Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.
Chagas disease is a parasitic infection with high re-emergence rates in some Amazon regions. The main vectors of Trypanosoma cruzi are haematophagous insects, the triatomines. Only a few reports are available about the occurrence of these wild vectors and their contact with the inhabitants of the riverside regions of the Amazon. This study describes the unusual behaviour of the triatomines that have invaded the homes of the residents of Abaetetuba, the city that has the second highest number of cases of Chagas disease.Two cross-sectional studies were conducted using sero-epidemiological surveys of the inhabitants of Abaetetuba with registered triatomine home invasions. The frequencies of the variables of interest were analysed using Epi Info version 7.2.In 2014 and 2017, 145 persons registered home invasions of triatomines in their domiciles and 16.55% reported having been bitten by insects. The environmental features described indicated potential conditions for the persistence of the parasite's life cycle. Of the enrolled inhabitants, 0.47% were positive for immunoglobulin G anti-T. cruzi antibodies.Home invasions of triatomines were confirmed in two periods, with a description of unusual behaviour for the genus Rhodnius. The use of serological surveillance in human populations at risk of this occurrence may constitute a new tool for the early detection of silent infections.
The Brazilian Amazon has long been considered a non-endemic area for Chagas disease, in spite of the well-known enzootic cycle involving a variety of wild mammals and triatomine bugs of this region (Rodrigues & Melo 1942, Deane 1964, 1967), whose natural environment has already been much altered by human activities in ways that are important for vector-host balance (Coura 1990, Fraiha Neto et al. 1995), necessiting attention and specific programs of epidemiological vigilance (Feitosa 1995).Chagas disease merits close attention at this time: there is growing number of cases that now exceeds one hundred cases in the past few years, the peri-domestic cycle of Trypanosoma cruzi is still in the adaptation phase in the region, and the time is opportune for the adoption of vector control measures.Chagas disease in the Brazilian Amazon is on the rise.Data from January of 1998, reveal 148 cases of which 121 were acute with 5 resulting in death (67 cases were associated with family episodes and 54 were not so associated) and 27 chronic cases.In terms of occurrence by state, 71 were in Pará (47.9%), 51 in Amapá (34.5%), 14 in Amazonas (9.5%), 9 in Maranhão (6.1%), and 7 in Acre (4.7%), not considering serological screening done in the region.It must be remembered also that these data represent only those notifications that came to the notice of the Instituto Evandro Chagas (IEC) and surely represent only the tip of the epidemiological 'iceberg'.The State of Pará shows the greatest number of cases because it has in Belém facilities for diagnosis, while no cases were reported from the states of Roraima and
A total of 179 individuals with acute Chagas disease mainly transmitted by oral source, from Pará and Amapá State, Amazonian, Brazil were included during the period from 1988 to 2005. Blood samples were used to survey peripheral blood for T. cruzi hemoparasites by quantitative buffy coat (QBC), indirect xenodiagnosis, blood culture and serology to detection of total IgM and anti-T. cruzi IgG antibodies by indirect immunofluorescence assay (IFA) and indirect hemagglutination assay (HA). All assays were performed pre-treatment (0 days) and repeated 35 (±7) and 68 (±6) days after the initiation of treatment with benznidazol and every 6 months while remained seropositive. The endpoint of collection was performed in 2005. Total medium period of follow-up per person was 5.6 years. Also, a blood sample was collected from 72 randomly chosen treated patients to perform polimerase chain reaction (PCR) method. Proportions of subjects with negative or positive serology according to the number of years after treatment were compared. In the endpoint of follow-up we found 47 patients (26.7%) serologically negative, therefore considered cured and 5 (2.7%) exhibited mild cardiac Chagas disease. Other 132 patients had persistent positive serologic tests. The PCR carried out in 72 individuals was positive in 9.8%. Added, there was evidence of therapeutic failure immediately following treatment, as demonstrated by xenodiagnosis and blood culture methods in 2.3% and 3.5% of cases, respectively. There was a strong evidence of antibody clearing in the fourth year after treatment and continuous decrease of antibody titers. Authors suggest that control programs should apply operational researches with new drug interventions four years after the acute phase for those treated patients with persistently positive serology.
Dupla abordagem de infecções por Trypanosoma cruzi e/ou Plasmodium spp.aplicada ao diagnóstico de doença de Chagas e exposição vetorial triatomínica na Amazônia brasileira Dual approach of Trypanosoma cruzi and
Trabalho apresentado no Congresso da Sociedade Brasileira de Medicina Tropical, 44.; Encontro de Medicina Tropical do Cone Sul, 2.; Encontro de Medicina Tropical dos Paises de Lingua Portuguesa, 3., 2008, Porto Alegre.
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