Aspectos epidemiológicos, clínicos e laboratoriais de pacientes com infecção ou doença de chagas do município de Berilo, Vale do Jequitinhonha MG, após nove anos do tratamento específico com benzonidazol.

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

The parasitological and clinical cure of the Chagas disease in patients treated in the chronic phase is of complex evaluation and when observed occurred later especially in those treated in the chronic phase. The definition of the cure involves the use of some clinical and laboratorial examinations that need to be repeated throughout a long period of time. The objective of this work was to carry out an epidemiological, clinical and laboratorial evaluation, before and nine years after the etiologic treatment with Benzonidazole of patients with chronic chagasic infection and presenting different clinical forms of the disease. Thus, thirty-one patients treated in 1997 were epidemiological, clinical (anamneses, physical examination, ECG, ray-X of thorax) and laboratorially [hemoculture, PCR, conventional (ELISA, HAI) and non-conventional (anti-live tripomastigote antibodies (ALTA) serologies] evaluated. An improvement of the housing conditions of 51.7% of the patients was verified. The triatomines vector were recognized by 77.4% of the patients and 70.9% have some alive relative with Chagas disease or that have dead having this disease as cause of death. Before treatment twenty-two patients presented the indeterminate form of the disease and in the present evaluation 95.5% (21/22) were clinically stable. Only 4.5% (4/31) of the total of patients presented clinical evolution being that three of them presented electrocardiogram or X-ray changes compatible with Chagas disease. Pos-treatment the hemoculture was positive in 9.6% (3/31) of the cases being all they symptomatic; the PCR was positive in 40% (12/30), negative in 16.6% (5/30) and oscillating in 43.4% (13/30) of the patients; the conventional serology was positive in all patients. The semiquantitative ELISA reaction, compared between sera samples of 18/31 patients, obtained before and nine years after treatment, presented significant serological decrease (p<0.05) of antibodies level in patients that received treatment in the indeterminate clinical form of the disease. No significant changes of antibodies levels were observed in patients that before treatment presented electrocardiography or in ray- X/radiological changes compatible with Chagas disease. No significant changes were also observed in anti-live tripomastigote antibodies (ALTA) levels by flow cytometry in all patients seven and nine years after treatment. It was demonstrated by the semiquantitative ELISA reaction that the serum dilution of 1:320 was the best for discriminate the serological decrease of IgG antibodies anti Trypanosoma cruzi in patients treated with Benzonidazole. The analysis of the absorbance evaluated before and nine years after treatment confirmed that this dilution would be the best for precocious evaluation of the therapeutic efficacy in Chagas disease. Although the laboratory evaluations have not revealed any parasitological cure, five patients presented laboratorial data (negative PCR and hemoculture and significant decrease in serological reactivity observed only in patients that presented after treatment the indeterminate clinical form of the disease) indicative of therapeutic action. Data still suggest that the treatment prevented or delayed the natural evolution of Chagas disease in 95.5% (21/22) of the patients treated with the indeterminate form of the disease and in 40% (2/5) of the patients treated with some electrocardiography or ray-X compatible with Chagas disease. Data still suggest that even in absence of proven parasitological cure, benefit effects of the treatment were observed since the index of clinical evolution of patients treated with the indeterminate clinical form of the disease was very low (0.5%/year). New evaluations, with longer period of follow-up will be necessary to better verify the therapeutic efficacy.

ASSUNTO(S)

chagas, doença de - berilo (mg) quimioterapia imunologia tripanossomo

ACESSO AO ARTIGO

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