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Resumo Introdução: No Brasil, a vigilância entomológica da doença de Chagas (DCh) é respaldada na participação comunitária, que notifica a presença dos vetores nas habitações. Assim, a sustentabilidade desta medida de controle depende do conhecimento da população sobre os vetores. Objetivo: Avaliar o conhecimento de escolares sobre a doença de Chagas nos municípios mineiros de Itatiaiuçu (vigilância ativa) e Sabará (vigilância inativa). Método: Questionário semiestruturado foi aplicado para alunos matriculados no ensino médio em duas escolas de Sabará (rural e urbana) e uma em Itatiaiuçu (urbana). Resultados: Em geral, os alunos residentes em Sabará demonstraram conhecimento limitado acerca dos vetores, patógeno, transmissão e doença (sem diferenças relevantes quanto à localização entre área urbana e rural), quando comparados aos residentes em Itatiaiuçu, que apesar de ter uma vigilância mais atuante, também não apresentaram conhecimento totalmente satisfatório. Conclusões: Os resultados enfatizam a carência de informações sobre a DCh tanto em relação ao conhecimento acadêmico quanto às campanhas de educação firmadas pelo programa. Ações educativas para sensibilizar a comunidade e promover o conhecimento sobre esta doença mostram-se necessárias e fundamentais para a manutenção da vigilância ao longo do tempo e espaço.
Abstract Background: In Brazil, entomological surveillance of Chagas disease (ChD) is based on community participation, which notifies the presence of vectors inside their homes. Thus, the sustainability of this control measure depends on the knowledge of the population about the vectors. Objective: To evaluate the knowledge of schoolchildren about ChD in the municipalities of Itatiaiuçu (active surveillance) and Sabará (inactive surveillance). Method: A semi-structured questionnaire was given to students enrolled in two high schools in Sabará (rural and urban) and one in Itatiaiuçu (urban). Results: In general, students living in Sabará demonstrated only limited knowledge about vectors, pathogens, transmission, and disease (with no significant differences between the schools in urban and rural areas). Similarly, the schoolchildren in Itatiaiuçu, despite living in an area of active surveillance, also did not have a fully satisfactory knowledge of ChD. Conclusions: The results emphasize the lack of information about ChD, both in relation to academic knowledge and the education campaigns established by the program. Improvements in educational interventions to raise community awareness and promote knowledge about ChD are necessary and vital for maintaining vigilance against ChD over space and time.
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In this chapter, the main prognostic markers of Chagas heart disease are addressed, with an emphasis on the most recent findings and questions, establishing the basis for a broad discussion of recommendations and new approaches to managing Chagas cardiopathy. The main biological and genetic markers and the contribution of the electrocardiogram, echocardiogram and cardiac magnetic resonance are presented. We also discuss the most recent therapeutic proposals for heart failure, thromboembolism and arrhythmias, as well as current experience in heart transplantation in patients suffering from severe Chagas cardiomyopathy. The clinical and epidemiological challenges introduced by acute Chagas disease due to oral contamination are discussed. In addition, we highlight the importance of ageing and comorbidities in influencing the outcome of chronic Chagas heart disease. Finally, we discuss the importance of public policies, the vital role of funding agencies, universities, the scientific community and health professionals, and the application of new technologies in finding solutions for better management of Chagas heart disease.
Assuntos
Cardiomiopatia Chagásica , Doença de Chagas , Transplante de Coração , Cardiomiopatia Chagásica/diagnóstico , Doença Crônica , Coração , Humanos , Infecção Persistente , PrognósticoRESUMO
In this chapter, the main prognostic markers of Chagas heart disease are addressed, with an emphasis on the most recent findings and questions, establishing the basis for a broad discussion of recommendations and new approaches to managing Chagas cardiopathy. The main biological and genetic markers and the contribution of the electrocardiogram, echocardiogram and cardiac magnetic resonance are presented. We also discuss the most recent therapeutic proposals for heart failure, thromboembolism and arrhythmias, as well as current experience in heart transplantation in patients suffering from severe Chagas cardiomyopathy. The clinical and epidemiological challenges introduced by acute Chagas disease due to oral contamination are discussed. In addition, we highlight the importance of ageing and comorbidities in influencing the outcome of chronic Chagas heart disease. Finally, we discuss the importance of public policies, the vital role of funding agencies, universities, the scientific community and health professionals, and the application of new technologies in finding solutions for better management of Chagas heart disease.
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In spite of long-term efforts to eliminate Triatoma infestans (Klug 1834) from Brazil, residual foci still persist in the states of Bahia and Rio Grande do Sul. Data on the genetic variability and structuring of these populations are however lacking. Using nine microsatellite loci, we characterized one residual T. infestans population from Bahia and four from Rio Grande do Sul, and compared them with bugs originally from an older focus in São Paulo; 224 bugs were genotyped. The number of alleles per locus ranged from 5 to 11. Observed and expected heterozygosities per locus ranged, respectively, from 0 to 0.786 and from 0 to 0.764. Significant departures from Hardy-Weinberg equilibrium, mainly due to heterozygote deficits, were detected in all loci and in most populations. Global indices estimated by AMOVA were: Fis was 0.37; Fst was 0.28; and Fit was 0.55; overall indices with p = 0.00 indicated substantial differentiation. Inter-population Fst ranged from 0.118 to 0.562, suggesting strong genetic structuring and little to no gene flow among populations. Intra-population Fis ranged from 0.301 to 0.307. Inbreeding was apparent in all populations except that from Bahia-which might be either linked by gene flow to nearby unsampled populations or part of a relatively large local population. The overall pattern of strong genetic structuring among pyrethroid-susceptible residual T. infestans populations suggests that their persistence is probably due to operational control failures. Detection and elimination of such residual foci is technically feasible and must become a public health priority in Brazil.
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Insetos Vetores/genética , Repetições de Microssatélites , Triatoma/genética , Alelos , Animais , Brasil , Variação Genética , Genótipo , GeografiaRESUMO
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 .
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Doença de Chagas , Consenso , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/terapia , Doença de Chagas/transmissão , HumanosRESUMO
Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. 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 collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.
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Doença de Chagas/diagnóstico , Doença de Chagas/terapia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/terapia , Brasil/epidemiologia , Doença de Chagas/mortalidade , Doença de Chagas/transmissão , Doença Crônica , Consenso , Gerenciamento Clínico , Humanos , Doenças Negligenciadas/mortalidade , Doenças Negligenciadas/prevenção & controle , Saúde Pública , Medicina TropicalRESUMO
INTRODUCTION: Triatomines are targeted for the control of Chagas disease in endemic areas of Brazil. METHODS: Data regarding triatomines captured during 2001-2008 in 34 municipalities in the Northeast of Minas Gerais were analyzed. RESULTS: In total, 11,187 triatomines from eight species were captured, mostly in henhouses and bedrooms. Trypanosomes were found in 203 samples. Main species were Triatoma sordida, Panstrongylus megistus, and Triatoma vitticeps. The number of P. megistus adults was positively correlated with temperature and precipitation, whereas the number of nymphs followed the inverse pattern. CONCLUSIONS: Occurrence of triatomines in domiciles indicates the need for sustained entomological surveillance.
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Habitação , Insetos Vetores/classificação , Panstrongylus , Rhodnius , Triatoma , Animais , Brasil , Doença de Chagas/transmissão , Feminino , Masculino , Densidade Demográfica , Dinâmica PopulacionalRESUMO
A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.
Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. 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 collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.
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Humanos , Masculino , Feminino , Doença de Chagas/diagnóstico , Doença de Chagas/prevenção & controle , Doença de Chagas/epidemiologia , Brasil , Conferência de Consenso , Doença de Chagas/terapia , Doença de Chagas/transmissãoRESUMO
Chagas disease is a neglected chronic condition with ahigh 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 controlof 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...
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Atenção à Saúde , Brasil , Consenso , Diagnóstico , Doença de Chagas , Epidemiologia , TerapêuticaRESUMO
A woman had been followed since 1957 for acute phase Chagas disease. Parasitological and serological tests were positive, and treatment included benznidazole in 1974. Following treatment, parasitological test results were negative and conventional serology remained positive until 1994, with subsequent discordant results (1995-1997). The results became consistently negative since 1999. She had an indeterminate chronic form until 1974. Only two minor and transitory nonspecific alterations on electrocardiogram were noted, with the last nine records normal until June 2014. This case confirms the possibility of curing chronic disease and suggests the benefit of specific treatments for preventing long-term morbidity.
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Doença de Chagas/tratamento farmacológico , Nitroimidazóis/administração & dosagem , Tripanossomicidas/administração & dosagem , Doença Aguda , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Fatores de Tempo , Trypanosoma cruzi/imunologiaRESUMO
ABSTRACTA woman had been followed since 1957 for acute phase Chagas disease. Parasitological and serological tests were positive, and treatment included benznidazole in 1974. Following treatment, parasitological test results were negative and conventional serology remained positive until 1994, with subsequent discordant results (1995-1997). The results became consistently negative since 1999. She had an indeterminate chronic form until 1974. Only two minor and transitory nonspecific alterations on electrocardiogram were noted, with the last nine records normal until June 2014. This case confirms the possibility of curing chronic disease and suggests the benefit of specific treatments for preventing long-term morbidity.
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Idoso , Feminino , Humanos , Doença de Chagas/tratamento farmacológico , Nitroimidazóis/administração & dosagem , Tripanossomicidas/administração & dosagem , Doença Aguda , Doença Crônica , Seguimentos , Fatores de Tempo , Trypanosoma cruzi/imunologiaRESUMO
The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox's univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.
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Cardiomiopatia Chagásica/mortalidade , Adulto , Idoso , Cardiomiopatia Chagásica/fisiopatologia , Progressão da Doença , Eletrocardiografia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Função Ventricular Esquerda , Adulto JovemRESUMO
The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox’s univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.
A identificação de preditores da progressão da cardiopatia chagásica crônica (CCC) é essencial ao manejo adequado do paciente. Estudo coorte não concorrente de 165 pacientes portadores de CCC entre 1985-2010 quanto a preditores independentes da evolução da CCC. Os desfechos foram piora da classificação da CCC e surgimento de disfunção ventricular esquerda ao ecoDopplercardiograma. Variáveis sócio-demográficas, epidemiológicas, clínicas e propedêuticas foram estudadas e realizadas análise descritiva, análise de sobrevida com análise univariada (Kaplan-Meier e modelo univariado de Cox) e multivariada (modelo de regressão de Cox). O seguimento foi de dois a 20 anos, com média de 8,2 anos. A média de idade dos pacientes foi de 44,8 anos (20- 77 anos). Comparando ambos os tempos do estudo, no tempo 2 houve significância estatística do aumento do intervalo PR e da duração do QRS, além da redução da frequência cardíaca (Wilcoxon < 0,01). Os preditores da evolução da CCC no modelo final de regressão foram sexo masculino (HR = 2,81), pausas iguais ou maiores que dois segundos ao Holter (HR = 3,02), aumento do índice cardiotorácico (HR = 7,87) e tempo de uso de digital (HR = 1,41), destacando-se necessidade de seguimento e tratamento mais rigoroso para os chagásicos que cumulam estes fatores.