Chagas disease: one of the diseases that most affects the heart – 04/18/2023 – Health

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Chagas disease is a condition that affects more than 1 million people in Brazil each year and 5 million worldwide. About 70% of those infected do not know they have the disease.

In this issue, I talk about one of the least understood neglected tropical diseases.

Chagas, a neglected disease: Chagas disease is caused by protozoan Trypanosoma cruzi and has different phases, which can be asymptomatic or cause fever and body achesin the acute phase, to cause changes in the esophagusat the digestive system or not heartin the chronic phase.

The main route of transmission is through the contaminated faeces of the kissing bug, a bedbug (genus triatoma) which, when biting humans, also eliminates the parasite in the feces. There has also been a growth in other cases of infection such as:

• ingestion of contaminated food and drink, such as sugarcane juice or açaí;
• from mothers to babies through pregnancy;
• by blood transfusion or organ transplantation;
• by laboratory accidents (the latter still in smaller numbers).

Most cases of Chagas are still concentrated in countries in the Southern Hemisphere, where the kissing bug is found. In non-endemic places, the United States, where 300,000 live with the disease, and Spain, 50,000, are the countries with the most cases.

Chagas has been classified as a neglected tropical disease by the WHO (World Health Organization) since 2005. Such recognition serves as a warning as an international public health problem to increase prevention, treatment and early diagnosis actions in the places where it occurs.

Neglected tropical diseases (NTDs) are those with the highest incidence in poor countries and are linked to socioeconomic inequalities and access to health. They usually affect more children and women.

What’s the diagnosis? The test for detection of trypanosomes is carried out through serological analysis of the blood. The problem, according to specialists, is that many physicians do not suspect an initial diagnosis of Chagas disease and, therefore, do not request the test.

Many patients only discover that they have the protozoan infection when they donate blood, where the test is mandatory. For this reason, around 70% of people, according to estimates by PAHO (the Pan-American arm of the WHO) are unaware that they have Chagas disease.

• If detected in the acute phase, the disease can be treated and even cured;
• In more severe cases, when organs are affected, it is often necessary to remove part of the affected organs by surgery.

What’s the treatment? It is done with the use of two main drugs: benznidazole, available in the SUS (Unified Health System), and Nifurtimox.

In October, the Brazilian Society of Cardiology released a new guideline to issue an alert regarding the early diagnosis of Chagas disease. According to the guideline, this is the most lethal disease among the neglected ones that affect the heart.

In Brazil, about 1 in 50 children are born with congenital Chagas disease. Last week, Fiocruz signed an agreement with pharmaceutical company Bayer, producer of Nifurtimox, to expand the supply of the medicine in the country.

The drug is recommended for the treatment of the acute phase of any patient in situations where benznidazole is not tolerated (some of the side effects include constipation) and for the treatment of the chronic phase of children and adolescents.

Science to live better

News and studies on health and well-being

• In a new study published in the journal Jama, researchers at the Duke University School of Medicine and colleagues found no efficacy of ivermectin as a treatment for Covid. The randomized, double-blind study with a control group evaluated the use of the drug for six days in 1,206 patients with a positive diagnosis for Sars-CoV-2. Recovery from symptoms within one day was less than 0.1%.
• A survey of 437,000 adults aged 40 to 69 in the UK identified a increased risk of dementia in people with hearing impairment who did not use hearing aids compared to those who used hearing aids. According to the study, published in The Lancet, the risk of dementia was 1.7% in individuals who had loss and did not use the hearing aid, while the same risk observed was 1.2% in participants who used the hearing aid. device.
• Researchers at Penn State University and the University of Massachusetts found an intracellular pathway that may help in the development of drugs that prevent cells from aging. In the research, published in the journal Science Advances, the scientists describe the action of enzymes in the cell nucleus, where the genetic material is located, capable of turning on or off genes that act in gene expression. The enzyme, called sirtuin, manages to access cellular DNA and move specific sites in the nucleosome, where the coiled genetic material is located. Sirtuins are also capable of identifying cellular damage.