[Human American trypanosomiasis 90 years after its discovery by Carlos Chagas. II--Clinical aspects, physiopathology, diagnosis and treatment].
Cardiac, neurologic, and gastrointestinal manifestations of Chagas Disease have been well documented, but underlying pathophysiologic mechanisms, especially of chronic myocarditis, remain unclear. In the last decades, vectorial and transfusional transmission has been diminished. However congenital forms, which were long unknown and are still poorly understood, and reactive forms, which occur in patients with acquired or induced immunodeficiency, have confounded conventional wisdom concerning the evolution of this disease. Several new diagnostic tools have been developed without replacing the traditional methods, e.g. the xenodiagnostic technique proposed by Brumpt. With regard to indirect diagnosis, further progress is needed to improve specificity and sensitivity as well as the discriminating ability of the numerous techniques now available. Recently several double-blind randomized trials showed that benznidazole may be useful for early stage disease in children under 12 years of age. Further study with long-term follow-up will be necessary to determine the value of generalizing treatment to all patients with Chagas disease regardless of age and disease stage. However the ideal trypanocidal agent has yet to be found. Although attempts to immunize animals have not been complete failures, current results are not adequate to hold forth hope of a vaccine for use in man within the foreseeable future.
Pays
J F
JF
Laboratoire de Pathologie Parasitaire et Exotique, Faculté de Médecine Necker-Enfants Malades, Université Paris V René Descartes, Paris, France. pays@necker.fr
D001927:Brain Diseases / Q000469:parasitology / Q000503:physiopathology; D002598:Chagas Cardiomyopathy / Q000503:physiopathology; D014355:Chagas Disease / Q000151:congenital / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology* / Q000635:transmission; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004199:Disease Vectors; D004311:Double-Blind Method; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000469:parasitology / Q000503:physiopathology; D006801:Humans; D007114:Immunization; D007153:Immunologic Deficiency Syndromes / Q000469:parasitology; D008137:Longitudinal Studies; D009205:Myocarditis / Q000469:parasitology / Q000503:physiopathology; D009593:Nitroimidazoles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014612:Vaccines
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; D014612:Vaccines; C009999:benzonidazole