Chagas disease

Revision as of 02:10, 13 January 2015 by Arsmd (talk | contribs) (background, clinical findings)

Background

  • Endemic in rural parts of Cental and South America
    • Rare cases found in Southern United States
  • Caused by the parasite trypanosoma cruzi
    • Vector: Reduviid (kissing bug)
    • The parasite is transmitted in the feces of the host vector
      • When the vector bites, it also defecates and the parasites enter the blood stream through the bite wound

Transmission

  • Disease of poverty
    • Spread by the Triatominae bug (also known as the kissing bug)
      • The Triatomina bug thrives in housing that is old, has thatched roofs and dwellings where the roof does not abut the wall.
  • Other methods of transmission
    • Vertical (mother to child)
    • Transfusion/organ donation

Clinical Features

Acute phase

  • Romañas sign
    • swelling of the eye thought to be secondary to rubbing the feces into the eye
  • Chagoma
    • Localized swelling at the area of parasite entry
  • Non-specific signs and symptoms
    • Fever, fatigue, myalgias, headache, anorexia, vomiting, diarrhea
  • Serious complications
    • Myocarditis, arrhythmia, encephalitis

Chronic phase

  • Between 20-40% of patients will develop chronic complications
  • Cardiac complications
    • Dilated cardiomyopathy (CHF)
    • Dysrhythmias
  • GI complications
    • Megaesophagus
    • Megacolon
    • Achalasia
    • Hepatosplenomegaly (secondary to HF)
  • Neuro symptoms
    • Neuritis

Diagnosis

  • Blood smear
    • Can visualize parasites
  • Blood tests
    • PCR, ELISA, immunoflorescence

Work-Up

  • EKG
  • Liver Enzymes
  • Blood smear
  • PCR, ELISA, Etc

Treatment

  • Benznidazole or Nifurtimox
  • Symptomatic treatment

See Also

Source

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