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In 2006, a total of 178 cases of acute Chagas disease were reported from the Amazonian state of Para, Brazil. Eleven occurred in Barcarena and were confirmed by visualization of parasites on blood smears. Using cohort and case-control studies, we implicated oral transmission by consumption of acai palm fruit.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:28Z No. of bitstreams: 1 S0036-46652010000300007.pdf: 964482 bytes, checksum: 54f4d6cd74cfa9899850cde78fa50605 (MD5) Made available in DSpace on 2013-08-22T19:05:28Z (GMT). No. of bitstreams: 1 S0036-46652010000300007.pdf: 964482 bytes, checksum: 54f4d6cd74cfa9899850cde78fa50605 (MD5) Previous issue date: 2010-06-01 Made available in DSpace on 2013-09-30T20:09:21Z (GMT). No. of bitstreams: 2 S0036-46652010000300007.pdf: 964482 bytes, checksum: 54f4d6cd74cfa9899850cde78fa50605 (MD5) S0036-46652010000300007.pdf.txt: 34657 bytes, checksum: dd562e7c39fe2020718054f35c5e3bd0 (MD5) Previous issue date: 2010-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:17:40Z No. of bitstreams: 2 S0036-46652010000300007.pdf: 964482 bytes, checksum: 54f4d6cd74cfa9899850cde78fa50605 (MD5) S0036-46652010000300007.pdf.txt: 34657 bytes, checksum: dd562e7c39fe2020718054f35c5e3bd0 (MD5) Made available in DSpace on 2014-05-20T15:17:40Z (GMT). No. of bitstreams: 2 S0036-46652010000300007.pdf: 964482 bytes, checksum: 54f4d6cd74cfa9899850cde78fa50605 (MD5) S0036-46652010000300007.pdf.txt: 34657 bytes, checksum: dd562e7c39fe2020718054f35c5e3bd0 (MD5) Previous issue date: 2010-06-01 Desde a década de 1970 não se notificavam casos autóctones de doença de Chagas aguda em São Paulo. em março de 2006 a Vigilância Epidemiológica registrou óbito por doença de Chagas aguda, em Itaporanga, de paciente de seis anos de idade. Exame histopatológico post mortem realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu confirmou o diagnóstico. Consultamos prontuários de hospitais e entrevistamos profissionais de saúde envolvidos além de familiares do paciente. Descrevemos medidas adotadas in loco para identificar a via de transmissão, reservatórios e vetores. Discutimos as possíveis fontes de infecção. Na região não foram identificados outros casos humanos, vetores ou reservatórios vertebrados infectados por Trypanosoma cruzi. Salientamos a importância de manter a vigilância, mesmo em áreas onde a transmissão de doença de Chagas está interrompida e naquelas ainda infestadas por triatomíneos. Deve-se admitir a hipótese diagnóstica de doença de Chagas quando observados: edema palpebral (uni ou bilateral), insuficiência cardíaca, miocardite, pericardite, anasarca, quadros similares aos de síndrome nefrótica ou glomerulonefrite sem causas outras aparentes, em pacientes com dados epidemiológicos positivos. Encontro, mesmo em raras ocasiões, de triatomíneos na região ou ainda contato com alimento contaminável com formas infectantes de T. cruzi. 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 six-year-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. Superintendência de Controle de Endemias Centro de Vigilância Epidemiológica Dr. Alexandre Vranjac Secretaria de Vigilância em Saúde Grupo Técnico de Vigilância UNESP Faculdade de Medicina de Botucatu USP Faculdade de Medicina UNESP Faculdade de Medicina de Botucatu