Chagas disease: morbidity profile in an endemic area in northeastern Brazil
Trypanosoma cruzi, Chagas cardiomyopathy, megaesophagus, megacolon
OBJECTIVE: Several studies on chronic Chagas disease in endemic areas have been performed in patients with stratification of clinical forms by symptomatology and have not been used contrast examinations of the esophagus and colon. This study characterized for the first time and not estimated the clinical manifestations of patients in the chronic phase of Chagas disease from an endemic area, northeastern Brazil.
METHODS: The clinical profile of chronic Chagas disease was evaluated in 186 patients from west of the state do Rio Grande do Norteby electrocardiogram, echocardiogram, chest X-rays and contrast radiography of esophagus and colon.
RESULTS: Indeterminate, cardiac, digestive and cardiodigestive clinical forms were observed in 51.6% (96/186), 32.3% (60/186), 8.1% (15/186) and 8.1% (15/186), respectively. Heart failure was detected in 7.5% (14/186) of patients with functional classes ranging I to IV (New York Heart Association). Cardiomegaly was detected in 10.2% (19/186) of patients and electrocardiographic changes in 48.1% (91/186) of them. The apical aneurysm was diagnosed in 10.8% (20/186) and changes of segmental myocardial contractility of the left ventricle in 33.9% (63/186). Isolated digestive clinical form was registered, and 7.0% (13/186) of patients presented different groups of megaesophagus (I to IV) and 12.9% (24/186) megacolon grades from 1 to 3, of these 29.2% (7/24) with both organs affected.
CONCLUSION: Our findings demonstrated clinical forms of the disease at different stages and that symptoms are not always sufficient to determine or rule out cardiac and/or digestive damage, and could underestimate the number of patients with symptomatic clinical forms of disease.