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Quimioterapia da doença de Chagas: estado da arte e perspectivas no desenvolvimento de novos fármacos; Chemotherapy of Chagas' disease: state of the art and perspectives for the development of new drugs

DIAS, Luiz C.; DESSOY, Marco A.; SILVA, Jean Jerley N.; THIEMANN, Otavio Henrique; OLIVA, Glaucius; ANDRICOPULO, Adriano Defini
Fonte: Sociedade Brasileira de Química Publicador: Sociedade Brasileira de Química
Tipo: Artigo de Revista Científica
POR
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Neglected diseases are a major global cause of illness, long-term disability and death. Chagas' disease is a parasitic infection widely distributed throughout Latin America, with devastating consequences in terms of human morbidity and mortality. The existing drug therapy suffers from a combination of drawbacks including poor efficacy, resistance and serious side effects. In 2009, we celebrate the 100th anniversary of the discovery of Chagas' disease, facing the challenges of developing new, safe and effective drugs for the treatment of this disease. This brief review attempts to highlight the state of the art, limitations and perspectives of Chagas' disease drug development.; WHO World Health Organization - Organização Mundial de Saúde; Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Central nervous system involvement in Chagas' disease: an updating

Pittella,José Eymard Homem
Fonte: Instituto de Medicina Tropical Publicador: Instituto de Medicina Tropical
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/1993 EN
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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.

Comparison of esophageal motility impairment caused by Chagas' disease in two age groups

Dantas,Roberto Oliveira; Aprile,Lilian Rose Otoboni
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2006 EN
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BACKGROUND: Chagas' disease and the aging process cause loss of neurons of the esophageal myenteric plexus. AIM: To evaluate the esophageal motility impairment caused by Chagas' disease in two age groups. Our hypothesis was that the aging process may cause further esophageal motility impairment in patients with Chagas' disease. METHODS: We studied the esophageal motility of 30 patients with Chagas' disease and dysphagia, with esophageal retention of barium sulfate and an esophageal diameter within the normal range. Fifteen were 34 to 59 years old (younger group, median 51 years) and 15 were 61 to 77 years old (older group, median 66 years). As a control group we studied 15 subjects aged 33 to 58 years (median 42 years) and 7 subjects aged 61 to 73 years (median 66 years). The esophageal contractions were measured by the manometric method with continuous perfusion after five swallows of a 5 mL bolus of water at 2, 7, 12 and 17 cm below the upper esophageal sphincter. RESULTS: Patients with Chagas' disease had lower amplitude of contractions and fewer peristaltic, more simultaneous, and more non-conducted contractions than controls. Older patients with Chagas' disease had lower amplitude of contractions in the distal esophagus (mean ± SE: 30.8 ± 4.3 mm Hg) than younger patients (51.9 ± 8.6 mm Hg). From 12 to 17 cm...

Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

Martins-Melo,Francisco Rogerlândio; Ramos Junior,Alberto Novaes; Alencar,Carlos Henrique; Heukelbach,Jorg
Fonte: Sociedade Brasileira de Medicina Tropical - SBMT Publicador: Sociedade Brasileira de Medicina Tropical - SBMT
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2012 EN
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INTRODUCTION: Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). METHODS: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). RESULTS: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. CONCLUSIONS: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.

New evidence of spontaneous cure in human Chagas' disease

Francolino,Sonia S.; Antunes,Antonio Fernandez; Talice,Rodolfo; Rosa,Rachel; Selanikio,Joel; Rezende,Joffre Marcondes de; Romanha,Álvaro J.; Dias,João Carlos Pinto
Fonte: Sociedade Brasileira de Medicina Tropical - SBMT Publicador: Sociedade Brasileira de Medicina Tropical - SBMT
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 EN
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A new case of spontaneous cure of human Chagas' disease is described in Uruguay. An 87-year-old man who had a typical acute phase of Trypanosoma cruzi infection in 1947 and never received specific treatment against the disease, when examined in 1998 revealed several completely negative parasitological and serological tests, including traditional serology, PCR and flow cytometry. As a whole, such findings fulfill the current criteria to define the cure of Chagas' disease. Clinical data suggest the possibility of a benign evolution of Chagas' disease in this case, but the basic findings (slight cardiac and esophageal impairment) could also be due to the advanced age of the patient.

Persistent infections in chronic Chagas' disease patients treated with anti-Trypanosoma cruzi nitroderivatives

BRAGA,M. Socorro; LAURIA-PIRES,Liana; ARGAÑARAZ,Enrique R.; NASCIMENTO,Rubens J.; TEIXEIRA,Antonio R. L.
Fonte: Instituto de Medicina Tropical Publicador: Instituto de Medicina Tropical
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2000 EN
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We used a molecular method and demonstrated that treatment of the chronic human Trypanosoma cruzi infections with nitroderivatives did not lead to parasitological cure. Seventeen treated and 17 untreated chronic Chagas' disease patients, with at least two out of three positive serologic assays for the infection, and 17 control subjects formed the study groups. PCR assays with nested sets of T. cruzi DNA primers monitored the efficacy of treatment. The amplification products were hybridized to their complementary internal sequences. Untreated and treated Chagas' disease patients yielded PCR amplification products with T. cruzi nuclear DNA primers. Competitive PCR was conducted to determine the quantity of parasites in the blood and revealed < 1 to 75 T. cruzi/ml in untreated (means 25.83 ± 26.32) and < 1 to 36 T. cruzi/ml in treated (means 6.45 ± 9.28) Chagas' disease patients. The difference between the means was not statistically significant. These findings reveal a need for precise definition of the role of treatment of chronic Chagas' disease patients with nitrofuran and nitroimidazole compounds.

Morphologic and morphometric evaluation of pancreatic islets in chronic Chagas' disease

Saldanha,João Carlos; Santos,Vitorino Modesto dos; Reis,Marlene Antônia dos; Cunha,Daniel Ferreira da; Teixeira,Vicente de Paula Antunes
Fonte: Faculdade de Medicina / Universidade de São Paulo - FM/USP Publicador: Faculdade de Medicina / Universidade de São Paulo - FM/USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2001 EN
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PURPOSE: Hyperglycemia and abnormal glucose tolerance tests observed in some patients with chronic Chagas' disease suggest the possibility of morphological changes in pancreatic islets and/or denervation. The purpose of this study was to describe the morphology and morphometry of pancreatic islets in chronic Chagas' disease. METHODS: Morphologic and computerized morphometric studies were performed in fragments of the head, body, and tail regions of the pancreas obtained at necropsies of 8 normal controls and 17 patients with chronic Chagas' disease: 8 with the digestive form (Megas) and 9 with the congestive heart failure form. RESULTS: The Megas group had a larger (p < 0.05) pancreatic islet area in the tail of the pancreas (10649.3 ± 4408.8 µm²) than the normal control (9481.8 ± 3242.4 µm²) and congestive heart failure (9475.1 ± 2104.9 µm²) groups; likewise, the density of the pancreatic islets (PI) was greater (1.2 ± 0.7 vs. 0.9 ± 0.6 vs. 1.9 ± 1.0 PI/mm², respectively). In the tail region of the pancreas of patients with the Megas form, there was a significant and positive correlation (r = +0.73) between the area and density of pancreatic islets. Discrete fibrosis and leukocytic infiltrates were found in pancreatic ganglia and pancreatic islets of the patients with Chagas' disease. Trypanosoma cruzi nests were not observed in the examined sections. Individuals with the Megas form of Chagas' disease showed increased area and density of pancreatic islets in the tail of the pancreas. CONCLUSION: The observed morphometric and morphologic alterations are consistent with functional changes in the pancreas...

Pancreatic lesions in acute experimental Chagas' disease

Corbett,Carlos Eduardo Pereira; Scremin,Luciano Henrique Gazoni; Lombardi,Rafael Arsky; Gama-Rodrigues,Joaquim José; Okumura,Masayuki
Fonte: Faculdade de Medicina / Universidade de São Paulo - FM/USP Publicador: Faculdade de Medicina / Universidade de São Paulo - FM/USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2002 EN
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BACKGROUND: Chagas' disease is an endemic tropical affliction found from southern United States to Argentina. The acute phase of this disease is difficult to study in man because the symptoms are non-specific and most cases require no medical assistance. Experimental models have been developed for sequential studies, and intense parasitism in all organs and tissues, including the pancreas, have been detected in the acute phase. PURPOSE: To evaluate the involvement of the pancreas in acute experimental Chagas' disease in a mouse model by histopathological characterization. CASUISTIC AND METHODS: Ten BALBc mice, about 20 g, injected i.p. with 100 000 forms of the Y strain of Trypanosoma cruzi were used. The animals were sacrificed after 14 days of infection. Fragments of pancreas were processed by conventional paraffin embedding and hematoxylin-eosin staining. RESULTS: Ruptured pseudocysts and release of parasites to the extracellular medium caused by necrosis of acinar and duct cells and foci of fat were the most striking histopathological features of acute Chagasic pancreatitis. CONCLUSION: Parasitism is the main cause of acute pancreatitis in Chagas' disease.

Chagas' Disease and HIV Co-infection: Genotypic Characterization of the Trypanosoma cruzi Strain

Pacheco,Raquel S; Ferreira,Marcelo S; Machado,Maria Inês; Brito,Célia MM; Pires,Marize Q; Da-Cruz,Alda M; Coutinho,Sérgio G
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/1998 EN
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In the past few years, new aspects of the immunopathology of Chagas' disease have been described in immunosuppressed patients, such as fatal central nervous system lesions related to the reactivation of the parasite. This article is the first description of the genotypic characterization, at the strain level, of Trypanosoma cruzi isolated from a patient with Chagas` disease/AIDS co-infection. The presence of four hypodense lesions was observed in the cranial compute tomographic scan. The diagnosis of AIDS was assessed by the detection of anti-HIV antibodies using enzyme-linked immunosorbent assay (ELISA) and Western blot techniques. The CD4+ lymphocyte counts were maintained under 200 cells/mm3 during one year demonstrating the severity of the state of immunosuppression. Chagas' disease was confirmed by serological and parasitological methods. Trypomastigote forms were visualized in a thick blood smear. The parasite isolated is genotypically similar to the CL strain. The paper reinforces that cerebral Chagas' disease can be considered as another potential opportunistic infection in AIDS resulting from the reactivation of a dormant T. cruzi infection acquired years earlier.

Leptin levels in different forms of Chagas' disease

Fernandes,F.; Dantas,S.; Ianni,B.M.; Ramires,F.J.A.; Buck,P.; Salemi,V.M.C.; Lopes,H.F.; Mady,C.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2007 EN
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Leptin is produced primarily by adipocytes. Although originally associated with the central regulation of satiety and energy metabolism, increasing evidence indicates that leptin may be an important mediator in cardiovascular pathophysiology. The aim of the present study was to investigate plasma leptin levels in patient with Chagas' heart disease and their relation to different forms of the disease. We studied 52 chagasic patients and 30 controls matched for age and body mass index. All subjects underwent anthropometric, leptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements and were evaluated by echocardiography, 12-lead electrocardiogram (ECG), and chest X-ray. All patients had fasting blood samples taken between 8:00 and 9:00 am. Chagasic patients were divided into 3 groups: group I (indeterminate form, IF group) consisted of 24 subjects with 2 positive serologic reactions for Chagas' disease and no cardiac involvement as evaluated by chest X-rays, ECG and two-dimensional echocardiography; group II (showing ECG abnormalities and normal left ventricular systolic function, ECG group) consisted of 14 patients; group III consisted of 14 patients with congestive heart failure (CHF group) and left ventricular dysfunction. Serum leptin levels were significantly lower (P < 0.001) in the CHF group (1.4 ± 0.8 ng/mL) when compared to the IF group (5.3 ± 5.3 ng/mL)...

Esophageal striated muscle contractions in patients with Chagas' disease and idiopathic achalasia

Dantas,R.O.; Aprile,L.R.O.; Aben-Athar,C.G.; Miranda,A.L.M.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2002 EN
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Chagas' disease causes degeneration and reduction of the number of intrinsic neurons of the esophageal myenteric plexus, with consequent absent or partial lower esophageal sphincter relaxation and loss of peristalsis in the esophageal body. The impairment of esophageal motility is seen mainly in the distal smooth muscle region. There is no study about esophageal striated muscle contractions in the disease. In 81 patients with heartburn (44 with esophagitis) taken as controls, 51 patients with Chagas' disease (21 with esophageal dilatation) and 18 patients with idiopathic achalasia (11 with esophageal dilatation) we studied the amplitude, duration and area under the curve of esophageal proximal contractions. Using the manometric method and a continuous perfusion system we measured the esophageal striated muscle contractions 2 to 3 cm below the upper esophageal sphincter after swallows of a 5-ml bolus of water. There was no significant difference in striated muscle contractions between patients with heartburn and esophagitis and patients with heartburn without esophagitis. There was also no significant difference between patients with heartburn younger or older than 50 years or between men and women or in esophageal striated muscle contractions between patients with heartburn and Chagas' disease. The esophageal proximal amplitude of contractions was lower in patients with idiopathic achalasia than in patients with heartburn. In patients with Chagas' disease there was no significant difference between patients with esophageal dilatation and patients with normal esophageal diameter. Esophageal striated muscle contractions in patients with Chagas' disease have the same amplitude and duration as seen in patients with heartburn. Patients with idiopathic achalasia have a lower amplitude of contraction than patients with heartburn.

Chagas' disease and Duffy antigen/receptor for chemokine (DARC): a mini-review

Oliveira,AP; Mattos,LC; Cavasini,CE
Fonte: Centro de Estudos de Venenos e Animais Peçonhentos - CEVAP, Universidade Estadual Paulista - UNESP Publicador: Centro de Estudos de Venenos e Animais Peçonhentos - CEVAP, Universidade Estadual Paulista - UNESP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 EN
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Duffy gene (FY) codifies the transmembrane glycoprotein Duffy (gp-Fy) of 35 to 43 kDa which is moderately immunogenic. This glycoprotein is polymorphic, and constitutes the antigens of the Duffy histo-blood system which were designated receptors for chemokines and denominated DARC (Duffy antigen/receptor for chemokine). This receptor has an important role in the regulation of chemokine levels in the circulation, as it binds and adsorbs them on the surface of red cells as a reservoir. It plays a "sink" role, which can contribute to homeostasis by removing inflammatory chemokines from circulation as well as maintaining them in plasmatic levels. Chronic Chagas' cardiopathy (CCC) is the most frequent form of the disease. It is an inflammatory disease, in which infiltrated inflammatory cells play an important role in the development and progress of the infection. High chemokine levels in the plasma have been associated with the disease severity in patients with heart failure. In this context, the profile of DARC expression could play an important function as a receptor for chemokines in Chagas' disease, in patients with CCC, as it can modulate damage from this inflammatory disease.

Upper esophageal sphincter pressure in patients with Chagas' disease and primary achalasia

Dantas,R.O.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2000 EN
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The most important component of the upper esophageal sphincter (UES) is the cricopharyngeal muscle. During the measurement of sphincter pressure the catheter passed through the sphincter affects the pressure value. In Chagas' disease and primary achalasia there is an esophageal myenteric plexus denervation which may affect UES pressure. We measured the UES pressure of 115 patients with Chagas' disease, 28 patients with primary achalasia and 40 healthy volunteers. We used a round manometric catheter with continuous perfusion and the rapid pull-through method, performed in triplicate during apnea. Pressures were measured in four directions, and the direction with the highest pressure (anterior/posterior) and the average of the four directions were measured. The highest UES pressure in Chagas' disease patients without abnormalities upon radiologic esophageal examination (N = 63) was higher than in normal volunteers (142.8 ± 47.4 mmHg vs 113.0 ± 46.0 mmHg, mean ± SD, P<0.05). There was no difference in UES pressure between patients with primary achalasia and patients with Chagas' disease and similar esophageal involvement and normal volunteers (P>0.05). There was no difference between patients with or without esophageal dilation. In the group of subjects less than 50 years of age the UES pressure of primary achalasia (N = 21) was lower than that of Chagas' disease patients with normal radiologic esophageal examination (N = 41)...

Minor segmental wall motion abnormalities detected in patients with Chagas' disease have adverse prognostic implications

Pazin-Filho,A.; Romano,M.M.D.; Almeida-Filho,O.C.; Furuta,M.S.; Viviani,L.F.; Schmidt,A.; Marin-Neto,J.A.; Maciel,B.C.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2006 EN
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Recent data from our laboratory have shown that patients with the indeterminate form of Chagas' disease can have impairment of left ventricular contractility, as evaluated by the slope of the left ventricle end-systolic pressure-dimension relationship. We also showed that Chagas' disease patients with minimal baseline wall motion abnormalities detected by two-dimensional echocardiography have more intense contractility impairment when compared to patients with the indeterminate form of the disease without this abnormality. The prognostic implications of these findings have not been established. We evaluated 59 patients (37-76 years, mean = 55 years) with different clinical forms of Chagas' disease, who had normal left ventricular global systolic function at baseline (57.6 ± 6.9%) and who had at least one additional echo during clinical follow-up (0.4-17.6; mean 4.6 years). Group 1 consisted of 14 patients with minor baseline left ventricle wall motion abnormalities and group 2 consisted of 45 patients without these abnormalities. During follow-up, global left ventricle systolic function deterioration was observed in 10 group 1 patients (71.4%) and in only 10 group 2 patients (22.2%; P < 0.005). Age and duration of follow-up were not independent determinants of left ventricular function deterioration in these patients. The present data indicate that mild segmental left ventricular wall motion abnormalities are associated with worsening of systolic function in Chagas' disease patients who have normal baseline global systolic performance.

Trypanosoma cruzi calreticulin: A possible role in Chagas' disease autoimmunity

Molina Sampayo, María Carmen; Aguilar, Lorena; López Bartolucci, Carolina; Ramírez, Galia; Lavandero González, Sergio; Rodríguez, Margarita; Martínez, Ramón; Schwaeble, Wilhelm; Maldonado, Ismael; González, Carlos; Troncoso Cotal, Rodrigo Andrés;
Fonte: PERGAMON-ELSEVIER SCIENCE LTD Publicador: PERGAMON-ELSEVIER SCIENCE LTD
Tipo: Artículo de revista
EN
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Trypanosoma cruzi (T cruzi) is the causative agent of Chagas' disease, an endemic and chronic illness that affects 18 million people in Latin America. The mechanisms underlying its pathogenesis are controversial. There is a growing body of evidence supporting the view that T cruzi infection elicits severe autoimmune responses in the host, which significantly contribute to the pathogenesis of Chagas' disease, and several recent studies have reported the presence of autoantibodies and effector T lymphocytes against parasite and self antigens in infected patients and experimentally infected animals. T cruzi calreticulin (TcCRT) is a 45 kDa protein, immunogenic in humans, rabbits and mice. It has a high degree of homology with human (HuCRT) and mouse calreticulin (MoCRT), which would explain why an immune response to TcCRT could contribute to autoimmune reactions in Chagas' disease. Anti-TcCRT antibodies generated in A/J mice immunized with recombinant TcCRT (rTcCRT) reacted with rHuCRT and bound to neonatal and adult isogenic cardiomyocytes cultured in vitro. Interestingly, histological alterations, such as edema formation and cell infiltrates, which include CD3(+) cells, were detected in heart sections from immunized animals. Therefore...

Avaliação morfológica e morfométrica das ilhotas pancreáticas na fase crônica da doença de Chagas; Morphologic and morphometric evaluation of pancreatic islets in chronic Chagas' disease

Saldanha, João Carlos; Santos, Vitorino Modesto dos; Reis, Marlene Antônia dos; Cunha, Daniel Ferreira da; Teixeira, Vicente de Paula Antunes
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/10/2001 ENG
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OBJETIVO: Hiperglicemia e anormalidades em testes de tolerância à glicose, observadas em alguns pacientes chagásicos crônicos, sugerem um possível papel de alterações morfológicas e desnervação de ilhotas pancreáticas (IP). Nosso objetivo foi descrever a morfologia e a morfometria de ilhotas pancreáticas na doença de Chagas crônica. MÉTODOS: Estudo morfológico e morfometria computadorizada foram realizados em fragmentos da cabeça, corpo e cauda de pâncreas obtidos em necropsias de oito controles normais e dezessete pacientes chagásicos crônicos; oito com a forma digestiva (Megas) e nove com o quadro clínico de insuficiência cardíaca congestiva. RESULTADOS: O grupo Megas mostrou ilhotas pancreáticas de maior (p < 0,05) área na cauda do pâncreas (10.649,3 ± 4.408,8 µm²) do que os controles normais (9.481,8 ± 3.242,4 µm²) e que o grupo com insuficiência cardíaca congestiva (9.475,1 ± 2.104,9 µm²); o mesmo ocorrendo com a densidade das ilhotas na cauda do pâncreas (respectivamente, 1,2 ± 0,7 vs. 0,9 ± 0,6 vs. 1,9 ± 1,0 IP/mm²). Na cauda do pâncreas dos casos com Megas, houve correlação positiva e significante (r = + 0,73) entre a área e a densidade das ilhotas pancreáticas. Discreta fibrose e infiltrados leucocitários foram vistos nas ilhotas e em gânglios pancreáticos dos pacientes chagásicos. Ninhos de Trypanosoma cruzi não foram observados nos cortes examinados. Indivíduos com a forma Megas da doença de Chagas mostraram aumento da área e da densidade das ilhotas na cauda do pâncreas. CONCLUSÃO: As alterações morfológicas e morfométricas observadas são consistentes com alterações funcionais do pâncreas...

Lesões pancreáticas em Doença de Chagas aguda experimental; Pancreatic lesions in acute experimental Chagas' disease

Corbett, Carlos Eduardo Pereira; Scremin, Luciano Henrique Gazoni; Lombardi, Rafael Arsky; Gama-Rodrigues, Joaquim José; Okumura, Masayuki
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/01/2002 ENG
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INTRODUÇÃO: A Doença de Chagas é uma endemia tropical encontrada desde o sul dos Estados Unidos até a Argentina. Os estudos de fase aguda da doença são difíceis de serem realizados em seres humanos porque os sintomas são inespecíficos e a maioria dos casos não requer socorro médico. Em modelos experimentais desenvolvidos a doença aguda aparece com intenso parasitismo em todos os órgãos e tecidos. OBJETIVO: Caracterizar histopatologicamente o envolvimento pancreático na Doença de Chagas aguda experimental. CASUÍSTICA E MÉTODOS: Com esta finalidade utilizamos animais inoculados intraperitonialmente com 100.000 formas de cepa Y de Trypanosoma cruzi. Os animais foram sacrificados após 14 dias de infecção e os fragmentos colhidos foram processados em parafina e corados pela H&E. RESULTADOS: As características histopatológicas mais importantes da pancreatite aguda na Doença de Chagas experimental são: pseudocistos intensamente parasitados, íntegros ou rompidos, parasitas no espaço extracelular, necrose de células acinares e ductais, além de focos de esteatonecrose. CONCLUSÃO: O parasitismo dos tecidos é o principal mecanismo patogenético da pancreatite aguda na Doença de Chagas.; BACKGROUND: Chagas' disease is an endemic tropical affliction found from southern United States to Argentina. The acute phase of this disease is difficult to study in man because the symptoms are non-specific and most cases require no medical assistance. Experimental models have been developed for sequential studies...

Transmissão da doença de Chagas por transplante renal: ocorrência da forma aguda da doença em dois receptores de um mesmo doador; Transmission of Chagas' disease through transplantede kidney: occurrence of the acute form of the disease in two recipients from the same donor

Ferraz, A.S.; Figueiredo, J.F.C.
Fonte: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo Publicador: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/10/1993 POR
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Two cases of acute Chagas' disease acquired after renal transplantation are reported. The two patients received the kidney from the same donor. The present paper confirms this form of transmission of Chagas' disease and reinforces the need to exclude kidney donors with Trypanosoma cruzi infection.; São apresentados dois casos de doença de Chagas aguda, adquiridos através de transplante de rins originários de um mesmo doador. O presente relato confirma a transmissão da doença de Chagas a partir do transplante renal e reforça a necessidade de exclusão de doadores renais infectados pelo Trypanosoma cruzi.

Envolvimento do sistema nervoso central na doença de Chagas': revisão atual; Central nervous system involvement in Chagas' disease: an updating

Pittella, José Eymard Homem
Fonte: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo Publicador: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/04/1993 ENG
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Fez-se revisão da literatura publicada a respeito do envolvimento do sistema nervoso central (SNC) na doença de Chagas. A análise crítica dos 31 trabalhos existentes sobre a forma aguda nervosa e de outros 17 sobre a forma crônica nervosa, todos com estudo neuropatológico, permitiu estabelecer uma possível história natural do envolvimento do SNC na doença de Chagas, destacando-se entre outros fatos os seguintes: 1) a fase inicial, aguda, da infecção pelo Trypanosoma cruzi é usualmente assintomática, subclínica; 2) somente uma pequena percentagem de casos desenvolve encefalite na fase aguda da doença de Chagas; 3) as formas agudas sintomáticas acompanhadas de encefalite chagásica são graves, com morte em virtualmente todos os casos, resultante do próprio acometimento cerebral ou da miocardite chagásica aguda, geralmente intensa, sempre presente; 4) os indivíduos com a forma aguda assintomática e a forma aguda sintomática leve provavelmente não apresentam infecção do SNC ou, em alguns casos, exibem encefalite discreta, em focos esparsos, com involução total das lesões ou, então, com persistência de nódulos inflamatórios residuais relativamente insignificantes, não havendo, portanto, base anatômica que possa caracterizar a existência da forma crônica nervosa da doença de Chagas; 5) reativação da infecção no SNC na forma crônica da doença de Chagas é incomum e ocorre somente em pacientes imunossuprimidos.; 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...

Cardiac transplantation for Chagas' disease

Bacal,Fernando; Bocchi,Edimar Alcides
Fonte: Insuficiencia cardíaca Publicador: Insuficiencia cardíaca
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2008 EN
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Over the last 20 years the immunosuppression protocols in chagasic heart transplanted patients lived at least three different moments and we testified several changes and discoveries on Chagas' disease reactivation, mortality and neoplasias development. The primary phase was important especially because, until that time, Chagas' disease was an absolute contraindication for transplantation. The second phase started when immunosuppression protocol adjustment was made, with lower dosage to avoid adverse effects, especially neoplasias. Nowadays strategies to change the immunosuppression, especially replacement of mycophenolate mofetil by azathioprine were shown to be effective in reducing Chagas' disease reactivation. Cardiac transplantation for Chagas' disease is a reality. Although chagasics have several different implications when submitted to the transplant comparing to others aethiologies, actually these difficulties are well known, so treatments and preventive strategies are also better established.