American Trypanosomiasis (Chagas disease)

Abstract Chagas disease is caused by Trypanosoma cruzi, a protozoan parasite endemic in Latin America, where 6 million people are infected. Due to migration, Chagas disease has now emerged in North America and Europe. It is transmitted by triatomine vectors, congenitally, by blood transfusion or organ donation, and via contaminated food or drink. The natural history includes the acute phase lasting 2 to 3 months and the chronic phase, which lasts the lifetime. Twenty to thirty percent of those infected will progress over a period of years to clinically evident cardiac and/or gastrointestinal disease. Diagnosis of acute and early congenital infection requires demonstration of the parasite in blood by microscopy, polymerase chain reaction (PCR), or hemoculture. Diagnosis of chronic infection relies on serologic tests. There are currently only two available therapies: benznidazole and nifurtimox; an indication for anti-parasitic therapy depends on the phase of the disease and the clinical status of the patient.