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Epidemiology of concurrent Chagas disease and ischemic stroke in a population attending a multicenter quaternary rehabilitation network in Brazil

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Abstract

Background and purpose

Chagas disease and ischemic stroke (IS) have a close but poorly understood correlation. In endemic settings, continued transmission over time has resulted in increasing prevalence of both asymptomatic infection and cardiomyopathy with increasing age. Latin America has made substantial progress towards Chagas disease control. Although several epidemiological studies have been conducted, information regarding epidemiology and distribution of IS in Chagas disease is still lacking.

Methods

We retrospectively studied the electronic medical record data of all patients with both IS and Chagas disease admitted at SARAH Hospitals across Brazil from 2009 to 2013 to make epidemiological quantifications and statistical inferences.

Results

A total of 279 patients with Chagas disease and IS were analyzed from 7729 IS-related admissions, indicating a median prevalence of 3.6% of Chagas disease in IS patients in our cohort. Mean age was 60 years, with female predominance (65%). Most of the cases were from Bahia (61%), followed by Minas Gerais (19%) and Goiás (9.7%). Low-income cities, with decreased access to healthcare, showed the highest number of cases. Distribution of vascular risk factors and outcome after stroke differed among the units. According to current guidelines, secondary prevention was inadequate in 60% of patients.

Conclusions

Chagas disease was common in IS patients; prevalence of concurrent Chagas disease and IS was high in some regions of the country. However, the infection frequency seems to be reduced in the last few years. Public health issues for improving the treatment of Chagas disease and IS are urgently needed.

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Abbreviations

IS:

Ischemic stroke

CT:

Computed tomography

MRI:

Magnetic resonance imaging

mRS:

Modified Rankin Scale

SSS-CCS:

Stop Stroke Study Causative Classification System

TOAST:

Trial of ORG 10172 in Acute Stroke Treatment

References

  1. Chagas C (1909) New human trypanosomiasis: studies in the morphology and the evolutionary cycle of the Schizotrypanum cruzi n. Gen., n. SP Etiologic Agent of new morbid entity in man. Mem Inst Oswaldo Cruz 1:159–218

    Article  Google Scholar 

  2. F.J. Carod-Artal, J. Gascon J, Chagas disease and stroke, Lancet Neurol, (2010) 533–542, 9

    Article  Google Scholar 

  3. Carod-Artal FJ, Vargas AP, Melo M, Horan TA (2003) American trypanosomiasis (Chagas’ disease): an unrecognised cause of stroke. J Neurol Neurosurg Psychiatry 74:516–518

    Article  CAS  Google Scholar 

  4. Lima-Costa MF, Firmo JOA, Uchoa E (2011) Cohort profile: the Bambuí (Brazil) cohort study of ageing. Int J Epidemiol 40:862–867

    Article  Google Scholar 

  5. Lima-Costa MF, Matos DL, Ribeiro AL (2010) Chagas disease predicts 10-year stroke mortality in community-dwelling elderly. Stroke 41:2477–2482

    Article  Google Scholar 

  6. Dias JCP, Matos CS (2013) Seventy years of the Chagas Bambuí project: celebration and perspectives. Rev Soc Bras Med Trop 46:533–535

    Article  Google Scholar 

  7. Paixão LC, Ribeiro AL, Valaccio RA, Teixeira AL (2009) Chagas disease: independent risk factor for stroke. Stroke 40:3691–3694

    Article  Google Scholar 

  8. Matos CS, Junior JES, Medeiros FA, Furtado E, Dias JCP (2014) Current situation and perspectives regarding human Chagas disease in midwestern of the state of minas Gerais, Brazil. Mem Inst Oswaldo Cruz 109:374–378

    Article  Google Scholar 

  9. Santos VRC, Meis J, Savino W, Andrade JAA, Vieira JRS, Coura JR, Junqueira ACV (2018) Acute Chagas disease in the state of Pará, Amazon region: is it increasing? Mem Inst Oswaldo Cruz 113:e170298

    PubMed  PubMed Central  Google Scholar 

  10. Bern C (2015) Chagas disease. N Engl J Med 373:456–466

    Article  CAS  Google Scholar 

  11. Coura JR, Junqueira ACV, Ferreira JM (2018) Surveillance of seroepidemiology and morbidity of Chagas disease in the Negro River, Brazilian Amazon. Mem Inst Oswaldo Cruz 113:17–23

    Article  Google Scholar 

  12. Oliveira-Filho J, Viana LC, Vieira de Melo RM, Faiçal F, Torreão JA, Villar FA, Reis FJ (2005) Chagas disease is an independent risk factor for stroke: baseline characteristics of a Chagas disease cohort. Stroke. 36:2015–2017

    Article  Google Scholar 

  13. Carvalho JAM (1963) Tromboembolismo na doença de Chagas em Pernambuco– considerações em torno da incidência em material de necrópsia. Rev Bras Malaria Doenças Tropicais 3:611–616

    Google Scholar 

  14. Montanaro VVA, Hora TF, Silva CM, Santos CVV, Lima MIR, Negrão EM, Ribeiro DSM, Oliveira EMJ, de Freitas GR (2018) Mortality and stroke recurrence in a rehabilitation cohort of patients with cerebral infarcts and Chagas disease. Eur Neurol 79:177–184

    Article  Google Scholar 

  15. Ay H, Benner T, Arsava EM, Furie K, Singhaal A, Jensen MB, Ayata C, Towfighi A, Smit EE, Chong JY, Koroshetz WJ, Sorensen AG (2007) A computerized algorithm for etiologic classification of ischemic stroke: the causative classification of stroke system. Stroke 39:2979–2984

    Article  Google Scholar 

  16. H. Ay, Causative classification system for ischemic stroke. https://ccs.mgh.harvard.edu/ccs_title.php. Accessed from January 15 to May 10, 2017

  17. Montanaro VVA, Silva CM, Santos CVV, Lima MIR, Negrão EM, de Freitas GR (2016) Ischemic stroke classification and risk of embolism in Chagas disease. J Neurol 263:2411–2415

    Article  CAS  Google Scholar 

  18. Andrade JP, Neto JAM, Paola AAV, Vilas-Boas F, Oliveira GMM, Bacal F, Bocchi EA, Almeida DR, Fragata Filho AA, Moreira Mda C, Xavier SS, Oliveira Junior WA, Dias JC (2011) Latin American Guidelines for the Diagnosis and Treatment of Chagas’ Heart disease: executive summary. Arq Bras Cardiol 96:434–442

    Article  Google Scholar 

  19. Martins-Melo FR, Ramos AN Jr, Alencar CH, Heukelbach J (2014) Prevalence of Chagas disease in Brazil: a systematic review and meta-analysis. Acta Trop 130:167–174

    Article  Google Scholar 

  20. Martins MFS, Pereira MB, Ferreira JJG, França AO, Cominetti MC, Ferreira EC, Dorval MEMC, Rossi CL, Mazon SB, de Almeida DA, Costa SCB, Marcon GEB (2018) Serological and molecular inquiry of chagas disease in an Afro-descendant settlement in mato Grosso do Sul state, Brazil. PLoS One 13:e0189448

    Article  Google Scholar 

  21. Freitas YBN, Souza CSF, Magalhães JM, Souza MLR, d’Escoffer LN, Valle TZ, Gonçalves TCM, Gil-Santana HR, Kazimoto TA, Amora SSA (2018) Natural infection by Trypanosoma cruzi in triatomines and seropositivity for Chagas disease of dogs in rural areas of Rio Grande do Norte, Brazil. Rev Soc Med Trop 51:190–197

    Article  Google Scholar 

  22. Martin-Melo FR, Ramos AN Jr, Alencar CH, Heukelbach J (2014) Prevalence of Chagas disease in Brazil: a systematic review and meta-analysis. Acta Trop 130:167–174

    Article  Google Scholar 

  23. Boletim epidemiológico (2015). Secretaria de vigilência em saúde – Ministério da saúde. 46:21; 1–9

  24. Gasparim AZ, Fontes CER, Rossoni DF, Toledo MJO (2018) Epidemiological and clinical profile of patients with Chagas disease in the central-north area of Paraná, southern Brazil. Rev Soc Bras Med Trop 51:225–230

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank the SARAH Network of Rehabilitation Hospitals for providing the means and time for completion of this research paper.

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Authors and Affiliations

  1. SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil

    Vinícius Viana Abreu Montanaro, Thiago Falcão Hora & Eleonora Maria de Jesus Oliveira

  2. Neurological Rehabilitation Program, SARAH Network of Rehabilitation Hospitals, Brasília, Brazil

    Creuza Maria da Silva, Carla Verônica de Viana Santos & Maria Inacia Ruas Lima

  3. D’Or Institute for Research and Education, Universidade Federal Fluminense, Rio de Janeiro, Brazil

    Gabriel R. de Freitas

Authors
  1. Vinícius Viana Abreu Montanaro
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  2. Thiago Falcão Hora
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  3. Creuza Maria da Silva
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  4. Carla Verônica de Viana Santos
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  5. Maria Inacia Ruas Lima
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  6. Eleonora Maria de Jesus Oliveira
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  7. Gabriel R. de Freitas
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Corresponding author

Correspondence to Vinícius Viana Abreu Montanaro.

Ethics declarations

As stated in the Methods section of the manuscript, the ethics committee of the SARAH Network of Hospitals approved our study protocol and the requirement for patient consent was waived by the committee. This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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The authors declare that they have no conflict of interest.

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Figure 2

(Supplemental material): Geographical distribution of Chagas disease and ischemic stroke based on naturality; numbers represent absolute frequency (JPG 400 kb)

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Montanaro, V.V.A., Hora, T.F., da Silva, C.M. et al. Epidemiology of concurrent Chagas disease and ischemic stroke in a population attending a multicenter quaternary rehabilitation network in Brazil. Neurol Sci 40, 2595–2601 (2019). https://doi.org/10.1007/s10072-019-04018-8

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  • DOI: https://doi.org/10.1007/s10072-019-04018-8

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