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Medina-Rincón GJ, Gallo-Bernal S, Jiménez PA, Cruz-Saavedra L, Ramírez JD, Rodríguez MJ, Medina-Mur R, Díaz-Nassif G, Valderrama-Achury MD, Medina HM. Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review. Pathogens 2021; 10:pathogens10111493. [PMID: 34832648 PMCID: PMC8619182 DOI: 10.3390/pathogens10111493] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi’s infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite’s life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.
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Affiliation(s)
- Germán J. Medina-Rincón
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Correspondence: ; Tel.: +57-310-817-2369
| | - Sebastián Gallo-Bernal
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Paula A. Jiménez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Lissa Cruz-Saavedra
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - María Juliana Rodríguez
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Ramón Medina-Mur
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Gustavo Díaz-Nassif
- Division of Gastroenterology and Liver Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 111221, Colombia;
| | | | - Héctor M. Medina
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
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Oliveira GMMD, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, Souza MDFMD, Soares GP, Xavier Junior GF, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Silvestre OM, Teixeira RA, Sampaio RO, Gaziano TA, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol 2020; 115:308-439. [PMID: 33027364 PMCID: PMC9363085 DOI: 10.36660/abc.20200812] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil.,Disciplina de Cardiologia, Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil
| | - Luisa Campos Caldeira Brant
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Carisi Anne Polanczyk
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre , RS - Brasil.,Serviço de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS - Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre , RS - Brasil
| | - Andreia Biolo
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre , RS - Brasil.,Serviço de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS - Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre , RS - Brasil
| | - Bruno Ramos Nascimento
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Maria de Fatima Marinho de Souza
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Organização Vital Strategies , Nova York - EUA
| | - Gabriel Porto Soares
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil.,Curso de Medicina da Universidade de Vassouras , Vassouras , RJ - Brasil
| | | | | | - Marcio Sommer Bittencourt
- Divisão de Clínica Médica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP - Brasil.,Faculdade Israelita de Ciências da Saúde Albert Einstein , São Paulo , SP - Brasil
| | - Octavio M Pontes Neto
- Serviço de Neurologia Vascular e Emergências Neurológicas, Divisão de Neurologia, Departamento de Neurociências e Ciências do Comportamento , Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP), São Paulo , SP - Brasil
| | | | - Renato Azeredo Teixeira
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Roney Orismar Sampaio
- Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo , SP - Brasil.,Programa de Pós-Graduação da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo , SP - Brasil.,Unidade Clínica de Cardiopatias Valvares do Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Thomaz A Gaziano
- Brigham and Women's Hospital , Boston - EUA.,Department of Medicine , Cardiovascular, Harvard Medical School , Boston - EUA
| | - Gregory A Roth
- Global Health and Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME), Washington - EUA.,Division of Cardiology at the University of Washington School of Medicine , Washington - EUA
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
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Massaro AR, Lip GYH. Stroke Prevention in Atrial Fibrillation: Focus on Latin America. Arq Bras Cardiol 2016; 107:576-589. [PMID: 28558081 PMCID: PMC5210462 DOI: 10.5935/abc.20160116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 12/25/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention. The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events. The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.
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Affiliation(s)
| | - Gregory Y H Lip
- City Hospital, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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