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Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.34 no.6 São Paulo Nov./Dec. 1992

http://dx.doi.org/10.1590/S0036-46651992000600015 

PONTO DE VISTA

 

Patogênese da miocardite chagásica crônica: o papel de fatores autoimunes e microvasculares

 

Chronic chagasic myocarditis pathogenesis: dependence on autoimmune and microvascular factors

 

 

Marcos A. RossiI; José O. MengelII

IDepartamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Pesquisador 1A do Conselho Nacional de Desenvolvimento Científico e Tecnológico (Proc. 301109/79-6)
IIDepartamento de Parasitologia, Microbiologia e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Endereço para correspondência

 

 


RESUMO

A patogênese da miocardite chagásica crônica permanece incompletamente compreendida. Diferentes hipóteses têm sido propostas: (1) lesão direta do tecido pelo Trypanosoma cruzi;(2) teoria neurogênica; (3) reações imunológicas anti-miocárdio; e (4) doença microvascular. Apresentamos, no presente trabalho, uma hipótese alternativa. Acreditamos que o desenvolvimento da miocardite está relacionado à necrose celular focal progressiva e acumulativa, associada à fibrose intersticial reparativa e reativa e hipertrofia miocitária circunjacente. Esses processos seriam iniciados e perpetuados por fatores autoimunes e alterações na microcirculação do miocárdio. Esse mecanismo fisiopatogênico teria possíveis implicações em futuras estratégias terapêuticas no tratamento do paciente chagásico crônico visando otimizar o tratamento médico e auspiciosamente melhorar o prognóstico.

Unitermos: Miocardite chagásica crônica; Doença de Chagas; Trypanosoma cruzi; Cardiopatia chagásica; Miocardite.


SUMMARY

The pathogenesis of chronic chagasic myocarditis remains incompletely understood. Several hypotheses have been proposed: (1) direct tissue destruction by Trypanosoma cruzi; (2) neurogenic theory; (3) anti-heart immune reactions; and (4) microvascular disease. We present herein a dynamic alternative hypothesis. We believe that the development of myocarditis is related to progressive and additive focal cellular necrosis, and associated reactive and reparative myocardial fibrosis and surrounding myocytes hypertrophy. These processes may be initiated and perpetuated by autoimmune factors and alterations in the myocardial microcirculation. This could imply future therapeutic strategies in the management of chronic chagasic patients to optimize the medical treatment and hopefully improve the prognosis.


 

 

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Endereço para correspondência:
Prof. Dr. Marcos A. Rossi
Professor Titular de Patologia, Departamento de Patologia
Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
14049 - Ribeirão Preto, S.P., Brasil

Recebido para publicação em 26/03/1992.
Aceito para publicação em 22/05/1992.
Financiado pelo Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

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