Early electrocardiographic abnormalities in Trypanosoma cruzi-seropositive children.
As part of a major epidemiologic study on Chagas' disease, we compared the prevalence of electrocardiographic (ECG) abnormalities among 141 school children 7-12 years of age and seropositive for Trypanosoma cruzi, and 282 age-, sex-, and school-matched seronegative children in an endemic area in Brazil. The prevalence of ECG abnormalities was 11.3% among seropositive children and 3.5% among seronegative children (odds ratio = 3.5, 95% confidence interval [CI] = 1.5-8.4). The prevalence rate of ECG alterations was 10.7% for seropositive males versus 8.9% for seropositive females. Complete right bundle branch block (CRBBB), which is highly suggestive of Chagas' disease cardiopathy, was diagnosed in nine (6.4%) seropositive children and in only one (0.3%) seronegative child (odds ratio = 18.5, 95% CI = 2.3-146.5, attributable fraction = 58.3%). Five incident new cases of CRBBB were diagnosed after a 36-month follow-up of seropositive children who were enrolled in an independent clinical field trial. No case of frequent and/or multifocal ventricular premature beats was found in the cohort of children. The surprisingly high frequency of early ECG abnormalities, which indicates a rapid evolution from infection to disease, suggests the existence of endemic areas with a particular accelerated disease progression that was not described before. Under such conditions, a public health chemotherapy program focusing on the treatment of young seropositive children would be recommended.
de Andrade
A L
AL
Communicable Diseases Program, Pan American Health Organization, Washington, District of Columbia 20037, USA.
Zicker
F
F
Rassi
A
A
Rassi
A G
AG
Oliveira
R M
RM
Silva
S A
SA
de Andrade
S S
SS
Martelli
C M
CM
D014355:Chagas Disease / Q000503:physiopathology*; D002648:Child; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male