The case reports of three patients with chronic chagasic cardiomyopathy with unusual mechanisms of sudden death are presented. It was unexpected in two of them, one by infarction and the other by bronchopneumonia after gut infarction without mesenteric vessel obstruction. The third had cardiac failure and her expected sudden death was due to cardiac tamponade after spontaneous right ventricular rupture.

Adolescent↗

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[Prevalence of visceromegalies in necropsies carried out in Triângulo Mineiro from 1954 to 1988].

One thousand seven hundred and eight chronic chagasic post-mortem examinations studied from a total of 4690 autopsies performed at our Institution. Two hundred and seventy-three chagasic had megas. Megacolon was the most frequent, followed by megaesophagus. Megacolon associated with megaesophagus was the third most common finding. Our data are discussed and compared with the literature. Megacolon and megaesophagus were more prevalent in man, as shown by other workers. Higher parasitemia perhaps could explain this finding.

Adult↗

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[Sudden death caused by the spontaneous rupture of the right ventricle in a woman with chronic Chagas disease].

We report a case of sudden death from hemopericardium consequent to spontaneous rupture of the right ventricle in a 49-year-old chronic chagasic woman. To our knowledge, this is the third reported case of spontaneous cardiac rupture with chagasic cardiomyopathy. In our case we believe that the thinning of the anterior right ventricular wall, its large ray curvature and the increased ventricular pressure were factors favoring the rupture. There was no infarction and the chronic cardiopathy was significant. It caused the thinning of the rupture region through chronic myocarditis.

Chagas Cardiomyopathy↗

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[Association of encephalic vascular accidents and Chagas disease].

The frequency of strokes was studied in chronic chagasic and years of age, non-chagasic patients, older than 15 coming to necropsy in Uberaba, from 1979 than 1988. The study consisted of paired sex and age matched controls. Two hundred and eight pairs were analysed. Either ischemic or hemorrhagic strokes were found in 41 (19.7%) of the chagasics and in 55 (26.4%) of the non-chagasic, a difference not significant at the level of 5%. Twelve (75%) of the former had infarcts and 4 (25%) had brain hemorrhage; five (31.3%) of the non-chagasics had ischemic strokes and 11 (68.7%) had hemorrhagic strokes. The differences were significant to the level of 5%. The results indicate a high frequency of ischemic strokes in human Chagas' disease and demonstrate a lesser frequency of hemorrhagic stroke in chagasics when compared with non-chagasics.

Adolescent↗

PubMedDate not supplied

[A quantitative analysis of the mastocytes and eosinophilic granulocytes in the myocardium of Wistar rats chronically infected by Trypanosoma cruzi. A contribution to the knowledge of myocardial fibrosis].

We did mast cell and eosinophil granulocyte counts in the myocardium of forty chronic chagasic Wistar albino rats. We used 10 controls rats and 30 animals with late-stage (8th month) infection of São Felipe, Y and Colombian Trypanosoma cruzi strains, with variable degree of chronic myocarditis. We found chronic fibrosing myocarditis (fibrosis) in 40% of the infected animals. It was detected increased mast cell count in the chagasic rats associated with infection and not related with myocardial fibrosis. There was no increase in the eosinophil counts.

Animals↗

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[Intracardial autonomous nervous system in a fatal case of acute Chagas disease].

An analysis of the intracardiac autonomic nervous system (ICANS) has been made in 150 histological sections obtained from atrial fragments of a 74 year-old man who died of cardiac failure, as a consequence of acute Chagas' disease (ACD), probably acquired via digestive tract. Small quantities of mononuclear infiltrate around ganglia and/or nerve branches without significant morphologic alterations of the neurons were found in 10 slides; another slide showed ganglionitis and periganglionitis of moderate intensity associated to neuronal alterations. Focal epicarditis, usually of slight degree, was observed in all slides. The findings suggest: a) that the inflammation of ganglia and fibers of the ICANS in the ACD occurs at least in part by expansion from adjacent epicarditis; b) that even in the fatal cases of the trypanosomiasis cruzi the pathologic lesions of the ICANS may be slight.

Acute Disease↗

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[Chronic Chagas' cardiopathy causing congestive heart failure in childhood: a clinical and histopathological study of a case with emphasis on the lesions of the intracardiac conduction and autonomic nervous systems].

A case of decompensated chagasic cardiopathy in a nine-year-old boy from the south of the State of Goiás, is described. He developed congestive heart failure four months before death. The serological reaction for Chagas' disease and the xenodiagnosis were positive. Electrocardiograms showed sinusal tachycardia, ventricular and supraventricular extrasystoles, left anterior hemiblock, complete right bundle branch block and signs of chambers overload. The echocardiogram demonstrated chamber dilatation with diffuse hypocontractility. He presented a downhill course complicated with several pneumonic episodes, the last one just before death. At necropsy, the heart, exhibited a chronic pancarditis with fibrosing chronic myocarditis involving mainly the interventricular septum and left ventricle. The heart conduction system showed slight to moderate exudative, inflammatory changes. Scattered foci of slight chronic periganglionitis and rare degenerative phenomena of ganglionic cells were found in intracardiac autonomic nervous, without neuronal depopulation.

Autonomic Nervous System↗

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[Human chronic chagasic myocarditis: quantitative study of CD4+ and CD8+ lymphocytes in inflammatory exudates].

Myocardial exsudate CD4+ and CD8+ lymphocytes were counted in transmural left ventricular free wall frozen sections taken from 10 necropsied chronic cardiac chagasic patients. The cells were labeled with monoclonal antibodies using a streptavidin-biotin technique. We counted: 1) lymphocytes in the total exsudate (LTE) and, separately, 2) the lymphocytes touching or very near to myocells (LTVNM). Lymphocytes were considered very near whenever their own nuclear shortest nuclear diameter was larger than their distance from myocells. CD8+ lymphocytes were more numerous than CD4+ lymphocytes, especially among the LTVNM. The LTE CD4/CD8 ratio was 0.37 +/- 0.20, but the LTVNM CD4/CD8 ratio was smaller (0.23 +/- 0.11). Among the LTE, 34 +/- 11% of CD8+ (against 24 +/- 12% of CD4+) were LTVNM. All these differences were statistically significant. Both subtypes of T-lymphocytes were found to have an intimate relationship with both ruptured and unruptured myocells, and parasites were not seen. These findings are in accordance with the idea that the myocardial cell lesions in the cardiac form of human Chagas' disease are mediated mainly by T-cytotoxic lymphocytes.

CD4-Positive T-Lymphocytes↗

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[A comparative study of the incidence of sudden death from Chagas' disease in Uberaba in the years 1980 and 1990].

A comparison was made between the years 1980 and 1990 for the frequency and causes of sudden death occurring in the urban and rural areas of the city of Uberaba in individuals older than 15 years. It aims mainly to analyse the current frequency of sudden death in that region and to evaluate the impact, it any, of prophylaxis and therapy on sudden death due to Chagas' disease. For the 1226 deaths cases studied from our 1980, 54 (4.4%) were sudden ones; out of these, 13 (24.1%) were supposedly due to Chagas' disease. For the 1740 death cases studied form our 1990 series, 44 (2.5%) were sudden ones; out of these, only 3 (6.8%) were considered to be due to Chagas' disease. The results indicate a significant decrease in the frequency both for sudden death in general and for sudden death due to Chagas' disease when the year 1990 is compared with 1980. Probable explanations for the findings are discussed.

Adolescent↗

PubMedDate not supplied

[Acute Chagas cardiopathy. A systematic study of the intracardiac excitatory-conduction and autonomic nervous systems in an autochthonous case in Acre].

The histopathology of the heart is described in an acute case of Chagas' disease (DC). Lesions involving the conducting system (SC) and the autonomic intracardiac nervous system (SNAIC) are emphasized. Light microscopy showed acute pan-carditis with plenty of Trypanosoma cruzi amastigotes within heart muscle cells. Multiple inflammatory foci were found in the SC with parasitic nests within the atrioventricular node and left his bundle. There were also severe atrial periganglionitis and perineuritis with or without peripheral involvement of those structures. Apparently there was no cardiac neuronal depopulation. The epidemiological study suggested transmission through Rhodnius pictipes. To the best of our knowledge, this is the first reported case of acute DC from the Amazonian basin with systematized microscopy study of the SC and SNAIC.

Acute Disease↗

PubMedDate not supplied

Acute Chagas' cardiopathy in a polar bear (Ursus maritimus) in Guadalajara, Mexico.

We report a 24-year-old female polar bear (Ursus maritimus) who contracted Chagas' infection at the Guadalajara Zoo, in Jalisco, México, and died of acute Chagas' carditis 15 days later. The histopathological findings are described, as well as the presence of triatomids (Triatoma longipennis Usinger) infected with Trypanosoma cruzi collected within 5 meters from the place where the animal lived in the city of Guadalajara.

Animals↗

PubMedDate not supplied

[Pancreatic neuronal loss in chronic Chagas' disease patients].

We have not found any anatomical studies about the intrapancreatic ganglia in the chronic Chagas' disease. The lesions in these structures could explain at least in part the functional disturbances in the exocrine and endocrine pancreas described in this form of the disease. Thus we decided to morphologically analyze these ganglia. For this analysis, we studied transversal segments of the head, body and tail of the pancreas of twelve chronic chagasics whose mean age were 46.5 +/- 9.1 years and fourteen controls, mean age 41.2 +/- 11.0 years. These segments were histologically processed and cut into sections in a serial form up to the end and one cut of each seven was analyzed. For statistical analysis we used the non-parametric test of Mann-Whitney. In the head of the pancreas, the mean count of neurons was 57.3 +/- 50.8 in the chagasic group and 117.5 +/- 99.0 for the control group (p < 0.05); in the body 25.9 +/- 19.4 for the chagasic group and 54.7 +/- 47.8 for the control group (p < 0.05); in the tail 23.4 +/- 16.3 for the chagasic group and 54.1 +/- 29.2 for the control group (p < 0.01), the total count being 106.6 +/- 71.1 for the chagasic group and 226.3 +/- 156.5 for the controls (p < 0.01). Our data permitted us to conclude that: a) there was a statistically significant neuronal depopulation in the chagasic group, as compared to the control group, in each pancreatic segment that was analyzed, as well as in the organ as a whole; b) 50% of the chagasics had the total number of neurons smaller than the lowest number observed in the controls (80); c) 75% and 91.6% of the chagasics had the number of neurons smaller than, respectively, the median (171) and the mean (226) of the control group; d) therefore, the pancreatic neuronal depopulation was common, but not constant; e) the variable age was apparently not responsible for the neuronal depopulation of the chagasics.

Adult↗