American trypanosomiasis

Last edited 02/2022 and last reviewed 02/2022

Chagas' disease is caused by Trypanosoma cruzi, which is spread by Reduviid bugs (1,2,3)

• American Trypanosomiasis or Chagas disease is an endemic disease mainly in Central and South America
  • it is a zoonosis caused by the flagellated protozoan Trypanosoma cruzi (T. cruzi). In endemic areas, the primary route of transmission is vector borne, usually by triatomine bugs of the Reduviidae family, subfamily Triatominae
  • may also be transmitted orally, parenterally, by accidental exposure to contaminated material, by transplantation of organs and/or tissues, via blood transfusion, and vertically from an infected mother to her newborn child
  • principal vectors involved in the transmission are grouped into three genera (Triatoma, Rhodnius, and Panstrongylus) highlighting five species with a specific geographical distribution:
    • Triatoma infestans is found mainly in southern South America; Rhodnius prolixus in the north of South America and Central America; Triatoma dimidiata as the previous and in Mexico; Panstrongylus megistus in the region from the south-western United States to central Argentina, Brazil, and Paraguay; and Triatoma brasiliensis in Brazil and the Amazon basin

After implantation a nodule - a Chagoma - forms which may scar.

Annual incidence in Brazil is approximately 120,000 cases.

The only two drugs are currently available for Chaga's disease treatment are benznidazole (BZN) and nifurtimox (NF) (4)

• treating Chaga's disease-infected patients, especially children and women of reproductive age, is vital in order to prevent long-term sequelae, such as heart and gastrointestinal dysfunction

Reference:

• Galvão C, Carcavallo R, Rocha DD, Jurberg J. A checklist of the current valid species of the subfamily Triatominae Jeannel, 1919 (Hemiptera, Reduviidae) and their geographical distribution, with nomenclatural and taxonomic notes: Magnolia Press, 2003.
• Kirchhoff LV (1993). American trypanosomiasis (Chaga's disease) - a tropical disease in the United States, NEJM, 329, 639-643.
• Control of Chaga's disease:report of WHO expert committee. WHO Tech Rep Ser 1991;811:27-37.
• Lascano, F, García Bournissen, F, Altcheh, J. Review of pharmacological options for the treatment of Chagas disease. Br J Clin Pharmacol. 2022; 88( 2): 383- 402. doi:10.1111/bcp.14700