Clinical manifestations of peripheral nervous system involvement in human chronic chagas disease

Genovese, Osvaldo; Ballario, Carlos; Storino, Ruben; Segura, Elsa; Sica, Roberto E. R.

doi:10.1590/S0004-282X1996000200002

Abstracts

We conducted a clinical and electromyographical study in patients with Chagas' disease in the indeterminate or chronic stages of the illness. Altogether 841 patients were examined. Only 511 were admitted within the protocol; the remainder patients were rejected because they showed other causes able to damage the nervous system. Fifty two (10.17%) out of the 511 patients showed signs and symptoms of peripheral nervous system involvement in the form of sensory impairment and diminished tendon jerks suggesting the presence of neuropathy. Forty five of them were submitted to a conventional electromyographical examination. Fifteen of mem showed normal results, while the remainder 30 disclosed a reduced interference pattern, being most of the remaining motor unit potentials fragmented or poliphasic, reduced sensory and motor conduction velocities and diminished amplitude of the sensory action potential. The findings suggest that some chagasic patients in the indeterminate or chronic stages of the disease may develop a clinical mild sensory-motor peripheral neuropathy.

Chagas' disease; neuropathy; clinical assessment

El estúdio presente fue diseftado con ei objeto de pesquizar Ia existência de manifestaciones clinicas en pacientes afectados por enfermedad de Chagas, en estádio indeterminado o crônico, que tuviesen, ai menos, 2 reacciones serologicas positivas. En total fueron examinados 841 enfermos. De ellos solo 511 fueron admitidos en ei protocolo; los restantes fueron rechazados por mostrar Ia presencia de otras causas que hubiesen podido danar su sistema nervioso. Dentro de los 511 pacientes admitidos, 52 (10.17%) evidenciaron alteraciones objetivas y subjetivas de Ia sensibilidad y disminucion de los reflejos osteotendinosos. Estos signos y sintomas, que sugieren la presencia de neuropatia, podian combinarse de diferente manera. Como complemento dei examen clinico, se efectuo estúdio electromiografico convencional en 45 de estos pacientes. En 15 los hallazgos fueron normales, en tanto que en los restantes 30 pudo demostrarse reduccion de la capacidad de reclutamiento voluntário de unidad motora, presencia de potenciales de unidad motora fragmentados o polifasicos, reduccion de la velocidad de conduccion motora y sensitiva y disminucion de la amplitud dei potencial sensitivo. Los resultados obtenidos sefialan que una proporcion de los pacientes en el estádio indeterminado o crônico de la infeccion pueden desarrollar una moderada neuropatia sensitivo-motora con expresion clinica.

enfermedad de Chagas; neuropatia; evaluacion clinica

Clinical manifestations of peripheral nervous system involvement in human chronic chagas disease

Manifestaciones clinicas de compromiso del sistema nervioso periférico en el estádio crônico de la enfermedad de Chagas

Osvaldo Genovese^I; Carlos Ballario^II; Ruben Storino^III; Elsa Segura^III; Roberto E. R. Sica^I

^IDivision Neurologia, Hospital Ramos Mejia, Universidad de Buenos Aires, Buenos Aires

^IIHospital Centenário, Universidad de Rosário, Rosário, Santa Fe

^IIIInstituto para el Diagnostico y Tratamiento de la Enfermedad de Chagas Dr. Fatala Chaben, Buenos Aires

ABSTRACT

We conducted a clinical and electromyographical study in patients with Chagas' disease in the indeterminate or chronic stages of the illness. Altogether 841 patients were examined. Only 511 were admitted within the protocol; the remainder patients were rejected because they showed other causes able to damage the nervous system. Fifty two (10.17%) out of the 511 patients showed signs and symptoms of peripheral nervous system involvement in the form of sensory impairment and diminished tendon jerks suggesting the presence of neuropathy. Forty five of them were submitted to a conventional electromyographical examination. Fifteen of mem showed normal results, while the remainder 30 disclosed a reduced interference pattern, being most of the remaining motor unit potentials fragmented or poliphasic, reduced sensory and motor conduction velocities and diminished amplitude of the sensory action potential. The findings suggest that some chagasic patients in the indeterminate or chronic stages of the disease may develop a clinical mild sensory-motor peripheral neuropathy.

Key words: Chagas' disease, neuropathy, clinical assessment.

RESUMEN

El estúdio presente fue diseftado con ei objeto de pesquizar Ia existência de manifestaciones clinicas en pacientes afectados por enfermedad de Chagas, en estádio indeterminado o crônico, que tuviesen, ai menos, 2 reacciones serologicas positivas. En total fueron examinados 841 enfermos. De ellos solo 511 fueron admitidos en ei protocolo; los restantes fueron rechazados por mostrar Ia presencia de otras causas que hubiesen podido danar su sistema nervioso. Dentro de los 511 pacientes admitidos, 52 (10.17%) evidenciaron alteraciones objetivas y subjetivas de Ia sensibilidad y disminucion de los reflejos osteotendinosos. Estos signos y sintomas, que sugieren la presencia de neuropatia, podian combinarse de diferente manera. Como complemento dei examen clinico, se efectuo estúdio electromiografico convencional en 45 de estos pacientes. En 15 los hallazgos fueron normales, en tanto que en los restantes 30 pudo demostrarse reduccion de la capacidad de reclutamiento voluntário de unidad motora, presencia de potenciales de unidad motora fragmentados o polifasicos, reduccion de la velocidad de conduccion motora y sensitiva y disminucion de la amplitud dei potencial sensitivo. Los resultados obtenidos sefialan que una proporcion de los pacientes en el estádio indeterminado o crônico de la infeccion pueden desarrollar una moderada neuropatia sensitivo-motora con expresion clinica.

Palabras-chaves: enfermedad de Chagas, neuropatia, evaluacion clinica.

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Aceite: 24-Janeiro-1996.

Dr. R.E.R Sica - Division Neurologia, Hospital Ramos Mejia - Urquiza 609 - 1221 Buenos Aires - Argentina Fax 541 952 5658.

1. Chagas C. Les formes nerveuses d'un nouvelle trypanosomyase, T. Cruzi inocule par Tryatoma Megista. Nouv Iconogr Sapetriere 1913;26:1-10.
2. Collares-Moreira JV. A forma nervosa da moléstia de Chagas. Thesis, Faculdade de Medicina de Rio de Janeiro. Rio de Janeiro, 1925.
3. De Faria CR, Melo Souza SE, Rassi A. Evidencias eletromiograficas de desnervacao motora em pacientes na fase crônica da doença de Chagas. Rev Goiana Med 1977;23:125-130.
4. Esquivei M, Segura E. Estimacion dei numero de infectados chagasicos en Ia Argentina (carta al Editor). Medicina 1994;54:91-92.
5. Garcia Erro M, Genovese O, Correale J, Sica RER Neuromuscular transmission studies in human chronic Chagas' disease. Arq Neuropsiquiatr 1989;47:279-282.
6. Genovese O, Ballario C, Marelli E, Segura E, Riarte A, Sica RER Compromiso clinico del sistema nervioso periférico en la enfermedad de Chagas crônica humana. Rev Neurol Arg 1992;17:79-82.
7. Gonzalez Cappa SM, Sanz OP, Muller LA, Molina HA, Fernandez J, Rimoldi MT, Sica REP. Peripheral nervous system damage in experimental chronic Chagas' disease. Am J Trop Med Hyg, 1987;36:41-45.
8. Koberle F, Alcantara F. Mecanismo de destruição neuronal do sistema nervoso na moléstia de Chagas. Hospital 1960;57:1057-1060.
9. Losavio A, Jones M, Sanz OP, Mirkin G, Gonzalez Cappa SM, Muchnik S, Sica REP. A sequential study of the peripheral nervous system involvement in experimental Chagas' disease. Am J Trop Med Hyg 1989;41:539-546.
10. Losavio A, Sica REP, Sanz OP, Mirkin G, Gonzalez Cappa SM, Muchnik S. Functional changes of the sciatic nerve in mice chronically infected with Trypanosoma cruzi. Medicina 1993;53:129-132.
11. Mirkin G, Jones M, Sanz OP, Rey RD, Sica REP, Gonzalez Cappa SM. Experimental Chagas' disease: electrophysiology and cell composition of neuromyopatic inflammatory lesions in mice infected with myotropic and pantropic strains of Trypanosoma cruzi. Clin Immunol Immunopathol 1994;73:69-79.
12. Molina HA, Cardoni R, Rimoldi MT. The neuromuscular pathology of experimental Chagas' disease. J Neurol Sci 1987;81:287-291.
13. Said G, Joskowits M, Barreira A, Eisen H. The neuromuscular pathology of experimental Chagas' disease. Ann Neurol, 1985;18:676-681.
14. Sanz OP, Ariustimufto G, Ratusnu AF, O'Neill E, Sica REP. An electrophysiological investigation of skeletal muscle in human chronic Chagas' disease. Arq Neuropsiquiatr 1978;36:319-326
15. Sanz OP, Ratusnu AF, Aristimufío G, O'Neill E, Sica REP. Despoblacion de neuronas motoras alfa en la enfermedad de Chagas crônica. Medicina, 1977;37:551.
16. Sica REP, Filipini D, Panizza M, Fumo T, Basso S, Lazzari J, Molina HA. Involvement of the peripheral sensory nervous system in human chronic Chagas' disease. Medicina, 1986;46:662-669.
17. Sica REP, Genovese O, Garcia Erro M. Peripheral motor nerve conduction studies in patients with chronic Chagas' disease. Arq Neuropsiquiatr 1991;49:405-408.
18. Sica REP, Sanz OP, Aristimufío G, Basso S, Fumo T, Pagano M, Taratuto A, Ratusnu AF, Colombi A. Muscle denervation in chronic Chagas' disease. Medicina 1979;39:579-588.
19. Sica REP, Sanz OP, Colombi A. The effects of aging upon the human soleus muscle: an electrophysiological study. Medicina, 1976;36:443-448.
20. Storino R, Barragan H. Epidemiologia. In Storino R, Milei J (eds). Enfermedad de Chagas. Buenos Aires: J. Mosby 1994.
21. Vichi FL. Moléstia de Chagas experimental: parasitismo na cadeina ganglionar simpática, medula espinal, gânglio raquideano, e musculatura estriada. Hospital 1963;64:131-138.
22. Villela E, Magarinhos Torres CB. Estudo histopatologico do sistema nervoso central en paralisia experimental determinada pelo Schizotripanum cruzi. Mem Inst Oswaldo Cruz 1926;19:175-180.

Publication Dates

Publication in this collection
06 Dec 2010
Date of issue
June 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Chagas C. Les formes nerveuses d'un nouvelle trypanosomyase, T. Cruzi inocule par Tryatoma Megista. Nouv Iconogr Sapetriere 1913;26:1-10.

[2] 2. Collares-Moreira JV. A forma nervosa da moléstia de Chagas. Thesis, Faculdade de Medicina de Rio de Janeiro. Rio de Janeiro, 1925.

[3] 3. De Faria CR, Melo Souza SE, Rassi A. Evidencias eletromiograficas de desnervacao motora em pacientes na fase crônica da doença de Chagas. Rev Goiana Med 1977;23:125-130.

[4] 4. Esquivei M, Segura E. Estimacion dei numero de infectados chagasicos en Ia Argentina (carta al Editor). Medicina 1994;54:91-92.

[5] 5. Garcia Erro M, Genovese O, Correale J, Sica RER Neuromuscular transmission studies in human chronic Chagas' disease. Arq Neuropsiquiatr 1989;47:279-282.

[6] 6. Genovese O, Ballario C, Marelli E, Segura E, Riarte A, Sica RER Compromiso clinico del sistema nervioso periférico en la enfermedad de Chagas crônica humana. Rev Neurol Arg 1992;17:79-82.

[7] 7. Gonzalez Cappa SM, Sanz OP, Muller LA, Molina HA, Fernandez J, Rimoldi MT, Sica REP. Peripheral nervous system damage in experimental chronic Chagas' disease. Am J Trop Med Hyg, 1987;36:41-45.

[8] 8. Koberle F, Alcantara F. Mecanismo de destruição neuronal do sistema nervoso na moléstia de Chagas. Hospital 1960;57:1057-1060.

[9] 9. Losavio A, Jones M, Sanz OP, Mirkin G, Gonzalez Cappa SM, Muchnik S, Sica REP. A sequential study of the peripheral nervous system involvement in experimental Chagas' disease. Am J Trop Med Hyg 1989;41:539-546.

[10] 10. Losavio A, Sica REP, Sanz OP, Mirkin G, Gonzalez Cappa SM, Muchnik S. Functional changes of the sciatic nerve in mice chronically infected with Trypanosoma cruzi. Medicina 1993;53:129-132.

[11] 11. Mirkin G, Jones M, Sanz OP, Rey RD, Sica REP, Gonzalez Cappa SM. Experimental Chagas' disease: electrophysiology and cell composition of neuromyopatic inflammatory lesions in mice infected with myotropic and pantropic strains of Trypanosoma cruzi. Clin Immunol Immunopathol 1994;73:69-79.

[12] 12. Molina HA, Cardoni R, Rimoldi MT. The neuromuscular pathology of experimental Chagas' disease. J Neurol Sci 1987;81:287-291.

[13] 13. Said G, Joskowits M, Barreira A, Eisen H. The neuromuscular pathology of experimental Chagas' disease. Ann Neurol, 1985;18:676-681.

[14] 14. Sanz OP, Ariustimufto G, Ratusnu AF, O'Neill E, Sica REP. An electrophysiological investigation of skeletal muscle in human chronic Chagas' disease. Arq Neuropsiquiatr 1978;36:319-326

[15] 15. Sanz OP, Ratusnu AF, Aristimufío G, O'Neill E, Sica REP. Despoblacion de neuronas motoras alfa en la enfermedad de Chagas crônica. Medicina, 1977;37:551.

[16] 16. Sica REP, Filipini D, Panizza M, Fumo T, Basso S, Lazzari J, Molina HA. Involvement of the peripheral sensory nervous system in human chronic Chagas' disease. Medicina, 1986;46:662-669.

[17] 17. Sica REP, Genovese O, Garcia Erro M. Peripheral motor nerve conduction studies in patients with chronic Chagas' disease. Arq Neuropsiquiatr 1991;49:405-408.

[18] 18. Sica REP, Sanz OP, Aristimufío G, Basso S, Fumo T, Pagano M, Taratuto A, Ratusnu AF, Colombi A. Muscle denervation in chronic Chagas' disease. Medicina 1979;39:579-588.

[19] 19. Sica REP, Sanz OP, Colombi A. The effects of aging upon the human soleus muscle: an electrophysiological study. Medicina, 1976;36:443-448.

[20] 20. Storino R, Barragan H. Epidemiologia. In Storino R, Milei J (eds). Enfermedad de Chagas. Buenos Aires: J. Mosby 1994.

[21] 21. Vichi FL. Moléstia de Chagas experimental: parasitismo na cadeina ganglionar simpática, medula espinal, gânglio raquideano, e musculatura estriada. Hospital 1963;64:131-138.

[22] 22. Villela E, Magarinhos Torres CB. Estudo histopatologico do sistema nervoso central en paralisia experimental determinada pelo Schizotripanum cruzi. Mem Inst Oswaldo Cruz 1926;19:175-180.

Brasil

Brasil

Clinical manifestations of peripheral nervous system involvement in human chronic chagas disease

Manifestaciones clinicas de compromiso del sistema nervioso periférico en el estádio crônico de la enfermedad de Chagas

Abstracts

Publication Dates