Chagas disease

Background

Also known as American Trypanosomiasis
Endemic in rural parts of Cental and South America
- Rare cases found in Southern United States
Caused by the parasite trypanosoma cruzi
- Vector: Reduviid (kissing bug)
- The parasite is transmitted in the feces of the host vector
  - When the vector bites, it also defecates and the parasites enter the blood stream through the bite wound

Transmission

Disease of poverty
- Spread by the Triatominae bug (also known as the kissing bug)
  - The Triatomina bug thrives in housing that is old, has thatched roofs and dwellings where the roof does not abut the wall.
Other methods of transmission
- Vertical (mother to child)
- Transfusion/organ donation

Clinical Features

Acute phase

Romañas sign
- swelling of the eye thought to be secondary to rubbing the feces into the eye
Chagoma
- Localized swelling at the area of parasite entry
Non-specific signs and symptoms
- Fever, fatigue, myalgia, headache, anorexia, vomiting, diarrhea
Serious complications
- Myocarditis, arrhythmia, encephalitis

Chronic phase

Between 20-40% of patients will develop chronic complications
Cardiac complications
- Dilated cardiomyopathy (CHF)
- Dysrhythmias
GI complications
- Megaesophagus
- Megacolon
- Achalasia
- Volvulus
- Hepatosplenomegaly (secondary to HF)
Neuro symptoms
- Neuritis

Differential Diagnosis

Evaluation

ECG
LFTs
Blood smear
- Can visualize parasites
- PCR, ELISA, immunofluorescence

Management

Benznidazole or Nifurtimox
Symptomatic treatment

External Links

CDC: American Trypanosomiasis (also known as Chagas Disease)

See Also

Parasitic Diseases
Travel Medicine

References

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