Skip to main content

Advertisement

Log in

Changing epidemiology and approaches to therapy for Chagas disease

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Impressive progress has been made in reducing the incidence of Chagas disease, or American trypanosomiasis, in many countries in which the illness is endemic. This has been achieved through expanded blood screening programs and low-technology vector control. Despite the progress made in reducing the number of new cases, the burden of disability and mortality in the endemic countries is enormous and will continue to be so for many years since a substantial portion of the 16 to 18 million persons already infected will develop chronic symptomatic Chagas disease. Unfortunately, no progress has been made in developing new drugs for Trypanosoma cruzi infection, and nifurtimox and benznidazole, both of which lack efficacy and often cause severe side effects, remain the only options for treatment.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Kirchhoff LV: American trypanosomiasis (Chagas’ disease). In Tropical Infectious Diseases. Principles, Pathogens, & Practice. Edited by Guerrant RL, Walker DH, Weller PF. Philadelphia: Churchill Livingstone; 1999:785–796.

    Google Scholar 

  2. Schmunis GA: Prevention of transfusional Trypanosoma cruzi infection in Latin America. Memorias do Instituto Oswaldo Cruz 1999, 94:93–101.

    PubMed  Google Scholar 

  3. Freilij H, Altcheh J: Congenital Chagas’ disease: diagnostic and clinical aspects. Clin Infect Dis 1995, 21:551–555.

    PubMed  CAS  Google Scholar 

  4. Chagas disease, Chile. Certification of interruption of transmission. Wkly Epidemiol Rec 2000, 49:10–12.

  5. Kirchhoff LV, Neva FA: Chagas’ disease in Latin American immigrants. JAMA 1985, 254:3058–3060.

    Article  PubMed  CAS  Google Scholar 

  6. Tanowitz HB, Kirchhoff LV, Simon D, et al.: Chagas’ disease. Clin Microbiol Rev 1992, 5:400–419.

    PubMed  CAS  Google Scholar 

  7. Schmunis GA: A Tripanossomiase Americana e seu Impacto na Saude Publica das Americas. In Trypanosoma Cruzi e Doença de Chagas, edn 2. Edited by Brener Z, Andrade ZA, Barral-Netto M. Rio de Janeiro: Guanabara Koogan; 2000:1–20.

    Google Scholar 

  8. Schofield CJ, Dias JC: The Southern Cone initiative against Chagas disease. Adv Parasitol 1999, 42:1–27.

    Article  PubMed  CAS  Google Scholar 

  9. Segura EL, Cura EN, Estani SA, et al.: Long-term effects of a nationwide control program on the seropositivity for Trypanosoma cruzi infection in young men from Argentina. Am J Trop Med Hyg 2000, 62:353–362. This article presents clear evidence of the striking reduction in vector-borne transmission of T. cruzi achieved to date in Argentina.

    PubMed  CAS  Google Scholar 

  10. Coura JR, Junqueira AC, Boia MN, et al.: Chagas disease in the Brazilian Amazon: IV. A new cross-sectional study. Rev Instit Med Trop Sao Paulo 2002, 44:159–165.

    Google Scholar 

  11. Guzman-Bracho C: Epidemiology of Chagas disease in Mexico: an update. Trends Parasitol 2001, 17:372–376. This is a comprehensive review of the epidemiology of Chagas disease in Mexico. This information should be of particular interest to US health care providers, since roughly 7 million persons born in Mexico currently live here.

    Article  PubMed  CAS  Google Scholar 

  12. Moya P, Moretti E, Paolasso R, et al.: Neonatal Chagas disease: laboratory diagnosis during the first year of life [Spanish]. Medicina 1989, 49:595–599.

    PubMed  CAS  Google Scholar 

  13. Russomando G, de Tomassone MM, de G I, et al.: Treatment of congenital Chagas’ disease diagnosed and followed up by the polymerase chain reaction. Am J Trop Med Hyg 1998, 59:487–491.

    PubMed  CAS  Google Scholar 

  14. Riarte A, Luna C, Sabatiello R, et al.: Chagas’ disease in patients with kidney transplants: 7 years of experience 1989–1996. Clin Infect Dis 1999, 29:561–567.

    PubMed  CAS  Google Scholar 

  15. Zayas CF, Perlino C, Caliendo A, et al.: Chagas disease after organ transplantation - United States, 2001. Morbid Mortal Wkly Rep 2002, 51:210–212. In this report CDC staff and local health officials describe the transmission of T. cruzi from one immigrant organ donor to three transplant recipients.

    Google Scholar 

  16. Ochs DE, Hnilica V, Moser DR, et al.: Postmortem diagnosis of autochthonous acute chagasic myocarditis by polymerase chain reaction amplification of a species-specific DNA sequence of Trypanosoma cruzi. Am J Trop Med Hyg 1996, 34:526–529.

    Google Scholar 

  17. Bureau of Census: Statistical Abstract of the United States. In The National Data Book, edn 116. Washington, DC: United States Department of Commerce; 1996.

  18. Schmunis GA: Trypanosoma cruzi, the etiologic agent of Chagas’ disease: status in the blood supply in endemic and nonendemic countries. Transfusion 1991, 31:547–557.

    Article  PubMed  CAS  Google Scholar 

  19. Kirchhoff LV, Gam AA, Gilliam FC: American trypanosomiasis (Chagas’ disease) in Central American immigrants. Am J Med 1987, 82:915–920.

    Article  PubMed  CAS  Google Scholar 

  20. Appleman MD, Shulman IA, Saxena S, Kirchhoff LV: Use of a questionnaire to identify potential donors at risk for infection with Trypanosoma cruzi. Transfusion 1993, 33:61–64.

    Article  PubMed  CAS  Google Scholar 

  21. Shulman IA, Appleman MD, Saxena S, et al.: Specific antibodies to Trypanosoma cruzi among blood donors in Los Angeles, California. Transfusion 1997, 37:727–731.

    Article  PubMed  CAS  Google Scholar 

  22. Leiby DA, Read EJ, Lenes BA, et al.: Seroepidemiology of Trypanosoma cruzi, etiologic agent of Chagas’ disease, in U.S. blood donors. J Infect Dis 1997, 176:1047–1052.

    PubMed  CAS  Google Scholar 

  23. Frank M, Hegenscheid B, Janitschke K, Weinke T: Prevalence and epidemiologic significance of Trypanosoma cruzi infection among Latin American immigrants in Berlin, Germany. Infection 1997, 25:1–4.

    Article  Google Scholar 

  24. Nickerson P, Orr P, Schroeder M-L, et al.: Transfusion-associated Trypanosoma cruzi infection in a non-endemic area. Ann Intern Med 1989, 111:851–853.

    PubMed  CAS  Google Scholar 

  25. Grant IH, Gold JWM, Wittner M, et al.: Transfusion-associated acute Chagas disease acquired in the United States. Ann Intern Med 1989, 111:849–851.

    PubMed  CAS  Google Scholar 

  26. Cimo PL, Luper WE, Scouros MA: Transfusion-associated Chagas’ disease in Texas: report of a case. Texas Med 1993, 89:48–50.

    CAS  Google Scholar 

  27. Leiby DA, Lenes BA, Tibbals MA, Tames-Olmedo MT: Prospective evaluation of a patient with Trypanosoma cruzi infection transmitted by transfusion [letter]. N Engl J Med 1999, 341:1237–1239.

    Article  PubMed  CAS  Google Scholar 

  28. Villalba R, Fornes G, Alvarez MA, et al.: Acute Chagas’ disease in a recipient of a bone marrow transplant in Spain: case report. Clin Infect Dis 1992, 14:594–595.

    PubMed  CAS  Google Scholar 

  29. Coura JR, de Castro S: A critical review on Chagas disease chemotherapy. Mem Inst Oswaldo Cruz 2002, 97:3–24. This review outlines in detail the sorry state of drug treatment for T. cruzi infection.

    CAS  Google Scholar 

  30. Marr JJ, Docampo R: Chemotherapy for Chagas’ disease: a perspective on current therapy and considerations for future research. Rev Infect Dis 1986, 8:884–903.

    PubMed  CAS  Google Scholar 

  31. Rassi A, Ferreira HO: Tentativas de tratamento específico da fase aguda da doença de Chagas com nitrofuranos em esquemas de duração prolongada. Rev Soc Bras Med Trop 1971, 5:235–262.

    Google Scholar 

  32. Ferreira HO: Tratamento específico na fase aguda da doença de Chagas. Jornal de Pediatria 1988, 64:1–3.

    Google Scholar 

  33. Jones EM, Colley DG, Tostes S, et al.: Amplification of a Trypanosoma cruzi DNA sequence from inflammatory lesions in human Chagasic cardiomyopathy. Am J Trop Med Hyg 1993, 48:348–357.

    PubMed  CAS  Google Scholar 

  34. Andrade SG, Stocker-Guerret S, Pimentel AS, Grimaud JA: Reversibility of cardiac fibrosis in mice chronically infected with Trypanosoma cruzi, under specific chemotherapy. Mem Inst Oswaldo Cruz 1991, 86:200.

    Google Scholar 

  35. Bellotti G, Bocchi EA, de Moraes AV, et al.: In vivo detection of Trypanosoma cruzi antigens in hearts of patients with chronic Chagas’ heart disease. Am Heart J 1996, 131:301–307.

    Article  PubMed  CAS  Google Scholar 

  36. Andrade ALSS, Zicker F, Oliveira RM, et al.: Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection. Lancet 1996, 348:1407–1413.

    Article  PubMed  Google Scholar 

  37. Fragata Filho AA, Boianain E, Silva MAD, et al.: Validade do tratamento etiológico da fase crônica da doença de Chagas com benznidazol. Arq Bras Cardiol 1995, 65(Suppl 1):71.

    Google Scholar 

  38. Viotti R, Vigliano C, Armenti H, Segura E: Treatment of chronic Chagas’ disease with benznidazole: clinical and serologic evolution of patients with long-term follow-up. Am Heart J 1994, 127:151–162.

    Article  PubMed  CAS  Google Scholar 

  39. In Tratamiento Etiológico de la Enfermedad de Chagas: Conclusiones de una Consulta Técnica. OPS/HCP/HCT/140/99. Geneva: Pan American Health Organization; 1999.

  40. Villar JC, Marin-Neto JA, Ebrahim S, Yusuf S: Trypanocidal drugs for chronic asymptomatic Trypanosoma cruzi infection. Cochrane Database of Systematic Reviews 2002, CD003463.

  41. Silveira CA, Castillo E, Castro C: Evaluation of an specific treatment for Trypanosoma cruzi in children, in the evolution of the indeterminate phase [Portuguese]. Rev Soc Bras Med Trop 2000, 33:191–196.

    Article  PubMed  CAS  Google Scholar 

  42. Lauria-Pires L, Braga MS, Vexenat AC, et al.: Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives. Am J Trop Med Hyg 2000, 63:111–118. This article and the two that follow present the results of long-term follow-up of treated Chagas disease patients that indicate clearly that parasitologic cure is the exception rather than the rule.

    PubMed  CAS  Google Scholar 

  43. Cancado JR: Long term evaluation of etiological treatment of Chagas disease with benznidazole. Rev Instit Med Trop Sao Paulo 2002, 44:29–37.

    Google Scholar 

  44. Braga MS, Lauria-Pires L, Arganaraz ER, et al.: Persistent infections in chronic Chagas’ disease patients treated with anti-Trypanosoma cruzi nitroderivatives. Rev Instit Med Trop Sao Paulo 2000, 42:157–161.

    CAS  Google Scholar 

  45. Barousse AP, Costa JA, Esposto M, et al.: Enfermedad de Chagas e inmunosupresión. Medicina (B Aires) 1980, 40 (Suppl 1):17–26.

    Google Scholar 

  46. Rivero I, Moravenik M, Morales J, et al.: Chagas’ disease - another hazard in acute leukemia. N Engl J Med 1974, 290:285.

    PubMed  CAS  Google Scholar 

  47. Kohl S, Pickering LK, Frankel LS, Yaeger RG: Reactivation of Chagas’ disease during therapy of acute lymphocytic leukemia. Cancer 1982, 50:827–828.

    Article  PubMed  CAS  Google Scholar 

  48. Salgado PR, Gorski AG, Aleixo AR, de Barros EOM: Tumor-like lesion due to Chagas’ disease in a patient with lymphocytic leukemia. Rev Inst Med Trop Sao Paulo 1996, 38:285–288.

    PubMed  CAS  Google Scholar 

  49. Leiguarda R, Roncoroni A, Taratuto AL, et al.: Acute CNS infection by Trypanosoma cruzi (Chagas’ disease) in immunosuppressed patients. Neurology 1990, 40:850–851.

    PubMed  CAS  Google Scholar 

  50. Pizzi TP, De Criozret VA, Smok G, Diaz M: Enfermedad de Chagas en un paciente con transplante renal y tratamiento inmunosupresor. Rev Med Chile 1982, 110:1207–1211.

    PubMed  CAS  Google Scholar 

  51. Mocelin AJ, Brandina L, Gordon PA, et al.: Immunosuppression and circulating Trypanosoma cruzi in a kidney transplant recipient. Transplantation 1977, 23:163.

    Article  PubMed  CAS  Google Scholar 

  52. Kirchhoff LV: American trypanosomiasis (Chagas’ disease) - A tropical disease now in the United States. N Engl J Med 1993, 329:639–644.

    Article  PubMed  CAS  Google Scholar 

  53. Bocchi EA, Fiorelli A: The paradox of survival results after heart transplantation for cardiomyopathy caused by Trypanosoma cruzi. First Guidelines Group for Heart Transplantation of the Brazilian Society of Cardiology. Ann Thorac Surg 2001, 71:1833–1838.

    Article  PubMed  CAS  Google Scholar 

  54. Rocha A, Oliveira de Meneses AC, da Silva AM, et al.: Pathology of patients with Chagas’ disease and acquired immunodeficiency syndrome. Am J Trop Med Hyg 1994, 50:261–268.

    PubMed  CAS  Google Scholar 

  55. Sartori AM, Shikanai-Yasuda MA, mato Neto V, Lopes MH: Follow-up of 18 patients with human immunodeficiency virus infection and chronic Chagas’ disease, with reactivation of Chagas’ disease causing cardiac disease in three patients. Clin Infect Dis 1998, 26:177–179.

    PubMed  CAS  Google Scholar 

  56. Reed SG: In vivo administration of recombinant IFN-gamma induces macrophage activation, and prevents acute disease, immune suppression, and death in experimental Trypanosoma cruzi infections. J Immunol 1988, 140:4342–4347.

    PubMed  CAS  Google Scholar 

  57. Urbina JA, Payares G, Contreras LM, et al.: Antiproliferative effects and mechanism of action of SCH 56592 against Trypanosoma (Schizotrypanum) cruzi: in vitro and in vivo studies. Antimicrob Agents Chemother 1998, 42:1771–1777. This report presents the results obtained by treating T. cruzi-infected mice with posaconazole, which is currently the best hope for improved therapy for Chagas disease.

    PubMed  CAS  Google Scholar 

  58. Chuster M: Implante de marcapasso nas bradiarritmias chagásicas. In Cardiopatia Chagásica. Edited by Cançado JR, Chuster M. Belo Horizonte, Brazil: Fundação Carlos Chagas; 1985:289–297.

    Google Scholar 

  59. Hagar JM, Rahimtoola SH: Chagas’ heart disease in the United States. N Engl J Med 1991, 325:763–768.

    Article  PubMed  CAS  Google Scholar 

  60. Hagar JM, Rahimtoola SH: Chagas’ heart disease. Curr Probl Cardiol 1995, 20:827–924.

    Google Scholar 

  61. Salis GB, Chiocca JC, Perisse E, et al.: Acalasia del esófago: Veinte años de experiencia en el tratamiento no quirúrgico. Acta Gastroent Latinoam 1991, 21:249–254.

    Google Scholar 

  62. Pinotti HW, Felix VN, Zilberstein B, Cecconello I: Surgical complications of Chagas’ disease: megaesophagus, achalasia of the pylorus, and cholelithiasis. World J Surg 1991, 15:198–204.

    Article  PubMed  CAS  Google Scholar 

  63. Pinotti HW, Habr-Gama A, Cecconello I, et al.: The surgical treatment of megaesophagus and megacolon. Dig Dis 1993, 11:206–215.

    Article  PubMed  CAS  Google Scholar 

  64. Kobayasi S, Mendes EF, Rodrigues MAM, Franco MF: Toxic dilatation of the colon in Chagas’ disease. Br J Surg 1992, 79:1202–1203.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirchhoff, L.V. Changing epidemiology and approaches to therapy for Chagas disease. Curr Infect Dis Rep 5, 59–65 (2003). https://doi.org/10.1007/s11908-003-0066-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-003-0066-y

Keywords

Navigation