Chagas Disease (American Trypanosomiasis or Kissing Bug Disease)

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Chagas disease (kissing bug disease) facts

  • Chagas disease is an infection caused by a protozoan parasite (Trypanosoma cruzi) that can result in acute inflammatory skin changes (chagomas) and may eventually cause infection and inflammation of many other body tissues, especially those of the heart and intestinal tract.
  • Chagas disease was first described in 1909 in Brazil.
  • Chagas disease is caused by a protozoan parasite named Trypanosoma cruzi that is transmitted to humans from the feces of triatomine bugs (kissing bugs).
  • The parasites usually enter the mammalian (human) host through the bug bite, or breaks in the skin or conjunctiva, replicate in mammalian cells, and may eventually reach other organs through the blood.
  • Chagas disease may proceed through three phases in an individual: acute, intermediate or indeterminate, and chronic.
  • Chagas disease symptoms vary widely from no symptoms to severe in the chronic phase.
  • Acute-phase symptoms of Chagas disease may be swelling and/or redness at the skin infection site (termed chagoma), rash, swollen lymph nodes, fever, head and body aches, fatigue, nausea, vomiting and/or diarrhea, liver and/or spleen enlargement, and the Romaña sign.
  • Chronic-phase symptoms and signs of Chagas disease may be irregular heartbeats, palpitations, fainting (syncope), cardiomyopathy, congestive heart failure, short of breath (dyspnea), emphysema, stroke, sudden death, chronic abdominal pain, chronic constipation, dilated colon, and difficulty swallowing.
  • Patient history, physical exam, direct microscopic visualization of the parasites, and detection of antibodies against the parasites are methods used to diagnose Chagas disease.
  • Treatment with antiparasitic drugs benznidazole (Rochagan, Ragonil) and nifurtimox (Lampit) kill or inhibit T. cruzi parasites.
  • Chronic-phase patients are usually treated using treatments directed at the specific symptoms or organ damage.
  • There is no vaccine against Chagas disease parasites for humans, but many experts suggest that elimination of primitive housing and education may prevent most cases of Chagas disease.

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What are the signs and symptoms of Chagas disease?

There are two phases of Chagas disease: the acute phase and the chronic phase. Both phases can be symptom free or life threatening.

The acute phase lasts for the first few weeks or months of infection. It usually occurs unnoticed because it is symptom free or exhibits only mild symptoms and signs that are not unique to Chagas disease. The symptoms noted by the patient can include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. The signs on physical examination can include mild enlargement of the liver or spleen, swollen glands, and local swelling (a chagoma) where the parasite entered the body. The most recognized marker of acute Chagas disease is called Romaña's sign, which includes swelling of the eyelids on the side of the face near the bite wound or where the bug feces were deposited or accidentally rubbed into the eye. Even if symptoms develop during the acute phase, they usually fade away on their own, within a few weeks or months. Although the symptoms resolve, the infection, if untreated, persists. Rarely, young children (<5%) die from severe inflammation/infection of the heart muscle (myocarditis) or brain (meningoencephalitis). The acute phase also can be severe in people with weakened immune systems.

During the chronic phase, the infection may remain silent for decades or even for life. However, some people develop:

  • cardiac complications, which can include an enlarged heart (cardiomyopathy), heart failure, altered heart rate or rhythm, and cardiac arrest (sudden death); and/or
  • intestinal complications, which can include an enlarged esophagus (megaesophagus) or colon (megacolon) and can lead to difficulties with eating or with passing stool.

The average life-time risk of developing one or more of these complications is about 30%.



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