title: Pathophysiology of the heart in Chagas' disease: current status and new developments.
abstract: In the present review we have summarized remarkable historical data on Chagas' disease studies putting special emphasis on histopathological findings and pathogenetic theories as well as recent discoveries based on the use of advanced modern technologies in pathology and immunology. A unified theory that links almost all of these findings is proposed. Chronic cardiac Chagas' disease represents the result of a close interaction between the host and the parasite, causing different clinical pictures: patients with an efficient immune response may adequately circumvent the parasitic infection and the individual will develop the indeterminate form. Deficient immune response of the host and/or a high initial parasitemia favor an immune imbalance that might lead to development of a permanent inadequate immunological response against the parasite. The inflammatory response, which is probably recurrent, undergoing periods of more accentuated exacerbation, is most likely responsible for progressive neuronal damage, microcirculatory alterations, heart matrix deformations and consequent organ failure.
authors.affiliation: Laboratory of Pathology, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar 44, São Paulo (SP), 05403-000, Brazil. amplourdes@incor.usp.br
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Higuchi
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Benvenuti
authors.forename: Marcia
authors.initials: M
authors.lastname: Martins Reis
authors.forename: Martin
authors.initials: M
authors.lastname: Metzger
mesh_terms: D000818:Animals; D015703:Antigens, CD / Q000276:immunology; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D015551:Autoimmunity; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D015815:Cell Adhesion Molecules / Q000276:immunology; D002598:Chagas Cardiomyopathy / Q000209:etiology* / Q000276:immunology / Q000469:parasitology; D016207:Cytokines / Q000276:immunology; D006321:Heart / Q000469:parasitology*; D006801:Humans; D007108:Immune Tolerance; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D018512:Parasitemia; D014349:Trypanosoma cruzi / Q000276:immunology
chemical_list: D015703:Antigens, CD; D015815:Cell Adhesion Molecules; D016207:Cytokines; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor