Chagas’ Disease

Abstract

T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 373;5 nejm.org July 30, 2015 456Review Article C hagas' disease is caused by the protozoan parasite Trypanosoma cruzi, which is transmitted when the infected feces of the triatomine vector are inoculated through a bite site or through an intact mucous membrane of the mammalian host (Fig. 1). 2 Vectorborne transmission is limited to areas of North America, Central America, and South America. Both in endemic and in nonendemic areas, other infection routes include transfusion, organ and bone marrow transplantation, and congenital transmission. Outbreaks attributed to contaminated food or drink have been reported in northern South America, where transmission cycles involving wild vector populations and mammalian reservoir hosts are prominent. 3 Infection is lifelong in the absence of effective treatment. The most important consequence of T. cruzi infection is cardiomyopathy, which occurs in 20 to 30% of infected persons. 4 Epidemiol ogyThe global epidemiologic profile of Chagas' disease is the result of two major forces: domestic vectorborne transmission over the lifetime of the current population of Latin America and large-scale rural-to-urban migration over the past 50 years (Fig. 2). 2,4 The most epidemiologically important vectors live in the cracks in mud walls and thatched roofs of rustic rural houses. Inhabitants of infested houses are repeatedly exposed to the vector and parasite over many years. Stercorarian transmission (i.e., transmission through the feces of an infected vector) is relatively inefficient: the incidence of T. cruzi infection is generally estimated to be less than 1% per year. 6,7 The highest estimated incidence is 4% per year, in the hyperendemic Bolivian Chaco. 8 In an endemic setting, continued transmission over time results in a pattern of increasing prevalence of both infection and cardiomyopathy with increasing age. 8,9 Over the past several decades, millions of infected persons have moved from endemic rural villages to Latin American cities, and hundreds of thousands now live in the United States, Spain, and other countries outside Latin America. 10,11 Latin America has made substantial progress toward the control of Chagas' disease. 4 The estimated global prevalence of T. cruzi infection declined from 18 million in 1991, when the first regional control initiative began, to 5.7 million in

Chagas Disease: Where to now?

“…6 The authors describe the vector parasite aspects of CD and how each year 56,000 new cases of infection and 12,000 deaths linked to CD are seen in endemic areas. 7 They describe the two phases of CD, the initial, acute phase with a high number of parasites circulating in the blood and mild nonspecific symptoms (fever, headache, enlarged lymph glands, pallor, muscle pain, swelling and others) and the chronic phase which develops in approximately one third of patients two or three decades after the acute infection. This phase is asymptomatic in around 70% of the patients.…”

Multiple Spectroscopic and Theoretical Approaches to Study the Interaction between HSA and the Antiparasitic Drugs: Benznidazole, Metronidazole, Nifurtimox and Megazol

“…vector are inoculated through a bite site or through an intact mucous membrane of a mammalian host. 2 Two nitro heterocyclic compounds, 4-[(5-nitrofurfurylidene) amino-3-methyl thio morpholine-1,1-dioxide] (nifurtimox, NFX) and N-benzil-2-nitro-1-imidazole acetamide (benznidazole, BZL) are at present used to treat Chagas disease. BZL, a nitroimidazole derivative, is better tolerated when compared to NFX, a 5-nitrofuran derivative, and is generally considered the drug of choice.…”

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

“…Clinical presentation is characterized by thromboembolic events, arrhythmias, and heart failure (HF); such symptoms account for the majority of morbidity, mortality, and decreased quality of life attributable to Chagas disease (5) (6) (7) . Chagas heart failure (CHF) is associated with higher mortality rates than HF from other etiologies, and accounts for 25-30% of death among patients with Chagas disease (8) .…”