On an acute case of Chagas disease in a region under vector control in the state of São Paulo, Brazil

Resumo

No vector transmitted cases of Chagas disease had been notified in the state
of São Paulo since the 1970s. However, in March, 2006, the death of a sixyear-
old boy from the municipality of Itaporanga was notified to the Center
for Epidemiological Survey of the São Paulo State Health Secretariat: an
autochthonous case of acute Chagas disease. The postmortem histopathological
examination performed in the Hospital das Clínicas of the Botucatu School of
Medicine confirmed the diagnosis. Reference to hospital records, consultation
with the health professionals involved in the case and interviews with members
of the patient’s family supplied the basis for this study. We investigated parasite
route of transmission, probable local reservoirs and vectors. No further human
cases of acute Chagas disease were diagnosed. No locally captured vectors or
reservoirs were found infected with Trypanosoma cruzi. Alternative transmission
hypotheses - such as the possible ingestion of foods contaminated with vector
excreta - are discussed, as well as the need to keep previously endemic regions
and infested houses under close surveillance. Clinicians should give due attention
to such signs as uni- or bilateral palpebral edema, cardiac failure, myocarditis,
pericarditis, anasarca and atypical signs of nephrotic syndrome or nephritis and
consider the diagnostic hypothesis of Chagas disease.