miocarditis infecciosa
TRANSCRIPT
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Miocarditis infecciosa
Fredy RS Gutiérrez MD, MSc, PhD
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Miocarditis infecciosaEtiología
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Miocarditis infecciosaPresentación clínica
• Antecedente de Infección respiratoria• Dolor torácico leve (pericarditis), fiebre,
sudoración, disnea.• Arritmias síncope, • Falla cardíaca de curso rápido en un paciente
sin riesgo cardiovascular (joven)
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Miocarditis viral
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Virus Coxsackie
• Enterovirus– Picornavirus
• Grupo A: Lesiones cutáneas (herpangina)• Grupo B: Miocarditis, pericarditis, pleuritis,
pancreatitis, hepatitis (noA) .• Distribución mundial• Resistente a cond. Ambientales (cápside)• Transmisión fecal-oral
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Enterovirus
Gillespe Medical microbiology at a glance 4th Ed
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Enterovirus
Murray Microbiologia Médica ed
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Receptores de enterovirus
Mandell, Bennett Enfermedades infecciosas 7ª Ed. 2010
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Miocarditis viralVirus Coxsackie B
1. Viremia2. Lesión directa de cardiomiocito3. Respuesta inflamatoria intensa4. Autoinmunidad ()5. Cardiopatia dilatada
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Miocarditis viralVirus Coxsackie B
• Manejo– Manejo de falla cardíaca, arritmias– Medidas generales, reposo– Anti-inflaamatorios
• Prevención– Higiene
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Miocarditis por Trypanosoma cruzi
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Enfermedades infecciosas y parasitarias
Age-standardised disability-adjusted life year (DALY) rates from Infectious and parasitic diseases by country (per 100,000 inhabitants).
Death and DALY estimates for 2004 by cause for WHO Member States (Persons, all ages) (2009-11-12)
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Pérdida de años de vida ajustados en función de la discapacidad
10 principales causas mundiales
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Enfermedades desatendidas
Figure1.Overlappingneglectedtropicaldiseases
74%ofaf fecte
d
countriesarefacingwithtwoormore
diseases.
3 diseases – 18%
2 diseases – 15%
1 disease – 26%
4 diseases – 13%
7 diseases – 6%8 diseases – 2%
6 diseases – 11%
5 diseases – 9%
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Enfermedades desatendidas
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Financiación de investigación en enfermedades desatendidas
doi:10.1371/journal.pntd.0000244.g001
2001–2002 2007–2008
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TripanosomiasisDistribución geográfica
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Tripanosoma cruzi
Ribeiro, A. L. et al. Nat. Rev. Cardiol. 9, 576–589 (2012); published online 31 July 2012
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Enfermedad de Chagas en Colombia
Guhl F et al, 2005 Trends in parasitology
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Enfermedad de ChagasHistoria
Nature 210
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Enfermedad de ChagasHistoria
Nature 210
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Lane 1: Molecular weight markers lambdaHindIII.Lane 2: Negative control, mummy Eg-1 muscletissue. Lane 3: Positive control, mummy For-1 hearttissue. Lane 4: Mummy Az-75, T-43, esophagus tissue.Lane 5: Mummy Az-75, T-133, C-1, heart tissue. Lane 6: T. cruzi stock tulahuen from culture. Lane 7: Trypanosome-free human blood. Lane 8: Control reaction, H2O.
Am J Phys Anthropol 108:401–407, 1999
Co-evolución
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El vector: Triatominae
Journal of Tropical Medicine Volume 2012, Article ID 357948,11page
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Enfermedad de ChagasControl de la transmisión vectorial
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Enfermedad de ChagasControl de la transmisión vectorial
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El parásito: T. cruzi
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Tripanosoma cruziCiclo devida en humanos
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Epimastigotas
Teixeira DE, Benchimol M, Crepaldi PH, de Souza W (2012) Interactive Multimedia to Teach the Life Cycle of Trypanosoma cruzi, the Causative Agent of Chagas Disease. PLoS Negl Trop Dis 6(8): e1749. doi:10.1371/journal.pntd.0001749http://www.plosntd.org/article/info:doi/10.1371/journal.pntd.0001749
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Teixeira DE, Benchimol M, Crepaldi PH, de Souza W (2012) Interactive Multimedia to Teach the Life Cycle of Trypanosoma cruzi, the Causative Agent of Chagas Disease. PLoS Negl Trop Dis 6(8): e1749. doi:10.1371/journal.pntd.0001749http://www.plosntd.org/article/info:doi/10.1371/journal.pntd.0001749
Amastigotas
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Teixeira DE, Benchimol M, Crepaldi PH, de Souza W (2012) Interactive Multimedia to Teach the Life Cycle of Trypanosoma cruzi, the Causative Agent of Chagas Disease. PLoS Negl Trop Dis 6(8): e1749. doi:10.1371/journal.pntd.0001749http://www.plosntd.org/article/info:doi/10.1371/journal.pntd.0001749
Tripomastigotas
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T. Cruzi
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Parasitismo miocárdicoT. cruzi
Frontiers in immunology October 2012| Volume 3| Article 327| 1
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Invasión de cardiomiocitos
Frontiers in immunology October 2012| Volume 3| Article 327| 1
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Invasión de cardiomiocitos
Frontiers in immunology October 2012| Volume 3| Article 327| 1
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Chagas agudo, evolucion
Infect Dis Clin N Am 26 (2012) 275–291
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Chagas crónico, evolución
Infect Dis Clin N Am 26 (2012) 275–291
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Manifestaciones digestivas
Infect Dis Clin N Am 26 (2012) 275–291
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Enfermedad de ChagasManifestaciones clínicas
Dermatol Clin 29 (2011) 53–62
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Manifestaciones electrocardiográficas
Ribeiro, A. L. et al. Nat. Rev. Cardiol. 9, 576–589 (2012); published online 31 July 2012
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Enfermedad de ChagasArritmias
Ribeiro, A. L. et al. Nat. Rev. Cardiol. 9, 576–589 (2012); published online 31 July 2012
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Tripanosomiasis americanaSitio de inoculación del parásito
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Tripanosomiasis americanaCardiopatía dilatada
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Tripanosomiasis americanaEnfermedad de Chagas
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Tripanosomiasis americanaEnfermedad de Chagas
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Tripanosomiasis americanaEnfermedad de Chagas
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Tripanosomiasis americanaEnfermedad de Chagas
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Tripanosomiasis americanaEnfermedad de Chagas: autoinmunidad
INFECTION AND IMMUNITY, Sept. 2001, p. 5643–5649
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Enfermedad de ChagasHistoria natural
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Tripanosomiasis Americana
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Macrófagos residentes del miocardio
Immunity 40, this issue, 91–104. 2014
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Tripanosoma cruziCiclio de vida
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Tripanosomiasis americana
J. Clin. Invest. 118:1301–1310 (2008)
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Trypanosoma cruziCiclo de vida
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Ciclo de T. cruzi
• http://goo.gl/sWSxdu • http://goo.gl/v0J0QJ
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Infección por T. cruziReconocimiento de T. cruzi por el sistema inmune
Gutierrez FR, 2011 Springer
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Infección por T. cruziInducción/inhibición de apoptosis
Immunology today 21 10 489, 2000
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Infección por T. cruziProducción de quimiocinas por cardiomiocitos
Trends Parasitology Vol.18 No.6 June 2002
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Infección por T. cruziRespuesta inmune frente a T. cruzi
Expert reviews in Molecular medicine Vol. 12; e29; September 2010
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Infección por T. cruziRespuesta inmune frente a T. cruzi
Gutierrez FR, 2011 Springer
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Enfermedad de ChagasHistoria natural
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Enfermedad de ChagasHistoria natural
Heart 2009;95:524–534. doi:10.1136/hrt.2008.159624
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Enfermedad de ChagasEstrategias de Prevención
Heart 2009;95:524–534. doi:10.1136/hrt.2008.159624
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Infección por T. cruziRegulación de la respuesta inmune
Homeostasis inmunológica,
Persistencia del parásito,
Fibrosis
Control del parásito, daño
colateral
IFN-g, TNF-a, NO, ROS, IL-17, MMP, TLR, NLR
IL-10, TGF-b, NO, T-reg
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Mimetismo molecular
Circulation 2007;115:1109-1123
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Inmunopatologia de la enfermedad de Chagas
Gutierrez FR, 2009 Parasite Immunology
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Abordaje del paciente
JAMA. 2007;298(18):2171-218
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Enfermedad de ChagasTratamiento
Ribeiro, A. L. et al. Nat. Rev. Cardiol. 9, 576–589 (2012); published online 31 July 2012
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Enfermedad de ChagasPrevención
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Enfermedad de ChagasImpacto de estrategias Prevención
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Cobertura de las acciones de control de la transmisión 1996-
2000
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Lecturas sugeridas• Maria C. Bewley et al. Structural Analysis of the Mechanism of
Adenovirus Binding to Its Human Cellular Receptor, CAR. Science 19 November 1999,
• Anis Rassi Jr, Anis Rassi, José Antonio Marin-Neto. Chagas Disease. Lancet2010; 375: 1388–40
• Caryn Bern et al. Evaluation and Treatment of Chagas Disease in the United States. A Systematic Review. JAMA. 2007;298(18):2171-218
• Ribeiro, A. L. et al. Diagnosis and management of Chagas disease and cardiomyopathy. Nat. Rev. Cardiol. 9, 576–589 (2012)
• Dirceu E. Teixeira et al. Interactive Multimedia to Teach the Life Cycle of Trypanosoma cruzi, the Causative Agent of Chagas Disease. PLoS Negl Trop Dis. 2012 Aug;6(8):e174