Chagas Disease in Postmortem Examination. Analysis of 11 Autopsies in Bucaramanga, Colombia
JC Mantilla-Hernandez, JA Diaz-Perez, P Aranda-Valderrama, EA Castilla. Universidad Industrial de Santander, Bucaramanga, Santander, Colombia; Fundacion Para el Avance de la Anatomia Patologica, Citologia y Clinica Molecular, Bucaramanga, Santander, Colombia; Bethesda North Hospital, Cincinnati, OH; University of Cincinnati, Cincinnati, OH
Background: Chagas disease (CD) is an important cause of morbidity and mortality in South America. Involvement of heart, esophagus and colon has been typically found in Tripanosoma cruzi infection.
Design: A prospective descriptive study was conducted in autopsies performed at the Hospital Universitario de Santander in Bucaramanga, Colombia, from January 2002 to May 2009.
Results: Out of 682 non-perinatal autopsies performed, 11 cases of CD (1.8%) were identified. The mean age was 29 years; the study included nine men and two women. In only one of them (9.1%), a correct premortem diagnosis of CD was rendered. The erroneous/inaccurate clinical pre-mortem diagnosis included: Hantavirus infection (2), exogenous intoxication (2), cytomegalovirus infection in kidney transplant recipient (1), pneumonia (1), central nervous system (CNS) tumor (1), cerebral toxoplasmosis in AIDS (1), infective endocarditis (1), and heart failure, not otherwise specified (1). In all the cases the presence of trypanosomiasis was documented histologically. All eleven cases showed evidence of cardiac involvement. Esophageal involvement was found in a single case, and CNS involvement was found also in one case. In every case the cause of death was ultimately related to CD. The presumed route of transmission included: Oral transmission (five cases), triatominae bite (four cases), reactivation of chronic CD due to AIDS-related immunosuppresion (one case), and reactivation after immunosuppressive therapy for renal transplantation (one case).
Conclusions: Despite the fact that CD is endemic in some regions of South America, a correct premortem diagnosis of CD is only rendered in a minority of cases. Cardiac involvement remains the most common -and frequently the only- manifestation of T. cruzi infection. Reactivation after immunosuppresion should be considered in endemic and non-endemic geographic regions.
Monday, March 22, 2010 2:00 PM
Platform Session: Section G, Monday Afternoon