The chronic nervous form of Chagas’ disease

Abstract

The chronic form of Chagas' disease presents its main aspect as a cardiopathia, clinically, anatomicopathologically, radiologically and eletrocardiographically well characterized, Under this aspect the disease is well known through all the country, where its effects in certain regions show an endemic character. But things are different with the chronic neurologic form of the disease whose most frequent manifestations are the infantile encephalopathy about which Chagas and the Oswaldo Cruz Institute have published several works, proving anatomicopathologically and experimentally its clinical existence. In Argentine, Mazza et al. presented also neurologic patients of the American trypanosomiasis, publishing cases that very much resembled those related by Brazilian authors. The initial objections of Krauss, Maggio, Rosenbush, Mc Carrison and others who declared the similitude between the schizotrypanic encephalopathy and the common manifestations of the endemic cretinism still find followers in some modern authors. They doubt or even deny the existence of the neurologic form of Chagas' disease. The authors of the present paper describe a case of infantile encephalopathy - hemiplegic spastic form - with hemiathetosis and mental deficiency, to what they give a schizotrypanic etiology. They name it, after a diagnosis of exclusion, as a chronic neurologic form of Chagas' disease. The patient had arrived from an endemic region. The houses in which he had lived were infested by “barbeiros” - reduviidae - that are the biological vectors of the disease. When the patient was two years old he had been ill and became a hemiplegic. He had never been sick before. When the patient was twenty years old he entered the Hospital, complaining of dyspnea, mostly at night. Reactions for syphilis in the blood or liquor, repeatedly made were negative. Ecg. partly marred by the extrapyramidal tremor, showed myocardial damage.

The reaction of Machado Guerreiro was positive (++++) in the blood and negative in the liquor, Inoculation with the spinal fluid was not executed. The authors dealt with a patient that had been ill for a long time - twenty years - and they could scarcely obtain any satisfactory datum with this exam. The authors name this case, after a diagnosis of exclusion, as a chronic form of the neurotrypanosomiasis.