ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Global leprosy situation, World Health Organization, 2010. Wkly Epidemiol Rec 33: 333–340.
-
2.
Bolletin de la Organizacion Panamericana de la Salud, 2006. Estimacion Cuantitativa de la Enfermedad de Chagas en las Americas. Montevideo, Uruguay: OPAS.
-
3.
Portal de Saúde. Available at: http://portal.saude.gov.br/portal/saude/profissional/area.cfm?id_area=1466. Accessed September 29, 2010.
-
4.
Ridley DS, Jopling WH, 1966. Classification of leprosy according to immunity: a five-group system. Int J Lepr 34: 255–273.
-
5.
Naafs B, Wheate HW, 1978. The time interval between the start of anti-leprosy treatment and the development of reactions in borderline patients. Lepr Rev 49: 153–157.
-
6.
Kahawita IP, Lockwood DN, 2008. Towards understanding the pathology of erythema nodosum leprosum. Trans R Soc Trop Med Hyg 102: 329–337.
-
7.
Higuchi ML, Benvenuti LA, Reis MM, Metzger M, 2003. Pathophisiology of the heart in Chagas'disease: current status and new developments. Cardiovasc Res 60: 96–107.
-
8.
Bilate AMB, Cunha-Neto E, 2008. Chagas disease cardiomyopathy: current concepts of an old disease. Rev Inst Med Trop Sao Paulo 50: 67–74.
-
9.
Hotez PJ, Pecoul B, 2010. “Manifesto” for advancing the control and elimination of neglected tropical diseases. PLoS Negl Trop Dis 4: e718.
-
10.
Diniz O, 1948. Lepra e doença de Chagas. Arq Min Leprol 8: 155–169.
-
11.
Dias JCP, Cunha DA, 1970. Hanseníase e doença de Chagas. Estudos realizados no Sanatório São Francisco de Assis, em Babuí, Minas Gerais. Rev Soc Bras Med Trop 4: 31–43.
-
12.
Bottasso OA, Morini JC, 1993. Electrocardiographic alterations in lepromatous leprosy patients with concomitant Trypanosoma cruzi infection. Int J Lepr 61: 468–471.
-
13.
Mathur SN, Itigi A, Krishnaveni A, Rao PD, 1976. Congestive heart failure in two patients with lepromatous leprosy. Lepr India 48: 75–80.
-
14.
Lima MA, Rodrigues-Jr V, Silva-Vergara ML, Nomelini MB, Paim N, Santos TA, Santos VM, 1998. Hanseníase virchowiana em cardiopata chagásico: relato de necropsia. Relato de caso. Rev Soc Bras Med Trop 31: 385–390.
-
15.
Sartori AM, Ibrahim KY, Nunes Westphalen EV, Braz LM, Oliveira OC Jr, Gakiya E, Lopes MH, Shikanai-Yasuda MA, 2007. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Trop Med Parasitol 101: 31–50.
-
16.
Dagur PK, Sharma B, Kumar G, Khan G, Khan NA, Katoch VM, Senguypta U, Joshi B, 2010. Mycobacterial antigen(s) induce anergy by altering TCR- and TCR/CD28- induced signaling events: insights into T-cell unresponsiveneness in leprosy. Mol Immunol 42: 941–952.
-
17.
Campos SV, Strabelli TM, Amato Neto V, Silva CP, Bacal F, Bocchi EA, Stolf NA, 2008. Risk factors for Chagas'disease reactivation after heart transplantation. J Heart Lung Transplant 27: 597–602.
-
18.
Riarte A, Luna C, Sabatiello R, Sinagra A, Shiavelli R, De Rissio A, Maiolo E, Garcia MM, Jacob N, Pattin M, Lauricella M, Segura EL, Vasquez M, 1999. Chagas' disease in patients with kidney transplants: 7 years of experience, 1989–1996. Clin Infect Dis 29: 561–567.
-
19.
d'Avila SC, d'Avila AM, Pagliari C, Gonçalves VM, Duarte MI, 2005. Eritema nodoso como forma de reativação da doença de Chagas em transplantado cardíaco. Rev Soc Bras Med Trop 38: 61–63.
-
20.
Brazilian consensus on Chagas' disease diagnosis, 2005. Rev Soc Bras Med Trop 38 (Supplement III): 1–29.
-
21.
Gomes ML, Galvão LM, Macedo AM, Pena SD, Chiari E, 1999. Chagas' disease diagnosis: comparative analysis of parasitologic, molecular, and serologic methods. Am J Trop Med Hyg 60: 205–210.
-
22.
Junqueira AC, Chiari E, Wincker P, 1996. Comparison of the polymerase chain reaction with two classical parasitological methods for the diagnosis of Chagas disease in an endemic region of north-eastern Brazil. Trans R Soc Trop Med Hyg 90: 129–132.
-
23.
Avila HA, Sigman DS, Cohen LM, Millikan RC, Simpson L, 1991. Polymerase chain reaction amplification of Trypanosoma cruzi kinetoplast minicircle DNA isolated from whole blood lysates: diagnosis of chronic Chagas' disease. Mol Biochem Parasitol 48: 211–222.
-
24.
Portela-Lindoso AB, Shikanai-Yasuda MA, 2003. Chronic Chagas' disease: from xenodiagnosis and hemoculture to polymerase chain reaction. Rev Saúde Pública 37: 107–115.
-
25.
Roy SG, De P, Mukherjje D, Chander V, Konar A, Bandyopadhyay D, Babdyopadhyay A, 2009. Excess of glucocorticoid reduces cardiac dysfunction via activating angiotensin II pathway. Cell Physiol Biochem 24: 1–10.
-
26.
Rassi A Jr, Rassi A, Marin-Neto JA, 2010. Chagas disease. Lancet 375: 1388–1402.
-
27.
Korhonen R, Lahti A, Hämäläinen M, Kankaanranta H, Moilanen E, 2002. Dexamethasone inhibits inducible nitric-oxide synthase expression and nitric oxide production by destabilizing mRNA in lipopolysaccharide-treated macrophages. Mol Pharmacol 62: 698–704.
-
28.
Elenkov IJ, 2004. Glucocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci 1024: 138–146.
-
29.
Rassi A, Amato Neto V, de Siqueira AF, Doles J, Leite MS, Silva OQ, Cardoso VM, 1997. Influência de corticóide, na doença de Chagas crônica, administrado em virtude de afecções associadas. Rev Soc Bras Med Trop 30: 93–99.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 304 | 272 | 24 |
| Full Text Views | 288 | 11 | 0 |
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A Patient with Erythema Nodosus Leprosum and Chagas Cardiopathy: Challenges in Patient Management and Review of the Literature
Maria Ângela B. Trindade
Maria Ângela B. Trindade
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Noemia B. Carvalho
Noemia B. Carvalho
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Elaini C. Belfort
Elaini C. Belfort
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Carla Pagliari
Carla Pagliari
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Erika Gakiya
Erika Gakiya
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Neusa Y. Sakai-Valente
Neusa Y. Sakai-Valente
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Gil Benard
Gil Benard
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Maria A. Shikanai-Yasuda
Maria A. Shikanai-Yasuda
Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.
Author Notes
Authors' addresses: Maria Ângela B. Trindade, Division of Clinical Dermatology, Clinics Hospital, Medical School, University of Sao Paulo, Brazil and Health Institute, São Paulo State Health Department, Brazil, E-mail: angelatrindade@uol.com.br. Noemia B. Carvalho, Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Brazil, E-mail: nobc@uol.com.br. Elaini C. Belfort, Division of Clinical Dermatology, Clinics Hospital, Medical School, University of Sao Paulo, Brazil, E-mail: ecbelfort@uol.com.br. Carla Pagliari, Department of Pathology, Medical School, University of Sao Paulo, Brazil, E-mail: cpagliari@usp.br. Erika Gakiya, Laboratory of Medical Investigation Unit 46, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: erikagakiya@hotmail.com. Neusa Y. Sakai-Valente, Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: neusavalente@itelefonica.com.br. Gil Benard, Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Brazil and Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: mahong@usp.br. Maria A. Shikanai-Yasuda, Laboratory of Medical Investigation Unit 48, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: shikanaiyasuda@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Global leprosy situation, World Health Organization, 2010. Wkly Epidemiol Rec 33: 333–340.
-
2.
Bolletin de la Organizacion Panamericana de la Salud, 2006. Estimacion Cuantitativa de la Enfermedad de Chagas en las Americas. Montevideo, Uruguay: OPAS.
-
3.
Portal de Saúde. Available at: http://portal.saude.gov.br/portal/saude/profissional/area.cfm?id_area=1466. Accessed September 29, 2010.
-
4.
Ridley DS, Jopling WH, 1966. Classification of leprosy according to immunity: a five-group system. Int J Lepr 34: 255–273.
-
5.
Naafs B, Wheate HW, 1978. The time interval between the start of anti-leprosy treatment and the development of reactions in borderline patients. Lepr Rev 49: 153–157.
-
6.
Kahawita IP, Lockwood DN, 2008. Towards understanding the pathology of erythema nodosum leprosum. Trans R Soc Trop Med Hyg 102: 329–337.
-
7.
Higuchi ML, Benvenuti LA, Reis MM, Metzger M, 2003. Pathophisiology of the heart in Chagas'disease: current status and new developments. Cardiovasc Res 60: 96–107.
-
8.
Bilate AMB, Cunha-Neto E, 2008. Chagas disease cardiomyopathy: current concepts of an old disease. Rev Inst Med Trop Sao Paulo 50: 67–74.
-
9.
Hotez PJ, Pecoul B, 2010. “Manifesto” for advancing the control and elimination of neglected tropical diseases. PLoS Negl Trop Dis 4: e718.
-
10.
Diniz O, 1948. Lepra e doença de Chagas. Arq Min Leprol 8: 155–169.
-
11.
Dias JCP, Cunha DA, 1970. Hanseníase e doença de Chagas. Estudos realizados no Sanatório São Francisco de Assis, em Babuí, Minas Gerais. Rev Soc Bras Med Trop 4: 31–43.
-
12.
Bottasso OA, Morini JC, 1993. Electrocardiographic alterations in lepromatous leprosy patients with concomitant Trypanosoma cruzi infection. Int J Lepr 61: 468–471.
-
13.
Mathur SN, Itigi A, Krishnaveni A, Rao PD, 1976. Congestive heart failure in two patients with lepromatous leprosy. Lepr India 48: 75–80.
-
14.
Lima MA, Rodrigues-Jr V, Silva-Vergara ML, Nomelini MB, Paim N, Santos TA, Santos VM, 1998. Hanseníase virchowiana em cardiopata chagásico: relato de necropsia. Relato de caso. Rev Soc Bras Med Trop 31: 385–390.
-
15.
Sartori AM, Ibrahim KY, Nunes Westphalen EV, Braz LM, Oliveira OC Jr, Gakiya E, Lopes MH, Shikanai-Yasuda MA, 2007. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Trop Med Parasitol 101: 31–50.
-
16.
Dagur PK, Sharma B, Kumar G, Khan G, Khan NA, Katoch VM, Senguypta U, Joshi B, 2010. Mycobacterial antigen(s) induce anergy by altering TCR- and TCR/CD28- induced signaling events: insights into T-cell unresponsiveneness in leprosy. Mol Immunol 42: 941–952.
-
17.
Campos SV, Strabelli TM, Amato Neto V, Silva CP, Bacal F, Bocchi EA, Stolf NA, 2008. Risk factors for Chagas'disease reactivation after heart transplantation. J Heart Lung Transplant 27: 597–602.
-
18.
Riarte A, Luna C, Sabatiello R, Sinagra A, Shiavelli R, De Rissio A, Maiolo E, Garcia MM, Jacob N, Pattin M, Lauricella M, Segura EL, Vasquez M, 1999. Chagas' disease in patients with kidney transplants: 7 years of experience, 1989–1996. Clin Infect Dis 29: 561–567.
-
19.
d'Avila SC, d'Avila AM, Pagliari C, Gonçalves VM, Duarte MI, 2005. Eritema nodoso como forma de reativação da doença de Chagas em transplantado cardíaco. Rev Soc Bras Med Trop 38: 61–63.
-
20.
Brazilian consensus on Chagas' disease diagnosis, 2005. Rev Soc Bras Med Trop 38 (Supplement III): 1–29.
-
21.
Gomes ML, Galvão LM, Macedo AM, Pena SD, Chiari E, 1999. Chagas' disease diagnosis: comparative analysis of parasitologic, molecular, and serologic methods. Am J Trop Med Hyg 60: 205–210.
-
22.
Junqueira AC, Chiari E, Wincker P, 1996. Comparison of the polymerase chain reaction with two classical parasitological methods for the diagnosis of Chagas disease in an endemic region of north-eastern Brazil. Trans R Soc Trop Med Hyg 90: 129–132.
-
23.
Avila HA, Sigman DS, Cohen LM, Millikan RC, Simpson L, 1991. Polymerase chain reaction amplification of Trypanosoma cruzi kinetoplast minicircle DNA isolated from whole blood lysates: diagnosis of chronic Chagas' disease. Mol Biochem Parasitol 48: 211–222.
-
24.
Portela-Lindoso AB, Shikanai-Yasuda MA, 2003. Chronic Chagas' disease: from xenodiagnosis and hemoculture to polymerase chain reaction. Rev Saúde Pública 37: 107–115.
-
25.
Roy SG, De P, Mukherjje D, Chander V, Konar A, Bandyopadhyay D, Babdyopadhyay A, 2009. Excess of glucocorticoid reduces cardiac dysfunction via activating angiotensin II pathway. Cell Physiol Biochem 24: 1–10.
-
26.
Rassi A Jr, Rassi A, Marin-Neto JA, 2010. Chagas disease. Lancet 375: 1388–1402.
-
27.
Korhonen R, Lahti A, Hämäläinen M, Kankaanranta H, Moilanen E, 2002. Dexamethasone inhibits inducible nitric-oxide synthase expression and nitric oxide production by destabilizing mRNA in lipopolysaccharide-treated macrophages. Mol Pharmacol 62: 698–704.
-
28.
Elenkov IJ, 2004. Glucocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci 1024: 138–146.
-
29.
Rassi A, Amato Neto V, de Siqueira AF, Doles J, Leite MS, Silva OQ, Cardoso VM, 1997. Influência de corticóide, na doença de Chagas crônica, administrado em virtude de afecções associadas. Rev Soc Bras Med Trop 30: 93–99.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 304 | 272 | 24 |
| Full Text Views | 288 | 11 | 0 |
| PDF Downloads | 67 | 11 | 0 |