Chagas disease (also called American trypanosomiasis) is a human tropical parasitic disease which occurs in the Americas, particularly in South America. Its pathogenic agent is a flagellate protozoan named Trypanosoma cruzi, which is transmitted to humans and other mammals mostly by hematophagous insects of the subfamily Triatominae (Family Reduviidae). Those insects are known by numerous common names varying by country, including assassin bug, benchuca, vinchuca, kissing bug, chipo, et cetera. The most common insect species belong to the genera Triatoma, Rhodnius, and Panstrongylus. Other forms of transmission are possible, though, such as ingestion of food contaminated with parasites, blood transfusion and fetal transmission. Tropical diseases are infectious diseases that either occur uniquely in tropical and subtropical regions (which is rare) or, more commonly, are either more widespread in the tropics or more difficult to prevent or control. ... A parasitic disease is a disease caused or transmitted by a parasite. ... The Americas (sometimes referred to as America) is the area including the land mass located between the Pacific Ocean and the Atlantic Ocean, generally divided into North America and South America. ... South America South America is a continent crossed by the equator, with most of its area in the Southern Hemisphere. ... Parasitic excavate (Giardia lamblia) Green alga (Chlamydomonas) Flagellates are cells with one or more whip-like organelles called flagella. ... Protozoa (in Greek protos = first and zoon = animal) are single-celled creatures with nuclei that show some characteristics usually associated with animals, most notably mobility and heterotrophy. ... Chagas disease (also called American trypanosomiasis) is a Mammalian disease occurring only in the Americas. ... Orders Subclass Monotremata Monotremata Subclass Marsupialia Didelphimorphia Paucituberculata Microbiotheria Dasyuromorphia Peramelemorphia Notoryctemorphia Diprotodontia Subclass Placentalia Xenarthra Dermoptera Desmostylia Scandentia Primates Rodentia Lagomorpha Insectivora Chiroptera Pholidota Carnivora Perissodactyla Artiodactyla Cetacea Afrosoricida Macroscelidea Tubulidentata Hyracoidea Proboscidea Sirenia The mammals are the class of vertebrate animals characterized by the presence of mammary glands... An Anopheles stephensi mosquito obtaining a blood meal from a human host through its pointed proboscis. ... A database query syntax error has occurred. ... Triatominae is a Subfamily of Reduviidae. ... Subfamilies Harpactorinae Reduviinae Stenopodainae Emesinae Apiomerinae Ectrichodiinae Peiratinae Tegeinae Triatominae etc. ... Subfamilies Harpactorinae Peiratinae Tegeinae Triatominae etc. ... Triatoma is a genus of the subfamily Triatominae. ... A parasite is an organism that lives in or on the living tissue of a host organism at the expense of that host. ... Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ... Fetus at eight weeks A fetus (alternatively foetus or fœtus) is an unborn human offspring from the end of the 8th week of pregnancy (when the major structures have formed) until birth. ...

T. cruzi is in the same genus as the infectious agent of African sleeping sickness, but its clinical manifestations, geographical distribution, life cycle and insect vectors are quite different. See genus (mathematics) for the use of the term in mathematics. ... Sleeping sickness or African trypanosomiasis is a parasitic disease in humans. ... Traditionally in medicine, a vector is an organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another. ...

Photomicrograph of Giemsa-stained Trypanosoma cruzi crithidia. Source: CDC

Photomicrograph of Trypanosoma cruzi parasites (Chagas disease pathogen). ... Photomicrograph of Trypanosoma cruzi parasites (Chagas disease pathogen). ...

History

The disease was named after the Brazilian physician and infectologist Carlos Chagas, who first described it in 1909, but the disease was not seen as a major public health problem in humans until the 1960s. He discovered that the intestines of Triatomidae harbored a flagellate protozoa, a new species of the Trypanosoma genus, and was able to prove experimentally that it could be transmitted to marmoset monkeys which were bitten by the infected bug. Chagas named this new parasite Schizotrypanum cruzi, in honor of Oswaldo Cruz (later renamed to Trypanosoma cruzi.) A physician is a person who practices medicine. ... Carlos Chagas Carlos Justiniano Ribeiro Chagas (born July 9, 1879, Oliveira, Minas Gerais, Brazil; died November 8, 1934, Rio de Janeiro), was a Brazilian physician. ... 1909 was a common year starting on Friday (see link for calendar). ... Public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis. ... The 1960s, or The Sixties, in its most obvious sense refers to the decade between 1960 and 1969, but the expression has taken on a wider meaning over the past twenty years. ... Species 18 species, see text The Marmosets are the genus Callithrix of New World monkeys. ...

Chagas named the pathogen that causes the disease after Oswaldo Cruz, the noted Brazilian physician and epidemiologist who fought successfully epidemics of yellow fever, smallpox, and bubonic plague in Rio de Janeiro and other cities in the beginning of the 20th century. Chagas’ work is unique in the history of medicine, because he was the only researcher so far to describe completely a new infectious disease: its pathogen, vector, host, clinical manifestations, and epidemiology. A pathogen (literally birth of pain from the Greek παθογένεια) is a biological agent that can cause disease to its host. ... Oswaldo Gonçalves Cruz (b. ... Epidemiology (Greek epi = upon, among; demos = people, district; logos = word, discourse), defined literally, is the study of epidemics in humans. ... An epidemic is generally a widespread disease that affects many individuals in a population. ... Smallpox (also known by the Latin names Variola or Variola vera) is a highly contagious disease unique to humans. ... Bubonic plague is an infectious disease that is believed to have caused several epidemics or pandemics throughout history. ... Ipanema beach Cristo Redentor A NASA satellite image of Rio de Janeiro Rio de Janeiro (meaning River of January in Portuguese) is the name of both a state and a city in southeastern Brazil. ... (19th century - 20th century - 21st century - more centuries) Decades: 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s As a means of recording the passage of time, the 20th century was that century which lasted from 1901–2000 in the sense of the Gregorian calendar (1900–1999 in the... All human societies have medical beliefs that provide explanations for, and responses to, birth, death, and disease. ... In medicine, infectious disease or communicable disease is disease caused by a biological agent (e. ... A pathogen (literally birth of pain from the Greek παθογένεια) is a biological agent that can cause disease to its host. ... The word vector means carrier in Latin; it is derived from the Latin verb vehere, which means to carry. ... Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems (Last 2001). ...

On another historical point of view, it has been hypothesized that Charles Darwin might have suffered from this disease as a result of a bite of the so-called Great Black Bug of the Pampas (vinchuca) (see Illness of Charles Darwin). The episode was reported by Darwin in his diaries of the HMS Beagle voyage. Darwin, who was young and in good health until he returned to London, soon afterward began to suffer from strange symptoms, becoming very incapacitated by it for the rest of his life. Attempts to test Darwin's remains at the Westminster Abbey by using modern PCR techniques were met with a refusal by the Abbey's curator. Charles Darwin, about the same time as the publication of The Origin of Species. ... The pampas (from Quechua for plain) are the fertile lowlands that extend across c. ... Charles Darwin Charles Darwins illness was suffered throughout Charles Darwins adult life and went undiagnosed by the medicine of his age. ... For other RN ships of this name, see HMS Beagle (disambiguation). ... St Stevens Tower - The Clock Tower of the Palace of Westminster which contains Big Ben London (see also different names) is the capital city of the United Kingdom and of England. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ... The Collegiate Church of St Peter, Westminster (Westminster Abbey), a mainly Gothic church, on the scale of a cathedral, is the traditional place of coronation and burial site for English monarchs. ... Wikipedia does not yet have an article with this exact name. ... A curator of a cultural heritage institution (e. ...

Epidemiology and geographical distribution

Chagas in Latin America (A:Endemic zones)

Chagas disease currently affects 16-18 million people, killing around 20,000 people annually and with some 100 million at risk of acquiring the disease. Chronic Chagas disease remains a major health problem in many Latin American countries, despite the effectiveness of hygienic and preventive measures, such as eliminating the transmitting insects, which have reduced to zero new infections in at least two countries of the region. With increased population movements, however, the possibility of transmission by blood transfusion has become more substantial in the United States [1]. Also, T. cruzi has already been found infecting wild opossums and raccoons as far as North Carolina [2]. Image File history File links Map of Chagas disease. ... Image File history File links Map of Chagas disease. ... Latin America consists of the countries of South America and some of North America (including Central America and some the islands of the Caribbean) whose inhabitants mostly speak Romance languages, although Native American languages are also spoken. ... Latin America consists of the countries of South America and some of North America (including Central America and some the islands of the Caribbean) whose inhabitants mostly speak Romance languages, although Native American languages are also spoken. ... This article or section should be merged with Virginia_opossum The word opossum (usually pronounced without the leading O, or with only a very slight schwa) refers either to the Virginia Opossum in particular, or more generally to any of the other marsupials of magnorder Ameridelphia. ... Binomial name Procyon lotor (Linnaeus, 1758) The Common Raccoon (Procyon lotor), also known as the Northern Raccoon or just Raccoon or coon, is a mammal native to the Americas. ...

The disease is distributed in the Americas, ranging from the southern United States to southern Argentina, mostly in poor, rural areas of Central and South America. The Americas (sometimes referred to as America) is the area including the land mass located between the Pacific Ocean and the Atlantic Ocean, generally divided into North America and South America. ... Rural areas are sparsely settled places away from the influence of large cities and towns. ... Central America is the region of North America located between the southern border of Mexico and the northwest border of Colombia, in South America. ... South America South America is a continent crossed by the equator, with most of its area in the Southern Hemisphere. ...

The disease is almost exclusively found in rural areas, where the Triatominae can breed and feed on the natural reservoirs (the most common ones being opossums and armadillos) of T.cruzi. Depending on the special local interactions of the vectors and their hosts, other humans, cats,dogs, rodents, monkeys, ground squirrels (Spermophilus beecheyi) and many other wild and domestic animals could also serve as important parasite reservoirs. Though Triatominae bugs feed on birds, these seem to be immune against infection and therefore are not considered to be a T. cruzi reservoir. Natural reservoir or nidus, refers to the long-term host of the pathogen of an infectious disease. ... This article or section should be merged with Virginia_opossum The word opossum (usually pronounced without the leading O, or with only a very slight schwa) refers either to the Virginia Opossum in particular, or more generally to any of the other marsupials of magnorder Ameridelphia. ... Genera Chlamyphorus Cabassous Chaetophractus Dasypus Euphractus Priodontes Tolypeutes Zaedyus Armadillo is also the name of an NES video game. ... Trinomial name Felis silvestris catus Schreber, 1775 The cat, also called domestic cat or house cat, is a small feline carnivorous mammal. ... Trinomial name Canis lupus familiaris The Dog is a canine carnivorous mammal that has been domesticated for at least 14,000 years and perhaps for as long as 150,000 years based on recent evidence. ... Families Many, see text The order Rodentia is the most numerous of all the branches on the mammal family tree. ... Cynomolgus Monkey at Batu Caves, Malaysia Monkeys, Mori Sosen (1749-1821) A monkey is any member of two of the three groupings of simian primates. ... Genera Many: see text. ... Binomial name Spermophilus beecheyi (Richardson, 1829) The California Ground Squirrel, Spermophilus beecheyi (referred to in some older sources as Otospermophilus beecheyi), is a common and easily observed ground squirrel of the western United States and Baja California; it is common in Oregon and California and its range has relatively recently...

The popular name of the vector insect in Brazil, barbeiro (The Barber), so called because it sucks the blood at night by biting the face of its victims, reveals some of its habits. The insects, who develop a predominant domiciliary and anthropophilic behaviour once they have infested a house [3], usually hide during the day in crevices and gaps in the walls and roofs of poorly constructed homes.

Even when the colonies of the insects are eradicated in the house and around (domestic animal shelters), they again can arrive (also by flying short distances) from nearby nature (possibly a palm tree), where animals and the insect which are part of the ancient, natural silvatic infection cycle use to live. This especially can happen in zones with mixed open savannah, clumps of trees, etc., interspersed by human habitation. Genera Many; see list of Arecaceae genera Arecaceae (also known as Palmae or Palmaceae), the palm family, is a family of flowering plants, belonging to the monocot order Arecales. ...

Dense vegetation, like in tropical rain forests, and urban habitats, are not ideal for the establishment of the human transmission cycle. However, in regions where the sylvatic habitat and its fauna are thinned out by economical exploitation and human habitation, such as in newly deforested areas of the Amazon region, this may occur, when the insects are searching for a new prey. A rainforest is a forested biome with high annual rainfall. ... The term habitat has a number of unrelated meanings: A concept in Ecology: see habitat. ... The name Amazon may refer to several concepts: The legendary Amazons, women renowned in antiquity for their prowess in battle. ...

Clinical manifestations

This child from Panama is suffering from Chagas disease manifested as an acute infection with swelling of the right eye (chagoma). Source: CDC.

The human disease occurs in two stages: the acute stage shortly after the infection. A local lesion (so called chagoma (see picture), palpebral edema) can appear at the site of inoculation. The acute phase is usually asymptomatic, but can present with manifestations that include fever, anorexia, lymphadenopathy, mild hepatosplenomegaly, and myocarditis. Some acute cases (10 to 20%) resolve over a period of 2 to 3 months into an asymptomatic chronic stage, only to reappear after several years. Download high resolution version (700x1077, 88 KB)This child from Panama is suffering from Chagas disease manifested as an acute infection with swelling of the right eye (chagoma). ... Download high resolution version (700x1077, 88 KB)This child from Panama is suffering from Chagas disease manifested as an acute infection with swelling of the right eye (chagoma). ... A disease is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected or those in contact with the person. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... Inoculation was a method of minimising the harm done by infection with smallpox. ... In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ... Fever, also known as pyrexia, is a medical symptom which describes an increase in internal body temperature to levels which are above normal (37 degrees Celsius, 98. ... In medicine, anorexia is the symptom of diminished appetite or appetite loss. ... Lymphadenopathy is seen in infection (e. ... Hepatosplenomegaly is the simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly). ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ...

The symptomatic chronic stage may not occur for years or even decades after initial infection. The disease affects the nervous system, digestive system and heart. Chronic infections result in various neurological disorders, including dementia, damage to the heart muscle (cardiomyopathy, the most serious manifestation), and sometimes dilation of the digestive tract (megacolon and megaesophagus), as well as weight loss. Swallowing difficulties may be the first symptom of digestive disturbances and may lead to malnutrition. After several years of an asymptomatic period, 27% of those infected develop cardiac damage, 6% develop digestive damage, and 3% present peripheral nervous involvement. Left untreated, Chagas disease can be fatal, in most cases due to the cardiomyopathy component. The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and processes input from the senses, and initiates actions. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... The heart (Latin cor) is a hollow, muscular organ that pumps blood through the blood vessels by repeated, rhythmic contractions. ... Dementia (from Latin demens) is progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Megaesophagus is a condition (in dogs) where peristalsis fails to occur properly and the esophagus is enlarged. ... In the context of physical health, weight loss is the process of losing body weight, usually by losing fat. ... Swallowing, known scientifically as deglutition is the reflex in the human body that makes something pass from the mouth, through the esophagus. ... Malnutrition is a general term for the medical condition in a person or animal caused by an unbalanced diet—either too little or too much food, or a diet missing one or more important nutrients. ...

Infection cycle

An infected triatomine insect vector takes a blood meal and releases trypomastigotes in its feces near the site of the bite wound. By scratching the site of the bite, the victim allows trypomastigotes to enter the host through the wound, or through intact mucosal membranes, such as the conjunctiva. Inside the host, the trypomastigotes invade cells, where they differentiate into intracellular amastigotes. The amastigotes multiply by binary fission and differentiate into trypomastigotes, and then are released into the circulation as bloodstream trypomastigotes. Trypomastigotes infect cells from a variety of biological tissues and transform into intracellular amastigotes in new infection sites. Clinical manifestations can result from this infective cycle and cell death at the target tissues. For example, it has been shown by Austrian-Brazilian pathologist Dr. Fritz Köberle in the 1950s at the Medical School of the University of São Paulo at Ribeirão Preto, Brazil (one of the excellent medical research centers on Chagas disease), that intracellular amastigotes destroy the intramural neurons of the autonomic nervous system in the intestine and heart, leading to megaintestine and heart aneurysms, respectively. The conjunctiva is a membrane that covers the sclera (white part of the eye) and lines the inside of the eyelids. ... Binary fission Binary fission is the asexual reproductive process used by most prokaryotes, which results in the reproduction of a living cell by division into two equal, or near equal, parts. ... Biological tissue is a group of cells that perform a similar function. ... Fritz Köberle (b. ... Millennia: 1st millennium - 2nd millennium - 3rd millennium // Events and trends The 1950s in Western society was marked with a sharp rise in the economy for the first time in almost 30 years and return to the 1920s-type consumer society built on credit and boom-times, as well as the... Faculdade de Medicina de Ribeirão Preto (Faculty of Medicine of Ribeirão Preto in Portuguese) is a medical school of the University of São Paulo located in the city of Ribeirão Preto, state of São Paulo, Brazil, founded 1952. ... Medical research is research conducted to aid the body of knowledge in the field of medicine. ... // Anatomy and Physiology of the A.N.S. In contrast to the voluntary nervous system, the involuntary or autonomic nervous system is responsible for homeostasis, maintaining a relatively constant internal environment by controlling such involuntary functions as digestion, respiration, perspiration, and metabolism, and by modulating blood pressure. ... An aneurysm (or aneurism) (from Greek ανευρυσμα, a dilatation) is a localized dilation or ballooning of a blood vessel. ...

The bloodstream trypomastigotes do not replicate (different from the African trypanosomes). Replication resumes only when the parasites enter another cell or are ingested by another vector. The “kissing” bug becomes infected by feeding on human or animal blood that contains circulating parasites. Also the bugs might be able to spread the infection to each other through their cannibalistic predatory behaviour. The ingested trypomastigotes transform into epimastigotes in the vector’s midgut. The parasites multiply and differentiate in the midgut and differentiate into infective metacyclic trypomastigotes in the hindgut. World map showing location of Africa A satellite composite image of Africa Africa is the worlds second_largest continent in both area and population, after Asia. ...

Trypanosoma cruzi can also be transmitted through blood transfusions, organ transplantation, transplacentally, breast milk [4] and in laboratory accidents. According to the World Health Organization infection rate in blood banks in Latin America vary between 3% and 53%, a figure higher than of HIV infection and hepatitis B and C. Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ... An organ transplant is the transplantation of an organ (or part of one) from one body to another, for the purpose of replacing the recipients damaged or failing organ with a working one from the donor. ... Human placenta shown a few minutes after birth. ... Breast milk usually refers to the milk produced by a human female which is usually fed to infants by breastfeeding. ... For other meanings of the acronym WHO, see WHO (disambiguation) WHO flag Headquartered in Geneva, Switzerland, the World Health Organization (WHO) is an agency of the United Nations, acting as a coordinating authority on international public health. ... A blood bank is a cache or bank of blood or blood components, gathered as a result of blood donation, stored and preserved for later use in blood transfusions. ... HIV (Human Immunodeficiency Virus) is a retrovirus that infects cells of the human immune system. ... Hepatitis is a gastroenterological disease, featuring inflammation of the liver. ... Infection cycle of Trypanosoma cruzi, the pathogen of Chagas disease. ...

Alternative infection mechanism

Researchers suspected since 1991 [5] that the transmission of the trypanosome by the oral route might be possible, due to a number of micro-epidemics restricted to particular times and places (such as a farm or a family dwelling), particularly in non-endemic areas such as the Amazonia (17 such episodes recorded between 1968 and 1997). In 1991, farm workers in the state of Paraiba, Brazil, were apparently infected by contamination of food with opossum feces; and in 1997, in Macapá, state of Amapá, 17 members of two families were infected by drinking assai palm fruit juice probably contaminated with crushed triatomine vector insects[6]. In the beginning of 2005, a new outbreak with 27 cases was detected in Amapá. A river in the Amazon rainforest The Amazon is a rainforest in South America. ... Paraíba is one of the states of Brazil, located in the northeastern part of the country, on the Atlantic coast. ... This article or section should be merged with Virginia_opossum The word opossum (usually pronounced without the leading O, or with only a very slight schwa) refers either to the Virginia Opossum in particular, or more generally to any of the other marsupials of magnorder Ameridelphia. ... Macapá is the capital of the state of Amapá in Brazil. ... Amapá is one of the states of Brazil, located in the extreme north, bordering French Guiana in the north. ... (Redirected from ) Species About 25-30 species including: Euterpe edulis Euterpe macrospadix Euterpe oleracea A Palm Euterpe is a genus of 25-30 species of palms native to tropical Central and South America, from Belize south to Brazil and Peru, growing mainly in floodplains and swamps. ... Amapá is one of the states of Brazil, located in the extreme north, bordering French Guiana in the north. ...

Recently (March 2005) a new startling outbreak was recorded in the state of Santa Catarina, Brazil, that seems to confirm this alternative mechanism of transmission. Several people in Santa Catarina who had ingested sugar cane juice ("garapa", in Portuguese) by a roadside kiosk acquired Chagas disease [7]. As of March 30th, 2005, 49 cases had been confirmed in Santa Catarina, including 6 deaths. The hypothesized mechanism, so far, is that trypanosome-bearing insects were crushed into the raw preparation. The health authorities of Santa Catarina have estimated that ca. 60,000 people might have had contact with the contaminated food in Santa Catarina and urged everyone in this situation to submit to blood tests. They have prohibited the sale of sugar cane juice in the state until the situation is rectified. 2005 is a common year starting on Saturday of the Gregorian calendar and is the current year. ... Santa Catarina is the name of several places: One of the federal states of Brazil; see Santa Catarina, Brazil. ... Species Ref: ITIS 42058 as of 2004-05-05 Sugarcane is one of six species of a tall tropical southeast Asian grass (Family Poaceae) having stout fibrous jointed stalks whose sap at one time was the primary source of sugar. ... Garapa is the Brazilian Portuguese term for the juice of raw sugar cane, a very popular drink in several Latin America countries. ... Foodborne illness or food poisoning is caused by consuming food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites. ...

The unusual severity of the disease outbreak has been blamed on a hypothetical higher parasite load achieved by the oral route of infection. Brazilian researchers at the Instituto Oswaldo Cruz, Rio de Janeiro, were able to infect mice via a gastrointestinal tube with trypanosome-infected oral preparations. Instituto Oswaldo Cruz is a scientific institution for research and development in biomedical sciences located in Rio de Janeiro, Brazil. ... Ipanema beach Cristo Redentor A NASA satellite image of Rio de Janeiro Rio de Janeiro (meaning River of January in Portuguese) is the name of both a state and a city in southeastern Brazil. ... Feral mouse Feral mouse A mouse is a mammal that belongs to one of numerous species of small rodents in the genus Mus and various related genera of the family Muridæ (Old World Mice). ...

Laboratory diagnosis

Demonstration of the causal agent is the diagnostic procedure in acute Chagas disease. It almost always yields positive results, and can be achieved by:

• Microscopic examination: a) of fresh anticoagulated blood, or its buffy coat, for motile parasites; and b) of thin and thick blood smears stained with Giemsa, for visualization of parasites.
• Isolation of the agent by: a) inoculation into mice; b) culture in specialized media (e.g. NNN, LIT); and c) xenodiagnosis, where uninfected reduviidae bugs are fed on the patient's blood, and their gut contents examined for parasites 4 weeks later.
• Serologic examination for antibodies, to distinguish strains (zymodemes) of T.cruzi with divergent pathogenities.

1852 microscope Compound microscope made by John Cuff in 1750 A microscope (Greek: micron = small and scopos = aim) is an instrument for viewing objects that are too small to be seen by the naked or unaided eye. ... Red blood cells (erythrocytes) are present in the blood and help carry oxygen to the rest of the cells in the body Blood is a circulating tissue composed of fluid plasma and cells (red blood cells, white blood cells, platelets). ... Giemsa stain is used for the histopathological diagnosis of Malaria and other parasites. ... A parasite is an organism that lives in or on the living tissue of a host organism at the expense of it. ... Feral mouse Feral mouse A mouse is a mammal that belongs to one of numerous species of small rodents in the genus Mus and various related genera of the family Muridæ (Old World Mice). ... Subfamilies Harpactorinae Reduviinae Stenopodainae Emesinae Apiomerinae Ectrichodiinae Peiratinae Tegeinae Triatominae etc. ... Wikipedia does not yet have an article with this exact name. ... Strain, in any branch of science dealing with materials and their behaviour, is the geometrical expression of deformation caused by the action of stress on a physical body. ...

Treatment

Medication for Chagas disease is usually effective when given during the acute stage of infection, only. The drugs of choice are azole or nitroderivatives such as benznidazole [8] or nifurtimox (under an Investigational New Drug protocol from the CDC Drug Service), but resistance to these drugs has already been reported [9]. Furthermore, these agents are very toxic and have many adverse effects, and cannot be taken without medical supervision. A 10-year study of chronic administration of drugs in Brazil has revealed that these drugs are not totally effective, too, in removing parasitemia [10]. Thus, the decision about whether to use antiparasitic therapy should be individualized in consultation with an expert. Acute may refer to: An acute accent is a diacritic character. ... California Department of Corrections Canadian Dairy Commission Career Development Course Centers for Disease Control and Prevention Child Development Center Citizens Development Corps Climate Diagnostics Center of the National Oceanic and Atmospheric Administration (NOAA) of the U.S. Department of Commerce Control Data Corporation Council for Disabled Children Connected Device Configuration... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Parasitemia is the quantitative content of parasites in the blood. ...

Use of oxidosqualene cyclase inhibitors and cysteine protease inhibitors has been found to cure experimental infections in animals [11].

In the chronic stage, treatment involves managing the clinical manifestations of the disease, e.g., drugs and heart pacemaker for chronic heart failure and heart arryhthmias; surgery for megaintestine, etc., but the disease per se is not curable in this phase. Chronic heart disease caused by Chagas is now a common reason for heart transplantation surgery. Until recently, however, Chagas disease was considered a contraindication for the procedure, since the heart damage could reoccur as the parasite was expected to seize the opportunity provided by the immunosuppression that follows surgery. The research that changed the indication of the transplant procedure for Chagas disease patients was conducted by Dr. Adib Jatene's group at the Heart Institute of the University of São Paulo, in São Paulo, Brazil [12]. The research noted that survival rates in Chagas patients can be significantly improved by using lower dosages of the immunosuppressant drug cyclosporine. Recently, direct stem cell therapy of the heart muscle using bone marrow cell transplantation has been shown to dramatically reduce risks of heart failure in Chagas patients [13]. Patients have also been shown to benefit from the strict prevention of reinfection, though the reason for this is not yet clearly understood. The word chronic has uses in many fields. ... A pacemaker (or artificial pacemaker, so as not to be confused with the hearts natural pacemaker) is a medical device designed by Nitish and Raheel to regulate the beating of the heart. ... A typical modern surgery operation For other meanings of the word, see Surgery (disambiguation) Surgery (from the Greek cheirourgia - lit. ... In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity. ... Immunosuppression is the medical suppression of the immune system. ... Landmark buildings Edifício Italia (at left) and Copan (curved façade at center), in São Paulo Downtown. ... Cyclosporine, Ciclosporin (INN), or cyclosporin (former BAN), is an immunosuppressant drug. ... Mouse embryonic stem cells. ... Bone marrow is the tissue comprising the center of large bones. ...

Some advances:

• Dermaseptins from Phyllomedusa oreades and Phyllomedusa distincta. Anti-Trypanosoma cruzi activity without cytotoxicity to mammalian cells.[14]
• The sesquiterpene lactone dehydroleucodine (DhL) affects the growth of cultured epimastigotes of Trypanosoma cruzi [15]

Prevention

Vector insect triatoma infestans (Kissing Bug)

A reasonably effective vaccine was developed in Ribeirão Preto in the 1970s, using cellular and subcellular fractions of the parasite, but it was found economically unfeasible. More recently, the potential of DNA vaccines for immunotherapy of acute and chronic Chagas disease is being tested by several research groups. Image File history File links Triatoma infestans File links The following pages link to this file: Chagas disease ... Image File history File links Triatoma infestans File links The following pages link to this file: Chagas disease ... A bottle and a syringe containing the influenza vaccine. ... Immunotherapy is a disease treatment based upon the concept of triggering the bodys own natural defenses to fight off the disease, usually by stimulating the immune system either locally or systemically. ...

Prevention is centered on fighting the vector (Triatoma) by using sprays and paints containing insecticides (synthetic pyrethroids), and improving housing and sanitary conditions in the rural area. For urban dwellers, spending vacations and camping out in the wilderness or sleeping at hostels or mud houses in endemic areas can be dangerous, a mosquito net is recommended. If the traveller intends to travel to the area of prevalence, he/she should get information on endemic rural areas for Chagas disease in traveller advisories, such as the CDC. Insecticide application by crop spraying An insecticide is a pesticide whose purpose is to kill or to prevent the multiplication of insects. ... Camping is an outdoor recreational activity involving the spending of one or more nights in a tent, primitive structure, a travel trailer or recreational vehicle at a campsite with the purpose of getting away from civilization and enjoying nature. ... California Department of Corrections Canadian Dairy Commission Career Development Course Centers for Disease Control and Prevention Child Development Center Citizens Development Corps Climate Diagnostics Center of the National Oceanic and Atmospheric Administration (NOAA) of the U.S. Department of Commerce Control Data Corporation Council for Disabled Children Connected Device Configuration...

In most countries where Chagas disease is endemic, testing for blood donors is already mandatory, since this can be an important route of transmission. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Blood donation is a process by which a blood donor voluntarily has blood drawn for storage in a blood bank for subsequent use in a blood transfusion. ...

With all these measures, some landmarks were achieved in the fight against Chagas disease in Latin America: a reduction by 72% of the incidence of human infection in children and young adults in the countries of the Initiative of the Southern Cone, and at least two countries (Uruguay, in 1997, and Chile, in 1999), were certified free of vectorial and transfusional transmission. In Brazil, with the largest population at risk, 10 out of the 12 endemic states were also certified free. The term Southern Cone (Cono Sur) refers to the southernmost countries of South America. ...

A yeast trap has been tested for monitoring infestations of certain species of the bugs. [16]

Original publication

• Chagas, C. Nova trypanozomíaze humana. Estudos sobre a morfologia e cíclo evolutivo do Schizotripanum cruzi n. gen. n. sp., agente etiològico de nova entidade mórbida do homem. Mem Inst Oswaldo Cruz, 1909, 1 (2): 159-218 (New human trypanosomiasis. Studies about the morphology and evolutive cycle of Schizotripanum cruzi, ethiological agent of a new morbid entity of man).

Bibliography

• Adler D. Darwin's illness. Isr J Med Sci. 1989 Apr;25(4):218-21. (Abstract)
• Kirchhoff, LV. American Trypanosomiasis (Chagas' Disease) -- A Tropical Disease Now in the United States. N Engl J Med. 329 (9):639-644, August 26, 1993 (Abstract)
• Garcia, S., Ramos, C. O., Senra, J. F. V., Vilas-Boas, F., Rodrigues, M. M., Campos-de-Carvalho, A. C., Ribeiro-dos-Santos, R., Soares, M. B. P. (2005). Treatment with Benznidazole during the Chronic Phase of Experimental Chagas' Disease Decreases Cardiac Alterations. Antimicrob. Agents Chemother. 49: 1521-1528 (Abstract)
• Buckner, F. S., Wilson, A. J., White, T. C., Van Voorhis, W. C. (1998). Induction of Resistance to Azole Drugs in Trypanosoma cruzi. Antimicrob. Agents Chemother. 42: 3245-3250 (Abstract)
• Engel, J. C., Doyle, P. S., Hsieh, I., McKerrow, J. H. (1998). Cysteine Protease Inhibitors Cure an Experimental Trypanosoma cruzi Infection. J. Exp. Med. 188: 725-734 (Abstract)
• Bocchi, E. A., Bellotti, G., Mocelin, A. O., Uip, D., Bacal, F., Higuchi, M. L., Amato-Neto, V., Fiorelli, A., Stolf, N. A. G., Jatene, A. D., Pileggi, F. (1996). Heart Transplantation for Chronic Chagas' Heart Disease. Ann. Thorac. Surg. 61: 1727-1733 (Abstract)
• Dumonteil E, Escobedo-Ortegon J, Reyes-Rodriguez N, Arjona-Torres A, Ramirez-Sierra MJ. Immunotherapy of Trypanosoma cruzi infection with DNA vaccines in mice. Infect Immun. 2004 Jan;72(1):46-53. (Abstract)
• Vilas-Boas F., Feitosa G.S., Soares M. B. P., Pinho Filho J.A., Almeida A., Mota A., Carvalho H. G., Oliveira A. D. D. Ribeiro-dos-Santos R. Bone marrow cell transplantation to the myocardium of a patient with heart failure due to Chagas cardiomyopathy. A case report. Arquivos Brasileiros de Cardiologia, 82(2):185-7, 2004. (Full text)
• Valente SAS, Valente VC, Fraiha-Neto H. Considerations on the epidemiology and transmission of Chagas disease in the Brazilian amazon. Mem. Inst. Oswaldo Cruz, Sept. 1999, vol.94 suppl.1, p.395-398. (Abstract)
• Shikanai-Yasuda MA, Marcondes CB, Guedes LA, Siqueira GS, Barone AA, Dias JC, Amato Neto V, Tolezano JE, Peres BA, Arruda Junior ER, et al. Possible oral transmission of acute Chagas' disease in Brazil. Rev Inst Med Trop Sao Paulo. 1991 Sep-Oct;33(5):351-7. (Abstract)

Further reading

• Coutinho M. Ninety years of Chagas disease: a success story at the periphery. Soc Stud Sci. 1999 Aug;29(4):519-49. Medline abstract
• Dias JC, Silveira AC, Schofield CJ. The impact of Chagas disease control in Latin America: a review. Mem Inst Oswaldo Cruz. 2002 Jul;97(5):603-12 Full text
• Kropf SP, Azevedo N, Ferreira LO. Biomedical research and public health in Brazil: the case of Chagas' disease (1909-50). Soc Hist Med. 2003 Apr;16(1):111-29. Medline abstract
• Moncayo A. Progress towards Interruption of Transmission of Chagas Disease, 1999, Mem Inst Oswaldo Cruz. 1999; 94(Sup I) 401-404.
• Prata A. Evolution of the clinical and epidemiological knowledge about Chagas disease 90 years after its discovery. Mem Inst Oswaldo Cruz. 1999;94 Suppl 1:81-8. Medline abstract

There is a special issue of the International Symposium to commemorate the 90th anniversary of the discovery of Chagas disease (Rio de Janeiro, April 11-16, 1999) in Memórias do Instituto Oswaldo Cruz, Vol. 94, Suppl. I, 1999 (Table of contents, with full text papers available in PDF]

External links

• Chagas: the disease. World Health Organization.
• Chagas Disease. PanAmerican Health Organization.
• Chagas disease. The UNDP-Unicef-WHO-World Bank Special Programme of Research (TDR).
• Chagas disease. Medline Plus.
• Disease Information. American Trypanosomiasis or Chagas Disease. Travel Medicine Program. Health Canada.
• Chagas Disease (American Trypanosomiasis. eMedicine.
• Chagas Control in the Southern Cone Countries: History of an International Initiative, 1991/2001, PAHO. (Full text e-book)
• Genome Sequencing Project

Sources

• American Trypanosomyasis. CDC Disease Information (US Federal Government public domain).
• Chagas disease. Medical Encyclopedia. Medline Plus.