Doença de Chagas congênita com manifestações pleomórficas: relato de caso

JUSTIFICATIVA E OBJETIVOS: A doenca de Chagas e uma infeccao parasitaria, endemica, em varias regioes do Brasil. Nas ultimas decadas, a via de transmissao predominante foi modificada de vetorial para congenita, devido ao exodo rural e aos metodos mais eficazes de combate aos vetores. Alguns pacientes jovens apresentam manifestacoes cronicas e intensas, consequentes da transmissao congenita. O objetivo deste estudo foi relatar um caso de uma paciente com doenca de Chagas de transmissao vertical com manifestacoes variadas da doenca. Ressalta-se a importância de se conhecer diversas formas de transmissao e, ademais, enfatiza-se a importância de realizar adequado pre-natal em areas endemicas para possivel diagnostico, tratamento precoce e acompanhamento clinico. RELATO DO CASO: Paciente do sexo feminino, 20 anos, solteira, apresentando ha 8 meses dispneia aos minimos esforcos, precordialgia, epigastralgia e tosse seca, evoluindo com disfagia, confirmando-se o diagnostico de insuficiencia cardiaca com exames complementares. A investigacao prosseguiu com provas sorologicas, eletrocardiograma, radiografia do coracao e vasos da base (RCVB), Ecodopplercardiograma, confirmando-se: IgG positivo para Chagas em dois testes sorologicos (hemaglutinacao indireta e imunofluorescencia para T. Cruzi), alteracoes eletrocardiograficas difusas, megaesofago grau II, cardiomegalia grau III. Foi realizado tratamento etiologico com benzonidazol (Rochagan®) para doenca de Chagas cronica de inicio recente. Apesar da dificuldade na obtencao dos exames complementares,objetivando maior acuracia no diagnostico e melhor acompanhamento do tratamento, concluiu-se que era um caso de doenca de Chagas congenita, uma vez que a historia familiar era positiva e a paciente nao teve contato com triatomideos (morou sempre na area urbana) e a transmissao vetorial esta diminuindo devido as campanhas de erradicacao dos vetores... BACKGROUND AND OBJECTIVES: Chagas disease is a parasitic infection, endemic in several regions of Brazil. In recent decades the predominant route of transmission changed from vectorial to congenital, due to rural exodus and more effective methods for fighting the vectors. Some young patients have chronic and severe manifestations due to congenital transmission. The aim of this study was to report a case of a young adult patient with Chagas disease vertical transmission, with varied clinical manifestations of the disease. The importance of knowing the various forms of transmission was emphasized and also of the importance of prenatal assistance in endemic areas for possible early diagnosis, treatment and clinical follow up. CASE REPORT: Female patient, 20 years old, single, has presented experiencing, for the previous 8 months, dyspnea on exertion, constrictive chest pain, epigastric pain, and dry cough associated with progressive dysphagia; the diagnosis of heart failure was confirmed by complementary tests. The investigation progressed with serological tests, electrocardiogram, chest teleradiograph, echodopplercardiogram, confirming: IgG positive for Chagas disease, in two different serological tests (indirect hemagglutination assay and immunofluorescence for T cruzi), diffuse electrocardiographic changes, grade II megaesophagus, grade III cardiomegaly. Etiological treatment was conducted with benzonidazol (Rochagan®) for chronic Chagas disease of recent onset. Despite the difficulty in obtaining additional tests, aiming greater accuracy in the diagnosis and better monitoring of the treatment, it was concluded that it was a case of congenital Chagas disease, since family history is positive and the patient denied having contact with triatomids (hematophagus bugs) as she has always lived in urban areas, and because vectorial transmission is declining due to campaigns for eradication of the vectors...