An unusual case of congestive heart failure in the Netherlands.
An unusual case of congestive heart failure in the Netherlands.
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DOI：
10.1099/jmmcr.0.005142
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发表时间：
2018-04
期刊：
影响因子：
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通讯作者：
van Hellemond JJ
中科院分区：
文献类型：
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作者：
Persoon MC;Manintveld OC;Mollema FPN;van Hellemond JJ
查加斯病是由原生动物克氏锥虫感染引起的。由于其昆虫媒介的分布，它是美洲大陆特有的。这种疾病偶尔会通过感染者的旅行传播到其他大陆。在荷兰，这种疾病很少被诊断出来，感染者的确切人数尚不清楚。临床表现可以从4-8周的急性期开始，伴有非特异性、轻度症状和发热性疾病。在慢性阶段，它可能导致致命的心脏和胃肠道并发症。我们描述了一个40岁的男子与终末期心肌病由于恰加斯病的情况下。他在伯明翰生活了20多年，在因肺炎和充血性心力衰竭住院之前，他的病史并不明显。尽管抗生素治疗和优化心脏药物，他的疾病进展到终末期心力衰竭，心脏移植是唯一剩下的治疗方法。植入左心室辅助装置（LVAD）作为移植的桥梁。LVAD手术后的组织分析显示恰加斯病引起的持续心肌炎。在文献回顾的基础上，提出了移植后随访和治疗方案。在来自流行国家的有相应临床症状的患者中，应考虑恰加斯病。查加斯心肌病患者的心脏移植伴随着特定的挑战，这是由于需要免疫抑制治疗，从而增加了潜伏T细胞再激活的风险。克氏感染
Chagas disease is caused by infection with the protozoan Trypanosoma cruzi. It is endemic to the American continent due to the distribution of its insect vectors. The disease is occasionally imported to other continents by travel of infected individuals. It is rarely diagnosed in the Netherlands and exact numbers of infected individuals are unknown. Clinical manifestations can start with an acute phase of 4–8 weeks with non-specific, mild symptoms and febrile illness. In the chronic phase, it can lead to fatal cardiac and gastro-intestinal complications. We describe a case of a 40-year-old man with end-stage cardiomyopathy due to Chagas disease. He lived in Surinam for more than 20 years and had an unremarkable medical history until he was hospitalized due to pneumonia and congestive heart failure. Despite antibiotic treatment and optimizing cardiac medication, his disease progressed to end-stage heart failure for which cardiac transplantation was the only remaining treatment. A left ventricular assist device (LVAD) was implanted as a bridge to transplantation. Tissue analysis after LVAD surgery revealed ongoing myocarditis caused by Chagas disease. Based on a literature review, a scheme for follow up and treatment after transplantation was postulated. Chagas disease should be taken into account in patients from endemic countries who have corresponding clinical signs. Heart transplantation in patients with Chagas cardiomyopathy is accompanied by specific challenges due to the required immunosuppressive therapy and the thereby increased risk of reactivation of a latent T. cruzi infection.