Skip to main content

Advertisement

SpringerLink
Log in

Neurologic Manifestations of Chagas Disease

  • Infection (Burk Jubelt, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Chagas disease is endemic in Latin America and has become an emerging problem in developed countries because of international migrations. The protozoan Trypanosoma cruzi is the etiologic agent and the disease is divided into two phases. The acute phase is mostly asymptomatic or presents with unspecific symptoms. Rarely, a severe and often fatal form occurs in immunosuppressed patients or infants, characterized by meningoencephalitis (sometimes including brain tumor–like lesions) and myocarditis. The chronic phase consists of an indeterminate, asymptomatic form followed by digestive, cardiac, or neurologic symptoms in about 30% of infected patients. Autonomous nervous system dysfunction is prominent in chagasic patients and participates in the affliction of the target organs. Stroke, mainly cardioembolic, may occur in the chronic phase, but other stroke etiologies are reported. Embolic sources and inflammation are thought to play a role in stroke mechanisms. Specific treatment for Chagas disease is scarce and preventive measures are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chagas C. Nova tripanozomíase humana. Estudos sobre a morfologia e o evolutivo da Schizotrypanum cruzi n. gen., n. sp., agente etiológico de nova entidade mórbida no homem. Mem Inst Oswaldo Cruz. 1909;1:159–218.

    Article  Google Scholar 

  2. World Health Organization - Media Center: Chagas disease (American trypanosomiasis). Available at: http://www.who.int/mediacenter/factsheets/fs340/en/index.html. Accessed May 2011.

  3. WHO Expert Committee. Control of Chagas disease. WHO Tech Rep Ser. 2002;905:1–109.

    Google Scholar 

  4. Prata A. Clinical and epidemiological aspects of Chagas’ disease. Lancet Infect Dis. 2001;2:92–100.

    Article  Google Scholar 

  5. Sanchez Negrete O, Mora MC, Basombrio MA. High prevalence of congenital Trypanosoma cruzi infection and family clustering in Salta, Argentina. Pediatrics. 2005;115:e668–72.

    Article  Google Scholar 

  6. Bern C, Montgomery SP. An estimate of the burden of Chagas disease in the United States. Clin Infect Dis. 2009;49:e52–4.

    Article  PubMed  Google Scholar 

  7. Gascon J, Bern C, Pinazo MJ. Chagas disease in Spain, the United States and other non-endemic countries. Acta Trop. 2010;115:22–7.

    Article  PubMed  Google Scholar 

  8. Assal A, Corbi C. Chagas disease and blood transfusion: an emerging issue in non-endemic countries. Transfus Clin Biol. 2011;18:286–91.

    Article  PubMed  CAS  Google Scholar 

  9. Pittella JEH. Central nervous system involvement in Chagas’ disease. An updating. Rev Inst Med Trop Sao Paulo. 1993;35:111–6.

    Article  PubMed  CAS  Google Scholar 

  10. Moretta G, Pettinicchi JP, Talarico ME, et al. Clinical reasoning: a 35-year-old man with a right hemiplegia and a cerebral mass. Neurology. 2009;73:e35–9.

    Article  PubMed  CAS  Google Scholar 

  11. Marchiori PE, Alexandre PL, Britto N, et al. Late reactivation of Chagas' disease presenting in a recipient as an expansive mass lesion in the brain after heart transplantation of chagasic myocardiopathy. J Heart Lung Transplant. 2007;26:1091–6.

    Article  PubMed  Google Scholar 

  12. Diaz-Granados CA, Saavedra-Trujillo CH, Mantilla M, et al. Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association. Lancet Infect Dis. 2009;9:324–30.

    Article  CAS  Google Scholar 

  13. Cordova E, Maiolo E, Corti M, Orduna T. Neurological manifestations of Chagas’ disease. Neurol Res. 2010;32:238–44.

    Article  PubMed  Google Scholar 

  14. Ministry of Health (Brazil): Brazilian consensus of Chagas’ disease. Rev Soc Bras Med Trop. 2005;38:1–29.

    Google Scholar 

  15. Chimelli L, Scaravilli F. Trypanosomiasis. Brain Pathology. 1997;7:599–611.

    Article  PubMed  CAS  Google Scholar 

  16. Leon-Sarmiento FE, Prada DG, Bayona-Prieto J, et al. Neurotripanosomiasis americana: aspectos clinicos de un problema basico. Biomedica. 2003;23:462–75.

    PubMed  Google Scholar 

  17. Marin-Neto JA, Rassi Jr A, Avezum Jr A, et al. The BENEFIT trial: testing the hypothesis that trypanocidal therapy is beneficial for patients with chronic Chagas heart disease. Mem Inst Oswaldo Cruz. 2009;104 Suppl 1:319–24.

    Article  PubMed  CAS  Google Scholar 

  18. Pedrosa RC, Campos MC. Teste ergométrico e o Holter de 24 horas da detecção de arritmias ventriculares complexas em diferentes estágios da cardiopatia chagásica crônica. Rev Soc Bras Med Trop. 2004;37:376–83.

    Article  PubMed  Google Scholar 

  19. Mahler-Araújo MB, Chimelli L. Autonomic dysfunction in Chagas disease: lack of participation of the vagus nerve. Trans R Soc Trop Med Hyg. 2000;94:405–8.

    Article  PubMed  Google Scholar 

  20. Cunha AB. A doença de Chagas e o envolvimento do sistema nervoso autônomo. Rev Port Cardiol. 2003;22:813–24.

    PubMed  Google Scholar 

  21. • Py M, Pedrosa R, Silveira J, et al. Neurological manifestations in Chagas disease without cardiac dysfunction: correlation between dysfunction of the parasympathetic nervous system and white matter lesions in the brain. J Neuroimaging 2009;19:332–6. The authors demonstrated that chagasic patients, even without cardiac dysfunction, presented signs of a parasympathetic nervous system disorder that correlated significantly with brain subcortical white matter lesions. No cognitive impairment or cerebral hemodynamics alterations were found.

    Article  PubMed  Google Scholar 

  22. Maud A, Qureshi AI. Parasympathetic nervous system dysfunction and neurological consequences of Chagas disease. Mediator or bystander? J Neuroimaging. 2010;20:107–8.

    Article  PubMed  Google Scholar 

  23. Py MO, Maciel L, Pedrosa RC, et al. The presence of antiautonomic membrane receptor antibodies do not correlate with brain lesions in Chagas’ disease. Arq Neuropsiquiatr. 2009;67:633–8.

    Article  PubMed  Google Scholar 

  24. Wackermann PV, Fernandes RMF, Elias Jr J, et al. Involvement of the central nervous system in the chronic form of Chagas’ disease. J Neurol Sci. 2008;269:152–7.

    Article  PubMed  Google Scholar 

  25. Sica RE, Gonzalez-Cappa SM, Sanz OP, et al. Peripheral nervous system involvement in human and experimental chronic American trypanosomiasis. Bull Soc Pathol Exot. 1995;88:156–63.

    PubMed  CAS  Google Scholar 

  26. Alencar A. Encefalopatia crônica chagásica. J Bras Neurol. 1982;18:7–12.

    Google Scholar 

  27. Oliveira-Filho J, Vieira-de-Melo RM, Reis PSO, et al. Chagas disease is independently associated with brain atrophy. J Neurol. 2009;256:1363–5.

    Article  PubMed  Google Scholar 

  28. Mangone CA, Sica RE, Pereyra S, et al. Cognitive impairment in human chronic Chagas’ disease. Arq Neuropsiquiatr. 1994;52:200–3.

    PubMed  CAS  Google Scholar 

  29. • Lima-Costa MF, Castro-Costa E, Uchoa E, et al. A population-based study of the association between Trypanosoma cruzi infection and cognitive impairment in old age (The Bambui Study). Neuroepidemiology 2009;32:122–8. A huge cohort of elderly people (Bambui Cohort Study of Aging) has been followed in an endemic Brazilian area of Chagas disease. In this paper, the authors found a graded and independent association between T. cruzi infection and cognitive disorders. A direct central nervous system involvement, probably mediated by an autoimmune mechanism interfering with cholinergic transmission, is suggested.

    Article  PubMed  Google Scholar 

  30. • Cordova E, Boschi A, Ambrosioni J, et al. Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992–2007. Int J Infect Dis. 2008;12:587–92. In a retrospective study ranging from 1992 to 2007 in Argentina, 15 AIDS patients were diagnosed with reactivated Chagas disease. Main clinical manifestations and laboratory findings are described as well as treatment results.

    Article  PubMed  Google Scholar 

  31. Sartori AM, Ibrahim KY, Nunes-Westphalen EV, et al. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Ann Trop Med Parasitol. 2007;101:31–50.

    Article  PubMed  CAS  Google Scholar 

  32. Nussenzweig I, Wajchember BL, Macruz R, et al. Acidentes vasculares cerebrais embólicos na cardiopatia chagásica crônica. Arq Neuropsiquiatr. 1953;11:386–402.

    Google Scholar 

  33. Queiroz AC. Estudo anatomopatológico do encéfalo na forma crônica da doença de Chagas. Rev Pathol Trop. 1978;7:135–45.

    Google Scholar 

  34. Pittella JEH. Ischemic cerebral changes in the chronic chagasic cardiopathy. Arq Neuropsiquiatr. 1984;42:105–15.

    Google Scholar 

  35. Oliveira JSM, Araújo RRC, Navarro MA, Muccillo G. Cardiac thrombosis and thromboembolism in chronic Chagas’ heart disease. Am J Cardiol. 1983;52:147–51.

    Article  PubMed  Google Scholar 

  36. •• Carod-Artal FJ, Vargas AP, Falcao T. Stroke in asymptomatic Trypanosoma cruzi infected patients. Cerebrovasc Dis. 2011;31:24–8. In this paper, ischemic stroke is reported as the first manifestation of Chagas disease, even without left ventricle dysfunction or cardiac arrhythmias. Stroke etiologies other than embolic were also present, mainly in asymptomatic chagasic patients. Stroke mechanisms in chagasic patients were discussed.

    Article  PubMed  Google Scholar 

  37. Carod-Artal FJ, Vargas AP, Melo M, Horan TA. American trypanosomiasis (Chagas’ disease): an unrecognized cause of stroke. J Neurol Neurosurg Psychiatry. 2003;74:516–8.

    Article  PubMed  CAS  Google Scholar 

  38. Carod-Artal FJ, Vargas AP, Horan TA, Nunes LGN. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. 2005;36:965–70.

    Article  PubMed  Google Scholar 

  39. Oliveira-Filho J, Viana LC, Vieira-de-Melo RM, et al. Chagas disease is an independent risk factor for stroke: baseline characteristics of a Chagas Disease cohort. Stroke. 2005;36:2015–7.

    Article  PubMed  Google Scholar 

  40. Paixao LC, Ribeiro AL, Valacio RA, Teixeira AL. Chagas disease: Independent risk factor for stroke. Stroke. 2009;40:3691–4.

    Article  PubMed  Google Scholar 

  41. Jesus PAP, Neville I, Cincura C, et al. Stroke history and Chagas disease are independent predictors of silent cerebral microembolism in patients with congestive heart failure. Cerebrovasc Dis. 2011;31:19–23.

    Article  PubMed  Google Scholar 

  42. •• Lima-Costa MF, Matos DL, Ribeiro ALP. Chagas disease predicts 10-year stroke mortality in community-dwelling elderly: The Bambui Cohort Study of Aging. Stroke 2010;41:2477–82. In the Bambui Cohort Study of Aging, there was twice the overall mortality rate from stroke among T. cruzi–infected patients than noninfected. An elevated B-type natriuretic peptide level was a strong and independent predictor of stroke mortality among T. cruzi–infected people.

    Article  PubMed  Google Scholar 

  43. Nunes MCP, Barbosa MM, Ribeiro ALP, et al. Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study. J Neurol Sci. 2009;278:96–101.

    Article  PubMed  Google Scholar 

  44. • Sousa AS, Xavier SS, de Freitas GR, Hasslocher-Moreno A. Prevention strategies of cardioembolic ischemic stroke in Chagas’ disease. Arq Bras Cardiol. 2008;91:280–4. In a cohort of 1043 patients, a risk score for cardioembolic stroke was created, to help the decision about the best prophylaxis against stroke for chagasic patients: anticoagulation, aspirin, or no treatment.

    Article  Google Scholar 

  45. Trabuco CC, Jesus PAP, Bacellar AS, Oliveira-Filho J. Successful thrombolysis in cardioembolic stroke from Chagas disease. Neurology. 2005;64:170–1.

    Article  PubMed  Google Scholar 

  46. Marin-Neto JA, Rassi Jr A, Morillo CA, et al. Rationale and design of a randomized placebo-controlled trial assessing the effects of etiologic treatment in Chagas’ cardiomyopathy: the BENznidazole Evaluation For Interrupting Trypanosomiasis (BENEFIT). Am Heart J. 2008;156:37–43.

    Article  PubMed  CAS  Google Scholar 

  47. The United States National Institutes of Health: Clinical Trials. Available at: http://clinicaltrials.gov/ct2/show/NCT01162967?term=benznidazole&rank=3 Accessed May 2011.

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Marechal Mascarenhas de Moraes, 191/408 - Copacabana, Rio de Janeiro, Brazil, 22030-040

    Marco Oliveira Py

Authors
  1. Marco Oliveira Py
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Oliveira Py.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Py, M.O. Neurologic Manifestations of Chagas Disease. Curr Neurol Neurosci Rep 11, 536–542 (2011). https://doi.org/10.1007/s11910-011-0225-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-011-0225-8

Keywords

Search

Navigation