Treatment for Chagas disease varies widely depending on its stage. If you suspect you have the disease, you should consult your physician for an accurate diagnosis and treatment. Chronic Chagas disease can have various symptoms, including cardiac dysfunction and gastrointestinal dysfunction. If your condition is severe, you may need advanced care, including heart transplantation.
Chronic phase
The chronic phase of Chagas disease is when the parasites remain in the body for a long time. This can result in heart failure and stroke. Patients with chronic Chagas disease are at a high risk for sudden death. In some cases, the disease may even result in massive flaccid dilation of the colon and esophagus. These complications are often difficult to treat and can be life-threatening.
The disease is caused by the protozoan parasite Trypanosoma cruzi. The parasite lives on humans and animals, and is transmitted through triatomine bug feces. Triatomines are insects found in Central and South America. While they live underground during the day, they come out at night to feed on humans and animals.
Cardiomyopathy is a major complication of chronic Chagas disease. A systematic review of 32 studies found that patients with this disease were at a high risk of developing this condition. However, the risk was much lower in the acute phase of the disease. Symptoms of cardiomyopathy may develop even in asymptomatic individuals with chronic Chagas disease.
In the past, Chagas disease was limited to impoverished areas of South and Central America, but more recent developments have led to the disease spreading throughout the world. The disease is now found in some African and Eastern Mediterranean countries and is even present in some Western Pacific countries. A recent study even showed that people with Chagas disease have been traveling around the world.
Antiparasitic medication can slow or prevent the progression of the disease. However, it is important to note that these drugs can have adverse effects in up to 40% of people who take them. For instance, benznidazole should not be taken by pregnant women and people with kidney failure. Furthermore, nifurtimox is contraindicated for people who have cardiovascular or psychiatric disorders.
While most chronic T. cruzi infection patients show no symptoms, about 20% to 30% of patients progress to clinically evident Chagas disease. Cardiomyopathy is the most common complication of chronic Chagas disease. It begins with abnormalities of the conduction system, such as right bundle branch block, and may progress to higher-grade heart block and complex ventricular arrhythmias.
Diagnosis
Diagnosis of Chagas disease is an important step in treatment. Patients suffering from the chronic form of this disease may need to undergo cardiac and gastrointestinal imaging tests. Antiparasitic drugs can be used to treat the infection. Patients with acute or congenital Chagas disease may be treated with antibiotics. Treatment for chronic Chagas disease is based on the balance between risks and benefits.
Testing for the disease is performed using specially prepared blood samples. These blood samples are examined under a microscope to look for the presence of T. cruzi parasites. During the acute phase of the disease, the parasite load in the bloodstream is high. However, after 90 days, the parasite count decreases rapidly. Consequently, microscopic testing is not reliable after this period.
The symptoms of acute Chagas disease can be confusing and may be mistaken for other diseases. For example, symptoms of infectious mononucleosis and HIV infection are similar to those of Chagas disease. In acute Chagas, the organism T. cruzi is not present in the bloodstream, so the patient may have a different cause of the symptoms. This is why it’s important to get a proper diagnosis as soon as possible.
Diagnosis of Chagas disease is possible with the use of PCR and microscopic examination of anticoagulated blood. However, PCR and serologic testing are not 100% accurate and may be false negative. An occasional baby may be infected with T cruzi but test negative for Chagas disease.
Diagnosis of Chagas disease is crucial in the prevention of the chronic manifestations of the disease. Depending on the stage of infection, the appropriate drug may be prescribed. A patient’s symptoms should be monitored closely, as the disease can progress to chronic forms. This disease is often difficult to diagnose because of lack of symptoms, but a positive test is important for early treatment.
Diagnosis of Chagas disease can be tricky, particularly when the patient has had no symptoms for several months. Luckily, there are several new techniques that have made the diagnosis easier and more accurate. A newly developed PCR technique, known as Architect Chagas, uses four recombinant proteins as antigens. However, the test is not yet widely available.
Treatment
Chagas disease is caused by a parasite called Trypanosoma cruzi. Throughout the last decade, researchers have made significant progress in treating Chagas disease. While there is no vaccine for the disease, medications that kill the parasites in their early stages can help a large number of chronic infection patients. Patients should discuss their symptoms and treatment options with their primary care provider or other health-care provider. The CDC also provides information on the various treatments available.
The acute phase of Chagas disease is relatively mild, lasting a few weeks or months. Most people will only experience fever and non-specific symptoms during this period. However, sometimes, symptoms become life-threatening. Ten to fifty percent of patients in the acute phase progress to chronic disease, a stage of the disease characterized by potentially life-threatening heart failure, megacolon, and esophagus infections.
In some cases, chronic Chagas disease may appear years after initial infection, and in some cases, long-term complications may result. The parasite responsible for the disease lives in rural areas of South and Central America. It is spread through kissing bugs, which are tiny, blood-sucking insects. They leave infected waste, which humans can pick up if they rub their eyes or lick their faces.
Researchers have found that circulating plasma microRNA-208a may serve as a biomarker for chronic Chagas disease. This biomarker may also be a valuable tool for identifying potential therapies. Researchers are now using lipidomics, metabolomics, and proteomics to develop novel anti-Chagas therapies.
Finding biomarkers for Chagas disease is an essential step in the development of new treatments. But as of yet, no biomarkers have reached clinical validation. In addition to RNA aptamers, biosensors, and serum antibodies are not proven to detect Chagas disease. This means that identifying biomarkers for chronic Chagas disease is still a difficult task.
Several studies have tried to identify candidate genes involved in the progression of the disease. One study, by Del Puerto FY and colleagues, found a genetic association between the HLA-DRB1*01-B*14 gene and chronic Chagas cardiomyopathy. These findings suggest that the genes involved in Chagas disease may play an important role in the pathogenesis of the disease. However, further studies are needed to fully understand the role of these genes in chronic Chagas disease.
Prevention
Prevention of Chagas disease requires a multidisciplinary approach. In endemic countries, the main objectives are to eliminate the domestic vectors, control disease transmission, and improve maternal screening. Although these initiatives have made considerable progress, they are not yet effective enough to completely eliminate the disease. However, they have contributed to a reduction in the disease burden and in the incidence of new infections.
The CDC is working to raise healthcare providers’ awareness of the disease and to provide resources that help them treat patients who are infected with the parasite. The organization also works with partners to improve healthcare provider awareness by developing new strategies, materials, and guidelines. Several countries have already started screening for the disease, including the US, Mexico, and Spain.
In the Amazon, an International Initiative for Chagas Disease Surveillance and Prevention was launched in 2002. It aims to promote a regional and international cooperative system for disease control and prevention. The initiative recommends training of technicians with the ability to recognize triatomines and to provide epidemiological and clinical diagnoses.
Besides frequent medical screening, prevention of Chagas disease can be achieved by controlling the spread of the triatomine bug. Some measures include spraying the house with insecticides and plastering the walls. People traveling to infected areas should also use bed nets and avoid eating contaminated food. Screening for the disease among pregnant women and blood donors can decrease the risk of infection.
Prevention of Chagas disease requires increased efforts in both endemic and non-endemic countries. A variety of strategies and technologies are needed for effective and sustainable control of the parasite. In addition, research priorities must be varied to enable development of multiple alternative control strategies. In endemic areas, successful campaigns on controlling the Triatominae vector should have interrupted the transmission of the parasite in the most common domestic populations. However, this does not account for the transmission of the disease by wild and peridomestic vectors.
Currently, most new cases of Chagas disease occur in newborns with congenital infection. Treatment of the infection prior to pregnancy is recommended in these areas to prevent congenital Chagas disease. This method is more effective than treatment during pregnancy and can reduce the risk of congenital transmission by 95 percent. Infected females should undergo cardiovascular and gastrointestinal evaluation before giving birth to a child.