas cardiomyopathy is associated with substantial morbidity and mortality. Precise estimates of the risk of developing cardiomyopathy among patients with the acute or indeterminate chronic forms of Chagas disease are lacking. Objective: To estimate the risk of developing chronic cardiomyopathy in patients with acute and indeterminate chronic forms of Chagas disease. Data Sources: A systematic search in the Cochrane Library, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), Medline, and Web of Science Core Collection databases was conducted from October 8 to October 24, 2018. Studies published between January 1, 1946, and October 24, 2018, that were written in the English, Spanish, and Portuguese languages were included. Search terms included Chagas disease; development of cardiomyopathy; latency duration; and determinants of the Chagas latency period. Study Selection: Longitudinal observational studies of participants diagnosed with the acute phase of Chagas infection or the indeterminate chronic form of Chagas disease who were followed up until the development of cardiomyopathy were included. Studies were excluded if they did not provide sufficient outcome data. Of 10 761 records initially screened, 32 studies met the criteria for analysis. Data Extraction and Synthesis: Critical appraisals of studies were performed using checklists from the Joanna Briggs Institute Reviewer's Manual, and data were collected from published studies. A random-effects meta-analysis was used to obtain pooled estimated annual rates. Data were analyzed from September 11 to December 4, 2019. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline for the registration of the protocol, data collection and integrity, assessment of bias, and sensitivity analyses. Main Outcomes and Measures: Main outcomes were defined as the composite of the development of any new arrhythmias or changes in electrocardiogram results, dilated cardiomyopathy and segmental wall motion abnormalities in echocardiogram results, and mortality associated with Chagas disease. Results: A total of 5005 records were screened for eligibility. Of those, 298 full-text articles were reviewed, and 178 of those articles were considered for inclusion in the quantitative synthesis. After exclusions, 32 studies that included longitudinal observational outcomes were selected for the analysis; 23 of those studies comprised patients with the indeterminate chronic form of Chagas disease, and 9 of those studies comprised patients in the acute phase of Chagas infection. The analysis indicated that the pooled estimated annual rate of cardiomyopathy development was 1.9% (95% CI, 1.3%-3.0%; I2 = 98.0%; τ2 [ln scale] = 0.9992) in patients with indeterminate chronic Chagas disease and 4.6% (95% CI, 2.7%-7.9%; I2 = 86.6%; τ2 [ln scale] = 0.4946) in patients with acute Chagas infection. Conclusions and Relevance: Patients with the indeterminate chronic form of Chagas disease had a significant annual risk of developing cardiomyopathy. The annual risk was more than double among patients in the acute phase of Chagas infection. ER - TY - JOUR T1 - Pathology and pathogenesis of chagas heart disease A1 - Bonney KM, Luthringer DJ, Kim SA, Garg NJ, Engman DM. Y1 - 2019/// JF - Annual Review of Pathology VL - 14 SP - 419 EP - 445 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Bonney KM, Luthringer DJ, Kim SA, Garg NJ - 2019 - Pathology and pathogenesis of chagas heart disease.pdf ER - TY - JOUR T1 - Cardiac involvement is a constant finding in acute Chagas' disease: A clinical, parasitological and histopathological study A1 - Parada, Henry A1 - Carrasco, Hugo A. A1 - Añez, Néstor A1 - Fuenmayor, Carmen A1 - Inglessis, Ignacio Y1 - 1997/// KW - Acute Chagas' disease KW - Cardiac disease KW - Myocardial biopsy JF - International Journal of Cardiology VL - 60 IS - 1 SP - 49 EP - 54 DO - 10.1016/S0167-5273(97)02952-5 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Parada et al. - 1997 - Cardiac involvement is a constant finding in acute Chagas' disease A clinical, parasitological and histopathologi.pdf N2 - During the last 8 years 58 acute cases of Chagas' disease were studied. Patients from an endemic area of the state of Barinas, Venezuela, showed fever (98%) and circulating forms of T. cruzi (100%), and were treated with oral benznidazole. The recorded mortality was 8.6%. Acute myocarditis was constantly found either in myocardial biopsies or at necropsy, even in patients without any other sign of cardiac compromise (36%), which was detected by chest X-ray in 58%, by 2D echocardiography in 52%, by resting ECG in 41% and by clinical findings in 27.5% of the patients. Cardiomegaly was due to pericardial effusion rather than ventricular dilatation in most instances. Treatment eliminated parasitemia but negativized serology in only 20% of patients. It also appeared to have little influence on the ongoing myocarditic process, emphasizing the need for better therapeutic schedules, able to avoid or control the early appearance of immunologic mechanisms and microcirculatory damage involved in the future development of chronic chagasic myocarditis. ER - TY - JOUR T1 - Chagas Disease : From Discovery to a Worldwide Health Problem A1 - Cláudia, Kárita A1 - Lidani, Freitas A1 - Andrade, Fabiana Antunes A1 - Bavia, Lorena Y1 - 2019/// KW - Chagas disease, epidemiology, Trypanosoma cruzi, C VL - 7 IS - July SP - 1 EP - 13 DO - 10.3389/fpubh.2019.00166 L1 - file:///C:/Users/NATALI/Downloads/chagas disease from discovery to a worldwide health problem.pdf ER - TY - STAT T1 - The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. [Bethesda, Md.] A1 - National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Y1 - 1978/// ER - TY - STAT T1 - Resolución número 8430 de 1993 A1 - Ministerio de Salud Y1 - 1993/// UR - https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF ER - TY - JOUR T1 - Duration and determinants of Chagas latency: an etiology and risk systematic review protocol A1 - Henao-Martínez, Andrés F. A1 - Chadalawada, Sindhu A1 - Villamil-Gomez, Wilmer E. A1 - DeSanto, Kristen A1 - Rassi, Anis A1 - Franco-Paredes, Carlos Y1 - 2019/// KW - 10 KW - 17 KW - 2122 KW - 2128 KW - chagas disease KW - chronic chagas cardiomyopathy KW - implement rep 2019 KW - indeterminate form KW - jbi database system rev KW - latency KW - trypanosoma cruzi JF - JBI database of systematic reviews and implementation reports VL - 17 IS - 10 SP - 2122 EP - 2128 DO - 10.11124/JBISRIR-D-18-00018 L1 - file:///C:/Users/NATALI/Downloads/Duration and determinants of Chagas latency.pdf N2 - OBJECTIVE: The objective of this systematic review is to explore and discuss the latency duration among asymptomatic people with chronic Chagas disease. INTRODUCTION: Studies estimate the latency period of Chagas disease to be approximately 10-30 years. However, new findings may indicate that this latency period is shorter and depends on the presence of clinical factors. This systematic review protocol will explore the duration and factors affecting this latency period to inform treatment, with the potential of improving outcomes. INCLUSION CRITERIA: Eligible studies will include asymptomatic people with indeterminate Chagas disease confirmed through positive serologic testing and the absence of structural cardiomyopathy with no heart failure symptoms and normal electrocardiography results. Studies that involve a longitudinal observation period of participants will be considered. This period must start from the acute acquisition of the infection or an already established indeterminate form of the disease until the development of a primary or secondary cardiac outcome. METHODS: The following electronic databases will be searched: MEDLINE, Embase, Cochrane Library, Web of Science Core Collection and LILACS. The search will include the following concepts: Chagas disease, latency duration and determinants of the Chagas latency period. The languages will be restricted to English, Spanish and Portuguese. Two reviewers will review the selected studies for methodological quality using critical appraisal tools and conduct data extraction. Studies will, where possible, be pooled in a statistical meta-analysis. All data will be presented and synthesized through tables, summaries, figures and charts. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019118019. ER - TY - ICOMM T1 - World Health Organization. Neglected tropical diseases. A1 - WHO UR - https://www.who.int/teams/control-of-neglected-tropical-diseases/overview ER - TY - JOUR T1 - Analytical Performance of a Multiplex Real-Time PCR Assay Using TaqMan Probes for Quantification of Trypanosoma cruzi Satellite DNA in Blood Samples A1 - Duffy, Tomas A1 - Cura, Carolina I. A1 - Ramirez, Juan C. A1 - Abate, Teresa A1 - Cayo, Nelly M. A1 - Parrado, Rudy A1 - Bello, Zoraida Diaz A1 - Velazquez, Elsa A1 - Muñoz-Calderon, Arturo A1 - Juiz, Natalia A. A1 - Basile, Joaquín A1 - Garcia, Lineth A1 - Riarte, Adelina A1 - Nasser, Julio R. A1 - Ocampo, Susana B. A1 - Yadon, Zaida E. A1 - Torrico, Faustino A1 - de Noya, Belkisyole Alarcón A1 - Ribeiro, Isabela A1 - Schijman, Alejandro G. Y1 - 2013/// JF - PLoS Neglected Tropical Diseases VL - 7 IS - 1 SP - e2000 EP - e2000 DO - 10.1371/journal.pntd.0002000 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Duffy et al. - 2013 - Analytical Performance of a Multiplex Real-Time PCR Assay Using TaqMan Probes for Quantification of Trypanosoma cr.pdf N2 - Background: The analytical validation of sensitive, accurate and standardized Real-Time PCR methods for Trypanosoma cruzi quantification is crucial to provide a reliable laboratory tool for diagnosis of recent infections as well as for monitoring treatment efficacy. Methods/Principal Findings: We have standardized and validated a multiplex Real-Time quantitative PCR assay (qPCR) based on TaqMan technology, aiming to quantify T. cruzi satellite DNA as well as an internal amplification control (IAC) in a single-tube reaction. IAC amplification allows rule out false negative PCR results due to inhibitory substances or loss of DNA during sample processing. The assay has a limit of detection (LOD) of 0.70 parasite equivalents/mL and a limit of quantification (LOQ) of 1.53 parasite equivalents/mL starting from non-boiled Guanidine EDTA blood spiked with T. cruzi CL-Brener stock. The method was evaluated with blood samples collected from Chagas disease patients experiencing different clinical stages and epidemiological scenarios: 1- Sixteen Venezuelan patients from an outbreak of oral transmission, 2- Sixty three Bolivian patients suffering chronic Chagas disease, 3- Thirty four Argentinean cases with chronic Chagas disease, 4- Twenty seven newborns to seropositive mothers, 5- A seronegative receptor who got infected after transplantation with a cadaveric kidney explanted from an infected subject. Conclusions/Significance: The performing parameters of this assay encourage its application to early assessment of T. cruzi infection in cases in which serological methods are not informative, such as recent infections by oral contamination or congenital transmission or after transplantation with organs from seropositive donors, as well as for monitoring Chagas disease patients under etiological treatment. © 2013 Duffy et al. ER - TY - JOUR T1 - A new genotype of Trypanosoma cruzi associated with bats evidenced by phylogenetic analyses using SSU rDNA, cytochrome b and Histone H2B genes and genotyping based on ITS1 rDNA A1 - Marcili, A. A1 - Lima, L. A1 - Cavazzana, M. A1 - Junqueira, A. C.V. A1 - Veludo, H. H. A1 - Maia Da Silva, F. A1 - Campaner, M. A1 - Paiva, F. A1 - Nunes, V. L.B. A1 - Teixeira, M. M.G. Y1 - 2009/// KW - Bat parasites KW - Chagas disease KW - Chiroptera KW - Cytochrome b KW - Evolution KW - Genotyping KW - Histone H2B KW - Phylogeny KW - SSU rDNA KW - Trypanosoma cruzi lineages JF - Parasitology VL - 136 IS - 6 SP - 641 EP - 655 DO - 10.1017/S0031182009005861 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Marcili et al. - 2009 - A new genotype of Trypanosoma cruzi associated with bats evidenced by phylogenetic analyses using SSU rDNA, cyto.pdf N2 - We characterized 15 Trypanosoma cruzi isolates from bats captured in the Amazon, Central and Southeast Brazilian regions. Phylogenetic relationships among T. cruzi lineages using SSU rDNA, cytochrome b, and Histone H2B genes positioned all Amazonian isolates into T. cruzi I (TCI). However, bat isolates from the other regions, which had been genotyped as T. cruzi II (TC II) by the traditional genotyping method based on mini-exon gene employed in this study, were not nested within any of the previously defined TCII sublineages, constituting a new genotype designated as TCbat. Phylogenetic analyses demonstrated that TCbat indeed belongs to T. cruzi and not to other closely related bat trypanosomes of the subgenus Schizotrypanum, and that although separated by large genetic distances TCbat is closest to lineage TCI. A genotyping method targeting ITS1 rDNA distinguished TCbat from established T. cruzi lineages, and from other Schizotrypanum species. In experimentally infected mice, TCbat lacked virulence and yielded low parasitaemias. Isolates of TCbat presented distinctive morphological features and behaviour in triatomines. To date, TCbat genotype was found only in bats from anthropic environments of Central and Southeast Brazil. Our findings indicate that the complexity of T. cruzi is larger than currently known, and confirmed bats as important reservoirs and potential source of T. cruzi infections to humans. © Cambridge University Press 2009. ER - TY - JOUR T1 - Histopathology of the heart conducting system in experimental chagas disease in mice A1 - Molina, H. A. A1 - Milei, J. A1 - Rimoldi, M. T. A1 - Gonzalez Cappa, S. M. A1 - Storino, R. A. Y1 - 1988/// JF - Transactions of the Royal Society of Tropical Medicine and Hygiene VL - 82 IS - 2 SP - 241 EP - 246 DO - 10.1016/0035-9203(88)90432-4 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Molina et al. - 1988 - Histopathology of the heart conducting system in experimental chagas disease in mice.pdf N2 - Although mice infected with Trypanosoma develop a wide variety of electrocardiographic (alterations, the typical isolated right bundle b block or its association with the left anterior hi lock patterns are not found in this model. Thi been explained as related to topographic differen the anatomy of the murine conducting sy However, there is no conclusive evidence tha murine conducting system differs from the h system. In this study, the anatomy of the m conducting system is described, as well as its in) ment in the chronic stages of experimental infei 24 three-month-old C3H mice were infected- wi bloodstream forms of T. cruzi, Tulahuen s Animals were killed after 3, 8 and 12 months.\frontal sections of the heart, including the condi system, were serially studied. The sinoatrial nod located in the right atrial appendage, or ii junction between the superior vena cava and the atrium, or "riding" on the interatrial septum, atrioventricular (A-V) node and the His b showed a similar anatomic course to that in Therefore, there was no important anatomical c ence that might have explained the lack of the patterns observed in human chagasic mj diopathy. The inflammatory involvement an` lesions of the conducting system were diverst rarely severe. No significant difference was obs in animals killed at different times. The lesions i working myocardium were similar to those obs in humans (chronic inflammatory infiltrates). bi theless, the topography of lesions was different: Was a selective involvement in the neighbourhc the A-V groove. The experimental chronic chi infection thus obtained did not reproduce th` tribution nor the large extension of the "panmj ditis" observed in man. The lack of comparabil the ECG of the human disease and this model i be due to 3 factors: (a) little damage to the condv system; (b) insufficient "cardiomyopathy" to get complete bundle branch blocks and arrhythmias (c), less probably, short time course of infecition. © 1988 Oxford University Press. ER - TY - BOOK T1 - Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association A1 - Nunes, Maria Carmo Pereira A1 - Beaton, Andrea A1 - Acquatella, Harry A1 - Bern, Caryn A1 - Bolger, Ann F. A1 - Echeverría, Luis E. A1 - Dutra, Walderez O. A1 - Gascon, Joaquim A1 - Morillo, Carlos A. A1 - Oliveira-Filho, Jamary A1 - Ribeiro, Antonio Luiz Pinho A1 - Marin-Neto, Jose Antonio Y1 - 2018/// KW - AHA Scientific Statements KW - American trypanosomiasis KW - Chagas disease KW - cardiac arrhythmia KW - cardiomyopathies KW - dilated cardiomyopathy KW - heart failure KW - thromboembolism JF - Circulation VL - 138 IS - 12 SP - e169 EP - e209 SN - 0000000000000 DO - 10.1161/CIR.0000000000000599 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Nunes et al. - 2018 - Chagas Cardiomyopathy An Update of Current Clinical Knowledge and Management A Scientific Statement From the Ameri.pdf N2 - BACKGROUND: Chagas disease, resulting from the protozoan Trypanosoma cruzi, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission. METHODS AND RESULTS: The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of T cruzi infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease. CONCLUSIONS: This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world. ER - TY - JOUR T1 - MicroRNAs miR-1, miR-133a, miR-133b, miR-208a and miR-208b are dysregulated in Chronic Chagas disease Cardiomyopathy A1 - Ferreira, Ludmila Rodrigues Pinto A1 - Frade, Amanda Farage A1 - Santos, Ronaldo Honorato Barros A1 - Teixeira, Priscila Camillo A1 - Baron, Monique Andrade A1 - Navarro, Isabela Cunha A1 - Benvenuti, Luiz Alberto A1 - Fiorelli, Alfredo Inácio A1 - Bocchi, Edimar Alcides A1 - Stolf, Noedir Antonio A1 - Chevillard, Christophe A1 - Kalil, Jorge A1 - Cunha-Neto, Edecio Y1 - 2014/// KW - Chagas disease KW - Heart KW - Trypanosoma cruzi KW - miRNA PB - Elsevier Ireland Ltd JF - International Journal of Cardiology VL - 175 IS - 3 SP - 409 EP - 417 DO - 10.1016/j.ijcard.2014.05.019 UR - http://dx.doi.org/10.1016/j.ijcard.2014.05.019 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ferreira et al. - 2014 - MicroRNAs miR-1, miR-133a, miR-133b, miR-208a and miR-208b are dysregulated in Chronic Chagas disease Cardiomyo.pdf N2 - Background/methods Chagas disease is caused by an intracellular parasite, Trypanosoma cruzi, and it is a leading cause of heart failure in Latin America. The main clinical consequence of the infection is the development of a Chronic Chagas disease Cardiomyopathy (CCC), which is characterized by myocarditis, hypertrophy and fibrosis and affects about 30% of infected patients. CCC has a worse prognosis than other cardiomyopathies, like idiopathic dilated cardiomyopathy (DCM). It is well established that myocardial gene expression patterns are altered in CCC, but the molecular mechanisms underlying these differences are not clear. MicroRNAs are recently discovered regulators of gene expression, and are recognized as important factors in heart development and cardiovascular disorders (CD). We analyzed the expression of nine different miRNAs in myocardial tissue samples of CCC patients in comparison to DCM patients and samples from heart transplant donors. Using the results of a cDNA microarray database on CCC and DCM myocardium, signaling networks were built and nodal molecules were identified. Results We observed that five miRNAs were significantly altered in CCC and three in DCM; importantly, three miRNAs were significantly reduced in CCC as compared to DCM. We observed that multiple gene targets of the differentially expressed miRNAs showed a concordant inverse expression in CCC. Significantly, most gene targets and involved networks belong to crucial disease-related signaling pathways. Conclusion These results suggest that miRNAs may play a major role in the regulation of gene expression in CCC pathogenesis, with potential implication as diagnostic and prognostic tools. © 2014 Elsevier Ireland Ltd. All rights reserved. ER - TY - JOUR T1 - 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of Amer A1 - Yancy, Clyde W. A1 - Jessup, Mariell A1 - Bozkurt, Biykem A1 - Butler, Javed A1 - Casey, Donald E. A1 - Colvin, Monica M. A1 - Drazner, Mark H. A1 - Filippatos, Gerasimos S. A1 - Fonarow, Gregg C. A1 - Givertz, Michael M. A1 - Hollenberg, Steven M. A1 - Lindenfeld, Jo Ann A1 - Masoudi, Frederick A. A1 - McBride, Patrick E. A1 - Peterson, Pamela N. A1 - Stevenson, Lynne Warner A1 - Westlake, Cheryl Y1 - 2017/// KW - AHA Scientific Statements KW - angioedema KW - angiotensin receptor blockers KW - angiotensin receptor-neprilysin inhibitor KW - angiotensin-converting enzyme inhibitors KW - beta blockers KW - ferric carboxymaltose KW - focused update KW - heart failure KW - hypertension KW - iron deficiency KW - ivabradine KW - natriuretic peptide biomarker KW - natriuretic peptides KW - sleep apnea JF - Circulation VL - 136 IS - 6 SP - e137 EP - e161 SN - 0000000000000 DO - 10.1161/CIR.0000000000000509 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Yancy et al. - 2017 - 2017 ACCAHAHFSA Focused Update of the 2013 ACCFAHA Guideline for the Management of Heart Failure A Report of the A.pdf ER - TY - JOUR T1 - Trypanosoma cruzi: Parasite persistence in tissues in chronic chagasic Brazilian patients A1 - Marcon, Gláucia E.Barbosa A1 - de Albuquerque, Dulcinéia Martins A1 - Batista, Angelica Martins A1 - Andrade, Paula Durante A1 - Almeida, Eros A. A1 - Guariento, Maria Elena A1 - Teixeira, Maria A.B. A1 - Costa, Sandra C.Botelho Y1 - 2011/// KW - Chagas Disease KW - Nested PCR KW - Real-time PCR KW - Trypanosoma cruzi JF - Memorias do Instituto Oswaldo Cruz VL - 106 IS - 1 SP - 85 EP - 91 DO - 10.1590/S0074-02762011000100014 L1 - file:///C:/Users/NATALI/Downloads/Trypanosoma cruzi parasite persistence in tissues in chronic chagasic brazilian patients.pdf N2 - Chagas disease in the chronic phase may develop into cardiac and/or digestive forms. The pathogenesis of the disease is not yet clear and studies have been carried out to elucidate the role of parasite persistence in affected organs. The aim of this study was to detect and quantify Trypanosoma cruzi in paraffin-embedded tissue samples from chronic patients using NPCR (nested polymerase chain reaction) and QPCR (quantitative polymerase chain reaction) methods. These results were correlated to anatomopathological alterations in the heart and gastrointestinal tract (GIT). Of the 23 patients studied, 18 presented the cardiac form and five presented the cardiodigestive form of Chagas disease. DNA samples were randomly isolated from formalin-fixed paraffin-embedded sections of heart and GIT tissue of 23 necropsies and were analyzed through NPCR amplification. T. cruzi DNA was detected by NPCR in 48/56 (85.7%) heart and 35/42 (83.3%) GIT samples from patients with the cardiac form. For patients with the cardiodigestive form, NPCR was positive in 12/14 (85.7%) heart and in 14/14 (100%) GIT samples. QPCR, with an efficiency of 97.6%, was performed in 13 samples (11 from cardiac and 2 from cardiodigestive form) identified previously as positive by NPCR. The number of T. cruzi copies was compared to heart weight and no statistical significance was observed. Additionally, we compared the number of copies in different tissues (both heart and GIT) in six samples from the cardiac form and two samples from the cardiodigestive form. The parasite load observed was proportionally higher in heart tissues from patients with the cardiac form. These results show that the presence of the parasite in tissues is essential to Chagas disease pathogenesis. ER - TY - JOUR T1 - Myocardial parasite persistence in chronic chagasic patients A1 - Añez, Nestor A1 - Carrasco, Hugo A1 - Parada, Henry A1 - Crisante, Gladys A1 - Rojas, Agustina A1 - Fuenmayor, Carmen A1 - Gonzalez, Nestor A1 - Percoco, Gloria A1 - Borges, Rafael A1 - Guevara, Palmira A1 - Ramirez, Jose Luis Y1 - 1999/// JF - American Journal of Tropical Medicine and Hygiene VL - 60 IS - 5 SP - 726 EP - 732 DO - 10.4269/ajtmh.1999.60.726 L1 - file:///C:/Users/NATALI/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Añez et al. - 1999 - Myocardial parasite persistence in chronic chagasic patients.pdf N2 - The persistence of Trypanosoma cruzi tissue forms was detected in the myocardium of seropositive individuals clinically diagnosed as chronic chagasic patients following endomyocardial biopsies (EMBs) processed by immunohistochemical (peroxidase-anti-peroxidase [PAP] staining) and molecular (polymerase chain reaction [PCR]) techniques. An indirect immunofluorescent technique revealed antigenic deposits in the cardiac tissue in 24 (88.9%) of 27 patients. Persistent T. cruzi amastigotes were detected by PAP staining in the myocardium of 22 (84.6%) of 26 patients. This finding was confirmed with a PCR assay specific for T. cruzi in 21 (91.3%) of 23 biopsy specimens from the same patients. Statistical analysis revealed substantial agreement between PCR and PAP techniques (k = 0.68) and the PCR and any serologic test (k = 0.77). The histopathologic study of EMB specimens from these patients revealed necrosis, inflammatory infiltrates, and fibrosis, and made it possible to detect heart abnormalities not detected by electrocardiogram and/or cineventriculogram. These indications of myocarditis were supported by the detection of T. cruzi amastigotes by the PAP technique or its genome by PCR. They suggest that although the number of parasites is low in patients with chronic Chagas' disease, their potential for heart damage may be comparable with those present during the acute phase. The urgent necessity for testing new drugs with long-term effects on T. cruzi is discussed in the context of the present results. ER -