Produção Nacional
Revisado por pares
[NO TITLE AVAILABLE]
1999; Instituto Oswaldo Cruz, Ministério da Saúde; Volume: 94; Issue: suppl 2 Linguagem: Inglês
10.1590/s0074-02761999000800004
ISSN1678-8060
AutoresBorges-Pereira Coura, Roni Evêncio de Araújo,
ResumoThe morbidity variation in Chagas disease was deeply evaluated by 32 specialists from Argentina, Bolivia, Brazil, Chile, Costa Rica, Paraguay, Peru, USA and Venezuela during a meeting on Geographic differences in Chagas disease held in Brasilia in August 1975(Prata, 1975).This variation could be due to the virulence and pathogenicity of different T. cruzi strains and clones, to the parasite inoculum (vector capacity for infective forms) and the host-parasite interactions.The evolutive pattern of Chagas disease is not yet completely defined and understood because its morbidity and mortality vary considerably from one area to another.Of 510 patients from different states in Brazil we observed in Rio de Janeiro (Coura et al., 1983), 39% of the cases were classified as indeterminate form, 52% were identified as cardiac form and 14% had digestive alterations (megaesophagus, megacolon or both (Fig. 1).An association of cardiopathy and "megas" was observed in 10.7% of the patients and megaesophagus with megacolon in 10.9%.The highest morbidity was observed in patients from Bahia and Minas Gerais and the lowest from Rio de Janeiro and Paraíba.Several sectional and longitudinal evaluation of the morbidity and mortality of Chagas disease have been conducted in Brazil as refered by Coura et al. (1984Coura et al. ( ,a,b, 1995Coura et al. ( , 1996)), Borges-Pereira (l998), Borges-Pereira et al. (l986, 1987, 1990) and Araujo (1998).In the last 25 years we have study and followed-up the morbidity of Chagas disease in different areas in Brazil in the states of Minas Gerais, Piauí, Paraíba, Amazonas and more recently in Mato Grosso do Sul (Fig. 2) which could be classified such as: a) High morbidity: Minas Gerais and Piauí.b) Low morbidity: Paraíba and Mato Grosso do Sul and c) Latent chronic infection: Amazonas. Areas of high morbidityFollow-up studies were carried-out during 25 years in Iguatama and Pains (Area 1), Northwest of Minas Gerais, 20 years in Virgem da Lapa (Area 2) and 10 years in Berilo (Area 2A) Northeast of the state.In the first crosssectional evaluation 264 pairs of persons from Iguatama and Pains with the same age and sex, (one with positive serology matched with one negative for Chagas disease), 274 pairs from Virgem da Lapa and 100 pairs from Berilo were studied.All pairs of persons investigated in the endemic areas were submitted to the same type of anamnesis, clinical examinations, electrocardiogram (ECG) with twelve standard leads and a chest X-ray, emphasizing the cardiac and digestive symptoms and signs.Two cross-sectional studies with the same parameters were also carried-out in the district of Oeiras (Area 3), Piauí, Northeast of Brazil, with the interval of 20 years.The first cross-sectional study carried-out in Iguatama, Pains, Virgem da Lapa, Berilo and Oeiras, showed a serologic prevalence for Chagas infection of 17.1%, 10.4%, 12.9%, 12.7% and 12.1% respectively.The morbidity rate for Chagas cardiomiopathy (ECG gradient of seropositive/seronegative) was respectively of 23.4%, 18.4%, 19%, 22.5% and 18.2% for each aforementioned areas.Chagas disease was progressive in about 2.5 to 3% of patient/year, the mortality was more than 5 times higher in chagasic patients and the lethality was around 2% patient/year. Areas of low morbidityCross-sectional studies carried-out in 8 districts of Sertão da Paraíba (Area 4) Northeast and 12 districts of Rio Verde, Mato Grosso do Sul (Area 6), Southwest of Brazil, involving, respectively, 5,137 and l4,700 persons, showed a serologic prevalence for Chagas infection of 9.5% in Paraiba and only 1.8% in Mato Grosso do Sul.The morbidity rate for Chagas cardiomiophaty (ECG gradient of seropositive/seronegative) was 12.8% in 305 pairs of persons from Paraiba and 15% in 70 pairs of authochtonous persons from Mato Grosso do Sul.Chagas disease was progressive in 1.3% patient/year in Paraiba and the lethality caused by Chagas heart disease was very low (less than 0.4% patient/year).The mortality and lethality were not yet evaluated in Mato Grosso do Sul so far. Latent chronic infectionThree cross-sectional studies were carried-out in the district of Barcelos (Area 5), in the micro region of Rio Negro in the northern part of the state of Amazonas, 490 Km by river from Manaus.In the first serological survey
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