CHAGAS DISEASE

Chagas disease or  American trypanosomiasis, is a tropical parasitic disease caused by the protozoan Trypanosoma cruzy . spread mostly by insects known as triatominae  or kissing bug

Chagas disease

EPIDEMIOLOGY 300,000–400,000 living in nonendemic countries

Affects 8 to 10 million people living in endemic Latin American countries

MUSCLE PAIN

DIARRHOEA

FEVER

NAUSEA VOMITING

RASH

ANOREXIA HEAD ACHE

ACUTE PHASE

ACUTE PHASE C NTNUE

signs on physical examination

mild enlargement of the liver or spleen

swollen glands

local swelling (a chagoma)

CHRONIC DISEASE

indeterminate chronic Chagas disease, : 60–80% will never develop symptoms

 determinate chronic Chagas disease: 20–40% will develop life-threatening heart and/or digestive disorders during their lifetime

CHRONIC PHASE

Dialated cardiomyopathy

Megacolon and megaesophagus

Neuritis Results in altered tendon reflexes and

sensory impairment.

The clinical manifestations of Chagas disease are due to cell death in the target tissues that

occurs during the infective cycle

TRANSMISSION

DIAGNOSIS

DIAGNOSIS

microscopic examination of fresh anticoagulated blood, or its buffy coat, for motile parasites

Immunoassays  distinguish among strains. These tests include:

detecting complement fixation indirect hemagglutination indirect fluorescence assays radioimmunoassays,  ELISA.  polymerase chain reaction (PCR)

PREVENTION

PREVENTION

No vaccine against Chagas disease  Decreasing the numbers of the insect that

spreads it (Triatoma) This is done by using sprays and paints

containing insecticides (synthetic pyrethroids)

Improving housing and sanitary conditions in rural areas.

 mosquito net is recommended the development and implementation

of blood bank screening tests

MANAGEMENT

Antiparasitic treatment azole or nitro derivatives, such

as benznidazole or nifurtimox managing the clinical manifestations of the

disease. pacemakers and medications for irregular

heartbeats, such as the anti-arrhythmia drug amiodarone

Heart tranplantation

Surgery for megaintestinelower dosages of the

immunosuppressant drug cyclosporindirect stem cell therapy of the heart

muscle using bone marrow cell transplantation

 

RESEARCH ABSTRACT

TREATMENT PATTERNS AND THEIR RELATION TO THE DIAGNOSIS OF CHAGAS DISEASE IN PATIENTS WITH HEART FAILURE, 2001-2011: BOGOTÁ, COLOMBIA

Methods retrospective cohort study, compiling data from medical files of patients hospitalized for heart failure between 2001-2011. Each CH patient (n=41) was matched with 1-2 comparable non-Chagas (no-CH) patients (n=77).

Hypothesis patients with Chagas disease receive a poorer quality of medical attention when compared to people treated for the same illness without Chagas disease

INCLUSION CRITERIA

INCLUSION CRITERIA

Diagnosis of heart failure upon

hospital admission, as defined

byColombian guide about the

evaluation and management of

chronic heart failure in adults

Administration of intravenous diuretics during hospitalization

Pulmonary Oedema, as defined by A.D.A.M.

Medical encyclopaedia, identified in patient chest

x-ray results.

EXCLUSION CRITERIA

The study excluded patients whose heart failure diagnosis was

secondary to a valvular heart disease

diagnosis

Matching Each Chagas patient

was matched with two non- Chagas controls to increase statistical power, using the following criteria:

1)No more than 5% difference of the ‘left ventricular ejection fraction

2)No more than five years difference in age;

3)No more than six

months difference in date of hospital admittance

DATA EXTRACTION AND ANALYSIS

Information regarding patient demographics, parasitology, clinical diagnostics and management of health during hospitalizations, including pharmacology, was collected directly into a data extraction form on Microsoft Access 2003

Analysis quantitative analysis of frequencies, Chi-squared (Χ2) tests, Kruskal-Wallis analysis of variance and Kaplan-Meier survival function.. An internal institutional review approved the study protocol and ethics. No personal information was collected from files that would be traceable to patients.

RESULTThey observed only a marked but

not significant difference in mortality between Chagas patients (12.2%) and non-Chagas patients

(3.9%) (P-value = 0.088). Therefore, the general equity

observed between CH and no-CH patients at FCI does not support

the hypothesis of inadequate care for CH patients.