Chagas disease

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Call for an appointment with one of our infectious diseases expert, Dr. Norman Beatty, if you think you may have Chagas disease.

What is Chagas Disease?

Chagas disease is a tropical disease caused by the parasite Trypanosoma Cruzi. The transmission occurs through direct interaction with insect vectors, known as the “kissing bugs,” which are only found in the Americas. A person can become infected by different routes. Fecal material of the bug carrying the parasite enters the body via skin bite or oral ingestion. Another route is congenital infection (passed down from mother to child). Other less common forms of transmission include blood transfusion and organ transplantation.

Who is at Risk?

  • Individual born or having lived in Mexico, Central or South America, excluding the Caribbean Islands
  • Individual whose mother was born in Mexico, Central America or South America
  • Individual who lived in the regions mentioned above for longer than 6 months
  • If there was a known exposure to the kissing bug (refer to images)
  • Those who screen positive for Chagas disease after blood donation

What are the Phases of Chagas disease?

Acute Phase - Signs and Symptoms

  • A majority of people will not present symptoms
  • Symptoms that may develop are non-specific, such as fever, enlarged lymph nodes, fatigue
  • Chagoma: skin inflammation at the site where the parasite entered
  • Romaña’s sign: swelling around the eye of person who contracted the parasite through mucous membranes
  • A serious acute infection may occur if the person has a weakened immune system

Indeterminate Phase - Signs and Symptoms

  • No clinical evidence of Chagas disease-related illness
  • Positive screening and confirmatory testing for parasite exposure
  • Majority of people remain asymptomatic (parasite may be detected in blood)
  • Parasite can reactivate if the person develops a condition that weakens immune system causing serious disease
  • Person should be monitored with a clinical provider for the potential development of the chronic phase

Chronic Phase - Signs and Symptoms

  • Heart disease (most common organ affected):
    • Abnormality in electrical activity
    • Sudden cardiac arrest
    • Dilated cardiomyopathy and congestive heart failure
  • Gastrointestinal tract disease (abnormal enlargement of esophagus and/or colon):
    • Trouble swallowing liquids and solids
    • Chronic constipation and abdominal pain
    • Colon enlargement can distend the abdomen
  • Thromboembolic disease: higher rates of pulmonary embolism and stroke

How to Get Tested?

Chagas testing may be arranged by a primary care provider or by an infectious disease specialist. Exams and tests consist of the following:

Physical Examination

  • Signs of heart failure: elevated jugular venous distension, edema in lower extremities
  • Irregular, slow and/or rapid heartbeat
  • Lymph nodes enlargement
  • Delayed bowel sounds
  • Distended abdomen
  • Enlarged spleen and/or liver

Tests

  • Chest X-Ray
  • Echocardiogram
  • Electrocardiogram
  • Cardiac magnetic resonance imaging
  • Blood tests to investigate for antibodies present in the blood

How Does Treatment Work?

  • The acute phase of the disease should be treated in children and most adults. Infants born with the infection should also be treated.
  • Adults in the indeterminant or chronic phases should discuss with a medical provider whether treatment will be necessary.
  • Antiparasitic drugs used for treatment are benznidazole and nifurtimox. These drugs may cause side effects and patients should be monitored
  • Cardiac devices, such as pacemakers and defibrillators are sometimes placed when certain abnormal heart rhythm is detected.
  • Advanced cardiac care is needed if the heart becomes too weak, which includes ventricular-assist devices, and even heart transplantation.

Outlook (Prognosis)

  • About one third of infected people likely develop chronic or symptomatic Chagas disease.
  • It can take more than 20 years from the time of the original infection to develop chronic illness, typically heart or gastrointestinal dysfunction.
  • Abnormal heart rhythms may cause cardiac arrest and sudden death.
  • Those who develop heart failure without management or heart transplant, usually die within several years.

Possible Complications

Chagas disease can cause these complications:

  • Enlarged heart
  • Heart failure
  • Arrhythmias or abnormal electricity of the heart
  • Sudden cardiac arrest
  • Enlarged colon
  • Enlarged esophagus with difficulty swallowing
  • Ischemic stroke
  • Reactivation due to immunocompromising condition or medication

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