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Chagas disease

Definition
Chagas disease is a tropical parasitic disease caused by the protozoan Trypanosoma cruzi, and associated with cardiomyopathy, arrhythmias, as well as megaviscera.
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Pathophysiology
Chagas disease is caused by the protozoan Trypanosoma cruzi.
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Epidemiology
The total estimated number of people with Chagas disease in the US is 238,091.
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Disease course
The transmission of the Trypanosoma cruzi parasite in the humans causes tissue damage and acute inflammatory response; with the persistence of infection, the chronic inflammatory response is elicited resulting in Romana sign, lymphadenopathy, hepatosplenomegaly, myocarditis, pericardial effusion, meningoencephalitis, cardiomyopathy, megaviscera, polyneuropathy, stroke, and death.
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Prognosis and risk of recurrence
The risk of mortality in advanced disease is as high as 85% at 10 years.
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Key sources
The following summarized guidelines for the evaluation and management of chagas disease are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2023), the European Society of Cardiology (ESC 2022), the Center for Disease Control (CDC 2021), the Pan American Health Organization (PAHO/WHO 2019), the International Society for Diseases of the Esophagus (ISDE 2018), the American Heart Association (AHA 2016), and the American Heart Association (AHA/HRS/ACC 2013).
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Guidelines

1.Screening and diagnosis

Indications for screening, in pregnancy
Obtain screening for Trypanosoma cruzi infection before or during pregnancy in females at risk for Chagas disease. Recognize that females lived in Mexico, Central America, and South America are at greatest risk for Chagas disease.
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Do not obtain routine screening for Trypanosoma cruzi infection in pregnant individuals living in the US unless there is concern for exposure to triatomines.
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  • Indications for screening (in infants)

  • Indications for screening (in family relatives)

2.Diagnostic investigations

Blood smear: as per CDC 2021 guidelines, obtain parasitologic tests, including identification of trypomastigotes in blood by microscopy, for the diagnosis of acute Trypanosoma cruzi infection. Recognize that circulating parasite levels decrease rapidly within a few months and are undetectable by most methods during the chronic phase.
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  • Serology

  • Work-up

3.Medical management

Antitrypanosomal therapy, indications, CDC: initiate antitrypanosomal therapy in all patients with acute or reactivated Chagas disease and in pediatric patients < 18 years old with chronic Trypanosoma cruzi infection. View the diagnosis of congenital Chagas disease as a form of acute Trypanosoma cruzi infection.
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  • Antitrypanosomal therapy (choice of agent)

4.Specific circumstances

Pregnant patients: obtain screening for Trypanosoma cruzi infection before or during pregnancy in females at risk for Chagas disease. Recognize that females lived in Mexico, Central America, and South America are at greatest risk for Chagas disease.
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  • Patients with congenital Chagas disease

  • Patients with Chagas cardiomyopathy (evaluation)

  • Patients with Chagas cardiomyopathy (amiodarone)

  • Patients with Chagas cardiomyopathy (ICD placement)

  • Patients with Chagas cardiomyopathy (catheter ablation)

  • Patients with Chagas disease esophagopathy

  • Patients with HIV

5.Patient education

General counseling: advise patients with Chagas disease to refrain from donating blood.
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