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Chagas disease is a parasitic infection prevalent in tropical regions and is spread by crawling, blood-sucking insects known as kissing bugs. The parasite Trypanosoma cruzi (T. cruzi) is the cause of the infection. In most instances, the transmission of the disease occurs when infected individuals are bitten by a triatomine bug, also known as a kissing bug.
Also known as American trypanosomiasis, this disease is prevalent in South America, Central America, and Mexico. Occasional instances of Chagas disease have been detected in the southern United States.
Chagas disease can affect people of all backgrounds. Both acute and chronic symptoms are possible. If left untreated, Chagas disease can lead to severe heart and digestive issues. If therapy is received shortly after infection, chagas disease is curable. However, once the disease becomes chronic, killing the parasite is no longer feasible. Treatment during this stage involves managing signs and symptoms. Preventive measures can be taken to reduce the risk of infection.
Symptoms
Chagas disease can develop into two different phases: acute or sudden phase, and chronic or long-lasting phase. Chagas disease symptoms can vary from mild to severe. Many people may not manifest symptoms until the chronic stage of the disease.
- Acute phase: During the acute period, signs and symptoms typically disappear on their own. Symptoms, which can last for a few days or weeks, are generally mild or may go unnoticed. However, if the infection remains untreated, there is a risk of progression to the chronic phase.
Mild symptoms include:- Swelling at the site of bug bite
- Enlarged spleen or liver
- Swollen glands
- Muscle pain
- Abdominal pain
- Swelling of the eyelids
- Fatigue
- Rash
- Headache
- Reduced appetite
- Nausea, diarrhea, or vomiting
- Chronic phase: Chronic Chagas disease can lead to significant complications impacting the heart and gastrointestinal tract. Symptoms may emerge many years or even decades following the initial infection, or they may not manifest at all.
- Heart failure
- Irregular heartbeat, or health palpitations
- Chest pain
- Sudden cardiac arrest
- Breathing difficulties
- Swallowing difficulties brought on by an enlarged esophagus
- Constipation or stomach pain brought on by an enlarged colon
- Dizziness
- Fatigue
- Fainting
If any of the signs and symptoms occur, consult a healthcare provider for proper diagnosis and treatment. Chagas disease can be readily diagnosed through a blood test, and individuals are encouraged to seek this test if they live in regions where the disease is prevalent or have travelled to areas where triatomine bugs are known to transmit Chagas disease.
Causes
Chagas disease results from a blood infection with the parasite Trypanosoma cruzi or T. cruzi. Most individuals who contract Chagas disease typically encounter T. cruzi through contact with the feces or urine of an infected triatomine insect, commonly known as the kissing bug.
These blood-sucking insects feed on both animals and humans. These insects hide in the day and crawl at night to feed. They typically bite while you’re asleep, often targeting areas around your face, which is why they are commonly referred to as “kissing bugs.” When these bugs feed, they excrete urine and feces near the site of the bite, potentially depositing the parasite T. cruzi. Inadvertently, you might scratch or rub the bite, causing the parasite T. cruzi to enter your bloodstream through the opening in your skin.
Chagas disease can also spread by:
- Congenital transmission refers to the process in which an expectant individual who is infected with the disease passes the infection to the developing fetus or the newborn during the childbirth process.
- Consuming raw food that has been tainted with feces from insects carrying the parasite.
- Receiving an organ transplant or blood transfusion from a person who has the parasite.
- Spending time in a forest where opossums and raccoons, among other wild creatures, are infected.
- Triatomine bites acquired while consuming raw sugar cane sticks.
- Although rare, a laboratory incident.
Risk factors
Chagas disease can develop in individuals who come into contact with the feces or urine of a kissing bug (triatomine) carrying the infection. The prevalence of this infection is highest in rural or poor areas of continental South America, Central America, and Mexico.
The majority of infections continue to be reported in urban areas of 21 Latin American countries, while instances of chronic disease remain rare in other countries.
Other risk factors include:
- Living or staying in structures made of materials such as mud, adobe, or thatch, where triatomine bugs are more commonly found.
- Receiving a blood transfusion or organ transplant from an infected individual.
Diagnosis
Generally, the diagnosis include an assessment of symptoms and risk, and conduct of a physical examination. The diagnosis is then confirmed through a straightforward blood test that detects the presence of antibodies against the parasite.
Upon a positive diagnosis and a thorough examination of the medical history, several tests may be required to exclude any potential heart or gastrointestinal complications.
Tests that may be ordered include:
- Electrocardiogram (EKG, ECG): It records the electrical activity of the heart using electrodes applied to the skin.
- Echocardiogram: It produces a thorough picture of the heart using sound waves.
- Chest X-ray: The diagnostic procedure that shows whether the heart is enlarged.
- Abdominal X-ray: The pictures of the colon, intestines, and stomach are produced using radiation technology.
- Upper endoscopy: It projects images of the esophagus into a screen using an endoscope.
Treatment
The treatment of Chagas disease depends on the severity of the condition. Timely administration of treatment typically results in a full recovery for most cases. Generally, the treatment focuses on eradicating the parasite and controlling the symptoms.
Benznidazole and nifurtimox are antiparasitic drugs that can be effective during the acute stage of Chagas disease. However, once the disease progresses to the chronic stage, medication is no longer considered a curative option. Nonetheless, individuals under the age of 50 may still be prescribed these drugs as they can potentially slow down the disease’s advancement and prevent further complications.
Additional inter vention may be necessary if there are cardiac or intestinal complications resulting from the disease:
- Digestive complications: Medication, corticosteroids, diet modifications, and surgery are among the treatment options for these cases.
- Complications in the heart: Medication, a pacemaker, or other heart rhythm control devices, surgery, or heart transplant, may be used as forms of treatment.
