Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Arruda, Hilda Maria Benevides da Silva de; Ribeiro, Marcelle Araújo; Silva, Antonia Marilene da; Vasconcelos, Daniel; Oliveira, Maria Regina Fernandes de; Noronha, Elza Ferreira

doi:10.1590/0037-8682-0541-2018

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Revista da Sociedade Brasileira de Medicina Tropical

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Sumário

Major Article • Rev. Soc. Bras. Med. Trop. 52 • 2019 • https://doi.org/10.1590/0037-8682-0541-2018 copy

Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION

Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil.

METHODS

We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR.

RESULTS

Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients.

CONCLUSIONS:

Chagas disease affected mostly women, with the indeterminate chronic form of the disease.

Keywords:
Epidemiological profile; University hospital; Chagas disease

		Indeterminate	Cardiac	Mixed	Digestive	P*
Sex	M	31 (26.7%)	14 (48.3%)	5 (62.5%)	9 (50.0%)	0.014
	F	85 (73.3%)	15 (51.5%)	3 (37.5%)	9 (50.0%)
Median age (IQR)		45.00 (12.00)	45.00 (16.00)	50.00 (14.00)	45.50(14.00)	0.647
Illiterate		16 (13.8%)	2 (6.9%)	2 (25.0%)	3 (16.7%)	0.108
Elementary 1		21 (18.1%)	(13.8%)	0.0	1 (5.6%)
Elementary 2		23 (19.8%)	11 (37.9%)	5 (62.5%)	6 (33.3%)
Incomplete high school		20 (17.2%)	4 (13.8%)	0.0	3 (16.7%)
Completed high school		22 (19.0%)	6 (20.7%)	1 (12.5%)	4 (22.5%)
Completed university		14 (12.5%)	2 (6.9%)	0.0	1 (5.6%)
Caucasian		25 (21.6%)	2 (6.9%)	3 (37.5%)	4 (22.5%)
Afro-Brazilian		15 (12.9%)	7(24.1%)	0.0	1 (5.6%)	0.503
Asian		2 (1.7%)	3 (10.3%)	0.0	1 (5.6%)
African		69 (59.5%)	17 (58.6%)	5 (62.5%)	12 (66.7)
Indigenous		1 (0.9%)	0.0	0.0	0.0
Unknown		3 (2.6%)	0.0	0.0	0.0
Declined to inform		1 (0.9%)	0.0	0.0	0.0
	A	1 (0.9%)	0.0	0.0	0.0	0.858
	B	18 (15.5%)	3 (10.3%)	0.0	2 (11.1%)
Economic level	C	73 (62.9%)	20 (69.0%)	5 (62.5%)	11 (61.1%)
	D	19 (16.4%)	6 (20.7%)	3 (37.5%)	4 (22.2%)
	E	5 (4.3%)	0.0	0.0	1 (5.6%)
Employed		66 (56.9%)	12 (41.4%)	4 (50.0%)	12 (66.7%)	0.348
Domestic worker		20 (17.5%)	0	1 (12.5%)	3 (15.8%)	0.546
General services		15 (14.3%)	2 (6.9%)	2 (25.0%)	4 (22.2%)
Trades services		17 (14.7%)	6 (20.7%)	0.0	2 (11.1%)
Missionary		0.0	1 (3.4%)	0.0	1 (5.3%)
Health care		2 (1.7%)	0.0	0.0	0.0
Teacher		4 (3.4%)	0.0	0.0	1 (5.6%)
Pensioner/retired		3 (2.6%)	0.0	0.0	1 (5.6%)
Government employee		2 (1.7%)	0.0	0.0	1 (5.6%)
Rural worker		5 (4.3%)	4 (13.8%)	1 (12.5%)	1 (5.6%)
Homemaker		5 (4.3%)	2 (6.9%)	0.0	1 (5.6%)
Rural residence		20 (17.2%)	7 (24.1%)	4 (50.0%)	3 (16.7%)	0.129
Urban residence		96 (82.8%)	22 (75.9%)	4 (50.0%)	15 (83.3%)
Previously bitten by triatomine		69 (59.5%)	21 (74.2%)	6 (75.0%)	10 (55.6%)	0.760
Family history of Chagas disease		84 (72.4%)	22 (75.9%)	4 (50.0%)	13 (72.2%)	0.465
Lived in rural area		107 (92.2%)	28 (96.6%)	8 (100.0%)	17 (94.4%)	0.805
Median time outside endemic area (years)		20.00 (31.00)	20.00 (30.00)	10.00 (35.00)	26.00 (18.00)	0.262

	Indeterminate	Cardiac	Mixed	Digestive	P*
Hypertension	26 (22.4%)	5 (17.2%)	2 (25.0%)	4 (22.2%)	0.941
Dyslipidemia	30 (25.9%)	2 (6.9%)	2 (25.0%)	1 (5.6%)	0.240
Depression	12 (10.3%)	2 (6.9%)	0.0	1 (5.6%)	0.904
Anxiety	8 (6.9%)	2 (6.9%)	1 (12.5%)	1 (5.6%)	0.957
Diabetes	9 (7.8%)	0.0	0.0	0.0	0.932
Hyperthyroidism	3 (2.6%)	1 (3.4%)	0.0	0.0	0.817
Gastritis	2 (1.7%)	0.0	0.0	0.0	0.893
Acquired immunodeficiency syndrome	0.0	1 (3.4%)	0.0	0.0	0.349
Asthma	1 (0.9 %)	0.0	0.0	1 (5.6%)	0.479
Hypothyroidism	3 (2.6%)	0.0	0.0	0.0	0.817
Celiac disease	1 (0.9%)	0.0	0.0	0.0	0.853
Antiphospholipid syndrome	0.0	1 (3.4%)	0.0	0.0	0.349
ACEI/ABR	25 (21.6%)	4 (13.8%)	2 (25%)	2 (11.1%)	0.566
Lipid-lowering agent	11 (9.5%)	1 (3.4%)	0.0	0.0	0.579
Antidepressant	8 (6.9%)	2 (6.9%)	0.0	1 (5.6%)	0.901
Beta-blocker	3 (2.6%)	7 (24.1%)	0.0	0.0	0.002
Omeprazole	5 (4.3%)	1 (3.4%)	1 (12.5%)	2 (11.1%)	0.352
Aspirin	4 (3.4%)	1 (3.4%)	0.0	0.0	0.882
Spironolactone	0.0	1 (3.4%)	0.0	0.0	0.320
Diuretic	12 (10.3%)	2 (6.9%)	0.0	0.0	0.700
Amiodarone	1 (0.9%)	0.0	0.0	0.0	0.746
Warfarin	0.0	1 (3.4%)	0.0	0.0	0.320
Antidiabetic agents	4 (3.4%)	1 (3.4%)	0.0	0.0	0.900
Other drugs	12 (10.3%)	3 (10.3%)	0.0	0.0	0.740
Consumption of alcoholic drinks	22 (19.0%)	9 (31.0%)	2 (25.0%)	5 (27.8%)	0.515
Smoking	8 (6.9%)	1 (3.4%)	0.0	2 (11.1%)	0.751
Physical activity	53 (45.7%)	15 (51.7%)	6 (75.0%)	10 (55.6%)	0.334
Benznidazole	38 (22,2%)	10(5,8%)	5 (2,9%)	6 (3,5%)	0,960
Positive PCR	63 (56.7%)	16 (55.2%)	6 (75.0%)	7 (43.8%)	0.578
Parasite load^†	0.01 (0.09)	0.02 (0.12)	0.05 (8.63)	0.00 (0.01)	0.038

	Indeterminate		Cardiac		Mixed		Digestive
	(n =114)		(n = 25)		(n = 8)		(n = 17)
	Median	IQR	Median	IQR	Median	IQR	Median	IQR	P*
LVEDV (mL/m²)	27.81	3.08	27.37	4.48	26.97	2.53	26.72	5.46	0.168
LA (mm/m²)	18.02	3.80	16.79	4.15	15.87	5.72	17.85	3.51	0.484
RV (mm/m²)	14.55	4.12	14.31	5.17	14.19	5.17	14.17	5.61	0.836
TAPSE (cm)	2.51	0.65	2.27	0.43	2.72	0.79	2.56	0.48	0.070
Color Doppler S Wave (cm/s)	13.40	2.72	13.60	2.45	13.40	2.85	13.45	2.90	0.776
RA VOL (mL/m²)	17.20	8.15	14.80	11.10	14.80	9.33	16.60	5.23	0.663
TEI / RV	0.39	0.33	0.41	0.35	0.43	0.39	0.40	0.38	0.750
FAC RV %	0.44	0.18	0.41	0.11	0.34	0.31	0.46	0.21	0.495
LA Vol (mL/m²)	18.75	9.23	17.63	6.78	23.90	11.68	20.73	8.85	0.578
LVEF %	70.16	10.52	69.90	12.61	70.28	8.80	67.53	13.07	0.839
LV MASS (g/m²)	71.30	25.95	65.70	29.80	60.45	20.75	64.15	22.23	0.230
Mitral flow E velocity (cm/s)	77.90	28.70	82.30	25.70	90.80	26.85	79.90	24.80	0.335
Mitral flow A velocity (cm/s)	58.70	22.37	63.20	23.10	51.35	53.38	60.00	34.50	0.762
S Vel (cm/s)	7.90	1.90	7.90	1.10	8.80	1.50	7.90	1.60	0.373
A' Vel (cm/s)	8.90	2.80	9.30	2.15	8.55	1.10	8.90	2.20	0.630
E’ Vel septal	10.00	3.40	9.70	2.80	11.00	3.18	9.40	3.65	0.537
E/A RATIO	1.33	0.68	1.30	0.63	1.42	0.94	1.57	0.77	0.439
Average e’' (cm/s)	11.15	3.57	11.05	4.50	11.72	4.86	9.97	2.72	0.544
Mitral DT (ms)	0.19	0.07	0.20	0.08	0.18	0.07	0.20	0.059	0.297
E/e’ (average e’)	7.08	2.80	7.35	3.33	7.98	4.60	8.10	2.98	0.610

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[1] Corresponding author: Hilda Maria Benevides da Silva de Arruda. e-mail:hbenevides.arruda@gmail.com