Chagas disease
Classification & external resources

Photomicrograph of Giemsa-stained Trypanosoma cruzi (CDC)
ICD-10	B57.
ICD-9	086
DiseasesDB	13415
MedlinePlus	001372
eMedicine	med/327
MeSH	D014355

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 blood-sucking assassin bugs of the subfamily Triatominae (Family Reduviidae). Those insects are known by numerous common names varying by country, including benchuca, vinchuca, kissing bug, chipo, chupança, and barbeiro. The most common insect species belong to the genera Triatoma, Rhodnius, and Panstrongylus. However, other methods of transmission are possible, such as ingestion of food contaminated with parasites, blood transfusion and fetal transmission. Photomicrograph of Trypanosoma cruzi parasites (Chagas disease pathogen). ... A complex of stains specific for the phosphate groups of DNA. Used in Giemsa banding (or G-banding) to stain chromosomes and often used to create a karyotype. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... 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. ... World map showing the Americas The Americas are the lands of the Western hemisphere historically considered to consist of the continents of North America and South America with their associated islands and regions. ... South America South America is a continent crossed by the equator, with most of its area in the Southern Hemisphere. ... A pathogen or infectious agent is a biological agent that causes disease or illness to its host. ... In epidemiology, a vector is an organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another. ... Flagellata from Ernst Haeckels Artforms of Nature, 1904 Parasitic excavate (Giardia lamblia) Green alga (Chlamydomonas) Flagellates are cells with one or more whip-like organelles called flagella. ... Leishmania donovani, (a species of protozoan) in a bone marrow cell (in Greek proto = first and zoa = animals) are one-celled eukaryotes (that is, unicellular microbes whose cells have membrane-bound nuclei) that commonly show characteristics usually associated with animals, mobility and heterotrophy. ... Trypanosoma cruzi is a species of parasitic protozoan trypanosomes. ... Subclasses & Infraclasses Subclass †Allotheria* Subclass Prototheria Subclass Theria Infraclass †Trituberculata Infraclass Metatheria Infraclass Eutheria Mammals (class Mammalia) are warm-blooded, vertebrate animals characterized by the presence of sweat glands, including those that produce milk, and by the presence of: hair, three middle ear bones used in hearing, and a neocortex... An Anopheles stephensi mosquito obtaining a blood meal from a human host through its pointed proboscis. ... Subfamilies Harpactorinae Peiratinae Tegeinae Triatominae etc. ... The members of Triatominae, a subfamily of Reduviidae, are also known as conenose bugs, kissing bugs or triatomines. ... Subfamilies Apiomerinae Ectrichodiinae Emesinae Harpactorinae Peiratinae Phymatinae Reduviinae Saicinae Salyavatinae Stenopodainae Tegeinae Triatominae Tribelocephalinae etc. ... Triatoma is a genus of the subfamily Triatominae. ... The Genus Rhodnius Stal, 1859 belongs to the subfamily Triatominae. ... The Genus Panstrongylus Berg, 1879 belongs to the subfamily Triatominae. ... A parasite is an organism that spends a significant portion of its life in or on the living tissue of a host organism and which causes harm to the host without immediately killing it. ... Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... For other uses, see Fetus (disambiguation). ...

The symptoms of Chagas' disease vary over the course of the infection. In the early, acute stage symptoms are mild and are usually no more than local swelling at the site of infection. As the disease progresses, over as much as twenty years, the serious chronic symptoms appear, such as heart disease and malformation of the intestines. If untreated, the chronic disease is often fatal. Current drug treatments for this disease are generally unsatisfactory, with the available drugs being highly toxic and often ineffective, particularly in the chronic stage of the disease.

Trypanosoma cruzi is a member of the same genus as the infectious agent of African sleeping sickness and the same order as the infectious agent of leishmaniasis, but its clinical manifestations, geographical distribution, life cycle and insect vectors are quite different. For other uses, see Genus (disambiguation). ... Sleeping sickness or African trypanosomiasis is a parasitic disease in people and animals, caused by protozoa of genus Trypanosoma and transmitted by the tsetse fly. ... In scientific classification used in biology, the order (Latin: ordo, plural ordines) is a rank between class and family (termed a taxon at that rank). ... In epidemiology, a vector is an organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another. ...

History

The disease was named after the Brazilian physician and infectologist Carlos Chagas, who first described it in 1909^[1][2][3] but, the disease was not seen as a major public health problem in humans until the 1960s (the outbreak of Chagas' disease in Brazil in the 1920s went widely ignored^[4]). He discovered that the intestines of Triatomidae harbored a flagellate protozoan, a new species of the Trypanosoma genus, and was able to prove experimentally that it could be transmitted to marmoset monkeys that were bitten by the infected bug. Later studies showed that squirrel monkeys were also vulnerable to infection.^[5] For other uses, see Doctor. ... Infectology is a medical speciality dealing with the diagnosis and treatment of infection. ... Carlos Justiniano Ribeiro Chagas (born July 9, 1879, Oliveira, Minas Gerais, Brazil; died November 8, 1934, Rio de Janeiro), was a Brazilian physician. ... Public health is concerned with threats to the overall health of a community based on population health analysis. ... Trypanosoma is a notable genus of trypanosomes, a monophyletic[1] group of unicellular parasitic protozoa. ... Type species Simia jacchus Linnaeus, 1758 Species 18 species, see text Marmosets are New World monkeys in the genus Callithrix, which contains 18 species. ...

Chagas named the pathogenic parasite that causes the disease Trypanosoma cruzi ^[1] and later that year as Schizotrypanum cruzi,^[6] both honoring 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. Nevertheless, he at least believed falsely until 1925, that the main infection route is by the bite of the insect - and not by its feces, as was proposed by his colleague Emile Brumpt 1915 and assured by Silveira Dias 1932, Cardoso 1938 and Brumpt himself 1939. Chagas was also the first to unknowingly discover and illustrate the parasitic fungal genus Pneumocystis, later to infamously be linked to PCP (Pneumocystis pneumonia in AIDS victims).^[2] Confusion between the two pathogens' life-cycles led him to briefly recognize his genus Schizotrypanum, but following the description of Pneumocystis by others as an independent genus, Chagas returned to the use of the name Trypanosoma cruzi. A pathogen or infectious agent is a biological agent that causes disease or illness 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 contagious disease unique to humans. ... The bubonic plague or bubonic fever is the best-known variant of the deadly infectious disease caused by the enterobacteria Yersinia pestis (Pasteurella pestis). ... This article is about the Brazilian city. ... This article does not adequately cite its references or sources. ... This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia. ... A pathogen or infectious agent is a biological agent that causes disease or illness to its host. ... In epidemiology, a vector is an organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another. ... Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. ... Horse feces Feces, faeces, or fæces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ... Alexandre Joseph Emile Brumpt (March 10, 1877 - July 8, 1951) was a French parasitologist who was born in Paris. ... Cardoso is a municipality in the state of São Paulo in Brazil. ... Pneumocystis pneumonia (PCP) is a form of pneumonia caused by the yeast-like fungal microorganism Pneumocystis jirovecii (Jirovecii is pronounced yee row vet zee eye). The causal agent was originally described as a protozoan and spelled and prior to then was formerly classified as a form of Pneumocystis carinii, a... Pneumocystis pneumonia (PCP) is a form of pneumonia caused by the yeast-like fungal microorganism Pneumocystis jirovecii (Jirovecii is pronounced yee row vet zee eye). The causal agent was originally described as a protozoan and spelled and prior to then was formerly classified as a form of Pneumocystis carinii, a...

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 Charles Darwin's illness). The episode was reported by Darwin in his diaries of the Voyage of the Beagle as occurring in March 1835 to the east of the Andes near Mendoza. Darwin was young and in general good health though six months previously he had been ill for a month near Valparaiso, but in 1837, almost a year after he returned to England, he began to suffer intermittently from a strange group of symptoms, becoming incapacitated for much of 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.^[7] For other people of the same surname, and places and things named after Charles Darwin, see Darwin. ... The pampas (from Quechua for plain) are the fertile lowlands that extend across c. ... Charles Darwin (1809-1882) For much of his adult life Charles Darwins illness repeatedly affected him with an uncommon combination of symptoms, leaving him severely debilitated for long periods of time, incapable of normal life and intellectual production, staying in bed most of the time for months. ... A watercolor by the HMS Beagles draughtsman, Conrad Martens. ... This article is about the mountain system in South America. ... Mendoza is one of the 23 provinces of Argentina, located in the western central part of the country in the Cuyo region. ... Valparaiso is the name of at least three cities and a village: Valparaíso, Chile Valparaiso, Florida Valparaiso, Indiana Valparaiso, Nebraska This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... For other uses, see England (disambiguation). ... The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... The Collegiate Church of St Peter, Westminster, which is almost always referred to by its original name of Westminster Abbey, is a mainly Gothic church, on the scale of a cathedral (and indeed often mistaken for one), in Westminster, London, just to the west of the Palace of Westminster. ... 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, with some 100 million (25% of the Latin American population) at risk of acquiring the disease,^[3] killing around 50,000 people annually.^[8] 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.^[9] Approximately 500,000 infected people live in the USA, virtually all of them immigrants.^[10] Also, T. cruzi has already been found infecting wild opossums and raccoons as far north as the state of North Carolina.^[11] 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. ... In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. ... 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. ... Immigration is the act of moving to or settling in another country or region, temporarily or permanently. ... Genera Several; see text Opossum fur is quite soft. ... Binomial name (Linnaeus, 1758) Common Raccoon native range in red, feral range in blue. ...

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.^[12] World map showing the Americas The Americas are the lands of the Western hemisphere historically considered to consist of the continents of North America and South America with their associated islands and regions. ... Sign in a rural area in Dalarna, Sweden Qichun, a rural town in Hubei province, China Rural areas (also referred to as the country, countryside) are settled places outside towns and cities. ... For other uses, see Central America (disambiguation). ... 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 infected humans, domestic animals like cats, dogs, guinea pigs and wild animals like rodents, monkeys, ground squirrels (Spermophilus beecheyi) and many others 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; but there remain suspicions of them being a feeding resource for the vectors near human habitations. Natural reservoir or nidus, refers to the long-term host of the pathogen of an infectious disease. ... Genera Several; see text Opossum fur is quite soft. ... For other uses, see Armadillo (disambiguation). ... Binomial name Felis catus Linnaeus, 1758 Synonyms Felis lybica invalid junior synonym The cat (or domestic cat, house cat) is a small carnivorous mammal. ... Trinomial name Canis lupus familiaris The dog (Canis lupus familiaris) is a domestic subspecies of the wolf, a mammal of the Canidae family of the order Carnivora. ... For other uses, see Guinea pig (disambiguation). ... Suborders Sciuromorpha Castorimorpha Myomorpha Anomaluromorpha Hystricomorpha Rodentia is an order of mammals also known as rodents, characterised by two continuously-growing incisors in the upper and lower jaws which must be kept short by gnawing. ... Approximate worldwide distribution of monkeys. ... Genera Ammospermophilus Spermophilus Cynomys Marmota Tamias Sciurotamias The ground squirrels are all members of the Sciuridae most closely related to the genus Marmota and included in the tribe Marmotini. ... 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 triatomine insects are known popularly in the different countries as vinchuca, barbeiro (the barber), chipo and other names,^[3] so called because it sucks the blood at night by biting the face of its victims. The insects, who develop a predominantly domiciliary and anthropophilic behaviour once they have infested a house,^[13] usually hide during the day in crevices and gaps in the walls and roofs of poorly constructed homes. More rarely, better constructed houses may harbor the insect vector, because of the use of rough materials for making roofs, such as bamboo and thatch. A mosquito net, wrapped under the mattress, will provide protection in these situations, when the adult insect might sail down from above, but one of the five nymphal stages (instars) could crawl up from the floor. For other uses, see Bamboo (disambiguation). ... Thatching is the art or craft of covering a roof with vegetative materials such as straw, reed or sedge. ... A bed covered by a mosquito net. ... An instar is a developmental stage of arthropods, such as insects, between each molt. ...

Even when the colonies of insects are eradicated from a house and surrounding domestic animal shelters, they can arrive again (e.g., by flying) from plants or animals that are part of the ancient, natural sylvatic infection cycle. This can happen especially in zones with mixed open savannah, clumps of trees, etc., interspersed by human habitation.

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, piassava palm (Leopoldinia piassaba) culture areas, and some parts of the Amazon region, this may occur, when the insects are searching for new prey.^[14] A rainforest is a forested biome with high annual rainfall. ... Habitat (which is Latin for it inhabits) is the place where a particular species live and grow. ... This article is about the process of deforestation in the environment. ... Binomial name Leopoldinia piassaba Wallace Leopoldinia piassaba (Para piassava, Piassava fiber palm, Piassava palm) is a palm native to Amazon Rainforest vegetation in Brazil and Venezuela, which is often used to produce the piassava. ... Binomial name Leopoldinia piassaba Wallace Leopoldinia piassaba (Para piassava, Piassava fiber palm, Piassava palm) is a palm native to Amazon Rainforest vegetation in Brazil and Venezuela, which is often used to produce the piassava. ... This article is about the river. ...

Clinical manifestations

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

The human disease occurs in two stages: the acute stage shortly after the infection, and the chronic stage that may develop over 10 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). ... This article is about the medical term. ... An infection is the detrimental colonization of a host organism by a foreign species. ...

In the acute phase, a local skin nodule called a chagoma can appear at the site of inoculation. When the inoculation site is the conjunctival mucous membranes, the patient may develop unilateral periorbital edema, conjunctivitis, and preauricular lymphadenitis. This constellation of symptoms is referred to as Romaña's sign. The acute phase is usually asymptomatic, but may present symptoms of 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. Inoculation, originally Variolation, is a method of purposefully infecting a person with smallpox (Variola) in a controlled manner so as to minimise the severity of the infection and also to induce immunity against further infection. ... The conjunctiva is a membrane that covers the sclera (white part of the eye) and lines the inside of the eyelids. ... Chagas disease (also called American trypanosomiasis) is a human tropical parasitic disease which occurs in the Americas, particularly in South America. ... In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ... An analogue medical thermometer showing the temperature of 38. ... Anorexia (deriving from the Greek α(ν)- (a(n)-, a prefix that denotes absence) + όρεξη (orexe) = appetite) is the decreased sensation of appetite. ... Lymphadenopathy is a term meaning disease of the lymph nodes. ... 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 Human Nervous System. ... what was here was sick and improperly spelled. ... The heart and lungs, from an older edition of Grays Anatomy. ... For other uses, see Dementia (disambiguation). ... 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... Megacolon is an abnormal dilatation of the colon (a part of the large intestines) that is not caused by mechanical obstruction. ... Megaesophagus is a condition in dogs where peristalsis fails to occur properly and the esophagus is enlarged. ... Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... For the Bush song, see Swallowed (song). ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ...

Infection cycle

An infected triatomine insect vector feeds on blood and releases trypomastigotes in its feces near the site of the bite wound. The victim, by scratching the site of the bite, causes trypomastigotes to enter the host through the wound, or through intact mucosal membranes, such as the conjunctiva. Then, inside the host, the trypomastigotes invade cells, where they differentiate into intracellular amastigotes. The amastigotes multiply by binary fission and differentiate into trypomastigotes, then are released into the circulation as bloodstream trypomastigotes. These trypomastigotes infect cells from a variety of biological tissues and transform into intracellular amastigotes in new infection sites. Clinical manifestations and cell death at the target tissues can occur because of this infective cycle. 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, 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. ... Amastigote is a stage in the development of protozoans, including that of the Leishmania protozoan. ... Binary fission Binary fission is the form of asexual reproduction in single-celled organisms by which one cell divides into two cells of the same size, used by most prokaryotes. ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... Fritz Köberle (b. ... 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. ... This article or section is in need of attention from an expert on the subject. ... Post surgical photo of brain aneurysm survivor. ...

The bloodstream trypomastigotes do not replicate (unlike 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. Moreover 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. ... Genera Blastocrithidia Crithidia Endotrypanum Herpetomonas Leishmania Leptomonas Phytomonas Trypanosoma Wallaceina The trypanosomes are a group of kinetoplastid protozoa, which are exclusively parasitic. ...

Trypanosoma cruzi can also be transmitted through blood transfusions, organ transplantation, transplacentally, breast milk,^[15] and in laboratory accidents. According to the World Health Organization, the infection rate in Latin American blood banks varies between 3% and 53%, a figure higher than of HIV infection and hepatitis B and C.^[3] Trypanosoma cruzi is a species of parasitic protozoan trypanosomes. ... 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 a sack of fat present in placental vertebrates, such as some mammals and sharks during gestation (pregnancy). ... It has been suggested that the section Benefits for the infant from the article Breastfeeding be merged into this article or section. ... WHO redirects here. ... 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. ... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ... Hepatitis (plural hepatitides) implies injury to liver characterised by presence of inflammatory cells in the liver tissue. ...

Children can also acquire Chagas' Disease while still in the womb. Chagas' disease accounts for approximately 13% of stillborn deaths in parts of Brazil. It is recommended that pregnant women be tested for the disease.^[16]

Image File history File links No higher resolution available. ...

Alternative infection mechanism

Researchers suspected since 1991 that the transmission of the trypanosome by the oral route might be possible,^[17] 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 Paraíba, 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 probably infected by drinking acai palm fruit juice contaminated with crushed triatomine vector insects.^[18] In the beginning of 2005, a new outbreak with 27 cases was detected in Amapá. Despite many warnings in the press and by health authorities, this source of infection continues unabated. In August 2007 the Ministry of Health released the information that in the previous one year and half 15 clusters of Chagas infection in 116 people via ingestion of assai have been detected in the Amazon region ^[19] A river in the Amazon rainforest The Amazon is a rainforest in South America. ... Flag of Paraíba See other Brazilian States Capital João Pessoa Largest City João Pessoa Area 56. ... Genera Several; see text Opossum fur is quite soft. ... Macapá Country Region State Amapá Founded 9 February 1758 Government  - Mayor João HenriquePT Area  - City 6. ... Flag of Amapá See other Brazilian States Capital Macapá Largest City Macapá Area 142 816 km² Population   - Total   - Density 477 032 3. ... (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. ... Flag of Amapá See other Brazilian States Capital Macapá Largest City Macapá Area 142 816 km² Population   - Total   - Density 477 032 3. ...

In March 2005, a new startling outbreak was recorded in the state of Santa Catarina, Brazil, that seemed 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.^[20] Between February 30 and March 30, 2005, 31 cases had been confirmed in Santa Catarina, including 5 deaths and 64 suspected cases.^[21] 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 around 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. Capital Florianópolis Largest city Joinville Demonym catarinense or barriga-verde Government  -  Governor Luiz Henrique  -  Vice Governor Leonel Pavan Area  -  Total 95. ... 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. ... February 30 occurs in some calendars, unlike the Gregorian calendar, where February contains only 28 or 29 days. ... is the 89th day of the year (90th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... Food safety is a scientific discipline describing the handling, preparation, and storage of food in ways that prevent Foodborne illness. ...

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. ... This article is about the Brazilian city. ... This article is about the animal. ...

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; it can be confused with the 50% longer Trypanosoma rangeli, which has not shown any pathogenicity in humans yet.
• 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.
• Various Immunodiagnostic tests; (also trying to distinguish strains (zymodemes) of T.cruzi with divergent pathogenicities).
  • Complement fixation
  • indirect hemagglutination
  • IFA, Indirect fluorescent assay
  • RIA, Radio-immunoassay
  • ELISA, Enzyme-Linked Immunosorbent Assay
• Diagnosis based on Molecular Biology techniques.
  • PCR, Polymerase chain reaction, most promising

Robert Hookes microscope (1665) - an engineered device used to study living systems. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Buffy coat is the fraction of a centrifugated blood sample that contains most of the white blood cells. ... 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. ... This article is about the animal. ... Subfamilies Apiomerinae Ectrichodiinae Emesinae Harpactorinae Peiratinae Phymatinae Reduviinae Saicinae Salyavatinae Stenopodainae Tegeinae Triatominae Tribelocephalinae etc. ... In biology, Strain can be used two ways. ... An immunological test for determining the presence of a particular antibody in which serum is treated in a manner that allows existing antibodies to accept and bind to a known amount of antigen. ... Hemagglutination (also haemagglutination) is a more specific form of agglutination that involves red blood cells. ... Radioimmunoassay is a scientific method used to test hormone levels in the blood without the need to use a bioassay. ... Elisa (born Elisa Toffoli on 19 December 1977) is an Italian singer and solo artist, writing and performing within several genres, notably rock, blues, soul and ambient. ... Molecular biology is the study of biology at a molecular level. ... Wikipedia does not yet have an article with this exact name. ...

Prognosis

An index for classification of patients who have Chagas' disease was published in the August 24, 2006 edition of the New England Journal of Medicine.^[22] Based on over 500 patients, this index includes clinical aspects, X-ray findings, EKG, echocardiography and Holter. The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... “QRS” redirects here. ... An echocardiogram. ... Holter monitor In medicine, a Holter monitor (also called an ambulatory electrocardiography device), named after its inventor, Dr. Norman J. Holter, is a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more. ...

The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying the extent of heart failure. ... Cardiomegaly is a medical condition wherein the heart is enlarged. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... “QRS” redirects here. ...

Treatment

Medication for Chagas' disease is usually only effective when given during the acute stage of infection. The drugs of choice are azole or nitroderivatives such as benznidazole^[23] or nifurtimox (under an Investigational New Drug protocol from the CDC Drug Service), but resistance to these drugs has already been reported.^[24] Furthermore, these agents are very toxic and have many adverse effects, and cannot be taken without medical supervision. The antifungal agent Amphotericin B has been proposed as a second-line drug, but cost and this drug's relatively high toxicity have limited its use. Moreover, 10-year study of chronic administration of drugs in Brazil has revealed that current chemotherapy does not totally remove parasitemia.^[25] Thus, the decision about whether to use antiparasitic therapy should be individualized in consultation with an expert. In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... Benznidazole (INN, marketed by Hoffman-La Roche under the trade names Rochagan® and Radanil®) is an antiparasitic medication used in the treatment of Chagas disease. ... Nifurtimox is a 5-nitrofuran and is used to treat diseases caused by trypanosomes (Chagas disease and sleeping sickness). ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... 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. ... Amphotericin B (Fungilin®, Fungizone®, Abelcet®, AmBisome®, Fungisome®, Amphocil®, Amphotec®) is a polyene antimycotic drug, used intravenously in systemic fungal infections. ... Parasitemia is the quantitative content of parasites in the blood. ... Antiparasitics are a class of medications which are indicated for the treatment of infection by parasites such as nematodes, cestodes, trematodes, infectious protozoa, and amoebas. ...

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' disease 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 recur 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.^[26] The research noted that survival rates in Chagas' patients can be significantly improved by using lower dosages of the immunosuppressant drug cyclosporin. 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.^[27] Patients have also been shown to benefit from the strict prevention of reinfection, though the reason for this is not yet clearly understood. In medicine, a chronic disease is a disease that is long-lasting or recurrent. ... 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. ... Congestive heart failure (CHF) (also called congestive cardiac failure and heart failure) is the inability of the heart to pump a sufficient amount of blood throughout the body, or requiring elevated filling pressures in order to pump effectively. ... Cardiac arrhythmia is a group of conditions in which muscle contraction of the heart is irregular for any reason. ... “Surgeon” redirects here. ... 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. ... Adib Domingos Jatene is a noted Brazilian physician, university professor, scientist and thoracic surgeon, one of the founders of the University of São Paulo Heart Institute and internationally respected as the inventor of the Jatene operation, a open heart surgery for revascularization of the myocardium. ... The Instituto do Coração da Universidade de São Paulo (Heart Institute of the University of São Paulo is one of the clinical institutes of the central Universitys teaching hospital (Hospital das Clínicas da Universidade de São Paulo, located in São Paulo, Brazil, and... This article is about the city. ... ... Mouse embryonic stem cells. ... This article does not cite any references or sources. ...

Some examples for the struggle for advances:

• Use of oxidosqualene cyclase inhibitors and cysteine protease inhibitors has been found to cure experimental infections in animals.^[28]
• Dermaseptins from frog species Phyllomedusa oreades and P. distincta. Anti-Trypanosoma cruzi activity without cytotoxicity to mammalian cells.^[29]
• Design of inhibitors to enzymes involved in trypanothione metabolism, which is unique to the kinetoplastid group of parasites.^[30]
• The sesquiterpene lactone dehydroleucodine (DhL) affects the growth of cultured epimastigotes of Trypanosoma cruzi^[31]
• The genome of Trypanosoma cruzi has been sequenced.^[32] Proteins that are produced by the disease but not by humans have been identified as possible drug targets to defeat the disease.^[33]

In November, 2007, the Olive View-UCLA Medical Center in Sylmar in the San Fernando Valley area of Los Angeles county, California has opened the first clinic in the nation that studies and treats Chagas disease gratis for LA county residents^[34][35]. Proteases are enzymes that degrade polypeptides. ... Dermaseptins are one of a number of families of peptides that have been identified, isolated and characterised from the Phyllomedusa genus of frogs. ... Species See text. ... Cytotoxicity is the quality of being poisonous to cells. ... Trypanothione is a unusual form of glutathione that is found in parasitic protozoa such as leishmania and trypanosomes (1). ... In biology the genome of an organism is the whole hereditary information of an organism that is encoded in the DNA (or, for some viruses, RNA). ...

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 ... Triatoma infestans is an important vector of Chagas disease, especially in the Southern Cone countries of South America; that is, in Argentina, Uruguay, Paraguay and Chile. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ... Motto: Bandeirantum Ager Location of Ribeirão Preto Coordinates: Country Brazil Region Southeast State São Paulo Government  - Mayor Welson Gasparini (PSDB Area  - City 651. ... The term immunotherapy incorporates an array of strategies of treatment based upon the concept of modulating the immune system to achieve a prophylactic and/or therapeutic goal. ...

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. It has been suggested that ovicide be merged into this article or section. ... Pyrethrum refers to several Old World plants of the genus Chrysanthemum (e. ... Car camping is camping in a tent, but nearby the car for easier access and for supply storage. ... A bed covered by a mosquito net. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

In most countries where Chagas' disease is endemic, testing of blood donors is already mandatory, since this can be an important route of transmission. The United States FDA has recently licensed a test for antibodies against T. cruzi for use on blood donors but has not yet mandated its use. The AABB recommends that past recipients of blood components from donors found to be infected be notified and themselves tested. In the past, donated blood was mixed with 0,25 g/L of gentian violet successfully to kill the parasites. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Give blood redirects here. ... Methyl Violet 10B Gentian violet (crystal violet, Methyl Violet 10B, hexamethyl pararosaniline chloride) is an antifungal agent. ...

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. Map that frames the area named Southern Cone The term Southern Cone (Spanish: Cono Sur, Portuguese: Cone Sul) refers to a geographic region composed of the southernmost areas of South America, below the Tropic of Capricorn. ...

Some stepstones of vector control:

• A yeast trap has been tested for monitoring infestations of certain species of the bugs:"Performance of yeast-baited traps with Triatoma sordida, Triatoma brasiliensis, Triatoma pseudomaculata, and Panstrongylus megistus in laboratory assays."^[36]
• Promising results were gained with the treatment of vector habitats with the fungus Beauveria bassiana, (which is also in discussion for malaria- prevention):"Activity of oil-formulated Beauveria bassiana against Triatoma sordida in peridomestic areas in Central Brazil."^[37]
• Targeting the symbionts of Triatominae through paratransgenesis.^[38]

Binomial name Beauveria bassiana (Bals. ... Malaria is a vector-borne infectious disease caused by protozoan parasites. ... Common Clownfish (Amphiprion ocellaris) in their Magnificent Sea Anemone (Heteractis magnifica) home. ... The members of Triatominae, a subfamily of Reduviidae, are also known as conenose bugs, kissing bugs or triatomines. ... This article or section is in need of attention from an expert on the subject. ...

See also

• Tropical disease
• Drugs for Neglected Diseases Initiative
• Distinguish from: Chaga mushroom

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. ... The Drugs for Neglected Diseases Initiative (DNDi) is a not-for-profit drug development organization focused on improving the health and quality of life of people suffering from neglected diseases. ... Binomial name Inonotus obliquus L. The Chaga mushroom (Inonotus obliquus), also known as tinder mushroom, is a fungus in Hymenochaetaceae family. ...

Notes

is the 317th day of the year (318th in leap years) in the Gregorian calendar. ... This article is about the year. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 330th day of the year (331st in leap years) in the Gregorian calendar. ...

References

• CDC, Division of Parasitic Diseases. Chagas Disease Fact Sheet. (23 September 2004). Accessed 24 September 2006.
• Dumonteil E, Escobedo-Ortegon J, Reyes-Rodriguez N, Arjona-Torres A, Ramirez-Sierra M (2004). "Immunotherapy of Trypanosoma cruzi infection with DNA vaccines in mice.". Infect Immun 72 (1): 46–53. PMID 14688079. 

is the 266th day of the year (267th in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... is the 267th day of the year (268th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ...

Further reading

External links

• VCU Virtual Parasite Project
• All About Chagas Disease, Chagas' disease Information & Prevention, Identification, also in Spanish.
• Chagaspace, also in Spanish.
• ChagMex: Database on-line. UNAM-Instituto de Biología.
• Chagas Disease. PanAmerican Health Organization.
• Disease Information. American Trypanosomiasis or Chagas' Disease. Travel Medicine Program. Health Canada.
• Links to Chagas' Disease pictures (Hardin MD/Univ of Iowa)
• Link to "The Kiss of Death". An anthropological view of Chagas' disease (Joseph Bastien/Univ of Texas at Arlington).

Recent news and events

• Chagas' disease parasite found in desert blood samples
• Chagas Control in the Southern Cone Countries: History of an International Initiative, 1991/2001, PAHO. (Full text e-book)
• Genome Sequencing Project
• Parasites' genetic code 'cracked' From BBC
• Catholic Relief Services. Housing Improvement and Chagas' Disease Prevention Project
• 2006: Nature.com / Scott M. Landfear: Flagella are whip-like structures that power the movement of certain cells. Analysis of a single-cell parasite, the African trypanosome, reveals that flagella are also essential for viability in this organism. (restricted commercial access now)
• Science Magazine Search Results: Chagas

Protozoa (in Greek protos = first and zoon = animal) are single-celled eukaryotes (organisms with nuclei) that show some characteristics usually associated with animals, most notably mobility and heterotrophy. ... Classes & Subclasses Aconoidasida Haemosporasina Piroplasmasina Blastocystea Conoidasida Coccidiasina Gregarinasina The Apicomplexa are a large group of protists, characterized by the presence of a unique organelle called an apical complex. ... Coccidia are microscopic, single-celled parasites that infect the intestine. ... Cryptosporidiosis is a parasitic disease affecting the intestines of mammals that is caused by Cryptosporidium, a protozoan parasite in the phylum Apicomplexa. ... Isosporiasis is a human intestinal disease caused by a parasite called Isosporiasis belli. ... Cyclospora cayetanensis is a pathogenic protozoan transmitted by feces or feces-contaminated fresh produce and water. ... Malaria is a vector-borne infectious disease caused by protozoan parasites. ... Blackwater fever is a complication of malaria characterized by intravascular haemolysis, haemoglobinuria and kidney failure. ... Babesiosis is a parasitic disease caused by protozoan parasites of the genus Babesia, which belongs to the phylum Apicomplexa. ... This article is about the protist group called excavates. ... Giardiasis (also known as beaver fever) is a disease caused by the flagellate protozoan Giardia lamblia (also Giardia intestinalis). ... Trypanosomiasis is the name of the diseases caused by parasitic protozoan trypanosomes of the genus trypanosoma in vertebrates. ... Sleeping sickness or African trypanosomiasis is a parasitic disease in people and animals, caused by protozoa of genus Trypanosoma and transmitted by the tsetse fly. ... Cutaneous leishmaniasis is the most common form of leishmaniasis. ... Visceral leishmaniasis (VL), also known as kala-azar and black fever, is the most severe form of leishmaniasis, a disease caused by parasites of the Leishmania genus. ... Trichomoniasis, sometimes referred to as trich, is a common sexually transmitted disease that affects 7. ... Blastocystosis refers to a medical condition caused by infection with Blastocystis. ... Dientamoebiasis is a medical condition caused by infection with Dientamoeba fragilis. ... An intestinal infection that causes diarrhea and wasting in persons with HIV. It results from two different species of microsporidia, a protozoal parasite. ... Binomial name Naegleria fowleri Carter (1970) Naegleria fowleri (pronounced nuh-GLEER-e-uh) is a free living amoeba typically found in warm fresh water, from 25-35 degrees Celsius in a flagellated stage. ...