Chagas Disease

Chagas Disease: Overview

Also called American trypanosomiasis, Chagas disease is an infection caused by the parasite Trypanosoma cruzi.  It is estimated that 16-18 million people are infected with Chagas disease; of those infected, 50,000 will die each year.  It is a serious disease.

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Incidence; Causes and Development

Chagas disease primarily affects low income people living in rural areas and many people get the infection during childhood.

It is spread by reduviid bugs, or "kissing bugs", which live in cracks and holes of substandard housing primarily found in South and Central America.  Insects become infected after biting an animal or person who already has Chagas disease.  Infection is spread to humans when an infected bug deposits feces on a person's skin, usually while they are sleeping.  If this person accidentally rubs the feces into the bite wound, an open cut, the eyes, or their mouth, then they can become infected.  Animals can become infected the same way, and they can also contract the disease by eating an infected bug.

Infection can also be spread by infected mothers passing infection to their baby during pregnancy, at delivery, or while breastfeeding; by blood transfusion or organ transplant; by eating uncooked food contaminated with infective feces of these "kissing bugs."

Signs and Symptoms

The early stage of infection (acute Chagas disease) usually is not severe, but sometimes it can cause death, particularly in infants.  In about one-third of those who get the infection, chronic symptoms develop after 10-20 years.  For these persons who develop chronic symptoms, average life expectancy decreases by an average of 9 years.

Symptoms may occur within a few days to weeks.  Most people do not have symptoms until the chronic stage of infection, 10-20 years after first being infected.  There are three stages of infection with Chagas disease; each stage has different symptoms.  Some persons may be infected and never develop symptoms.

  • Acute
    Acute symptoms only occur in about 1% of cases.  Most people infected do not seek medical attention.  The most recognized symptom of acute Chagas infection is the Romaña's sign, or swelling of the eye on one side of the face, usually at the bite wound or where feces were rubbed into the eye.  Other symptoms are usually not specific for Chagas infection.  These symptoms may include fatigue, fever, enlarged liver or spleen, and swollen lymph glands.  Sometimes a rash, loss of appetite, diarrhea, and vomiting occur.  Among infants and very young children with acute Chagas disease, swelling of the brain can develop and this can cause death.  In general, symptoms last for 4-8 weeks and then they go away, even without treatment.
  • Indeterminate
    Eight to 10 weeks after infection, the indeterminate stage begins.  During this stage, people do not have symptoms.
  • Chronic
    Ten to 20 years after infection, people may develop the most serious symptoms of Chagas disease.  Cardiac problems, including an enlarged heart, altered heart rate or rhythm, heart failure, or cardiac arrest are symptoms of chronic disease.  Chagas disease can also lead to enlargement of parts of the digestive tract, which result in severe constipation or problems with swallowing.  In persons who are immune compromised, including persons with HIV/AIDS, Chagas disease can be severe.  Not everyone will develop the chronic symptoms of Chagas disease.

Treatment and Prevention

Medication for Chagas disease is usually effective when given during the acute stage of infection.  Once the disease has progressed to later stages, medication may be less effective.  In the chronic stage, treatment involves managing symptoms associated with the disease.

Prevention and Avoidance of Chagas Disease
Chagas disease is locally transmitted in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela.  Those people who sleep in poorly-constructed houses found in the rural areas of these countries are at elevated risk of infection.  Houses constructed from mud, adobe, or thatch present the greatest risk.

Travelers planning on staying in hotels, resorts, or other well-constructed housing facilities are NOT at high risk for contracting Chagas disease from reduviid bugs.

  • Avoid sleeping in thatch, mud, or adobe houses.
  • Use insecticides to kill insects and reduce the risk of transmission.
  • Be aware that, in some countries, the blood supply may not always be screened for Chagas disease, and blood transfusions may carry a risk of infection.

There is neither a preventive vaccine nor recommended drug against Chagas disease.  If you think you might have this disease, see your health care provider who will order blood tests to look for the parasite or for antibodies in your blood.

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