Acute Chagas disease in Colombia: a rarely suspected disease. Report of 10 cases presented during the 2002-2005 period
Keywords:
Colombia, Chagas disease, Trypanosoma cruzi, acute phase, myocarditis, serology, polymerase chain reaction
Abstract
Introduction. In Colombia, reported cases of acute Chagas disease are sporadic.Objective. Ten cases were described that had been reported to the Parasitology Laboratory of the Colombian National Health Institute between December 2002 and November 2005.
Materials and methods. Information from clinical records, epidemiological report forms, laboratory and blood tests was collated. In addition the following data were compiled: demographic variables, clinical findings, results of laboratory tests and other exams (such as peripheral blood smears), IFAT for IgG antibodies, isolation in culture medium, inoculation in mice, polymerase chain reaction tests and isoenzyme eletrophoresis.
Results. All the cases presented in known endemic areas for Chagas disease transmission in Colombia. Three cases were from Putumayo Province, two each from the provinces of Arauca, Casanare, Norte de Santander and one from Santander Province. The probable mode of transmission was vector-borne. Seven cases presented in adults aged 18 to 50, three in children aged 6 months to 2 years. Seven were male and three were female. The most frequent symptom was fever in nine cases. Signs of portal of entry were rare; only one patient presented a possible Romaña´s sign. Three patients presented myocarditis, two acute cardiac failure and one cardiac tamponade. Parasitemia was evident in nine cases; five had positive IgG serological tests; five cases were confirmed through parasite isolation; isoenzyme electrophoresis showed Trypanosoma cruzi group I.
Conclusions. Clinical variability prevailed. In none of the cases was a clinical diagnosis suspected. The diagnosis was made and confirmed through laboratory tests alone. The results highlight the importance of including this disease in the differential diagnosis of febrile syndrome in endemic regions due to its good response to etiological treatment and thereby preventing its progression to the chronic phase.
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References
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28. Medrano-Mercado N, Luz MR, Torrico F, Tapia G, Van Leuven F, Araujo-Jorge TC. Acute-phase proteins and serologic profiles of chagasic children from an endemic area in Bolivia. Am J Trop Med Hyg
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29. Ministerio de Salud. Dirección General de Salud Pública. Grupo de Vigilancia en Salud Pública. Sistema de Vigilancia en Salud Pública - SIVIGILA. La Vigilancia en Salud Pública de eventos transmisibles y de fuente común. Tripanosomiasis americana. Protocolos. Santa Fe de Bogotá: Ministerio de Salud; 2000.p.1-9.
30. Lorca M. La enfermedad de Chagas congénita, transfusional y otras vías en el contexto de la interrupción vectorial. Rev Patol Trop 2002;31:86-9.
31. Olivares-Villagomez D, McCurley TL, Vnencak-Jones CL, Correa-Oliveira R, Colley DG, Carter CE. Polymerase chain reaction amplification of three different Trypanosoma cruzi DNA sequences from human chagasic cardiac tissue. Am J Trop Med Hyg 1998;59:563-70.
32. Antas PR, Medrano-Mercado N, Torrico F, Ugarte-Fernandez R, Gomez F, Correa Oliveira R et al. Early, intermediate, and late acute stages in Chagas' disease: a study combining anti-galactose IgG, specific serodiagnosis, and polymerase chain reaction analysis. Am J Trop Med Hyg 1999;61:308-14.
33. Umezawa ES, Luquetti AO, Levitus G, Ponce C, Ponce E, Henriquez D et al. Serodiagnosis of chronic and acute Chagas' disease with Trypanosoma cruzi recombinant proteins: results of a collaborative study in six Latin American countries. J Clin Microbiol 2004;42:449-52.
34. Devera R, Fernandes O, Coura JR. Should Trypanosoma cruzi be called "cruzi" complex? A review of the parasite diversity and the potential of selecting population after in vitro culturing and mice infection. Mem Inst Oswaldo Cruz 2003;98:1-12.
2. Guhl F, Restrepo M, Angulo VM, Antunes CM, Campbell-Lendrum D, Davies CR. Lessons from a national survey of Chagas disease transmission risk in Colombia. Trends Parasitol 2005;21:259-62.
3. Dias JC, Silveira AC, Schofield CJ. The impact of Chagas disease control in Latin America: a review. Mem Inst Oswaldo Cruz 2002;97:603-12.
4. Rassi A, Rassi AJ, Rassi G. Fase aguda. En: Brener Z, Andrade ZA, Barral-Neto M, editors. Trypanosoma cruzi e doenca de Chagas. Second Edition. Rio de Janeiro:Guanabara Koogan;2000.p.231-45.
5. Gurtler RE, Chuit R, Cecere MC, Castanera MB, Cohen JE, Segura EL. Household prevalence of seropositivity for Trypanosoma cruzi in three rural villages in northwest Argentina: environmental, demographic, and entomologic associations. Am J Trop Med Hyg 1998;59:741-9.
6. Guhl F, Vallejo GA. Interruption of Chagas disease transmission in the Andean Countries: Colombia. Mem Inst Oswaldo Cruz 1999;94 (Suppl. 1):413-5.
7. Rosas F, Guhl F, Velasco V, Jumbo L, Jaramillo C, Rodríguez D et al. Morbilidad de la enfermedad de Chagas en fase crónica en Colombia. Detección de pacientes chagásicos con cardiopatía en un área
endémica del departamento de Boyacá. Rev Col Cardiol 2002;9:349-58.
8. Guhl F, Nicholls RS. Manual de procedimientos para el diagnóstico de la enfermedad de Chagas. Bogotá D.C.: Quebecor Impresores;2001.p.12-58.
9. Sociedad Argentina de Cardiología. Consenso de enfermedad de Chagas. Rev Argent Cardiol 2002;70 (Suppl. 1):13-39.
10. Rodriques Coura J, de Castro SL. A critical review on Chagas disease chemotherapy. Mem Inst Oswaldo Cruz 2002;97:3-24
11. Kirchhoff LV. Chagas disease. American trypanosomiasis. Infect Dis Clin North Am 1993;7:487-502.
12. Cáceres D, Nicholls RS, Corredor A, Gualdrón L, Slait E, Dib J et al. Investigación de un brote de síndrome febril con miocarditis aguda en Guamal, Magdalena, 7 a 11 de junio de 1999. Inf Quinc Epidemiol Nac 1999;4:170-8.
13. Duque S, Pelaez D, Corredor A. Normas para cultivo in vitro de parásitos de la familia Tripanosomatidae. Manual de procedimientos. Bogotá: Instituto Nacional de Salud;1993. Cap VI.p.41.
14. Santana L, Montilla M, Nicholls S, Puerta C. Variación antigénica de la cepa Munantá de Trypanosoma cruzi después de pase por ratón. Biomédica 1998;18:134-40.
15. Montilla M, Guhl F, Jaramillo C, Nicholls S, Barnabe C, Bosseno MF et al. Isoenzyme clustering of trypanosomatidae Colombian populations. Am J Trop Med Hyg 2002;66:394-400.
16. Pavía P, Cuervo C, Montilla M, Nicholls S, Puerta, C. Diseño y estandarización de una prueba de PCR para la detección específica de Trypanosoma cruzi. Infectio 2003;7:129-36.
17. Vallejo GA, Guhl F, Chiari E, Macedo AM. Species specific detection of Trypanosoma cruzi and Trypanosoma rangeli in vector and mammalian hosts by polymerase chain reaction amplification of kinetoplast minicircle DNA. Acta Trop 1999;72:203-12.
18. Añez N, Carrasco H, Parada H, Crisante G, Rojas A, Gonzalez N et al. Acute Chagas' disease in western Venezuela: a clinical, seroparasitologic, and epidemiologic study. Am J Trop Med Hyg 1999;60:215-22.
19. Carme B, Aune I, Nguyen G, Aznar C, Beaudet B. Four cases of acute chagasic myocarditis in French Guiana. Am J Trop Med Hyg 2001;64:162-3.
20. Pinto AY, Valente SA, Valente Vda C. Emerging acute Chagas disease in Amazonian Brazil: case reports with serious cardiac involvement. Braz J Infect Dis 2004;8:454-60.
21. Mazza S, Miiraya S, Jorg M. Naturaleza de la reacción conjuntival en el primer periodo de la enfermedad de Chagas. En: Investigaciones sobre la enfermedad de Chagas. Publicación número 69. Buenos Aires: Universidad de Buenos Aires, Misión de Estudios de Patología Regional Argentina; 1945.
22. León-Sarmiento F, Prada D, Bayona J, Valderrama V, García I, León M et al. Neurotripanosomiasis americana: aspectos clínicos de un problema básico. Biomédica 2003;23:462-75.
23. Vaidian AK, Weiss LM, Tanowitz HB. Chagas' disease and AIDS. Kinetoplastid Biol Dis 2004;3:1-6.
24. Madalosso G, Pellini AC, Vasconcelos MJ, Ribeiro AF, Weissmann L, Oliveira Filho GS et al. Chagasic meningoencephalitis: case report of a recently included AIDS-defining illness in Brazil. Rev Inst Med Trop Sao Paulo 2004;46:199-202.
25. Tribulatti MV, Mucci J, Van Rooijen N, Leguizamon MS, Campetella O. The trans-sialidase from Trypanosoma cruzi induces thrombocytopenia during acute Chagas' disease by reducing the platelet sialic acid contents. Infect Immun 2005;73:201-7.
26. Medrano NM, Luz MR, Cabello PH, Tapia GT, Van Leuven F, Araujo-Jorge TC. Acute Chagas' disease: plasma levels of alpha-2-macroglobulin and C-reactive protein in children under 13 years in a high endemic area of Bolivia. J Trop Pediat 1996;42:68-74.
27. Melo Coutinho CM, Cavalcanti GH, Bonaldo MC, Mortensen RF, Araujo-Jorge TC. Trypanosoma cruzi: detection of a surface antigen cross-reactive to human C-reactive protein. Exp Parasitol 1998;90:143-53.
28. Medrano-Mercado N, Luz MR, Torrico F, Tapia G, Van Leuven F, Araujo-Jorge TC. Acute-phase proteins and serologic profiles of chagasic children from an endemic area in Bolivia. Am J Trop Med Hyg
1996;54:154-61.
29. Ministerio de Salud. Dirección General de Salud Pública. Grupo de Vigilancia en Salud Pública. Sistema de Vigilancia en Salud Pública - SIVIGILA. La Vigilancia en Salud Pública de eventos transmisibles y de fuente común. Tripanosomiasis americana. Protocolos. Santa Fe de Bogotá: Ministerio de Salud; 2000.p.1-9.
30. Lorca M. La enfermedad de Chagas congénita, transfusional y otras vías en el contexto de la interrupción vectorial. Rev Patol Trop 2002;31:86-9.
31. Olivares-Villagomez D, McCurley TL, Vnencak-Jones CL, Correa-Oliveira R, Colley DG, Carter CE. Polymerase chain reaction amplification of three different Trypanosoma cruzi DNA sequences from human chagasic cardiac tissue. Am J Trop Med Hyg 1998;59:563-70.
32. Antas PR, Medrano-Mercado N, Torrico F, Ugarte-Fernandez R, Gomez F, Correa Oliveira R et al. Early, intermediate, and late acute stages in Chagas' disease: a study combining anti-galactose IgG, specific serodiagnosis, and polymerase chain reaction analysis. Am J Trop Med Hyg 1999;61:308-14.
33. Umezawa ES, Luquetti AO, Levitus G, Ponce C, Ponce E, Henriquez D et al. Serodiagnosis of chronic and acute Chagas' disease with Trypanosoma cruzi recombinant proteins: results of a collaborative study in six Latin American countries. J Clin Microbiol 2004;42:449-52.
34. Devera R, Fernandes O, Coura JR. Should Trypanosoma cruzi be called "cruzi" complex? A review of the parasite diversity and the potential of selecting population after in vitro culturing and mice infection. Mem Inst Oswaldo Cruz 2003;98:1-12.
How to Cite
1.
Nicholls RS, Cucunubá ZM, Knudson A, Flórez AC, Montilla M, Puerta CJ, et al. Acute Chagas disease in Colombia: a rarely suspected disease. Report of 10 cases presented during the 2002-2005 period. biomedica [Internet]. 2007 Jan. 1 [cited 2024 May 17];27(1esp):8-17. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/244
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Case presentation
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