The Pathologic Lesions of the Cardiac Autonomic Nervous System in Chronic Chagas' Myocarditis

Abstract

The central nervous system of animals and man is affected in acute and chronic infections due to Trypanosoma cruzi. An absolute decrease in the number of cardiac ganglion cells, with or without associated inflammation, has been described. Leishmania have been identified rarely in the ganglion cells of the autonomic nervous system of the heart in animals with experimental acute infection. We have been unable to find a report of similar lesions in patients with acute infection. However, inflammatory infiltrates have been observed in and around cardiac nerves in animals and patients who died during the acute phase of the disease. Experimental chronic infection with T. cruzi produces lesions of the autonomic nervous system of the esophagus resulting in megaesophagus. Similar inflammatory and degenerative lesions of the ganglia of the heart and esophagus in patients dying of chronic Chagas'' myocarditis with or without megaesophagus have been identified. The present study comprises a series of 12 patients who died from chronic Chagas'' myocarditis with positive laboratory evidence for Chagas'' disease in 9. In all 12 cases there were numerous lesions of the cardiac nerves, i.e., swelling, shrinkage, neuronophagia and disintegration of the axis cylinders with or without perineural and intraneural inflammation. Only a few normal intracardiac autonomic ganglion cells were identified positively. It can therefore be stated that there are definite pathologic lesions in the autonomic nervous system of the heart in chronic Chagas'' myocarditis.