Risk of Chronic Cardiomyopathy Among Patients With the Acute Phase or Indeterminate Form of Chagas Disease

A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.

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Effects of vitamin C supplementation on acute phase Chagas disease in experimentally infected mice with Trypanosoma cruzi QM1 strain

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652012000600006 ◽

2012 ◽

Vol 54 (6) ◽

pp. 319-323 ◽

Cited By ~ 14

Author(s):

Ricardo Guimarães Marim ◽

Alex Silva de Gusmão ◽

Roberto Esteves Pires Castanho ◽

Rafael Deminice ◽

Altino Luiz Silva Therezo ◽

...

Keyword(s):

Lipid Peroxidation ◽

Vitamin C ◽

Chagas Disease ◽

Acute Phase ◽

Immune Reaction ◽

Parasite Clearance ◽

Vitamin C Supplementation ◽

Affected Tissue ◽

Tissue Changes ◽

High Doses

The tissue changes that occur in Chagas disease are related to the degree of oxidative stress and antioxidant capacity of affected tissue. Studies with vitamin C supplementation did not develop oxidative damage caused by Chagas disease in the host, but other studies cite the use of peroxiredoxins ascorbate - dependent on T. cruzi to offer protection against immune reaction. Based on these propositions, thirty "Swiss" mice were infected with T. cruzi QM1 strain and treated with two different vitamin C doses in order to study the parasitemia evolution, histopathological changes and lipid peroxidation biomarkers during the acute phase of Chagas disease. The results showed that the parasite clearance was greater in animals fed with vitamin C overdose. There were no significant differences regarding the biomarkers of lipid peroxidation and inflammatory process or the increase of myocardium in animals treated with the recommended dosage. The largest amount of parasite growth towards the end of the acute phase suggests the benefit of high doses of vitamin C for trypomastigotes. The supplementation doesn't influence the production of free radicals or the number of amastigote nests in the acute phase of Chagas disease.

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The anticancer drug tamoxifen is active against Trypanosoma cruzi in vitro but ineffective in the treatment of the acute phase of Chagas disease in mice

Memórias do Instituto Oswaldo Cruz ◽

10.1590/s0074-02762010000700021 ◽

2010 ◽

Vol 105 (7) ◽

pp. 945-948 ◽

Cited By ~ 5

Author(s):

Danilo Ciccone Miguel ◽

Marcela Lencine Ferraz ◽

Rosana de Oliveira Alves ◽

Jenicer KU Yokoyama-Yasunaka ◽

Ana Claudia Torrecilhas ◽

...

Keyword(s):

Trypanosoma Cruzi ◽

Chagas Disease ◽

Anticancer Drug ◽

Acute Phase

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Circulating miRNAs as Potential Biomarkers Associated with Cardiac Remodeling and Fibrosis in Chagas Disease Cardiomyopathy

International Journal of Molecular Sciences ◽

10.3390/ijms20164064 ◽

2019 ◽

Vol 20 (16) ◽

pp. 4064 ◽

Cited By ~ 10

Author(s):

Carolina Kymie Vasques Nonaka ◽

Carolina Thé Macêdo ◽

Bruno Raphael Ribeiro Cavalcante ◽

Adriano Costa de Alcântara ◽

Daniela Nascimento Silva ◽

...

Keyword(s):

Chagas Disease ◽

Cardiac Fibrosis ◽

Left Ventricular ◽

Pharmacological Therapy ◽

Functional Class ◽

Diagnostic Methods ◽

Individual Risk ◽

Indeterminate Form ◽

Potential Biomarkers

Chagas disease (CD) affects approximately 6–7 million people worldwide, from which 30% develop chronic Chagas cardiomyopathy (CCC), usually after being asymptomatic for years. Currently available diagnostic methods are capable of adequately identifying infected patients, but do not provide information regarding the individual risk of developing the most severe form of the disease. The identification of biomarkers that predict the progression from asymptomatic or indeterminate form to CCC, may guide early implementation of pharmacological therapy. Here, six circulating microRNAs (miR-19a-3p, miR-21-5p, miR-29b-3p, miR-30a-5p, miR-199b-5p and miR-208a-3p) were evaluated and compared among patients with CCC (n = 28), CD indeterminate form (n = 10) and healthy controls (n = 10). MiR-19a-3p, miR-21-5p, and miR-29b-3p were differentially expressed in CCC patients when compared to indeterminate form, showing a positive correlation with cardiac dysfunction, functional class, and fibrosis, and a negative correlation with ejection fraction and left ventricular strain. Cardiac tissue analysis confirmed increased expression of microRNAs in CCC patients. In vitro studies using human cells indicated the involvement of these microRNAs in the processes of cardiac hypertrophy and fibrosis. Our study suggests that miRNAs are involved in the process of cardiac fibrosis and remodeling presented in CD and indicate a group of miRNAs as potential biomarkers of disease progression in CCC.

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Reactive oxygen species and nitric oxide imbalances lead to in vivo and in vitro arrhythmogenic phenotype in acute phase of experimental Chagas disease

PLoS Pathogens ◽

10.1371/journal.ppat.1008379 ◽

2020 ◽

Vol 16 (3) ◽

pp. e1008379 ◽

Cited By ~ 5

Author(s):

Artur Santos-Miranda ◽

Julliane Vasconcelos Joviano-Santos ◽

Grazielle Alves Ribeiro ◽

Ana Flávia M. Botelho ◽

Peter Rocha ◽

...

Keyword(s):

Nitric Oxide ◽

Reactive Oxygen Species ◽

Chagas Disease ◽

Acute Phase ◽

Reactive Oxygen ◽

Oxygen Species

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Chagasic meningoencephalitis in the immunodeficient

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1998000100015 ◽

1998 ◽

Vol 56 (1) ◽

pp. 93-97 ◽

Cited By ~ 20

Author(s):

LAZO JAVIER ◽

ANTONIO CARLOS OLIVEIRA MENESES ◽

ADEMIR ROCHA ◽

MARCELO SIMÃO FERREIRA ◽

JAIME OLAVO MARQUEZ ◽

...

Keyword(s):

Natural History ◽

Trypanosoma Cruzi ◽

Chagas Disease ◽

Acute Phase ◽

Brain Pathology ◽

History Of ◽

The Brain

Based on their own experience and on the literature, the authors compare the brain pathology due to HIV+ associated Trypanosoma cruzi reactived infection to that described for the natural history of the Chagas' disease (CD). The peculiar focal necrotizing chagasic meningoencephalitis (MECNF) which appears only in immunedeficient chagasics, especially when the deficiency is due HIV is a safe criterion for reactivation of CD. MECNF morphologic findings are unlike to those found either for some cases of acute phase CD or for chronic nervous form of CD.

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