Central nervous system involvement in Chagas' disease: an updating

Detalhes bibliográficos
Autor(a) principal: Pittella, José Eymard Homem
Data de Publicação: 1993
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista do Instituto de Medicina Tropical de São Paulo
Texto Completo: https://www.revistas.usp.br/rimtsp/article/view/29013
Resumo: A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.
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spelling Central nervous system involvement in Chagas' disease: an updating Envolvimento do sistema nervoso central na doença de Chagas': revisão atual Chagas' diseaseChagasic encephalitisAcute nervous formImmuno-suppression A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients. Fez-se revisão da literatura publicada a respeito do envolvimento do sistema nervoso central (SNC) na doença de Chagas. A análise crítica dos 31 trabalhos existentes sobre a forma aguda nervosa e de outros 17 sobre a forma crônica nervosa, todos com estudo neuropatológico, permitiu estabelecer uma possível história natural do envolvimento do SNC na doença de Chagas, destacando-se entre outros fatos os seguintes: 1) a fase inicial, aguda, da infecção pelo Trypanosoma cruzi é usualmente assintomática, subclínica; 2) somente uma pequena percentagem de casos desenvolve encefalite na fase aguda da doença de Chagas; 3) as formas agudas sintomáticas acompanhadas de encefalite chagásica são graves, com morte em virtualmente todos os casos, resultante do próprio acometimento cerebral ou da miocardite chagásica aguda, geralmente intensa, sempre presente; 4) os indivíduos com a forma aguda assintomática e a forma aguda sintomática leve provavelmente não apresentam infecção do SNC ou, em alguns casos, exibem encefalite discreta, em focos esparsos, com involução total das lesões ou, então, com persistência de nódulos inflamatórios residuais relativamente insignificantes, não havendo, portanto, base anatômica que possa caracterizar a existência da forma crônica nervosa da doença de Chagas; 5) reativação da infecção no SNC na forma crônica da doença de Chagas é incomum e ocorre somente em pacientes imunossuprimidos. Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo1993-04-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/rimtsp/article/view/29013Revista do Instituto de Medicina Tropical de São Paulo; Vol. 35 No. 2 (1993); 111-116 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 35 Núm. 2 (1993); 111-116 Revista do Instituto de Medicina Tropical de São Paulo; v. 35 n. 2 (1993); 111-116 1678-99460036-4665reponame:Revista do Instituto de Medicina Tropical de São Pauloinstname:Instituto de Medicina Tropical (IMT)instacron:IMTenghttps://www.revistas.usp.br/rimtsp/article/view/29013/30870Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Pauloinfo:eu-repo/semantics/openAccessPittella, José Eymard Homem2012-07-02T01:35:00Zoai:revistas.usp.br:article/29013Revistahttp://www.revistas.usp.br/rimtsp/indexPUBhttps://www.revistas.usp.br/rimtsp/oai||revimtsp@usp.br1678-99460036-4665opendoar:2022-12-13T16:50:46.389359Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)true
dc.title.none.fl_str_mv Central nervous system involvement in Chagas' disease: an updating
Envolvimento do sistema nervoso central na doença de Chagas': revisão atual
title Central nervous system involvement in Chagas' disease: an updating
spellingShingle Central nervous system involvement in Chagas' disease: an updating
Pittella, José Eymard Homem
Chagas' disease
Chagasic encephalitis
Acute nervous form
Immuno-suppression
title_short Central nervous system involvement in Chagas' disease: an updating
title_full Central nervous system involvement in Chagas' disease: an updating
title_fullStr Central nervous system involvement in Chagas' disease: an updating
title_full_unstemmed Central nervous system involvement in Chagas' disease: an updating
title_sort Central nervous system involvement in Chagas' disease: an updating
author Pittella, José Eymard Homem
author_facet Pittella, José Eymard Homem
author_role author
dc.contributor.author.fl_str_mv Pittella, José Eymard Homem
dc.subject.por.fl_str_mv Chagas' disease
Chagasic encephalitis
Acute nervous form
Immuno-suppression
topic Chagas' disease
Chagasic encephalitis
Acute nervous form
Immuno-suppression
description A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.
publishDate 1993
dc.date.none.fl_str_mv 1993-04-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://www.revistas.usp.br/rimtsp/article/view/29013
url https://www.revistas.usp.br/rimtsp/article/view/29013
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://www.revistas.usp.br/rimtsp/article/view/29013/30870
dc.rights.driver.fl_str_mv Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
publisher.none.fl_str_mv Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
dc.source.none.fl_str_mv Revista do Instituto de Medicina Tropical de São Paulo; Vol. 35 No. 2 (1993); 111-116
Revista do Instituto de Medicina Tropical de São Paulo; Vol. 35 Núm. 2 (1993); 111-116
Revista do Instituto de Medicina Tropical de São Paulo; v. 35 n. 2 (1993); 111-116
1678-9946
0036-4665
reponame:Revista do Instituto de Medicina Tropical de São Paulo
instname:Instituto de Medicina Tropical (IMT)
instacron:IMT
instname_str Instituto de Medicina Tropical (IMT)
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reponame_str Revista do Instituto de Medicina Tropical de São Paulo
collection Revista do Instituto de Medicina Tropical de São Paulo
repository.name.fl_str_mv Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)
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