Fatal evolution of acute Chagas disease in a child from Northern Brazil: factors that determine poor prognosis

Trypanosoma cruzi is the causative agent of Chagas disease. Nowadays, the transmission in Brazil occurs mainly by oral ingestion of contaminated food that has been associated with more severe clinical manifestations. We report a case of Acute Chagas disease caused by oral transmission in a child fro...

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Bibliographic Details
Published in:	Revista do Instituto de Medicina Tropical de São Paulo Vol. 61; pp. e27 - 5
Main Authors:	Esper, Helena Rangel, Freitas, Vera Lucia Teixeira de, Assy, João Guilherme Pontes Lima, Shimoda, Erika Yoshie, Berreta, Olivia Campos Pinheiro, Lopes, Marta Heloisa, França, Francisco Oscar Siqueira
Format:	Journal Article
Language:	English
Published:	Brazil Instituto de Medicina Tropical de Sao Paulo 01-01-2019 Instituto de Medicina Tropical Instituto de Medicina Tropical de São Paulo Universidade de São Paulo (USP)
Subjects:	Acute Chagas disease Bacaba palm fruit Blood Case Report Chagas disease Children Clinical outcomes Disease Edema Food contamination & poisoning Hospitals Infections Medical diagnosis Medical prognosis Protozoa qPCR Tropical diseases TROPICAL MEDICINE Trypanosoma cruzi Brazil qPCR Children Bacaba palm fruit Acute Chagas disease Trypanosoma cruzi
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Summary:	Trypanosoma cruzi is the causative agent of Chagas disease. Nowadays, the transmission in Brazil occurs mainly by oral ingestion of contaminated food that has been associated with more severe clinical manifestations. We report a case of Acute Chagas disease caused by oral transmission in a child from Northern Brazil. In the hospital admission, physical examination showed tachycardia, hepatomegaly, bipalpebral edema and anasarca. Trypanosoma cruzi trypomastigotes were found in microscopy during blood cell count. Twenty-three days before hospitalization, the child had ingested the "bacaba palm fruit's wine". Even with the appropriate diagnosis and starting of treatment, she did not survive. Quantitative analysis of Trypanosoma cruzi DNA in a blood sample resulted in 54,053.42 parasite equivalents/mL and the DTU TcIV was identified. The outcome may have been determined by several factors, including the delay to seek a medical service beyond the high parasitemia, detected by qPCR. DTU TcIV could also have influenced the natural history of the disease.
Bibliography:	CONFLICT OF INTERESTS Helena Rangel Esper and Vera Lucia Teixeira de Freitas conceptualized and designed the study, drafted the initial manuscript and reviewed the manuscript; João Guilherme Pontes Lima Assy and Olivia Campos Pinheiro Berreta designed the data collection instruments, collected data, carried out the initial analyses and reviewed the manuscript; Erika Yoshie Shimoda carried out the molecular assays, the initial analyses and reviewed the manuscript; Marta Heloisa Lopes and Francisco Oscar Siqueira França conceptualized and designed the study, coordinated and supervised data collection, have written and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the study. AUTHORS' CONTRIBUTIONS The authors have no conflict of interests to disclose.
ISSN:	1678-9946 0036-4665 1678-9946
DOI:	10.1590/s1678-9946201961027