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Chagas Disease Print E-mail

Dr. Kennedy Chagas disease is an infection caused by the parasite Trypanosoma cruzi. Also called American trypanosomiasis. It is transmitted by reduviid bugs, or kissing bugs, that live in cracks and holes of substandard housing primarily found in South and Central America. These insects become infected after biting an animal or person who already has Chagas disease. Infection is spread to humans when an infected bug deposits feces on a person's skin, usually while the person is sleeping at night. The person often accidently rubs the feces into the bite wound, an open cut, the eyes, or mouth. Infected mothers can pass infection to their baby during pregnancy, at delivery, or while breastfeeding.

Symptoms

In the "acute infection," a few people (only about 1% of cases) have symptoms soon after infection. The most recognized acute symptom is swelling of the eye on one side of the face, usually at the bite wound or where feces were rubbed into the eye. Other symptoms are tiredness, fever, enlarged liver or spleen, swollen lymph glands, and sometimes a rash, loss of appetite, diarrhea, and vomiting. Infants and very young children can get an often-fatal swelling of the brain.

In the "indeterminate stage" in which, about 8 to 10 weeks after infection, infected persons have no symptoms.

So, obviously, from a symtomatic standpoint, most people end up with a "chronic infection." Symptoms here can include one or more of the following: serious, irreversible damage to the heart or intestinal tract that appears 10 to 20 years after infection, Heart-related problems include an enlarged heart, altered heart rate or rhythm, heart failure, or cardiac arrest, enlargement of parts of the digestive tract which can result in severe constipation or problems with swallowing. Swelling of the brain with personality disturbance has also been reported.

Diagnosis

Diagnosis is made by blood test and may be confused with syphillis as it give a false positive test result for syphillis. The diagnosis of the chronic phase of infection is performed by indirect serological methods which, nevertheless, leave inconclusive results. One of the direct methods used for T. cruzi identification, blood culture in LIT (liver infusion tryptose) medium, presents low sensitivity in that phase of the disease. A negative result does not eliminate the possibility of infection, but a positive test has high absolute diagnostic value, which enables the indication of antiparasitic treatment. Molecular diagnosis (PCR) in this phase is promising and can be used as a confirmatory test, particularly when individuals present inconclusive results in conventional serological tests, such as ELISA, HAI and IFI. This study aimed at improving blood culture sensitivity in LIT medium by performing PCR in individuals with positive and inconclusive serology for chagasic infection.

Treatment

There are several options for treatment. Nifurtimox (Lampit, a nitrofuran derivative) is given in daily doses of 10 mg./kg. of body weight to adults and 15 mg./kg. to children for 60-90 days. Benznidazole (Radanil, a nitroimidazole derivative) is given in daily doses of 5-10 mg./kg. for 30-60 days. Since these drugs causes oxidative stress their use should be avoided in cases of glucose-6-phosphate dehydrogenase deficiency. Allopurinol, a drug presently in use for the treatment of gout is sometimes used. (Gentian or crystal violet is used in blood transfusions using blood from an infected person to inactivate trypanosomes in the blood.)



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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