Chagas disease, or American trypanosomiasis, is caused by the parasite Trypanosoma cruzi. Infection is most commonly acquired through contact with an infected triatomine bug (or "kissing bug," because it often bites the face). Infection can also occur from mother to baby (congenital), contaminated blood products (transfusions), or an organ transplanted from an infected donor. Chagas disease occurs mainly in Latin America, where an estimated 8 million to 11 million people are infected. People living in rural areas are at greatest risk. Most individuals with Chagas disease in the United States acquired their infections in other countries. Although there are triatomine bugs in the United States, only rare cases originating in the United States have been documented. The November 14, 2007, issue of JAMA includes an article about Chagas disease.
The acute infection phase lasts 2 to 3 months and is often mild; the chronic phase may be silent for many years. However, an estimated 30% of infected people will develop medical problems from Chagas disease over the course of their lives. Complications of chronic Chagas disease may include
heart rhythm abnormalities that can cause sudden death
dilated heart that doesn't pump blood well
dilated esophagus (tube leading from throat to stomach) or colon, leading to difficulties with eating or passing stool
For people who have suppressed immune systems (for example, due to AIDS or chemotherapy), Chagas disease can reactivate with parasites found in the circulating blood. This can potentially cause severe disease.
Medical history (including questions about travel and living conditions), physical examination, and an electrocardiogram are the first steps in determining whether an individual may have Chagas disease.
Chronic infection, affecting the heart or the intestinal system, may require specific tests of heart function or the condition of the esophagus or intestine.
Treatment for Chagas disease is recommended for all people diagnosed with an acute infection, congenital infection, and suppressed immune systems. Other chronically infected people (especially children, but also some adults) may also benefit from treatment. In the United States, medication for Chagas disease is available only through the Centers for Disease Control and Prevention. For questions regarding treatment, physicians can contact the Division of Parasitic Diseases at 770-488-7775. In Latin America, housing improvement and insecticide spraying have decreased the number of newly infected people and completely halted insect transmission in some areas. Screening of blood donations is another important public health tool in helping to prevent transfusion-acquired Chagas disease in Latin America and in the United States.
World Health Organizationhttp://www.who.int
Centers for Disease Control and Preventionhttp://www.cdc.gov/ncidod/dpd/parasites/chagasdisease
National Institute of Allergy and Infectious Diseaseshttp://www.niaid.nih.gov
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on poverty and health was published in the October 24/31, 2007, issue.
Sources: World Health Organization, Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases
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TOPIC: INFECTIOUS DISEASES
Torpy JM, Burke AE, Glass RM. Chagas Disease. JAMA. 2007;298(18):2222. doi:10.1001/jama.298.18.2222