Parada H, Carrasco H A, Añez N, Fuenmayor C, Inglessis I
Hospital Luis Razetti, Barinas, Venezuela.
Int J Cardiol. 1997 Jun 27;60(1):49-54. doi: 10.1016/s0167-5273(97)02952-5.
During the last 8 years 58 acute cases of Chagas' disease were studied. Patients from an endemic area of the state of Barinas, Venezuela, showed fever (98%) and circulating forms of T. cruzi (100%), and were treated with oral benznidazole. The recorded mortality was 8.6%. Acute myocarditis was constantly found either in myocardial biopsies or at necropsy, even in patients without any other sign of cardiac compromise (36%), which was detected by chest X-ray in 58%, by 2D echocardiography in 52%, by resting ECG in 41% and by clinical findings in 27.5% of the patients. Cardiomegaly was due to pericardial effusion rather than ventricular dilatation in most instances. Treatment eliminated parasitemia but negativized serology in only 20% of patients. It also appeared to have little influence on the ongoing myocarditic process, emphasizing the need for better therapeutic schedules, able to avoid or control the early appearance of immunologic mechanisms and microcirculatory damage involved in the future development of chronic chagasic myocarditis.
在过去8年里，对58例急性恰加斯病病例进行了研究。来自委内瑞拉巴里纳斯州一个流行地区的患者出现发热（98%）和克氏锥虫循环型（100%），并接受口服苯硝唑治疗。记录的死亡率为8.6%。在心肌活检或尸检中均持续发现急性心肌炎，即使在没有任何其他心脏损害迹象的患者中也是如此（36%），通过胸部X线检查在58%的患者中检测到，通过二维超声心动图在52%的患者中检测到，通过静息心电图在41%的患者中检测到，通过临床检查在27.5%的患者中检测到。在大多数情况下，心脏肿大是由于心包积液而非心室扩张。治疗消除了寄生虫血症，但仅20%的患者血清学转阴。治疗似乎对正在进行的心肌炎症过程影响很小，这强调了需要更好的治疗方案，以避免或控制涉及慢性恰加斯病性心肌炎未来发展的免疫机制和微循环损伤的早期出现。
