RESUMEN
Two Brazilian cases of Trypanosoma cruzi/HIV co-infection have recently been treated with azole derivatives. Benznidazole, the drug generally used for the treatment of Chagas disease, was initially used in one case but discontinued because of an adverse effect (retrobulbar neuritis) and replaced by itraconazole. The other case had oesophageal candidiasis, which was treated with ketoconazole, a drug that had already been shown to be effective in the treatment of Chagas disease. Since the medications were effective in reducing the T. cruzi parasitaemia in both patients, they probably helped prevent the severe morbidity sometimes associated with Chagas disease, although the HIV infections still proved fatal in both cases.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Enfermedad de Chagas/tratamiento farmacológico , Itraconazol/uso terapéutico , Cetoconazol/uso terapéutico , Tripanocidas/uso terapéutico , Adulto , Brasil , Quimioterapia Combinada , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parasitemia/tratamiento farmacológico , Trypanosoma cruzi/efectos de los fármacosRESUMEN
PURPOSE: Studying the mitral valve in chronic Chagas' heart disease, searching a possible cause effect relationship between this condition and valve prolapse. METHODS: Seventeen hearts were surveyed from individuals exhibiting chronic chagasic cardiopathy, 11 males and 6 females, aged between 31-84 (average 54) years. The hearts came from necropsies carried out until a year before. Properly preserved samples were analyzed macro and microscopically. Fragments were excised from the mitral valve papillary muscles, anterior, lateral and posterior regions of the left ventricle, interventricular septum, free wall of right ventricle and atrium walls. RESULTS: Chronic myocarditis was found ill all the samples (mild in 6 of them, moderate in 7 and severe in 4). Also, the papillary muscles exhibited myocarditis in all of the samples, and in 15 of them the degree of severity was equal to or superior than the observed in degree other regions of the heart. CONCLUSION: The chronic chagasic cardiopathy, the papillary muscle constitute a frequent site of myocarditis. This fact must be held in mind when one discusses the pathogenesis of the prolapse of the valve.
Asunto(s)
Cardiomiopatía Chagásica/complicaciones , Prolapso de la Válvula Mitral/etiología , Adulto , Anciano , Anciano de 80 o más Años , Cardiomiopatía Chagásica/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/patología , Músculos Papilares/patologíaRESUMEN
Thirty-two monkeys were captured and adapted to laboratory conditions captives isolated. They were submitted to multiple xenodiagnosis which were negative. Twelve were infected intraperitoneally with different strains of T. cruzi (1.10(5) to 5.10(6)). Twenty were the control group. Between on to six years both the control group and the infected monkeys, were submitted to xenodiagnosis, serological testing clinical examination and electrocardiography. The clinical examination and the electrocardiogram were always normal. The monkey were autopsied and histological examination detected in the infected group four monkeys with evidence of disease: one with parasites in the tissue and three with chronic myocarditis. Parasitaemia was in 66.66% of the monkeys in the acute phase and the serology was positive in 91.66% in the chronic phase. The authors concluded that Cebus monkeys were not susceptible to the development of the disease but they could be utilized to maintain of such strains and studies of serological research in long-terms infections.
Asunto(s)
Cebus/parasitología , Enfermedad de Chagas/diagnóstico , Modelos Animales de Enfermedad , Enfermedades de los Monos/diagnóstico , Animales , Enfermedad de Chagas/parasitología , Enfermedad de Chagas/patología , Electrocardiografía , Femenino , Masculino , Enfermedades de los Monos/parasitología , Enfermedades de los Monos/patología , Factores de Tiempo , Trypanosoma cruzi/aislamiento & purificaciónRESUMEN
A 46-year-old female patient with chronic Chagas' myocarditis without heart failure was submitted to chemotherapy because of Hodgkin's disease. During treatment the frequency of polymorphic ventricular extrasystoles raised and the patient died by a sudden cardiac arrest. Autopsy revealed chronic Chagas myocarditis with an acute exacerbation. Nests of amastygotes with a density of up to 14 pseudocysts/cm2 were found in the myocardium, although restricted to the septum and left ventricular posterolateral wall. Extensive histologic examination did not reveal parasites in other locations. This favors the concept of a localized exacerbation of Chagas' disease due to immunosuppression developing from a persistent parasitic focus in the heart. Although this reactivation during chemotherapy of malignant disease is rarely reported in literature, a careful monitoring of patients with positive Chagas' serology during chemotherapy is recommended.