About Chagas Disease
Chagas Disease, also known as American trypanosomiasis, is a parasitic infection caused by the protozoan parasite Trypanosoma cruzi. People become infected when they are bitten by a triatomine bug (also called a kissing bug) that is infected with the parasite or by consuming food or beverages that have been contaminated by the waste (feces or urine) of the kissing bug.
Chagas Disease is most common in rural areas of Latin American countries. However, cases have also been reported in other regions due to travel or migration.
The disease has two distinct phases: acute and chronic.
- During the acute phase, symptoms may be absent or mild, such as prolonged fever, malaise, headache, and enlarged lymph nodes. Specific signs like inoculation chagoma (skin lesion) or Romaa signal (swollen eyelid) are rare but can occur. Mortality during this phase is around 5% and is usually caused by acute myocarditis or meningoencephalitis.
- The chronic phase of Chagas Disease is characterized by an asymptomatic period that can last for decades. However, approximately 30% of individuals progress to develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances, and severe heart failure.
Treatment of Chagas Disease may include medicine to kill the parasite and treatments to manage symptoms or complications.
The pathophysiology of Chagas disease involves several mechanisms:
- Microvascular dysfunction: This refers to the impairment of small blood vessels, which can lead to reduced blood flow and tissue damage.
- Autonomic nervous system (ANS) impairment: Chagas disease can affect the ANS, which regulates various bodily functions. ANS dysfunction can contribute to heart rhythm abnormalities and digestive problems.
- Direct aggression from the parasite: The Trypanosoma cruzi parasite directly damages heart muscle cells, leading to cardiomyopathy and heart failure.
- Severe inflammatory activity: The immune response against the parasite can cause chronic inflammation, further damaging the heart and other organs.
Other than an infected mother passing an infection on to an unborn baby, Chagas Disease is not passed directly from person-to-person.
The main risk factor for Chagas disease is living in houses with cracks in the wall or thatched (straw) roofs in rural South America, Central America, and Mexico. This environment enables the kissing bugs to enter homes, where they may bite people. Less commonly, a person can become infected through consuming uncooked food in these areas.
People living in or visiting high-risk areas can help prevent Chagas Disease by:
- Avoiding sleeping in mud or adobe houses or houses with thatched roofs because kissing bugs may live in the cracks of such houses
- Use insecticide-soaked netting over the bed
- Use insect repellent on uncovered skin, including the face
- Use insecticide to remove kissing bugs
Common symptoms of the acute phase of Chagas Disease include:
- Swelling at the site of the kissing bug bite
- Flu-like symptoms, such as fever, body aches, headache, and feeling tired
- Muscle pain
- Abdominal (belly) pain
- Diarrhea
- Nausea or vomiting
- Rash
- Swollen eyelid
Symptoms of the chronic phase of Chagas Disease may appear many years, even decades, after the initial infection. Symptoms of the chronic phase of Chagas Disease include:
- Chest pain
- Fatigue
- Heart palpitations (irregular heartbeat)
- Difficulty breathing (being short of breath)
- Problems with the digestive system (difficulty eating, stomach pain, abdominal swelling, constipation)
It's important to note that an estimated 80% of patients with Chagas Disease may be not have symptoms during the acute phase, making early diagnosis challenging. If you experience any symptoms of Chagas Disease, especially after travelling to a high-risk area, it is crucial to consult with a healthcare professional for proper evaluation and diagnosis.
To diagnose Chagas Disease, the following examinations, tests, and procedures may be performed:
- Medical history: The healthcare provider will ask you about your symptoms and travel history.
- Physical exam: The healthcare provider will look for physical signs of the disease, such as a bite mark, skin lesions/rash, and swollen eyelid.
- Lab tests: These may include blood draws to check for the parasite or specific antibodies to the parasite.
Additional tests may be done to check for possible complications for the chronic phase of Chagas Disease:
- Electrocardiogram (EKG) to check the heart’s rhythm
- Imaging studies such as X-rays or MRI scans to examine the body for any abnormalities, such as an enlarged heart and abnormalities in the colon
- Echocardiogram to check the heart’s size and ability to pump blood
- Upper GI endoscopy to check the health of the esophagus and stomach
It's important to consult with a healthcare professional who can recommend and interpret these examinations and tests based on your individual situation.
The goals of treatment for Chagas Disease are to:
- Cure the infection: The primary goal is to eliminate the parasite from the body, which can help prevent or slow down the progression of the disease.
- Manage symptoms: Treatment aims to alleviate symptoms such as heart problems, digestive issues, and neurological complications.
The recommended treatment options for Chagas Disease include:
- Medications:
- Antiparasitic drugs are commonly used to kill the parasite and reduce its spread in the body. These medications are effective in the early stages of infection and may cure Chagas Disease. During the chronic phase, antiparasitics may not cure the disease but may be recommended to help slow progression of the Chagas Disease.
- During the chronic phase of Chagas Disease, medications may be needed to treat heart failure or other heart complications, or treat digestive complications
- Therapeutic procedures: In some cases, therapeutic procedures may be needed to treat complications of Chagas Disease.
- Heart complications: Pacemakers, implantable cardioverter-defibrillators, or heart surgery
- Digestive complications: Surgery
It's important to note that specific medication types and therapies depend on individual factors such as the stage of infection and the presence of complications. Consulting with a healthcare professional is crucial to determine the most appropriate treatment plan for each person.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur with medications. Check with your health care professional or read the information provided with your medication for additional side effect information.