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墨西哥的恰加斯病:14例儿童恰加斯性心肌病报告

Chagas Disease in Mexico: Report of 14 Cases of Chagasic Cardiomyopathy in Children.

作者信息

Salazar-Schettino Paz María, Cabrera-Bravo Margarita, Vazquez-Antona Clara, Zenteno Edgar, Alba-Alvarado Mariana De, Gutierrez Elia Torres, Gomez Yolanda Guevara, Perera-Salazar María Gabriela, Torre Guadalupe Garcia de la, Bucio-Torres Martha Irene

机构信息

Department of Microbiology and Parasitology, Faculty of Medicine, National Autonomous University of Mexico.

出版信息

Tohoku J Exp Med. 2016 Nov;240(3):243-249. doi: 10.1620/tjem.240.243.

Abstract

Chagas disease is a parasitic infection mainly found in Latin America; it is transmitted by a triatomine, also known as assassin bug or kissing bug. In humans, the parasite causes mostly cardiac disorders. Two-thirds of the Mexican territory are regarded as risk areas for vector transmission of Trypanosoma cruzi, the causal agent. The parasite can be found as a blood-borne trypomastigote or as an intracellular amastigote. The progression and severity of lesions could be due to frequent reinfections or to infection by highly virulent strains. A total of 3,327 individuals younger than 18 years old, living in risk areas for this disease in the rural setting of the States of Queretaro, San Luis Potosi, and Veracruz, underwent a seroepidemiological study. Among them, 37 subjects were seropositive for T. cruzi, and were studied to look for signs of cardiac pathology, which has only been reported in adults. A clinical record was prepared for all included individuals, and electrocardiography (ECG) and echocardiography (ECHO) studies were performed; 25 cases showed lesions compatible with the onset of Chagas cardiomyopathy. The other 12 patients showed either normal ECG and ECHO data or showed abnormal parameters that were not regarded as significant. Lesions found in the onset of Chagas cardiomyopathy in children are herein reported, along with 14 cases of cardiac pathology compatible with Chagas disease. Our results indicate that patients younger than 18 years can show a cardiac pathology similar to that observed in adults.

摘要

恰加斯病是一种主要在拉丁美洲发现的寄生虫感染疾病;它由一种锥蝽传播,锥蝽也被称为猎蝽或接吻虫。在人类中,这种寄生虫主要引发心脏疾病。墨西哥三分之二的领土被视为克氏锥虫(病原体)媒介传播的风险区域。这种寄生虫可以以血源型锥鞭毛体或细胞内无鞭毛体的形式被发现。病变的进展和严重程度可能归因于频繁的再次感染或高毒力菌株的感染。共有3327名18岁以下生活在克雷塔罗州、圣路易斯波托西州和韦拉克鲁斯州农村地区这种疾病风险区域的个体接受了血清流行病学研究。其中,37名个体克氏锥虫血清学呈阳性,并对其进行研究以寻找心脏病理学迹象,而此前心脏病理学迹象仅在成人中被报道过。为所有纳入个体准备了临床记录,并进行了心电图(ECG)和超声心动图(ECHO)检查;25例显示出与恰加斯心肌病发病相符的病变。另外12例患者的心电图和超声心动图数据正常,或者显示出被认为不显著的异常参数。本文报告了儿童恰加斯心肌病发病时发现的病变,以及14例与恰加斯病相符的心脏病理学病例。我们的结果表明,18岁以下的患者可能表现出与成人中观察到的类似的心脏病理学特征。

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