Photomicrograph of Giemsa-stained Trypanosoma cruzi crithidia (CDC)Chagas in Latin America (A:Endemic zones)This child from Panama is suffering from Chagas disease manifested as an acute infection with swelling of the right eye (chagoma). Source: CDC.Life cycle of Trypanosima cruzi. Source: CDC
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Chagas disease

Chagas disease (also called American trypanosomiasis) is a human tropical parasitic disease which occurs in the Americas, particularly in South America. Its pathogenic agent is a flagellate protozoan named Trypanosoma cruzi, which is transmitted to humans and other mammals mostly by hematophagous insects of the subfamily Triatominae (Family Reduviidae). Those insects are known by numerous common names varying by country, including assassin bug, benchuca, vinchuca, kissing bug, chipo, barbeiro, et cetera. The most common insect species belong to the genera Triatoma, Rhodnius, and Panstrongylus. more...

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Other forms of transmission are possible, though, such as ingestion of food contaminated with parasites, blood transfusion and fetal transmission.

Trypanosoma cruzi is a member of the same genus as the infectious agent of African sleeping sickness, but its clinical manifestations, geographical distribution, life cycle and insect vectors are quite different.

History

The disease was named after the Brazilian physician and infectologist Carlos Chagas, who first described it in 1909, but the disease was not seen as a major public health problem in humans until the 1960s. He discovered that the intestines of Triatomidae harbored a flagellate protozoan, a new species of the Trypanosoma genus, and was able to prove experimentally that it could be transmitted to marmoset monkeys which were bitten by the infected bug.

Chagas named the pathogenic parasite that causes the disease Schizotrypanum cruzi (later renamed to Trypanosoma cruzi), after Oswaldo Cruz, the noted Brazilian physician and epidemiologist who fought successfully epidemics of yellow fever, smallpox, and bubonic plague in Rio de Janeiro and other cities in the beginning of the 20th century. Chagas’ work is unique in the history of medicine, because he was the only researcher so far to describe completely a new infectious disease: its pathogen, vector, host, clinical manifestations, and epidemiology. Nevertheless, he at least believed falsely until 1925, that the main infection route is by the sting of the insect and not by the feces, as it was proposed by his collegue Emile Brumpt 1915 and assured by Dias 1932, Cardoso 1938 and Brumpt himself 1939.

On another historical point of view, it has been hypothesized that Charles Darwin might have suffered from this disease as a result of a bite of the so-called Great Black Bug of the Pampas (vinchuca) (see Illness of Charles Darwin). The episode was reported by Darwin in his diaries of the Voyage of the Beagle as occurring in March 1835 to the east of the Andes near Mendoza. Darwin was young and in general good health though six months previously he had been ill for a month near Valparaiso, but in 1837, almost a year after he returned to England, he began to suffer intermittently from a strange group of symptoms, becoming very incapacitated for much of the rest of his life. Attempts to test Darwin's remains at the Westminster Abbey by using modern PCR techniques were met with a refusal by the Abbey's curator.

Epidemiology and geographical distribution

Chagas disease currently affects 16-18 million people, killing around 20,000 people annually and with some 100 million at risk of acquiring the disease. Chronic Chagas disease remains a major health problem in many Latin American countries, despite the effectiveness of hygienic and preventive measures, such as eliminating the transmitting insects, which have reduced to zero new infections in at least two countries of the region. With increased population movements, however, the possibility of transmission by blood transfusion has become more substantial in the United States . Also, T. cruzi has already been found infecting wild opossums and raccoons as far as North Carolina .

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Evaluation of asymptomatic patients with cronic Chagas disease trhough the analisys of dynamic electrocardiogram, echocardiogram and B-type natriuretic
From CHEST, 10/1/05 by Divina S. Oliveira-Marques

PURPOSE: To evaluate asymptomatic patients with chronic Chagas' disease in relation to the prevalence of ventricular arrhythmia, left ventricular dysfunction, and B-type natriuretic peptide levels (BNP).

METHODS: Clinical evaluation, electrocardiogram (EKG). cardiothoracic index (CTI),dynamic electrocardiogram, echocardiogram and BNP dosing were used to evaluate 106 patients from the Chagas Disease Outpatient clinic, distributed into three groups: GI (50- normal EKG). GIIA (31-EKG with alterations characteristic of Chagas disease, and GIIB (25- EKG with other types of alterations).

RESULTS: The most prevalent electrocardiographic alterations were: GIIA group: right bundle branch block, anterior division of de left bundle branch block and inactive areas (18% each); GIIB group: alterations in the infero-lateral repolarization and left ventricular hypertrophy (26%). CTI mean values were similar (p=0,383). The prevalence of ventricular arrhythmia was greater in the GIIA (77%) and GIIB (75%) groups than in the GI group (46%) (p=0,002). Ventricular dysfunction was more frequent in the GIIA (52%) and GIIB (32%) groups than in the GI group (14%) (p= 0,001). Systolic dysfunction was more prevalent in the GIIA group (29%) than in the GIIB (20%) and GI (2%) (p< 0,001). Diastolic dysfunction was more frequent in the GII (42%) and GIIB (28%) groups than in the GI (12%) group (p=0,005). B-type natriuretic peptide levels were 30 [+ or -] 88 pg/ml for the GI group, 66 [+ or -] 194 for the GIIA group and 24 [+ or -] 82 for the GIIB group (p=0,121), respectively.

CONCLUSION: Arrhythmia and left ventricular dysfunction were more prevalent in the asymptomatic patients with chronic Chagas' disease and EKG alterations than in patients with normal EKGs. BNP levels were similar among the groups.

CLINICAL IMPLICATIONS: Patients with asymptomatic chronic form of the Chagas'disease and electrocardiographic alterations will have to be submitted to the inquiry in relation to the presence of arrhythmias and ventricular dysfunction.

DISCLOSURE: Divina Oliveira-Marques, None.

Divina S. Oliveira-Marques PhD * Manoel F. Canesin PhD Claudio J. Fuganti MD Antonio C. Pereira-Barretto PhD Londrina State University, Londrina, Brazil.

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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