Chagas disease

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• Named after Dr. Carlos Chagas, a Brazilian doctor who first described the disease in 1909

Pathogen

• Trypanosoma cruzi

Morphology

1. amastigote
2. promastigote
3. epimastigote
4. trypomastigote

nucleus, kintoplast, undulating membrane, flagellum

Life cycle

• T. brucei group don't infect human cells
• T. cruzi needs to infect human cells to multiply
  • Armadillo is natural reservoir

Transmission

by Triatomine

• Transmitted by oral ingestion or mucosal infestation of feces of Triatomine, so-called 'kissing bugs'
• Triatomine
  • Inhabits gaps on mud-built walls
  • Sucks human blood but no blood transmission occurs
  • Active during night

Epidemiology

• In 21 Latin American countries
• 700,000 new cases in 1990
• 38,000 new cases in 2010
• Estimated 10,000 deaths/year by Chagas disease

Clinical course

• Acute phase
  • Mainly asymptomatic
  • local swelling at the site of inoculation (Chagoma)
    • Romaña sign
  • fever, anorexia, lymphadenopathy, mild hepatosplenomegaly, myocarditis
  • trypomastigote found in blood for 8-12 weeks after infection
  • children <5y/o fatal 10% in acute phase

• Chronic phase
  • 20-30% of infection
  • 10-40 years after infection
  • cardiomegaly, arrhythmia, heart failure
    • trypomastigotes invade and destruct cardiac muscle cells
    • EKG shows typically right bundle branch block
  • dilation of esophagus, megacolon - dysphagia and constipation
    • trypomastigotes invade and destruct intestinal smooth muscle cells

Diagnosis

• blood smear, with blood centrifugation
• molecular
• serology
  • ELISA, IFA, IHA
• clinical diagnosis

Treatment

• acute phase
  • nifurtimox
  • benznidazole (nitroimidazole)
  • both contraindicated for pregnant women, kidney failure, liver failure

• chronic phase
  • no specific treatment targeted pathogens
  • supportive therapy for each organ dysfunction

prevention and control

• vector control
  • improvement of house constructions
  • insecticide
• mass screening