Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ, Brazil.
Arq Bras Cardiol. 2011 Jun;96(6):434-42. doi: 10.1590/s0066-782x2011000600002.
Much has been achieved in one century after Carlos Chagas' discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations. Although the vector and transfusion-derived transmission of the disease has been controlled in many countries, there remains a pressing need for sustained surveillance of the measures that led to this achievement. It is also necessary to adopt initiatives that enable appropriate management of social and medical conditions resulting from the migration of infected individuals to countries where the disease formerly did not exist. It's also necessary to standardize the most reliable methods of detection of infection with T. cruzi, not only for diagnosis purposes, but more crucially, as a cure criterion. The etiological treatment of millions of patients in the chronic stage of the disease is also to be unraveled. A renewed interest in this area is observed, including prospects of studies focusing on the association of drugs with benznidazole. We also wait for full evidence of the actual effectiveness of the etiological treatment to impact favorably on the natural history of the disease in its chronic phase. Eventually, cardiologists are primarily responsible for improving the clinical management of their patients with Chagas' disease, judiciously prescribing drugs and interventions that respect, as much as possible, the peculiar pathophysiology of the disease, wasting no plausible therapeutic opportunities.
在卡洛斯·查加斯发现后的一个世纪里，我们已经取得了很多成就。然而，在未来几十年里，我们肯定还有很多工作要做。目前，我们正在见证许多旨在监测疾病流行病学、更好地了解克氏锥虫生物学及其与人类相互作用以及慢性期并发症发病机制和病理生理学的显著努力，以及更恰当地处理晚期心脏和消化系统表现。尽管许多国家已经控制了该疾病的媒介和输血传播，但仍迫切需要对导致这一成就的措施进行持续监测。还需要采取主动行动，使受感染者迁移到以前不存在该疾病的国家后，能够妥善管理社会和医疗条件。此外，还需要标准化检测克氏锥虫感染的最可靠方法，不仅是为了诊断目的，更重要的是，作为治愈标准。对慢性期数百万患者进行病因治疗的问题也有待解决。人们对该领域重新产生了兴趣，包括对研究重点关注药物与苯并咪唑联合使用的前景。我们还在等待病因治疗的实际效果的充分证据，以对疾病慢性期的自然病程产生有利影响。最终，心脏病学家主要负责改善其患有恰加斯病患者的临床管理，谨慎地开具药物和干预措施，尽可能尊重疾病的特殊病理生理学，不错过任何合理的治疗机会。
