Chagas disease (also called American trypanosomiasis) is a mammalian disease occurring only in the Americas. It is caused by the protozoan Trypanosoma cruzi, one of the kinetoplastid flagellates, transmitted to humans by triatomine insects known in the different countries as assassin bug, vinchuca, kissing bug, chipo, barbeiro, etc. Common triatomine vector species for trypanosomiasis belong to the genera Triatoma, Rhodnius, and Panstrongylus. The most common transmitting species are Triatoma protracta and Triatoma infestans. The disease causing agent is closely related to that of African sleeping sickness, although the assassin bug vector is not related to the tsetse fly, which carries African sleeping sickness. Scientific classification or biological classification refers to how biologists group and categorize extinct and living species of organisms. ... Typical phyla Rhodophyta (red algae) Chromista Heterokontophyta (heterokonts) Haptophyta Cryptophyta (cryptomonads) Alveolates Pyrrhophyta (dinoflagellates) Apicomplexa Ciliophora (ciliates) Excavates Euglenozoa Percolozoa Metamonada Rhizaria Radiolaria Foraminifera Cercozoa Amoebozoa Choanozoa Many others; classification varies The Kingdom Protista or Protoctista is one of the commonly recognized biological kingdoms, including all the eukaryotes except for... Classes Euglenoidea Kinetoplastea Diplonemea Postgaardea The Euglenozoa are a large group of flagellate protozoa, dominated by the euglenids and kinetoplastids. ... Genera Blastocrithidia Crithidia Endotrypanum Herpetomonas Leishmania Leptomonas Phytomonas Trypanosoma Wallaceina The trypanosomes are a group of kinetoplastids that only have a single emergent flagellum. ... In biology, binomial nomenclature is a standard convention used for naming species. ... 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. ... 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 primarily characterized by the presence of mammary... 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. ... 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. ... Families Bodonidae Trypanosomatidae The kinetoplastids are a group of flagellate protozoa, including a number of parasites responsible for serious diseases in humans and other animals, as well as various forms found in soil and aquatic environments. ... Parasitic excavate (Giardia lamblia) Green alga (Chlamydomonas) Flagellates are cells with one or more whip-like organelles called flagella. ... Orders Subclass Apterygota Symphypleona - globular springtails Subclass Archaeognatha (jumping bristletails) Subclass Dicondylia Monura - extinct Thysanura (common bristletails) Subclass Pterygota Diaphanopteroidea - extinct Palaeodictyoptera - extinct Megasecoptera - extinct Archodonata - extinct Ephemeroptera (mayflies) Odonata (dragonflies and damselflies) Infraclass Neoptera Blattodea (cockroaches) Mantodea (mantids) Isoptera (termites) Zoraptera Grylloblattodea Dermaptera (earwigs) Plecoptera (stoneflies) Orthoptera (grasshoppers, crickets... Subfamilies Harpactorinae Peiratinae Tegeinae Triatominae etc. ... Binomial name Triatoma protracta Triatoma protracta (commonly called called Western Conenose, vinchuca, Mexican bedbugs or Kissing Bug) is an assassin bug (family Reduviidae) of the order Hemiptera. ... Sleeping sickness or African trypanosomiasis is a parasitic disease in humans. ... Binomial name Glossina morsitans The tsetse fly, Glossina morsitans, is a fly (order Diptera) that eats blood from animals, including humans. ...

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

History

The disease was named after the Brazilian physician Carlos Chagas, who first described it in 1909 but the disease was not seen as a major problem in humans until the 1960s. Chagas named the pathogen 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. For other uses, see Brazil (disambiguation). ... The word physician should not be confused with physicist, which means a scientist in the area of physics. ... 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. ... Centuries: 19th century - 20th century - 21st century Decades: 1900s 1910s 1920s 1930s 1940s 1950s - 1960s - 1970s 1980s 1990s 2000s 2010s Years: 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 Events and trends The 1960s was a turbulent decade of change around the world. ... 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. ... Yellow fever (also called black vomit or sometimes The American Plague) is an acute viral disease. ... 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 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...

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 Beagle voyage. Darwin, who was young and in good health until he returned to London, soon afterward began to suffer from strange symptoms. Unsuccesful attempts were made to test Darwin's remains at the Westminster Abbey by using modern PCR techniques, but were met with a refusal by the curator. For other possible meanings see Darwin (disambiguation) 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. ... The Abbey at night, from Deans Yard. ... Wikipedia does not yet have an article with this exact name. ...

Epidemiology and geographical distribution

Chagas disease currently affects 16-18 million people, killing around 20,000 annually and with some 100 million at risk of acquiring the disease. Chronic Chagas disease is a major health problem in many Latin American countries. With increased population movements, the possibility of transmission by blood transfusion has become more substantial in the United States [1]  (http://content.nejm.org/cgi/content/extract/329/9/639). Alarmingly, T. cruzi has already been found infecting wild opossums and racoons as far as North Carolina [2] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1597808). 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. ...

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. ... Argentina is a country in southern South America, situated between the Andes in the west and the southern Atlantic Ocean in the east. ... 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 totally prevalent in the rural area, where the Triatoma can breed and feed on the natural reservoirs (the most common ones being opossums and armadillos). Poor housing, with mud walls and straw roofs offer many hiding places for the insect vector, which can then bite humans at night. 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. ...

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. Most acute cases (10 to 20%) resolve over a period of 2 to 3 months into an asymptomatic chronic stage, which appears after several years. 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. ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ... 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 is also the name of an album by Kylie Minogue. ... Anorexia (deriving from the Greek word ανορεξία = without appetite (αν = without + όρεξη = appetite)) is the medical name for loss of appetite. ... 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 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. 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. ... This page is about the muscular organ, the Heart. ... 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. ... Cardiomyopathy is the deterioration of the cardiac muscle of the heart wall. ... 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. ...

Infection cycle

Source: CDC

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 excellence 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. ... Categories: Biology stubs | Cell biology | Biological reproduction ... Biological tissue is a group of cells that perform a similar function. ... Fritz Köberle (b. ... Events and trends Technology United States tests the first fusion bomb. ... 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, and metabolism, and by modulating blood pressure. ... An aneurysm (or aneurism) (from Gr. ...

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. 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, and in laboratory accidents. 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. ... The placenta is an ephemeral (temporary) organ present only in female placental mammals during gestation (pregnancy). ...

Alternative infection mechanism

Researchers suspected since 1991 [3] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1844961&dopt=Citation) that the transmission of the trypanosome by the oral route might be possible, due to a number of micro-epidemics involving a single restricted times and places (such as a farm of 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 [4] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10677763&dopt=Citation). 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. ...

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 have acquired Chagas disease [5] (http://aol.countrywatch.com/aol_wire.asp?vCOUNTRY=183&UID=1442449). Until March 30th, 2005, 49 cases had been confirmed in Santa Catarina, with 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 clarified. 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 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. ... For the input device, see computer mouse. ...

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.

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. ... For the input device, see computer mouse. ... Subfamilies Harpactorinae Peiratinae Tegeinae Triatominae etc. ...

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 [6]  (http://aac.asm.org/cgi/content/abstract/49/4/1521) or nifurtimox (under an Investigational New Drug protocol from the CDC Drug Service), but resistance to these drugs has already been reported [7]  (http://aac.asm.org/cgi/content/abstract/42/12/3245). 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 [8] (http://scholar.google.com/url?sa=U&q=http://www.ajtmh.org/cgi/reprint/63/3/111.pdf). Thus, the decision about whether to use antiparasitic therapy should be individualized in consultation with an expert. This page is not about the diacritic character; see acute accent for more information. ... 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 [9]  (http://www.jem.org/cgi/content/abstract/188/4/725).

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 is now a common cause for heart transplantation surgery and was first developed by Dr. Adib Jatene's group at the Heart Institute of the University of São Paulo, in São Paulo, Brazil [10]  (http://ats.ctsnetjournals.org/cgi/content/abstract/61/6/1727). Recently, direct stem cell therapy of the heart muscle using bone marrow cell transplantation has been shown to improve dramatically heart failure in Chagas patients [11]  (http://publicacoes.cardiol.br/abc/2004/8202/8202010i.pdf). Medicine In medicine, a persistent and lasting condition is said to be chronic (from Greek chronos). ... 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. ... Surgery Surgery (from the Greek cheirourgia - lit. ... 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. ... Sao Paulo and São Paulo (city) redirect here. ... Mouse embryonic stem cells. ... Bone marrow is the tissue comprising the center of large bones. ...

Prevention

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. 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 insecticides sprays and paints, 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. ...

Bibliography

• Adler D. Darwin's illness. Isr J Med Sci. 1989 Apr;25(4):218-21. ( Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2496051))
• 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  (http://content.nejm.org/cgi/content/extract/329/9/639))
• 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  (http://aac.asm.org/cgi/content/abstract/49/4/1521))
• 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  (http://aac.asm.org/cgi/content/abstract/42/12/3245))
• 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  (http://www.jem.org/cgi/content/abstract/188/4/725))
• 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  (http://ats.ctsnetjournals.org/cgi/content/abstract/61/6/1727))
• 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 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14688079))
• 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 (http://publicacoes.cardiol.br/abc/2004/8202/8202010i.pdf))
• 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 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10677763&dopt=Citation))
• 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 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1844961&dopt=Citation))

Source

• American Trypanosomyasis (http://www.dpd.cdc.gov/dpdx/HTML/TrypanosomiasisAmerican.htm). CDC Disease Information (US Federal Government public domain).