title: [The pathogenesis of chronic Chagas' myocarditis: the role of autoimmune and microvascular factors].
abstract: The pathogenesis of chronic chagasic myocarditis remains incompletely understood. Several hypotheses have been proposed: (1) direct tissue destruction by Trypanosoma cruzi; (2) neurogenic theory; (3) anti-heart immune reactions; and (4) microvascular disease. We present herein a dynamic alternative hypothesis. We believe that the development of myocarditis is related to progressive and additive focal cellular necrosis, and associated reactive and reparative myocardial fibrosis and surrounding myocytes hypertrophy. These processes may be initiated and perpetuated by autoimmune factors and alterations in the myocardial microcirculation. This could imply future therapeutic strategies in the management of chronic chagasic patients to optimize the medical treatment and hopefully improve the prognosis.
authors.affiliation: Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil.
authors.forename: M A
authors.initials: MA
authors.lastname: Rossi
authors.forename: J O
authors.initials: JO
authors.lastname: Mengel
mesh_terms: D001327:Autoimmune Diseases / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D002598:Chagas Cardiomyopathy / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D002908:Chronic Disease; D006801:Humans; D008833:Microcirculation / Q000503:physiopathology; D009205:Myocarditis / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D009206:Myocardium / Q000276:immunology
vernacular_title: Patogênese da miocardite chagásica crônica: o papel de fatores autoimunes e microvasculares.