From Big Medical Encyclopedia

SHAGASA BOLYoZNB (S. of Chagas, Brazilian doctor, 1879 — 1934; synonym; the American trypanosomiasis, Chagas's disease) — protozooz, characterized by fever, a hyperadenosis, it is frequent development of primary affect on skin or a conjunctiva, sometimes severe damage of heart and central nervous system.

Distinguish acute and chronic stages of a disease.

In 1907, the Brazilian scientific Sha-died away * found a trypanosome of Trypanosoma cruzi in intestines of the flying bugs, and in 1909 described to a zabole-bathtub of the person, at Krom allocated a trypanosome (see), identical found it at a bug.

The disease is eurysynusic in the majority of the countries Southern and Central America. According to the Pan-American organization of health care (1974), in the countries of Latin America from 1969 to 1972 it was registered apprx. 10 million Sh. are sick *.

Etiology. Disease-producing factor of Shagas Trypanosoma cruzi Chagas, 1909. The trypanosome has length apprx. 20 microns and width apprx.

2 microns. it is mobile, supplied with a flagellum. In a human body and mammals of a trypanosome are carried by blood and get into cells of internals and fabrics where turn into a leyshmanialny form (roundish educations without flagellum). In the struck cells there is a reproduction of parasites to formation of the following form — amastigota. Then amastigota turn into t-shaped tripomast» Gotha, having a flagellum; they destroy a cell and again come to blood.

Epidemiology. Distinguish natural and synanthropic focuses of the disease. In the natural centers sources of disease-producing factors are battleships, opossums, rodents, monkeys, etc.; in the synanthropic centers — the person, and also domestic animals (dogs, cats, pigs, etc.). Carriers of the activator — the flying bugs (see Bugs) relating to types of Bhodnius prolixus, Triatoma infestans, Panstron-gylus meglstus, etc. Bugs differ in bright coloring, length of their 15 — 35 mm; quite often they live in premises, sheds, holes of synanthropic rodents. Bugs attack the person and animals at night; bite the person more often in a face, especially in lips why received the name of potseluyny bugs. Infection of bugs occurs at food the blood of sick people or animals containing tripo-mastigota. In intestines of bugs parasites breed, transformed in invasive trypanosomes and in 15 — 30 days are allocated with excrements. Bugs keep trypanosomes during all life — apprx.

2 years. The trypanosomes allocated during krovo-suction with excrements of bugs get into a human body or animals through the injured skin (including in the place of a sting of a bug) and mucous membranes of eyes. Endemicity of III. is defined by the conditions promoting distribution of bugs in settlements.

Pathogeny and pathological anatomy. On site implementations of trypanosomes primary affect (shagoma) — the inflammatory infiltrate which is followed limfangiity and increase regional limf, nodes can develop. As a result of a hematogenous dissemi-yaation of a trypanosome get into various bodies and fabrics: heart, a head and spinal cord, a liver, a spleen, went. - kish. path, kidneys, adrenal glands, skeletal muscles, etc. Reproduction of parasites, their toksiko-allergic influence, autoallergichesky reactions lead to inflammatory and dystrophic changes, hemorrhages. Most jumps are found in a myocardium, a liver, intestines, a brain. Diffusion myocarditis develops (see). Further upon transition of a disease in hron. a stage the peculiar cardiomyopathy (see) caused by defeat of the carrying-out system of heart is observed.

On opening considerable expansion of cardial cavities, thinning and protrusion of an apical part of a left ventricle with formation of an anevrnzkhma come to light (see Aneurism of heart). Expansion of nek-ry departments of a digestive tract is observed, is more often than a gullet and a large intestine, them the disturbance of a vegetative innervation caused by defeat of intramural neuroplexes is the reason.

Infection of a fruit through a placenta from mother, sick Sh. is possible.

Clinical picture. Incubation interval of 5 — 14 days. Acute stage of Sh. it is observed preferential at children aged from 1 year up to 5 years and the adults coming in endemic on III. districts. The disease begins with an indisposition, a fever, a headache, muscular pains. Temperature increases to 39 — 40 °, has remittiruyu-shchy or constant character. Primary affect which is formed quite often on site implementations of trypanosomes reminds a furuncle by outward, but never suppurates. At implementation of a parasite through a mucous membrane of an eye primary affect is shown in the form of a so-called symptom complex of Romagna: conjunctivitis, swelled a century, with increase regional limf, nodes. The liver, spleen and peripheral limf, nodes are increased. In blood — a leukocytosis with limfomo-notsitozy.

Changes of heart — one of the main manifestations of an acute stage of a disease. Its borders are expanded, tones are muffled, the cantering rhythm is sometimes listened (see Gallop a rhythm). In hard cases heart failure develops and accrues. The heaviest manifestation of an acute stage of a disease is menpngoentsefalit, almost always from the death. From defeats of other bodies are described an orchitis (see), an epididymite (see) and parotitis (see). The acute stage proceeds 4 — 5 weeks then clinical manifestations disappear, and process accepts a chronic current. This stage of Sh. can proceed without clinical manifestations (latentno) or it is characterized by changes from heart. Patients complain of an asthma, heartbeat, pains in heart. Borders of heart are expanded, tones are muffled, pulse of small filling, the ABP is reduced, are noted splitting of the II tone at a top of heart and on a pulmonary artery, systolic noise at a top of heart and at bottom edge of a breast, premature ventricular contraction. The expressed changes on an ECG in the form of disturbances of vnutrizhelu-dochkovy conductivity are characteristic. The total block of the right leg of a ventriculonector is especially often observed (see the Heart block). Current hron. Sh.'s stages. long. Gradually the heart failure leading, as a rule, to a lethal outcome progresses. Also cases of sudden death from an acute heart failure are described, a cut fibrillation of ventricles, a thromboembolism or a rupture of aneurism of heart can be the cause. Frequent manifestations of Sh. in hron. stages happen changes of a digestive tract to expansion of its departments. At the same time there are abdominal pains, disturbance of swallowing, abdominal distention, locks.

The diagnosis in an acute stage of III. it is put on the basis of data of Epi-demiol. anamnesis, wedge, pictures and laboratory researches. Usually investigate blood on existence of trypanosomes; at a negative take — material from primary affect, cerebrospinal liquid, punctates limf, nodes, a spleen and marrow. In hron. stages of a trypanosome seldom are found in blood and fabrics. Apply reaction of binding complement to confirmation of the diagnosis (see), and also carry out a biological test on white mice, entering it blood of the patient with the subsequent research on trypanosomes of blood of an animal.

Treatment yields positive takes of hl. obr. in an acute stage of a disease. Use the drugs containing derivatives of quinoline (Primachinum, Chinocidum, arsenobenzosulfat). The symptomatic treatment generally consists in purpose of cardiacs.

P r about of N about z. The absolute recovery is observed seldom. Timely begun treatment in an acute stage of a disease promotes its more favorable current and reduces a lethality to 10%. In hron.

stages only the treatment begun at emergence of initial symptoms of heart failure is effective.

Prevention consists in improvement a dignity. - a gigabyte. living conditions of the population and in fight against the blood-sicking flying clones — processing by insecticides of walls, ceilings of premises, holes of rodents; seal of cracks in rooms. In districts, endemic according to Sh., obligatory examination of blood of donors by means of reaction of binding complement is conducted; for protection against attack of bugs it is recommended to sleep under bed curtains (see. Protecting screens).

See also Trypanosomiasis. Bibliography: Infectious diseases in the countries of America in 1969 — 1972, the Chronicle of WHO, t. 29, No. 8, page 415, 1975; Kassirsky I. A. and P l about t of N and to about in H. H. Diseases of tropical countries, page 137, M., 1964; Kireev P. M. Diseases of internals in tropical countries, page 41, M., 1978; Kireev P. M. and A. I Bales. American trypanosomiasis, M., 1981;

Committee of experts in a trypanosomiasis, lane with English, Geneva, WHO, 1963; JI about-ban K. M. and Carpenters of H. H. Lectures on infectious and parasitic diseases, p.1, page 256, M., 1970; Tropical diseases, under the editorship of E. P. Shuvalova, page 347, M., 1979; With ha gas C. Nova tripanozomiaze Humana, Mem. Inst. Osw., v. 1, p. 159, 1909. P. M. Kireev.