Rojo-Medina Julieta, Ruiz-Matus Cuitláhuac, Salazar-Schettino Paz María, González-Roldán Jesús Felipe
Secretaría de Salud, Centro Nacional de la Transfusión Sanguínea, Dirección General, Ciudad de México, México.
Secretaría de Salud, Dirección General de Epidemiologia, Ciudad de México, México.
Gac Med Mex. 2018;154(5):605-612. doi: 10.24875/GMM.18004515.
Chagas disease, which is caused by Trypanosoma cruzi, is considered to be the most serious parasitic disease in America. It is transmitted mainly by triatominae ("kissing bugs"). Mazzoti reported the first two human cases in Mexico. The form of transmission is by parasites entering the organism in feces of the insect, by blood transfusion, from mother to child, by organ transplant and laboratory accidents. In Mexico, 1.1 million people are estimated to be infected; the incidence in 2012 was 0.70 per 1,00,000 population. In 2017, the highest incidence rates were registered in Yucatán, Oaxaca and Hidalgo. The infection causes cardiomyopathies and mega-organs of the digestive tract. Diagnosis in the acute phase is by parasitological approach and, in the chronic phase, by laboratory screening studies. In Mexico's blood banks, screening for Chagas disease is mandatory; from 2007 to 2016, seroprevalence has decreased from 0.40 to 0.32 due to the improvement of donor selection processes and the ad hoc questionnaire. The targets of the parasite are neurons and smooth and myocardial muscle cells. The association of neuronal and smooth muscle destruction defines the presentation of chagas mega-syndromes. Initial manifestations of the disease can go unnoticed; 5% show apparent signs and symptoms and 30% will progress to the chronic asymptomatic phase. Currently available treatments have effect in the acute phase. For the control of Chagas disease, the Specific Action Program for the Prevention and Control of Chagas Disease (PAE Chagas 2013-2018) is available to initiate activities aimed at eliminating transfusion and congenital transmission and controlling vector transmission. The success of medical care depends on oportune detection, early etiological treatment and coverage broadening. On the other hand, monitoring and screening of pregnant women living in risk areas and blood and organ donors universal screening will enable the elimination congenital and transfusion transmission.
恰加斯病由克氏锥虫引起，被认为是美洲最严重的寄生虫病。它主要通过锥蝽（“接吻虫”）传播。马佐蒂报告了墨西哥的首例两例人类病例。传播途径包括寄生虫通过昆虫粪便进入机体、输血、母婴传播、器官移植以及实验室事故。在墨西哥，估计有110万人感染；2012年的发病率为每10万人0.70例。2017年，尤卡坦州、瓦哈卡州和伊达尔戈州的发病率最高。该感染会导致心肌病和消化道巨型器官。急性期的诊断采用寄生虫学方法，慢性期则通过实验室筛查研究。在墨西哥的血库中，恰加斯病筛查是强制性的；从2007年到2016年，由于献血者选择程序的改进和特设问卷，血清阳性率从0.40降至0.32。寄生虫的靶标是神经元以及平滑肌和心肌细胞。神经元和平滑肌破坏的关联决定了恰加斯巨型综合征的表现。该病的初始表现可能未被注意到；5%表现出明显的体征和症状，30%将进展为慢性无症状期。目前可用的治疗方法在急性期有效。为控制恰加斯病，可利用《恰加斯病预防和控制特别行动计划（2013 - 2018年）》开展旨在消除输血和先天性传播以及控制病媒传播的活动。医疗保健的成功取决于及时检测、早期病因治疗和扩大覆盖范围。另一方面，对生活在高危地区的孕妇进行监测和筛查以及对血液和器官捐献者进行普遍筛查将能够消除先天性和输血传播。
