Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

Abstract INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients’ (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.

摘要 引言：由克氏锥虫（Trypanosoma cruzi）感染引发的恰加斯病（Chagas disease，CD）患者，罹患其他慢性疾病的风险更高，此类共病可能会加重恰加斯病的病情严重程度。鉴于巴西南部巴拉那州的恰加斯病病例报告不足，本研究旨在明确巴西南部地区慢性克氏锥虫感染者的临床与流行病学特征。
方法：本研究依托社区医院开展，收集了巴西南部237例恰加斯病患者的临床与人口统计学特征数据。为分析不同分型恰加斯病与社会人口学、临床变量之间的关联，本研究采用赤池信息准则（Akaike information criterion）构建了多因素logistic回归模型。
结果：本研究纳入患者的平均年龄为57.5岁，其中59%为女性。60%的患者籍贯或出生地位于巴拉那州，且有64%的患者因出现心脏或消化道症状后前往恰加斯病专科门诊就诊。恰加斯病的主要临床分型为心脏型（53%），其次为未定型（36%）与消化道型（11%）。主要心电图异常表现为右束支传导阻滞（right bundle branch block，39%）与左前分支传导阻滞（left anterior fascicular block，32%）。患者的平均合并症数量为3.9±2.3；其中最常见的合并症为系统性动脉高血压（64%），其次为血脂异常（34%）与糖尿病（19%），重叠合并症将单独统计。男性与有症状的心脏型恰加斯病存在显著关联（优势比OR=2.92；95%置信区间CI：1.05~8.12；p=0.040）。
结论：本研究加深了对巴西南部恰加斯病患者分布特征与临床表型的认识，研究结果显示，该群体患者的合并症患病率较高，且因年龄偏大、发病致残风险显著，属于脆弱易感人群。