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Chagas disease or American trypanosomiasis, is a tropical parasitic disease caused by the protozoan Trypanosoma cruzy . spread mostly by insects known as triatominae or kissing bug
Chagas disease
EPIDEMIOLOGY 300,000–400,000 living in nonendemic countries
Affects 8 to 10 million people living in endemic Latin American countries
ACUTE PHASE C NTNUE
signs on physical examination
mild enlargement of the liver or spleen
swollen glands
local swelling (a chagoma)
CHRONIC DISEASE
indeterminate chronic Chagas disease, : 60–80% will never develop symptoms
determinate chronic Chagas disease: 20–40% will develop life-threatening heart and/or digestive disorders during their lifetime
The clinical manifestations of Chagas disease are due to cell death in the target tissues that
occurs during the infective cycle
DIAGNOSIS
microscopic examination of fresh anticoagulated blood, or its buffy coat, for motile parasites
Immunoassays distinguish among strains. These tests include:
detecting complement fixation indirect hemagglutination indirect fluorescence assays radioimmunoassays, ELISA. polymerase chain reaction (PCR)
PREVENTION
No vaccine against Chagas disease Decreasing the numbers of the insect that
spreads it (Triatoma) This is done by using sprays and paints
containing insecticides (synthetic pyrethroids)
Improving housing and sanitary conditions in rural areas.
mosquito net is recommended the development and implementation
of blood bank screening tests
MANAGEMENT
Antiparasitic treatment azole or nitro derivatives, such
as benznidazole or nifurtimox managing the clinical manifestations of the
disease. pacemakers and medications for irregular
heartbeats, such as the anti-arrhythmia drug amiodarone
Heart tranplantation
Surgery for megaintestinelower dosages of the
immunosuppressant drug cyclosporindirect stem cell therapy of the heart
muscle using bone marrow cell transplantation
RESEARCH ABSTRACT
TREATMENT PATTERNS AND THEIR RELATION TO THE DIAGNOSIS OF CHAGAS DISEASE IN PATIENTS WITH HEART FAILURE, 2001-2011: BOGOTÁ, COLOMBIA
Methods retrospective cohort study, compiling data from medical files of patients hospitalized for heart failure between 2001-2011. Each CH patient (n=41) was matched with 1-2 comparable non-Chagas (no-CH) patients (n=77).
Hypothesis patients with Chagas disease receive a poorer quality of medical attention when compared to people treated for the same illness without Chagas disease
INCLUSION CRITERIA
Diagnosis of heart failure upon
hospital admission, as defined
byColombian guide about the
evaluation and management of
chronic heart failure in adults
Administration of intravenous diuretics during hospitalization
Pulmonary Oedema, as defined by A.D.A.M.
Medical encyclopaedia, identified in patient chest
x-ray results.
EXCLUSION CRITERIA
The study excluded patients whose heart failure diagnosis was
secondary to a valvular heart disease
diagnosis
Matching Each Chagas patient
was matched with two non- Chagas controls to increase statistical power, using the following criteria:
1)No more than 5% difference of the ‘left ventricular ejection fraction
2)No more than five years difference in age;
3)No more than six
months difference in date of hospital admittance
DATA EXTRACTION AND ANALYSIS
Information regarding patient demographics, parasitology, clinical diagnostics and management of health during hospitalizations, including pharmacology, was collected directly into a data extraction form on Microsoft Access 2003
Analysis quantitative analysis of frequencies, Chi-squared (Χ2) tests, Kruskal-Wallis analysis of variance and Kaplan-Meier survival function.. An internal institutional review approved the study protocol and ethics. No personal information was collected from files that would be traceable to patients.
RESULTThey observed only a marked but
not significant difference in mortality between Chagas patients (12.2%) and non-Chagas patients
(3.9%) (P-value = 0.088). Therefore, the general equity
observed between CH and no-CH patients at FCI does not support
the hypothesis of inadequate care for CH patients.
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