Enfermedad de Chagas de transmisión oral, una emergencia pediátrica: Revisión de dos brotes escolares en Venezuela

Abstract

El escenario epidemiológico de la Enfermedad de Chagas (ECh) se ha modificado por efecto de la migración de latinoamericanos infectados, la presencia de vectores fuera del área endémica, la capacidad vectorial de otros artrópodos y la trasmisión oral a humanos de Trypanosoma cruzi (Tc). En Venezuela se han reportado las microepidemias más numerosas de ECh de transmisión oral (EChO), afectando principalmente a niños. La presencia de fiebre prolongada, edema facial, síntomas generales y otros sugestivos de miocarditis, debe orientarnos a la sospecha de EChO, sobre todo si hay varias personas con sintomatología similar y nexo epidemiológico entre ellas. La elevada morbilidad y mortalidad de la EChO hacen de esta entidad una emergencia sobre todo en población infantil. La determinación simultanea de IgG e IgM especifica aumenta la sensibilidad del diagnóstico serológico, la demostración de Tc y del genotipo circulante debe realizarse con métodos parasitológicos y moleculares. El tratamiento antiparasitario es mejor tolerado por los niños, pero a pesar de aplicarse tempranamente fue efectivo solo en 60% de los pacientes a los 10 años de seguimiento. La EChO puede simular otras infecciones, pero es necesario sospecharla para el pronto diagnóstico y administración temprana del tratamiento evitando la mortalidad.

The epidemiological scenario of Chagas Disease (ChD) has been modified by the effect of the migration of infected Latin Americans, the presence of vectors outside the endemic area, the vectorial capacity of other arthropods and the oral transmission of Trypanosoma cruzi (Tc) to humans. Acute Tc infection constitutes an emergency and when it affects children the risk of a fatal outcome increases. The consultation of review articles corresponding to three Latin American countries Brazil, Colombia and Venezuela reporting on acute cases of oral infection by Tc, suggests that the most numerous microepidemics of orally transmitted ChD (OChD) occurred in two schools Artículo Especial 14 I Rev. Hosp. Niños (B. Aires) 2023;65(288):13-22 / Artículo Original Alarcón de Noya B, et al. in Venezuela, affecting children mostly. The presence of prolonged fever, facial edema, general symptoms and others suggestive of myocarditis should lead us to suspect OChD, especially if there are several people with similar symptoms and an epidemiological link between them. The high morbidity and mortality of OChD make this entity an emergency, because morbidity and mortality are frequent in the child population. The simultaneous determination o f s pecific Ig G an d Ig M in creases the sensitivity of the serological diagnosis, the demonstration of Tc is more feasible in these acute cases, but the number of people affected limits the coverage of the parasitological diagnosis. Determination of parasitic DNA in all exposed persons is desirable because it is more sensitive than parasitological diagnosis and is useful for subsequent evaluation of treatment efficacy; however, the urgency of administering anti-parasitic treatment did not allow access to a second pretreatment sample for this purpose. The circulating genotype was characterized more for epidemiological investigation than as a diagnostic requirement. The antiparasitic treatment is better tolerated by children with OChD, but despite being applied early it was effective only in 60% of patients at 10 years of follow-up,based on serologyand parasiteDNAdeterminations. OChD can mimic other infections, but it is necessary to suspect it for prompt diagnosis and early administration of treatment, avoiding mortality.