Clinical outcomes of thirteen patients with acute chagas disease acquired through oral transmission from two urban outbreaks in northeastern Brazil.
BACKGROUND
Outbreaks of orally transmitted Trypanosoma cruzi continue to be reported in Brazil and are associated with a high mortality rate, mainly due to myocarditis.


METHODS
This study is a detailed report on the disease progression of acute Chagas disease in 13 patients who were infected during two micro-outbreaks in two northeastern Brazilian towns. Clinical outcomes as well as EKG and ECHO results are described, both before and after benznidazole treatment.


RESULTS
Fever and dyspnea were the most frequent symptoms observed. Other clinical findings included myalgia, periorbital edema, headache and systolic murmur. Two patients died of cardiac failure before receiving benznidazole treatment. EKG and ECHO findings frequently showed a disturbance in ventricular repolarization and pericardial effusion. Ventricular dysfunction (ejection fraction <55%) was present in 27.3% of patients. After treatment, EKG readings normalized in 91.7% of patients. Ventricular repolarization abnormalities persisted in 50% of the patients, while sinus bradycardia was observed in 18%. The systolic ejection fraction normalized in two out of three patients with initially depressed ventricular function, while pericardial effusion disappeared.


CONCLUSIONS
Myocarditis is frequently found and potentially severe in patients with acute Chagas disease. Benznidazole treatment may improve clinical symptoms, as well as EKG and ECHO findings.
Bastos
Claudilson J C
CJ
Medicine and Human Health PhD Program, Bahian School of Medicine and Public Health, Bahia, Brazil.
Aras
Roque
R
Mota
Gildo
G
Reis
Francisco
F
Dias
Juarez Pereira
JP
de Jesus
Robson Silva
RS
Freire
Miralba Silva
MS
de Araújo
Eline G
EG
Prazeres
Juliana
J
Grassi
Maria Fernanda Rios
MF
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D002648:Child; D004196:Disease Outbreaks; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009593:Nitroimidazoles / Q000627:therapeutic use; D013902:Radiography, Thoracic; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000302:isolation & purification
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole