Cardiac Evaluation in the Acute Phase of Chagas’ Disease with Post-Treatment Evolution in Patients Attended in the State of Amazonas, Brazil
Cardiac Evaluation in the Acute Phase of Chagas’ Disease with Post-Treatment Evolution in Patients Attended in the State of Amazonas, Brazil
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DOI：
10.5935/abc.20190007
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发表时间：
2019-03-01
影响因子：
2.6
通讯作者：
Ferreira, João Marcos Bemfica Barbosa
中科院分区：
文献类型：
--
作者：
Ortiz, Jessica Vanina;Pereira, Bruna Valessa Moutinho;Ferreira, João Marcos Bemfica Barbosa
背景资料：在过去二十年中，在巴西亚马逊地区发现了查加斯病的新流行病学概况，经口传播被认为是造成急性病例增加的原因。在亚马孙州，自2004年以来已登记了五起急性CD疫情。这些病例的心脏表现可能以弥漫性心肌炎为特征，伴有心电图（ECG）和经胸超声心动图（TTE）改变。目的：对急性期和接受急性CD治疗至少一年后的本地患者进行心脏评估，并评估与心脏改变相关的人口统计学变量。我们评估了2007年至2015年通过直接寄生虫学或血清学（IgM）方法诊断为急性CD的患者。所有患者均给予苯硝咪唑治疗，治疗前后均行心电图和经胸超声心动图检查。我们假设置信区间为95%（CI 95%，p < 0.05）的所有变量analysed.Results：我们观察到63例急性CD，其中口腔传播对应于75%。33%的病例发现心脏改变，其中心室复极改变的频率较高（13%），其次是心包积液（10%）和右束分支阻滞和左前分支阻滞（2%）。治疗后，对48名ECG患者和25名TTE患者进行了平均15.5 +/- 4.1个月的随访。其中，8%的患者心电图显示心脏改变正常，62.5%的患者心电图检查正常。所有患者治疗后TTE均正常。至于人口统计学变量，孤立的情况下，提出了更多的心脏改变比爆发（p = 0.044），以及从中央亚马逊mesoregion（p = 0.020）的情况下，结论：虽然心脏的变化并不频繁，在大多数研究人群中，该地区的疾病的临床流行病学动态的持续评估是必要的，以建立预防措施。
Background: In the past two decades, a new epidemiological profile of Chagas' disease (CD) has been registered in the Brazilian Amazon where oral transmission has been indicated as responsible for the increase of acute cases. In the Amazonas state, five outbreaks of acute CD have been registered since 2004. The cardiac manifestations in these cases may be characterized by diffuse myocarditis, with alteration in the electrocardiogram (ECG) and transthoracic echocardiogram (TTE).Objective: To perform a cardiac evaluation in autochthonous patients in the acute phase and at least one year after submitted to treatment for acute CD and evaluate the demographic variables associated with the presence of cardiac alterations.Methods: We evaluated patients diagnosed with acute CD through direct parasitological or serological (IgM) methods from 2007 to 2015. These patients were treated with benznidazole and underwent ECG and TTE before and after treatment. We assumed a confidence interval of 95% (CI 95%, p < 0.05) for all variables analyzed.Results: We observed 63 cases of an acute CD in which oral transmission corresponded to 75%. Cardiac alterations were found in 33% of the cases, with a greater frequency of ventricular repolarization alteration (13%), followed by pericardial effusion (10%) and right bundle branch block and left anterior fascicular block (2%). The follow-up occurred in 48 patients with ECG and 25 with TTE for a mean period of 15.5 +/- 4.1 months after treatment. Of these, 8% presented normalization of the cardiac alterations in ECG, 62.5% remained with the normal exams. All of the patients presented normal results in TTE in the post-treatment period. As for the demographic variables, isolated cases presented more cardiac alterations than outbreaks (p = 0.044) as well as cases from Central Amazonas mesoregion (p = 0.020).Conclusions: Although cardiac alterations have not been frequent in most of the studied population, a continuous evaluation of the clinical-epidemiological dynamics of the disease in the region is necessary in order to establish preventive measures.