Chagas disease, Chagas disease or South American thrypanosomiasis is an infectious disease that is not caused by bacteria, viruses or fungi, but by a parasite. Chagas disease was first described by Carlos Chagas in 1909.
What is Chagas disease?
Chagas disease is also commonly known as Chagas disease or South American thrypanosomiasis. It gets this name because the disease is mainly prevalent in South and Central America. The World Health Organization (WHO) estimates that about ten million people in Latin America are affected by Chagas disease. Brazilian infectiologist Carlos Chagas first encountered the strange tropical disease in 1909. He discovered that predatory bugs were responsible for transmitting the infectious disease and gave the parasite the name Trypanosoma cruzi – in reference to a well-known doctor from Brazil who was the namesake of the institute where Chagas was working at the time. The insidious Chagas disease occurs predominantly in rural areas and is now no longer limited to South America. With the increasing mobility of populations, Chagas disease has also been diagnosed in countries such as Canada, the United States, and some European and Western Pacific countries.
Causes
Chagas disease is a parasitic infectious disease. The unicellular parasite Trypanosoma cruzi is the trigger of the disease. Predatory bugs act as intermediate hosts (vectors), which ingest the pathogen via blood meals and excrete it through their feces. The pathogens of Chagas disease can enter their hosts through the smallest skin lesions or mucosal contacts. Among mammals, the main hosts are dogs, cats, isolated rodents, armadillos, and opossums. Through the animals, the infection is passed on to humans. In turn, it is possible that infection can also be passed from person to person (for example, via an organ transplant, a blood transfusion, or in the womb to the unborn child). In Chagas disease, the pathogens enter the bloodstream and infect the cells of the muscles and heart.
Symptoms, complaints, and signs
Chagas disease is accompanied by several common complaints of infection, although there are some characteristic symptoms that may directly indicate the disease. First and foremost, Chagas disease causes a very high fever, resulting in fatigue and exhaustion of the affected person. Most patients also suffer from shortness of breath and are therefore severely restricted in their daily lives. Diarrhea and severe abdominal pain also occur. The lymph nodes may also be swollen due to Chagas disease, which is often noticeable in the neck. If the disease is not treated, it usually leads to water retention. These occur mainly on the face or feet and can also have a negative effect on the aesthetics of the affected person. Heart complaints also occur, with most patients suffering from palpitations or heart pain. As the disease progresses, cardiac death occurs, reducing the life expectancy of the affected individual if Chagas disease is not treated. Breakthrough of the intestinal organs can also occur as a result of the disease, leading to the death of the affected person in the worst case scenario.
Diagnosis and course
Diagnosis of Chagas disease is particularly easy in the first weeks after infection. Under the microscope, the parasite can be detected in a blood smear. Chronic Chagas disease may be characterized by marked enlargement of the affected organ parts (for example, enlargement of the heart, enlargement of the esophagus and colon). In addition to microscopic detection of Chagas disease, xenodiagnosis can also be performed. This means that the blood-sucking predatory bugs are cultured in the laboratory and then placed on the patient’s skin. After a few weeks, the Trypanosoma cruzi pathogen can be detected in the feces of the predatory bugs. The incubation period of Chagas disease is about three weeks. After this time, a skin irritation occurs at the site of infection, the so-called chagoma. Other symptoms of Chagas disease include edema, fever, respiratory problems, diarrhea, cramps, abdominal pain, and swelling of the lymph nodes.
Complications
Chagas disease can lead to changes in the heart if left untreated. This can end in life-threatening complications. For example, there is an increased risk of developing cardiac arrhythmias such as atrial fibrillation or ventricular fibrillation. In atrial fibrillation, the blood can no longer be pumped properly, it stops in the atrium (stasis of the blood). As a result, the blood can clot on the wall of the atrium, forming a thrombus that can break loose and be transported further with the bloodstream. This can lead to further consequences such as a pulmonary embolism, which causes chest pain and shortness of breath in the affected person, or a stroke, which is characterized by a wide variety of paralyses and symptoms of failure, depending on the location. Furthermore, pulmonary edema may develop in Chagas disease. This can develop into inflammation in the lung tissue (pneumonia), which in the worst case can develop into sepsis. In the acute phase of Chagas disease, inflammation of the brain (encephalitis) or inflammation of the heart muscle (myocarditis) are also possible. Paralysis may result, or heart failure may develop. Some nerve cells that are needed for the muscles and thus movement of the gastrointestinal organs are also damaged. This can cause the contents of the food to build up, which can cause ileus or cause the organs to enlarge. This can cause the intestinal organs to rupture, which can also lead to death.
When should you go to the doctor?
When typical symptoms such as fever and shortness of breath appear, medical advice is needed. The physician can diagnose Chagas disease with the help of a blood smear and, if necessary, initiate treatment directly. A visit to the doctor is necessary at the latest if further complications develop. Thus, in case of chest pain and shortness of breath, the emergency physician should be called immediately. If pulmonary edema or a stroke occurs, first aid should be administered immediately. The patient must then spend some time in the hospital and requires comprehensive medical and therapeutic care afterwards as well. Psychological help is also recommended for the relatives in case of a severe course. After contact with dogs, cats and rodents, the risk of contracting Chagas disease is particularly high. The same applies after an organ transplant or a blood transfusion. Anyone to whom these factors apply should contact a physician quickly. In addition to the general practitioner, a specialist in infectious diseases can also help. In case of doubt, the emergency medical service or the ambulance service should be contacted.
Treatment and therapy
Untreated Chagas disease leads to death in about ten percent of affected patients. Mainly at risk are infants, young children, the elderly, and persons with weak immune systems. Chagas disease can only be treated with medication. However, this treatment is difficult. Therapy is carried out with the drugs nifortimox or benznidazole. However, these have serious side effects and can even alter the patient’s genetic material (so-called mutagens). In addition, there are even pathogens that are resistant to the drugs. In the acute phase, i.e. the initial phase of Chagas disease, attempts are made to combat Trypanosoma cruzi directly. The antibiotic agents nifortimox and benznidazole can destroy the parasite at the beginning of Chagas disease in most cases. The duration of treatment ranges from seven weeks to three months. However, the longer Chagas disease persists, the more difficult it becomes to find an effective remedy for the infection. In the chronic phase of Chagas disease, it is no longer sufficient to try to combat the pathogen alone. In this case, only a targeted therapy of the individual signs of the disease can lead to success in the fight against Chagas disease. The later the treatment is carried out, the more likely it is that cardiac arrhythmias, arterial embolisms or pulmonary edema will occur.
Outlook and prognosis
In the worst case scenario, Chagas disease can lead to the death of the patient and for this reason must be treated in any case. However, death usually occurs only if the disease is left completely untreated. People with a weakened immune system or patients of advanced age are particularly at risk.The disease itself is treated with the help of medication, which can completely limit the symptoms. In some cases, various medications must be tested for effectiveness before the appropriate drug is found. Chagas disease can also turn into a chronic condition and cause permanent discomfort. In this case, sufferers are then dependent on treatment of the heart and lungs, as these organs are affected by the disease. Early diagnosis and treatment of Chagas disease always has a positive effect on its course and can prevent further complications or, in the worst case, the death of the affected person. Some home remedies can alleviate the symptoms of the disease. The further course of the disease continues to depend on the extent of organ damage.
Prevention
For the prophylaxis of Chagas disease, the fight against the predatory bugs is mainly used. For example, insecticidal wall paints are used. One can also protect oneself against the bug bites by wearing suitable clothing and mosquito nets. The predatory bugs like to live in the sleeping places of pets. These places should be segregated. A vaccination against Chagas disease does not yet exist.
Aftercare
In most cases of Chagas disease, very few measures of direct aftercare are available to the affected person. In this disease, a quick and especially an early diagnosis is very important to avoid further complications or discomfort. In the worst case, Chagas disease can lead to the death of the affected person. The patient should stay away from the affected areas and protect himself from mosquitoes as much as possible. Various sprays can be used, and also, above all, long clothing should be worn, which properly covers all parts of the body. Self-cure cannot occur with this disease. In most cases, Chagas disease is treated by taking medication. The affected person should pay attention to the correct dosage and also to regular intake of the medication. Since in most cases antibiotics are administered, they must not be taken together with alcohol. Likewise, absolute bed rest should be observed in this disease. The patient should not perform any strenuous or physical activities. The disease itself is not contagious and can only be transmitted by the bite of the mosquito, so assisting other people is also allowed.
This is what you can do yourself
If Chagas disease is suspected, a doctor must be consulted immediately. Medical treatment is required in any case due to the severity of the infection. Nevertheless, there are some home remedies and measures that can be used to alleviate the symptoms independently. In mild cases of the disease, treatment with homeopathic preparations is useful. The use of globules and Co. should always be in consultation with a doctor and can not completely replace antibiotic treatment. Any medicinal plants should also be used purely symptomatically. For example, thyme, elderberry or speedwell help against fever, while diarrhea can be treated with bloodroot, oak and bilberry. For complaints of the lymphatic system, diet or purification can help. However, if medical treatment is delayed, cardiac arrhythmias, pulmonary edema, and other complications may occur. Depending on how severe these complications turn out to be, the doctor will then refer the patient to a therapist. This is especially necessary if permanent damage to the internal organs has occurred as a result of Chagas disease. In any case, the loss of quality of life must be worked through and accepted in the long term.
