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Background

Chagas' disease is a zoonosis that affects 20 million people throughout the Americas, including the United States.15 Chagas' disease is caused by Trypanosoma cruzi, a parasite that induces myocarditis, a blockade of the conduction system, and severe cardiac dysfunction.

SYNONYMS North American Trypanosomiasis

 

PATHOGENESIS CHARACTERIZATION
Trypanosoma cruzi

Transmitted to mammals by the reduviid insect vector

Metacyclic trypomastigote forms of the parasite enter the blood of the mammalian host via the skin or mucous membranes and invade host cells

After cell invasion, the parasites differentiate into amastigotes, which replicate and form parasite nests in the cytoplasm

Amastigotes differentiate into nondividing trypomastigotes, which are released into the bloodstream to invade target cells, including autonomic nerves, cardiac muscle, and intestinal and vascular smooth muscle

Overexpression of neural cell adhesion molecule in Chagas' myocarditis

Hum Pathol 2001:32;149-155.

Expression of NCAM in paraffin-embedded human heart tissues from 34 autopsies of patients with Chagas' myocarditis and from murine and canine experimental acute Chagas' myocarditis, using a polyclonal anti-NCAM antibody and immunohistochemistry

Dramatic upregulation of NCAM expression in the intercalated discs of cardiomyocytes in acute and chronic Chagas' myocarditis

NCAM signal was detected in intracellular nests of amastigote forms of the parasite, within infected cardiomyocytes of human and experimental Chagas' myocarditis
Cardiac cell-cell adhesion proteins, N-cadherin and -catenin, were found in intercalated discs distorted by the infection but absent from the amastigote nests

Proteins reactive to several antibodies against NCAM were detected by Western immunoblotting in cultured T cruzi parasites and in trypomastigote forms of T cruzi extracted from the blood of infected mice

Conclusion:
Upregulation of NCAM in Chagas' myocarditis and the expression of NCAM or a NCAM-like protein by T cruzi suggest that NCAM may act as a receptor for tissue targeting and cellular invasion by T cruzi in Chagas' disease

 

PROGNOSIS AND TREATMENT CHARACTERIZATION

Late results on the surgical treatment of Chagasic megaesophagus with the Thal-Hatafuku procedure.

Ferraz AA, da Nobrega Junior BG, Mathias CA, Bacelar TS, Lima FE, Ferraz EM.

Department of Surgery, University Hospital, Federal University of Pernambuco, Brazil.

J Am Coll Surg 2001 Nov;193(5):493-8 Abstract quote

BACKGROUND: Chagas' disease has a wide distribution in Central and South America. It is endemic in 21 countries, with 16 to 18 million persons infected and 100 million at risk. Surgical treatment of achalasia from Chagas' disease is the first choice in advanced stages. The aim of this study was to analyze the late clinical followup of 50 patients operated on for Chagas megaesophagus with the Thal-Harafuku procedure.

STUDY DESIGN: During the period of January 1966 to January 1993, 50 patients suffering from advanced achalasia from Chagas' disease were submitted to the Thal-Hatafuku procedure. The patients answered a questionnaire concerning the most relevant postoperative symptoms. The Thal-Hatafuku procedure was performed as the first surgical option (46 patients), and on reoperations because of failure of other surgical techniques (4 patients).

RESULTS: The mean followup was 63.11 months for the 44 patients with longterm followup. Postoperative complications included surgical site infection (3 of 50 patients), urinary infections (3 of 50 patients), atelectasis (2 of 50 patients), pleural effusion (2 of 50 patients), and deep venous thrombosis (1 of 50 patients). The main symptoms found in the postoperative period were dysphagia (20 of 44 patients), heartburn (11 of 44 patients), vomiting (13 of 44 patients), and retrosternal pain (6 of 44 patients). Eleven patients of the 44 remained asymptomatic at the end of the followup period. Outcomes were analyzed according to the modified Visick classification. Visick classes I and II represented 25% and 27.3%, respectively. Eighteen patients (40.9%) were classified as Visick III.

CONCLUSION: We conclude that the Thal-Hatafuku operation is a therapeutic option that should be considered in the treatment of achalasia of the esophagus secondary to Chagas' disease, in advanced cases.

N Engl J Med 329:639-644, 1993


Commonly Used Terms

Heart

Parasites


Last Updated 11/22/2001

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