title: Autonomic dysfunction and risk factors associated with Trypanosoma cruzi infection among children in Arequipa, Peru.
abstract: Chagas disease affects an estimated 8 million people in Latin America. Infected individuals have 20-30% lifetime risk of developing cardiomyopathy, but more subtle changes in autonomic responses may be more frequent. We conducted a matched case-control study of children in Arequipa, Peru, where triatomine infestation and Trypanosoma cruzi infection are emerging problems. We collected data on home environment, history, physical examination, electrocardiogram, and autonomic testing. Signs of triatomine infestation and/or animals sleeping in the child's room and household members with Chagas disease were associated with increased infection risk. Electrocardiogram findings did not differ between cases and controls. However, compared with control children, infected children had blunted autonomic responses by three different measures, the Valsalva maneuver, the cold pressor test, and the orthostatic test. T. cruzi-infected children show autonomic dysfunction, although the prognostic value of this finding is not clear. Sustained vector control programs are essential to decreasing future T. cruzi infections.
authors.affiliation: Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA. nbowman@post.harvard.edu
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Bowman
authors.forename: Vivian
authors.initials: V
authors.lastname: Kawai
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Cesar
authors.initials: C
authors.lastname: Bocangel
authors.forename: Gerson
authors.initials: G
authors.lastname: Galdos-Cardenas
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Levy
authors.forename: Juan Geny
authors.initials: JG
authors.lastname: Cornejo del Carpio
authors.forename: Freddy
authors.initials: F
authors.lastname: Delgado
authors.forename: Lauren
authors.initials: L
authors.lastname: Rosenthal
authors.forename: Vivian V
authors.initials: VV
authors.lastname: Pinedo-Cancino
authors.forename: Francis
authors.initials: F
authors.lastname: Steurer
authors.forename: Amy E
authors.initials: AE
authors.lastname: Seitz
authors.forename: James H
authors.initials: JH
authors.lastname: Maguire
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000293:Adolescent; D000818:Animals; D000829:Animals, Domestic; D000913:Antibodies, Protozoan / Q000097:blood; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D016022:Case-Control Studies; D014355:Chagas Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007303:Insect Vectors / Q000502:physiology; D008297:Male; D010568:Peru / Q000453:epidemiology; D012307:Risk Factors; D014225:Triatominae / Q000502:physiology; D014349:Trypanosoma cruzi / Q000276:immunology
chemical_list: D000913:Antibodies, Protozoan