The chagas disease

Chagas disease, also called American trypanosomiasis, is a life-threatening disease caused by the protozoan parasite Trypanosoma cruzi.

It is estimated that there are between 6 and 7 million people in the world infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Chagas disease is found mainly in endemic areas of 21 countries in Latin America1, where it is transmitted to humans mainly by the feces or urine of triatomine insects known as vinchucas, chinches or with many other names, depending on the geographical area.

The disease is named after Carlos Ribeiro Justiniano Chagas, a Brazilian doctor and researcher who discovered it in 1909.

How is its distribution?

Chagas disease is found mainly in the continental part of Latin America (and not in the Caribbean islands), but in recent decades has been observed more frequently in the United States of America, Canada, many European countries and some of the Western Pacific. This is mainly due to the mobility of the population between Latin America and the rest of the world.

What signs and symptoms does this disease have?

Chagas disease has two clearly differentiated phases. Initially, the acute phase lasts about two months after contracting the infection. During this acute phase, a large number of parasites circulate in the bloodstream. In most cases there are no symptoms or they are mild and not specific.

In less than 50% of people stung by a triatomine, a characteristic initial sign may be a skin lesion or a bruised eyelid swelling. In addition, they may have fever, headache, enlarged lymph nodes, pale skin, muscle aches, shortness of breath, swelling and abdominal or chest pain.

During the chronic phase, the parasites remain hidden mainly in the cardiac and digestive muscles. Up to 30% of patients suffer cardiac disorders and up to 10% have digestive disorders (typically, enlargement of the esophagus or colon), neurological or mixed. Over the years, the infection can cause sudden death by cardiac arrhythmias or progressive heart failure by destruction of the heart muscle and its innervations.

How is your transmission?

In Latin America, the T. cruzi parasite is transmitted mainly by contact with feces or urine infected with triatomine insects that feed on blood. In general, these live in the cracks and holes in the walls and roofs of poorly constructed houses in rural and suburban areas. Normally they remain hidden during the day and at night they enter into activity feeding on human blood.

How is the diagnosis of Chagas disease made?

The diagnostic procedure for Chagas disease varies depending on the stage of the disease in which the patient is located.

During the acute phase, the quickest way to make a clinical diagnosis is through a blood smear. By looking through the microscope, we will easily detect the presence of the parasite in the extended blood. This is because, in this phase, the presence of the parasite in blood is very important.

This diagnosis of Chagas disease can, however, be confirmed by aspiration of the contents of the lymph nodes, where the presence of the parasite is also safe (provided there is infection).

During the chronic phase, the presence of the parasite in the blood is no longer so important, and therefore the technique of direct smear detection is much less effective. In this case, we must resort to serology, or indirect diagnosis, through the detection of specific antibodies in the serum of patients. This test has been one of the most important supports for the diagnosis of Chagas since its introduction in 1913 by Guerreiro and Machado. The tests currently used are: indirect hemagglutination, indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA).

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