Anticuerpos contra Trypanosoma cruzi en pacientes con miocardiopatía dilatada en Tuxtla Gutiérrez, Chiapas

La enfermedad de Chagas es causada por el protozoario flagelado Trypanosoma cruzi. Encuestas seroepidemiologicas realizadas en Chiapas informan individuos seropositivos en comunidades rurales, y cabe la posibilidad de que la forma cronica de la enfermedad ocurra en el estado. La expresion clinica dominante en la enfermedad de Chagas cronica es cardiaca. Material y metodos: Con el objeto de conocer la frecuencia de cardiopatia chagasica cronica (CCC) se hizo una encuesta serologica a pacientes con miocardiopatia dilatada (MD) internados entre octubre de 2002 a octubre de 2003, en el Servicio de Cardiologia del Hospital General Regional "Dr. Rafael Pascacio Gamboa" de Tuxtla Gutierrez, Chiapas. El diagnostico fue establecido en forma independiente y el estudio seroinmunologico fue ciego. Resultados: Quince (54%) de 28 sujetos con MD tenian anticuerpos a T. cruzi. Todos provenian de medio rural pobre, su cuadro clinico incluyo insuficiencia cardiaca y/o trastornos del ritmo o conduccion. Conclusiones: Esta evidencia sugiere que en Chiapas, una zona endemica de enfermedad de Chagas, hay CCC. Dentro del estudio de la MD, la etiologia chagasica, debe ser considerada, ya que las condiciones socioeconomicas, culturales y regionales favorecen su presencia. Chagas disease is caused by the flagellate protozoan T. cruzi. Seroepidemiological surveys in Chiapas, Mexico have shown seropositive individuals, therefore, we searched for people affected by the chronic form of Chagas disease which involves the heart, causing a chronic, progressive and fatal disease called Chronic Chagasic Cardiopathy (CCC). Material and methods: To establish the frequency of CCC we studied 28 patients seen at the Hospital General Regional "Dr. Rafael Pascacio Gamboa" during October 2002 through October 2003 in Tuxtla Gutierrez, Chiapas, the State capital city, with diagnosis of dilated cardiomyopathy (DC), a serological survey for antibodies against T. cruzi was done. This hospital cares for people from all parts of Chiapas, Mexico. Clinical diagnosis of DC was established there and blind serological studies were performed in Mexico City. Results: Fifteen out of 28 DC patients (54%) had anti T. cruzi antibodies. All of them came from poor rural villages and they had heart failure and/or arrhythmia or heart blockade on EKG. Conclusions: This observation suggest that in Chiapas were Chagas disease is endemic, there are CCC patients. Any case with a clinical diagnosis of DC should be tested for antibodies against T. cruzi. The low socioeconomic status, culture and environment in this Mexican State favour the presence and transmission of this parasitic disease.