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SALUDCA Demexico La Enfermedad De Chagas En La República

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SALUDCA Demexico La Enfermedad De Chagas En La República SALUDCA PUBU deMEXICO ÉPOCA V • VOLUMEN XXII • NÚMERO 4 • ]ULID-AOOSTO, 1980 La enfermedad de Chagas en la República Mexicana JORGE TA 'f 'f COI.s.· TOJ', J.: La enfermedad de ~ ea" RepúbU .. Melll ...... Sal. Púb. MiL xxn: 409-450. I9se. Resumen: Se presentan los datos obtenidos de la re- en donde se han encontrado casos humanos, reservoríos visión minuciosa de la literatura médica de México y del no humanos y transmisores. Se hacen comentarios sobre extranjero sobre la enfermedad de Chagas desde 1939, los resultados obtenidos y se señala la importancia de en (Iue por primera vez se encontr6 a Trypanosoma cruzi incrementar los estudios de la enfermedad de Chagas en México, hasta 1979. en nuestro país. Mediante mapas y cuadros se señalan las localidades Estado actual de nuestros conocimientos so- Como hemos estado trabajando ininterrum- bre la enfermedad de Chagas en la República pidamente sobre esta enfermedad y hemos mexicana. contribuido en parte a su conocimiento en nuestro país, J, la, 14, Hi, 16, 17, 19 creemos eünve- niente reunir en esta publicación lo que se INTRODUCCION ha logrado hasta el momento en relación con la enfermedad de Chagas. esde la última revisión de la enfermedad Dde Chagas publicada en México por Biagi MATERIAL Y METODOS y Cols. en 19641 son pOC05los estudios que se han realizado. Sin embargo, cada vez hay más En esta publicación se concentra informa- investigadores que se interesan en tila y en ción obtenida mediante la consulta de revis- la literatura médica nacional se han consig- tas médicas y científicas de la República Me- nado hallazgos sobre la tripanosomiasis antes xicana y del extranjero; así como la que se mencíonada.'?" obtuvo en pláticas sostenidas con otros in- vestigadores del país y, las experiencias de "Depto. de Ecología Humana, Facultad de Medicina, los autores, Todo el material se presenta de la Universidad Nacional Autónoma de México. manera siguiente: casos humanos, reservoríos, 409 transmísores, estudios realizados con cepas y Canis familiaris (perro) habían sido en- de Trypanosoma cruzi aisladas de la Repú- contrados infectados por TrYl'llnosoma cruz; blica Mexicana y otros estudios. en condiciones naturales. En ese mismo año, Beltrán, E. descubrió otro reservorio, 'Iue es Rattus norveg;cus (rata). En 1970, Velasco RESULTADOS Y DISCUSION CASOS HUMANOS inform6 también que Can;s familiaris era re- servorio, Hasta 1961 solamente se había informado Aunque en México no se ha encontrado a de 6 casos humanos comprobados parasítoló- Suis domesticus (cerdo) infectado por T, gicamente.' En los últimos 20 años Sehan re- cruzi, Mazzotti y Brumpt en 1939 señalaron gistrado 142 casos más, de 10s cuales 23 Fue- haberlo logrado en forma experimental; sin ron conocidos mediante comunicaciones embargo, en Brasil, Pinto (1942) menciona personales, Io que hace un total de 148 (Fi- que este animal se encuentra infectado en la gura 1). naturaleza. Tay y Cols, hicicron observaeío- En el mapa 1 se muestran las localidades en nes sobre hallazgos de triatomas infectarlos que se han encontrado casos humanos. La con T. cruz;, en madrigueras, de mamíferos. mayoría de ellos ocurrieron en regiones que En 1979 Tay y Cols. puhlicaron 'I"e en el se encuentran en la vertiente del Océano Pa- estado de Jalisco, además de Ruttus lIorwgi· cífico, desde el estado de Zacatecas hasta el CllS, ya conocido ..se cncontró a Mus musculus sur del país. En el estado de Chiapas se hun )' a Scil'lls 1)lIlgaris como reservorios. No ohs- registrado 42 casos humanos.v ' en Jalisco tante haberse encontrado previamente C'lIlis 32;17,,, y en Oaxaca 11.',6, ra, le Es impor- [cnilliarís corno reservorio, en el estudio men- tante señalar que la mayoría de los casos cionado el resultado en este animal file ne- humanos diagnosticados no tienen estudio gativo, En la misma forma, Ortega y Cols. clínico, o si [o tienen, es superficial e íncorn- en Chiapas ohtuvíeron resultados negativos pleto; por lo que no se ha podido determinar en esta misma especie, donde además 18 ra- claramente si se trat6 de infección asintorná- tones (M,,, IIIlIselll1l8) Iueron negativos, Co- tica o si realmente fueron personas con enfer- mo se sabe, hay amplia dispersión de estas medad manifiesta, salvo en los casos en '1ue especies de vertebrados en el territorrio na- se demostr6, además de la infección, miocardio cional, por lo cual se deben hacer más estu- tis chagásica y cuadro clínico compatible con dios en ellos. la enfermedad de Chagas. Existe informaci6n de otros casos humanos TI\ANS~IIS0I\ES diagnosticados mediante -reacciones serológí- cas o por otros medios, los que se presentan El conocimiento de los transmisores de en la Figura 2.''', \4, Ir, TJ'/II'U1l0S0IJlll cruz; es quizá el aspecto sobre el '1ue más se ha contribuido, ya que desde RESERVORIOS los trahajos de Mazzotti, Biagi y Tay y Cols, se han encontrado numerosas localidades con Los estudios realizados sobre los reservo- transmisores. Prácticamente encontrarnos tria- rios de T. cruz; en nuestro país son muy po- t6minos infectaclos con Trijpanosoma cruzi en cos como se puede observar en el Mapa 2 y casi todos [os estados de la República Mexi- en Ia Figura 3, en los que se vé que se han cana (Mapa 3 y Cuadros 1 al 39), aunque la colectado s610 seis vertebrados mamíferos a mayor parte de las localidades se encuentran los que se les efectuaron estudios para de- en la vertiente del Pacífico y en altitudes de mostrar su infecci6n con T. cruzi. En 1947, O a 1800 metros sobre el nivel del mar (Mapa Díaz y Cols., encontraron el primer reservo- 4), 10 que hace suponer que la zona pro- río, que fue Didelphis marsupialis (tlacuache). bablemente endémica de enfermedad de En 1949 Mazzotti y Díaz informaron que Chagas sea muy amplia, casi las dos terceras Dasypus novemcinctus maximus (annadiHo) partes del territorio nacional. 410 SALUD PÚBLICA DE MÉXICO Figuro. 1 RELAClON DE CASOS HUMANOS COMPROBADOS DE TRIPANOSOMIASIS AMERICANA, REGISTRADOS EN MEXICO 1940-1977 No. DE A~O CASOS MUNICIPIO Y ESTADO INVESTIGADOR(ES) 1940 2 Teojomulco, Oaxaca Mazzctti'' 1947 2 Mértda, Yucatán Palcmot 1958 1 Tutuapa, Edo. de México Biagi y ccl.t 1959 1 Guaymas. Sonora Palencia y Montañot 1961 1 Atoyac. Guerrero Rodríguez, J.' 1961 1 Mixteca Baja, Oaxaca Tay y col.' 1fJ(;4 1 Tetitlán, Guerrero Bíagí. Tay y cols.! 1fJ64 4 Compostela, Nayarit Pérez. Reyes" 1965 1 Tierra Blanca. Veracruz Femández22 1965 1 Limón, Oaxaca Arce y Biagi13 1965 1 Tutepec. Oaxaca Arce y Biagi1:1 1966 1 Tuxpan, Michoacán Tay y Navarretet- 1967 5 Tepechitlán y Jalapa, Zacatecas; Chi- Cuartero y cols.ll matitlán, Sta. Ma. de los Angeles, Jalisco 1970 1 Acatlán de Juárez, Jalisco Velasco y COls,17 Hl71 1 Chila, Oaxaca Coldsrmth" 1972 1 Tepechitlán, Zacatecas Martínez Marañón!" 1972 1 Jojutla, Morelos González, A.l1 1973 1 Hunucma, Yucatán Zavala y col~.:w 1974 3 Atotonilco y Acatlán de Juárez. velasen y TayHI [altsco 1975 6 M1Ina. Itzincah, Yucatán Quintal y cols.::W 1976 74 Varios G.N.E.P.'R 1976 8 León Brindis. Palenque Ortega y cols. K Hl76 3 Agua Azul, Chilón, Chiapas Ortega y mls,f! HJ77 18 Yucatán Zavala y cols." W79 8 Zacoalco de lorres, Jalisco Tay y <.:0Is.17 1079 1 San Juan Colorado, Oaxaca Salazar y co15.13 TOTAL 148 "Comunicación personal. 411 • ~ o~ •r- eir •~ ~ Q. ~. oQ. on ~ 3 'g, 'o " O ~ 3 ~sr " Q. a o ~ • ~ 1 e:n •• al ~. o~ • ~" s • la· ¡¡ • ~o " 'oo • n ~" +• o' Ñ' 01. ~ [ + n Q. o + ~ ~ ~ 3 + ~ ",~",··~-c······\·····..······.r·tt+ ;;" • + + ..l . .'. ~. ....... ',..., " -: ~. ., ~"" .::, • "'.; .•....,.- :.~.:0'( ~,. \+.+ (..•• /"-i~~,e•. " . g.. !!,¡ : ~\ ... -.;r. \~ :.. 1 -::. 412 SALUD PÚBLICA DE MÉXICO Figura 2 IIELACION DE CASOS HUMANOS DE TIIIPANO SOMIASIS AMERICANA, D1AC¡';OSTICADOS POII IIEACCIOI'ES SEIIOLOCICAS. IIECISTRADOS EN MEXICO. 1940-1976 No. DE CASOS No. DE A80 ESTUDIADOS CASOS ESTADO INVESTIGADOR 1949 200 18 8.5 Guerrero Biagi y COIS.13 1947 4 Guerrero Perrín y <."0IS.13 1964 4 Guerrero Aceves y cols." 1965 2 Oaxaca Biagi y Arce Oómeata 1967 165 12 7.2 Mtchoncán Tay y <."0Is.1I7.1" 1968 75 10 13 Zacatecas Tay y <."Ols.lIIoI,1:; 197I 161 47 29 Oaxaca Coldsmlth y cols.e 1976 I Cuerrero Rotherg: y cnls.1:t 1978 5 Edo. de Marcuschumer y cols.!a México Michoacán Oaxaca Chiapas Tabasco SIN CO¡';FIRMACION PARASITOSCOPICA 1'1 SEIIOLOCICA POR ANTECEDE¡';TES Y MIOCARDITIS CONFIRMADA EN LA AUTOPSIA. A80 No. DE CASOS ESTADO INVESTIGADOR 1961 6 Oaxaca Tay y cols.to 1968 2 Zacatecas Tay y <.'oIS.I:-, "Comunicncíón personal. Figura 3 INFECCIONES COMPROBADAS EN VERTEBRADOS NO HUMANOS, HUESPEDES DE T~nosor.na cruzi NOMBIIE AUTOII A80 LOCALIDAD INFEC. Didelphys marsupíaiís Días, Perno y Brenes 1947 Agua Buena, Mich. + (tlacuache) DasyptJS novecinctus mericanu5' lIyckman y cols. 1940 Colima + {armadillo} Mazzotti y Dias 1949 Colima + Biagi y Tay 1964 Tetitlán, Cro. + Canis [amiliarís ( perro) Mazzotti y Dias 1949 Tututepec, Oax. + Velasco. O. 1970 Tepechitlán. Zac. + RattllS noroegicus (rata Beltnln, E. 1949 Ciudad de México (Mercado) + noruega) Tay y cols. 1979 Zacoalco de Torres, jnl. + Mus musculus (ratón) Tay y cols. 1979 Zacoalco de Torres, Ja1. + Scirus oulgaris (ardilla) Tay y cols. 1979 Zacoalco de Torres, Jal. + 413 •• •• •• ..•• .. ...',..~, __..\ .r!+ " .... , '. .) • ("·~-·f·~ + r ......... .. ') :.: ·....V··-,·_·· .-' ~..) (. ; . ..... • .- (" ..: 1 8 "-',1 j":;\ r.. F] "'-", ,) . .. t ¡'t. ...... t".1 + 414 SALUD PÚBLICA DE MÉXICO ........_0 • o .... r-. ......,,(.7...: .~.'.' ..' ..... ',., " ." o , ( , ·ó~·· • ++*+1..r·· ..·········\··-- .. ··: ..~._." ...- •• ,.0 + ~ \s + " + "~ O~ + o l;;" O "o .~ e • " " u" 8- " e ~ " u -e " ~E e '¡: l;; " '¡;¡' " au e + ~ ~ u u • 'el -e + ~ ~ :!! :!! -¡; -¡; u o ..¡s ..¡ O • 415 o ~ e, a.... 1» '"o 1» g.'" ri -00o o 2- a ¡a < '" 2- ~ 2- g .... 416 SALUD PÚBLICA DE MÉXICO Cuadro 1 TRIATOMINOS EN MEXICO Triatoma dimidiata macuíípennís {Stal, 1859) ESTADO WCALIDAD MUNICIPIO REFERENCIAS Campeche Bolonchenticul Campeche Biagi.
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