RESUMO
The evolution of Chagas' cardiomyopathy is poorly understood. We therefore examined the development of cardiac lesions in a rural Brazilian community for a period of 7 years. Initially, 42% of 1017 residents were seropositive for infection with Trypanosoma cruzi. Age-specific infection rates indicated that most had become infected before the age of 20 years. On follow-up, it appeared that those persons who developed cardiac lesions did so soon after infection, since the incidence of right bundle branch block and other ventricular conduction defects (VCDs) was also highest before age 20 years. The progressive nature of these lesions was demonstrated by frequent development of additional electrocardiographic abnormalities and high mortality among infected adults with VCDs. In contrast, mortality was low and approximately the same for seropositive and seronegative adults under 60 years who had normal electrocardiograms. Electrocardiography during the early asymptomatic stage of infection was able to distinguish persons with potentially lethal cardiac lesions from those with a benign prognosis.
Assuntos
Cardiomiopatia Chagásica/epidemiologia , Fatores Etários , Anticorpos/análise , Brasil , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/mortalidade , Eletrocardiografia , Seguimentos , Humanos , Estudos Prospectivos , População Rural , Trypanosoma cruzi/imunologiaRESUMO
An outbreak of 20 cases of acute Chagas' disease followed the movement of Triatoma infestans into the county of Riacho de Santana, Bahia, Brazil. The outbreak was unusual in that the majority of cases occurred in adults. Vector control measures were implemented. Three years after the outbreak, a rural community was examined to determine the extent of human infection and disease due to Trypanosoma cruzi. Ninety of 440 residents (20.5%) had serologic evidence of infection, but rates of electrocardiographic (EKG) abnormalities were low. Comparison of age-specific rates of seropositivity and EKG abnormalities with rates from areas with endemic Chagas' disease supported the hypothesis of a recent epidemic. Control measures appear to have interrupted transmission in the region.
Assuntos
Doença de Chagas/epidemiologia , Surtos de Doenças , Adulto , Idoso , Anticorpos/análise , Brasil , Cardiomiopatia Chagásica/epidemiologia , Doença de Chagas/transmissão , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Controle de Insetos , Insetos Vetores , Pessoa de Meia-Idade , População Rural , Triatoma , Trypanosoma cruzi/imunologiaAssuntos
Diuréticos/uso terapêutico , Hipertensão/tratamento farmacológico , Xipamida/uso terapêutico , Adulto , Glicemia/análise , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Ácido Úrico/sangue , Xipamida/administração & dosagemRESUMO
A xipamida, teve seu efeito anti-hipertensivo testado em 16 pacientes portadores de hipertensao arterial sisemica leve a moderada (95 mmHg < igual pressao diastolica < igual 115 mmHg), 11 mulheres e 5 homens, com idades entre 30 e 64 anos (media 47 anos). Um comprimido de xipamida oral de 20 mg por dia foi dado durante 180 dias. O controle da pressao arterial foi semanal no 1o. mes e mensal nos 5 meses restantes.Foram feitas determinacoes da caliemia, glicemia, uricemia e dos intervalos QT e PR do eletrocardiograma, antes e no final do estudo. Em 13 dos 16 pacientes (81,2%) houve reducao dos niveis tensionais para valores limiares ou normais, com pressao diastolica < igual 95 mmHg. Nos 3 restantes a PD ficou entre 95 e 100 mmHg. Nao houve alteracao de QT e PR. A caliemia apresentou diminuicao significativa (p < 0,00l). Paraefeitos de pequena intensidade foram observados em 8 pacientes (50%): tonturas em 5 (31%), fraqueza em 4 (25%), caimbras em 3 (18%), mal estar gastrico em 2 (12,5%), gosto amargo em 1 (6,2%) e hipoacusia em 1 (6,2). Concluiu-se que a xipamida apresentou efeito ani-hipertensivo satisfatorio, com boa tolerancia e pequeno grau de alteracoes metabolicas
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Xipamida , Hipertensão , Pressão ArterialRESUMO
The relationship between parasitemia, seroreactivity to Trypanosoma cruzi, and electrocardiographic abnormalities was studied in 115 individuals from a rural community in northeast Brazil where Chagas' disease is endemic. Vector control measures were introduced, and after 3 years 106 of the original participants were located and re-examined. Serum antibodies to T. cruzi were measured by complement fixation and indirect fluorescent antibody tests and parasitemia by xenodiagnosis and blood cultures. On both examinations more seropositive children than seropositive adults showed parasitemia, and parasitemia was more likely to persist over the 3-year period in younger individuals. Electrocardiographic (ECG) abnormalities were seen more frequently in seropositive individuals without parasitemia. However, ECG abnormalities, as expected, were more prevalent in older individuals and therefore no specific inverse relationship between ECG findings and parasitemia could be shown. The decreased prevalence of infection noted in younger individuals following the introduction of vector control measures indicates that this approach limited transmission.