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Chronic Chagas Disease—the Potential Role of Reinfections in Cardiomyopathy Pathogenesis

  • Comorbidities of Hearth Failure (J. Tromp, Section Editor)
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Abstract

Purpose of the Review

Chagas disease is a neglected anthropozoonosis of global importance with significant cardiovascular-associated mortality. This review focuses on the Trypanosoma cruzi reinfections’ role in chronic Chagas cardiomyopathy pathogenesis. We discuss and summarize the available data related to pathology, pathogenesis, diagnosis, and treatment of reinfections.

Recent Findings

Reinfections influence the genetic and regional diversity of T. cruzi, tissue tropism, modulation of the host’s immune system response, clinical manifestations, the risk for congenital infections, differences in diagnostics performances, response to antiparasitic therapy, and the natural history of the disease. Animal models suggest that reinfections lead to worse outcomes and increased mortality, while other studies showed an association between reinfections and lower parasitemia levels and subsequent infection protection. In some regions, the human risk of reinfections is 14% at 5 years. Evidence has shown that higher anti-T. cruzi antibodies are correlated with an increased rate of cardiomyopathy and death, suggesting that a higher parasite exposure related to reinfections may lead to worse outcomes.

Summary

Based on the existing literature, reinfections may play a role in developing and exacerbating chronic Chagas cardiomyopathy and are linked to worse outcomes. Control efforts should be redirected to interventions that address structural poverty for the successful and sustainable prevention of Chagas disease.

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Authors and Affiliations

  1. Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Christian Olivo Freites

  2. Internal Medicine Department, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Hendrik Sy

  3. Internal Medicine Department, Yale-Waterbury Hospital, Yale School of Medicine, New Haven, CT, USA

    Amal Gharamti

  4. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Nelson I. Agudelo Higuita

  5. Federico Gómez, Hospital Infantil de México, Mexico City, México

    Carlos Franco-Paredes

  6. Clinical Research Department, Investigador SNI Senacyt Panamá, Instituto Conmemorativo Gorgas de Estudios de La Salud, Panamá City, Republic of Panama

    José Antonio Suárez

  7. Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, USA

    Andrés F. Henao-Martínez

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  1. Christian Olivo Freites
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Olivo Freites, C., Sy, H., Gharamti, A. et al. Chronic Chagas Disease—the Potential Role of Reinfections in Cardiomyopathy Pathogenesis. Curr Heart Fail Rep 19, 279–289 (2022). https://doi.org/10.1007/s11897-022-00568-9

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