The Kiss of Death

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8. Nerve cells are decreased along the whole extension of the esophagus, resulting in loss of the coordinated peristalsis and sensitivity of the denervated musculature. This phenomenon, which occurs in the denervated hollow muscular organ, is called “aperistalsis” and describes the absence of esophageal motility (Brasil 1956). The denervated structure becomes supersensitive to any stimulus, inducing diffuse and severe spasms of the esophagus, which occasionally needs an urgent application of atropine.

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9. The consistency of what is ingested is very important, because the transport of solids requires a more coordinated peristalsis than does the movement of liquids; also, excessive solid transport can cause a high overload to the damaged organ. In addition, increased consistency (reduced liquidity) of the contents of the esophagus favors the development of megaesophagus. Patients often drink large quantities of liquids to aid the passage of solids through the organ. Generally either very hot or very cold food intensifies difficulties in swallowing, and perhaps the associated abundant salivation constitutes a type of auxiliary mechanism for the deficient deglutition.

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1. This center began in 1984 with assistance from Banco InterAmericano Desarrollo (BID) and a contract with the Universidad El Salvador de Buenos Aires, Ministerio de Prevision Social y Salud Publica, and La Universidad de Sucre.

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2. Figures have been adjusted to the 1992 census.

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3. Such pathologies include cardiac enlargement, mitral and tricuspid valve insufficiency, and pulmonary embolization. An abnormal left ventricular impulse may reflect the frequent apical aneurysm formation. Right- bundle-branch block is frequent. Complete heart block, high-grade ventricular ectopy, and atrial fibrillation have a grave prognostic significance, both aggravating the congestive heart failure and enhancing predisposition for sudden cardiac death (see Iosa 1994). (See Appendix 10.)

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4. Ventricular arrhythmias are a prominent feature of chronic Chagas’ disease. Ventricular premature depolarization, often with multiple morphologies, is seen frequently. Bouts of ventricular tachycardia and arterial hypertension may occur as well as bradycardia and arterial hypotension (Braunwald 1988:1447; Iosa 1994).

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5. See Brener (1994) and Appendix II for an overview of current theories on pathogenesis.

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6. Investigators have found autoantibody and self-reactive T-cell formation in human and experimental T. cruzi infections (Teixeira, Teixeira, and Santos-Buch 1975; Cossio et al. 1974). Cross-reactive autoantibodies were mainly directed toward ubiquitous and evolutionary conservative molecules (Levin et al. 1989, Kerner et al. 1991, Van Voorhis et al. 1991) which lack clinical and biological significance for the different clinical forms of chronic Chagas’ disease.

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7. The presence of an antibody against cardiac myosin is correlated with the development of chronic inflammatory cardiopathy in T. cruzi-infected mice (Tibbetts et al. 1994). Immunization with cardiac myosin HC induces aggressive myocarditis (Neu et al. 1987b). Cunha-Neto and colleagues (1995) have recognized a heart-specific T. cruzi cross-reactive epitope, with chronic heart lesions further indicating the involvement of cross-reactions of myosin and B13 in the pathogenesis of chronic Chagas’ disease.

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8. See Voltarelli, Donadi, and Falcao 1987; Cunningham, Grogl, and Kuhn 1980; Mosca, Briceno, and Hernandez 1991.

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9. These antigens include many stress proteins with sequence homology to those of living organisms (Young, Lathigra, and Hendrix 1988).

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1. An appropriate technology for chagasic control is to teach peasants how to prevent vinchuca infestation by means of readily available materials, such as the use of cow dung in plastering and the