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Chagas' Disease

Chagas' Disease

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 and 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 breastfeeding 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 two 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) begin.

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.

Resources

OTHER

Centers for Disease Control. http://www.cdc.gov/nccdphp/ddt/ddthome.htm.

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Chagas Disease

Chagas disease

Chagas disease is a human infection that is caused by a microorganism that establishes a parasitic relationship with a human host as part of its life cycle. The disease is named for the Brazilian physician Carlos Chagas, who described in 1909 the involvement of the flagellated protozoan known as Trypanosoma cruzi in a prevalent disease in South America.

The disease is confined to North, South, and Central America. Reflecting this, and the similarity of the disease to trypanosomiasis, a disease that occurs on the African continent, Chagas disease has also been dubbed American trypanosomiasis. The disease affects some 16 to 18 million each year, mainly in Central and South American. Indeed, in these regions the prevalence of Chagas disease in the population is higher than that of the Human Immunodeficiency Virus and the Hepatitis B and C viruses . Of those who acquire Chagas disease, approximately 50,000 people die each year.

The agent of Chagas disease, Trypanosoma cruzi, is a member of a division, or phylum, called Sarcomastigophora. The protozoan is spread to human via a bug known as Reduviid bugs (or "kissing bugs"). These bugs are also known as triatomines. Examples of species include Triatoma infestans, Triatoma brasiliensis, Triatoma dimidiata, and Triatoma sordida.

The disease is spread because of the close proximity of the triatomine bugs and humans. The bugs inhabit houses, particularly more substandard houses where cracks and deteriorating framework allows access to interior timbers. Biting an already infected person or animal infects the bugs themselves. The protozoan lives in the digestive tract of the bug. The infected bug subsequently infects another person by defecating on them, often while the person is asleep and unaware of the bug's presence. The trypanosomes in the feces gain entry to the bloodstream when feces are accidentally rubbed into the bite, or other orifices such as the mouth or eyes.

Chagas disease can also be transmitted in the blood. Acquisition of the disease via a blood transfusion occurs in thousands of people each year.

The association between the Reduviid bug and poor quality housing tends to make Chagas disease prevalent in underdeveloped regions of Central and South America. To add to the burden of these people, some 30% of those who are infected in childhood develop a chronic form of the disease 10 to 20 years later. This long-lasting form of Chagas disease reduces the life span by almost a decade.

Chagas disease may be asymptomatic (without symptoms)or can produce a variety of symptoms. The form of the disease that strikes soon after infection with Trypanosoma cruzi tends to persist only for a few months before disappearing. Usually, no treatment is necessary for relief from the infection. Symptoms of this type of so-called acute infection include swelling at the site of the bug bite, tiredness, fever, enlarged spleen or liver, diarrhea, and vomiting. Infants can experience a swelling of the brain that can be fatal.

The chronic form of Chagas disease can produce more severe symptoms, including an enlarged heart, irregularities in heart function, and the enlargement and malfunction of the digestive tract. These symptoms are of particular concern in those people whose immune system is not functioning properly.

Currently, there is no vaccine or other preventative treatment for Chagas disease. Avoidance of habitats where the Reduviid bug lives is the most prudent precaution. Unfortunately, given the economic circumstances of those most at risk, this option is not easily attainable. Trypanosoma cruzi can also be transmitted in the blood. Therefore, screening of blood and blood products for the presence of the protozoan is wise. Once again, however, the poverty that often plays a role in the spread of Chagas disease may also be reflected in less than adequate medical practices, including blood screening.

See also Parasites; Zoonoses

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Chagas' disease

Chagas' disease, disease of South and Central America caused by the parasite Trypanosoma cruzi. It usually affects children and young adults and is transmitted by the feces of infected insects, typically the assassin bug. Most of those infected have mild symptoms, such as fever and swelling and redness around the eyes, but from 10% to 30% develop chronic disease that may result in serious or fatal inflammation of the brain and heart tissues; persons with the disease also have an increased risk for stroke as they age as a result of heart problems. There is no vaccine and no satisfactory treatment. The incidence of Chagas' disease in the United States has increased since the 1970s, possibly because of increased immigration from Mexico and Central America, where the incidence is very high. In immunosuppressed patients (see AIDS) Chagas' disease can form a mass in the cranial cavity that mimics a tumor, presumably because the lymphocytes that guard against the parasite are the same that are depleted by the AIDS virus. See also trypanosome.

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Chagas’ Disease

Chagas Disease

What are the Symptoms of Chagas Disease?

How is Chagas Disease Diagnosed and Treated?

How is Chagas Disease Prevented?

Resources

Chagas (SHAH-gas) disease is a parasitic infection common in South and Central America. It is chronic (long-lasting) and can seriously damage the heart and the digestive system many years after a person gets infected. Another name for it is American trypanosomiasis (tri-pan-o~so-MY-a-sis).

KEYWORDS

for searching the Internet and other reference sources

American trypanosomiasis

Infection

Trypanosoma cruzi

Reduviidae

Chagas disease is an infection with a protozoan (pro-to-ZO-an), a tiny parasite called Trypanosoma cruzi. This parasite infects many kinds of mammals in South and Central America. It is spread to people by blood-sucking insects called reduviid (re-DOO-vi-id) bugs. These bugs, also called kissing or assassin bugs, pick up the parasite when they bite an infected person or animal. The parasites multiply inside the bugs. When the bugs bite other people, they deposit parasite-laden feces on the skin. If the people accidentally rub the feces into a cut or scratch, or into their eyes or mouth, they can get infected too.

Reduviid bugs tend to live in the cracks and crevices of poorly built houses in rural South and Central America and in Mexico. So Chagas disease used to be largely an illness of the rural poor in those areas. But in the 1970s and 1980s, many people moved from the countryside to Latin American cities, bringing the infection with them. In the cities, it started to spread through transfusions of contaminated blood. More rarely, it can also spread from a pregnant woman to her fetus. Chagas disease is estimated to kill up to 50,000 people a year.

What are the Symptoms of Chagas Disease?

Chagas disease has acute, indeterminate, and chronic phases.

Acute phase

People usually get infected as children. Most have no symptoms, but some have fever, swelling of the lymph nodes, or swelling around the eyes, if that was where the parasite entered the body. Symptoms usually go away in four to eight weeks. In rare cases, there may be heart damage or seizures. In people with weakened immune systems, such as those with AIDS, the acute stage can recur later, in a very severe form.

Indeterminate phase

The parasite is still present in the body but causes no symptoms. This stage lasts a lifetime in most infected people.

Chronic phase

In about one third of infected people, serious symptoms develop 10 to 20 years or more after they became infected. The most common problems are:

  • enlargement and weakening of the heart, a condition called cardiomyopathy (kard-ee-o-my-OP-a-thee), which can make a person feel weak and short of breath
  • ventricular dysrhythmias (dis-RITH-me-as)a form of irregular heartbeat that can cause sudden death
  • megacolonan enlargement of the colon (large intestine) that can cause extreme constipation and require surgical treatment
  • enlargement of the esophagus (the tube carrying food from the throat to the stomach), which can make eating difficult.

How is Chagas Disease Diagnosed and Treated?

In the acute stage, the parasites can be seen when blood is examined under a microscope. In the later stages, diagnosis is more difficult, and an array of different blood tests is used.

The U.S. and the World

Chagas disease occurs only in the Americas, mainly in South and Central America and in Mexico. It is believed to create a greater economic burden than any other tropical disease except malaria and schistosomiasis.

  • In South and Central America, about 16 million to 18 million people are infected with Chagas disease. Many live in thatch, mud, or adobe houses in poor areas.
  • In the United States, many people who emigrated from South and Central America are thought to be infected with Chagas disease, chiefly in the indeterminate or chronic stages. But it is extremely rare for someone to catch the disease in the United States. In a recent 20-year period, fewer than 20 newly acquired U.S. cases were reported, including three from blood transfusions.
  • About 50,000 people die each year from the disease.
  • The World Health Organization (WHO) reports that about 100 million people are at risk of developing Chagas disease.

In the acute stage, the parasites often can be eliminated by prescription medication taken for several months. In later stages, there is no proven cure. Instead, doctors try to treat the symptoms of the organ damage the parasites cause.

How is Chagas Disease Prevented?

In Latin America, many countries are taking part in a campaign to wipe out Chagas disease. They are using pesticides to kill the bugs that transmit the disease, and they are upgrading housing so the bugs cannot hide in cracked walls and thatched roofs. They also are trying to screen blood supplies more thoroughly.

This campaign is farthest along in the countries of the Southern Cone: Argentina, Brazil, Chile, Paraguay, and Uruguay. In this area, new infections of children and young adults reportedly were reduced by almost 70 percent in the late 1990s.

Travelers to areas where Chagas disease is common should use insect repellent (bug spray). If possible, they should avoid sleeping in thatch, mud, or adobe homes, or they should use bed nets at night.

See also

Dysrhythmia

Parasitic Diseases

Resources

The World Health Organization posts information about Chagas disease at its website. http://www.who.int/ctd/html/chag.html

The U.S. Centers for Disease Control and Prevention (CDC) has a Division of Parasitic Diseases that posts information about Chagas disease at its website. http://www.cdc.gov/ncidod/dpd/chagas.htm

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Chagas's disease

Chagas's disease A disease that can affect humans and other animals. It occurs chiefly in Central and S. America. The causal agent is a protozoon, Trypanosoma cruzi. The pathogen is transmitted by blood-sucking bugs. Symptoms may include anaemia and various signs of heart, gland, and nervous-system involvement. The disease is named after the Brazilian physician Carlos Chagas. Charles Darwin may have been infected with this disease in S. America, and some have suggested that his continual ill-health in later years was due to it.

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"Chagas's disease." A Dictionary of Zoology. . Encyclopedia.com. 19 Aug. 2017 <http://www.encyclopedia.com>.

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Chagass disease

Chagas's disease A disease that can affect humans and other animals. It occurs chiefly in Central and South America. The causal agent is a protozoon, Trypanosoma cruzi. The pathogen is transmitted by blood-sucking bugs. Symptoms may include anaemia and various signs of heart, gland, and nervous-system involvement. The disease is named after the Brazilian physician Carlos Chagas (1879–1934).

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