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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Chagas' disease
From Gale Encyclopedia of Medicine, 4/6/01 by David S. Kaminstein

Definition

Chagas' disease is named after Dr. Carlos Chagas who first found the organism in the early 1900s. It involves damage to the nerves that control the heart, digestive and other organs, and eventually leads to damage to these organs. Worldwide, Chagas' disease affects over 15 million persons, and kills 50,000 each year. Researchers believe that the parasite that causes the disease is only found in the Americas.

Description

When a person is infected with Chagas' disease, the parasite known as Trypanosoma cruzi first causes a mild, short-lived period of "acute" illness; then after a long period without symptoms, the effects of the infection begin to appear. The heart, esophagus, and colon are most frequently involved. These organs become unable to contract properly, and begin to stretch or dilate.

Causes & symptoms

T. cruzi is carried by insects or bugs known as reduviid or "kissing bugs." These insects are very common in Central and South America where they inhabit poorly constructed houses and huts. The insects deposit their waste material, exposing inhabitants to the parasites. The parasites then enter the body by way of a cut or via the eyes or mouth. T. cruzi can also be transmitted by blood transfusion. Eating uncooked, contaminated food or breast-feeding can also transmit the disease. The reduviids, in turn, become infected with the parasite by biting infected animals and humans.

There are three phases related to infection:

  • Acute phase lasts about 2 months, with non-specific symptoms of low grade fever, headache, fatigue, and enlarged liver or spleen.
  • Indeterminate phase lasts 10-20 years, during which time no symptoms occur, but the parasites are reproducing in various organs.
  • Chronic phase is the stage when symptoms related to damage of major organs (heart, esophagus, colon) begins.

In the chronic phase, irregularities of heart rhythm, heart failure, and blood clots cause weakness, fainting, and even sudden death.

Esophageal symptoms are related to difficulty with swallowing and chest pain. Because the esophagus does not empty properly, food regurgitates into the lungs causing cough, bronchitis, and repeated bouts of pneumonia. Inability to eat, weight loss, and malnutrition become a significant factor in affecting survival.

Involvement of the large intestine (colon) causes constipation, distention, and abdominal pain.

Diagnosis

The best way to diagnose acute infection is to identify the parasites in tissue or blood. Occasionally it is possible to culture the organism from infected tissue, but this process usually requires too much time to be of value. In the chronic phase, antibody levels can be measured. Efforts to develop new, more accurate tests are ongoing.

Treatment

In most cases treatment of symptoms is all that is possible. Present medications can reduce the duration and severity of an acute infection, but are only 50% effective, at best, in eliminating the organisms.

Cardiac effects are managed with pacemakers and medications. Esophageal complications require either endoscopic or surgical methods to improve esophageal emptying, similar to those used to treat the disorder known as achalasia. Constipation is treated by increasing fiber and bulk laxatives, or removal of diseased portions of the colon.

Prognosis

Those patients with gastrointestinal complications often respond to some form of treatment. Cardiac problems are more difficult to treat, particularly since transplant would rekindle infection.

Prevention

Visitors traveling to areas of known infection should avoid staying in mud, adobe, or similar huts. Mosquito nets and insect repellents are useful in helping to avoid contact with the bugs. Blood screening is not always effective in many regions where infection is common. It is necessary to carefully screen people who have emigrated from Central and South America before they make blood donations.

Key Terms

Achalasia
An esophageal disease of unknown cause, in which the lower sphincter or muscle is unable to relax normally, and leads to the accumulation of material within the esophagus.
Endoscopy
Exam using an endoscope (a thin flexible tube which uses a lens or miniature camera to view various areas of the gastrointestinal tract). When the procedure is performed to examine certain organs such as the bile ducts or pancreas, the organs are not viewed directly, but rather indirectly through the injection of x-ray.
Parasite
An organism that lives on or in another and takes nourishment (food and fluids) from that organism.
Regurgitation
Flow of material back up the esophagus and into the throat or lungs.

Further Reading

For Your Information

    Books

  • Kirchoff, Louis V. "Trypanosomiasis." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998, pp. 1193-1196.
  • Owen, Robert L. "American Trypanosomiasis (Chagas' Disease)." In Sleisenger & Fordtran's Gastrointestinal and Liver Disease, edited by Mark Feldman, et al. Philadelphia: W.B. Saunders Company, 1997, pp.1676-1679.

    Periodicals

  • Kirchoff, Louis V. "American Trypanosomiasis (Chagas' Disease)." Gastroenterology Clinics of North America. (September 1996): 517-533.
  • Kirchoff, Louis V. "Current Concepts: American Trypanosomiasis (Chagas' Disease)-A Tropical Disease Now in the United States." New England Journal of Medicine. 329 (9) (1993): 639.

    Other

  • "Chagas' disease (American trypanosomiasis)." http://www.cdc.gov/ncidod/dpd/chagas.htm.
  • "New approaches to Chagas' disease control may contain genetically engineered bacteria." http://www.cdc.gov/ncidod/focus/vol6no3/chagas.htm.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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