What is Chagas disease (American trypanosomiasis)?

From the Guidelines

Chagas disease is a parasitic infection caused by the protozoan Trypanosoma cruzi, primarily transmitted through the feces of blood-sucking triatomine bugs, also known as "kissing bugs," and it has a significant impact on morbidity, mortality, and quality of life, particularly in Latin America. This disease occurs mainly in Latin America but has spread to other regions through migration. Chagas disease has three phases: an acute phase lasting about two months with mild symptoms like fever, fatigue, body aches, and sometimes a characteristic swelling at the infection site called a chagoma; an indeterminate phase where there are no symptoms, but there are lifelong, low-grade parasitemias in association with antibodies; and a chronic phase where parasites hide in heart and digestive tissues, leading to serious cardiac or digestive complications, including heart failure, cardiac arrhythmias, or enlargement of the esophagus or colon 1. Most infected people remain asymptomatic for decades, but about 10% to 30% eventually develop serious cardiac or digestive complications.

Key Points

• The disease is transmitted through the feces of infected triatomine bugs, and improved housing conditions, insect control measures, and blood screening in endemic areas are crucial for prevention 1.
• Treatment is most effective during the acute phase, using antiparasitic medications like benznidazole (5-7 mg/kg/day for 60 days) or nifurtimox (8-10 mg/kg/day for 90 days), but the usefulness of trypanocidal treatment in adults with Chagas disease is questionable, with limited benefit of treatment with benznidazole in chronic disease 1.
• Early diagnosis through blood tests is crucial, as untreated Chagas disease can be life-threatening due to its cardiac complications, and the overall prognosis for patients with Chagas cardiomyopathy and heart failure is poor, with 50% of patients dying within a period of 4 years 1.
• The leading hypothesis with respect to the pathogenesis of Chagas cardiomyopathy is that patients develop progressive myocardial damage caused by parasite persistence and autoimmune responses, and the presence of complete heart block, atrial fibrillation, left bundle-branch block, and complex ventricular ectopy suggests poor prognosis 1.

Treatment and Prevention

• Treatment with benznidazole or nifurtimox should be considered on a case-by-case basis, taking into account the phase of the disease, the presence of symptoms, and the risk of adverse events.
• Prevention involves improved housing conditions, insect control measures, and blood screening in endemic areas, and early diagnosis through blood tests is crucial to reduce the risk of transmission and provide appropriate treatment for positive cases 1.

From the FDA Drug Label

Benznidazole Tablets are indicated in pediatric patients 2 to 12 years of age for the treatment of Chagas disease (American trypanosomiasis) caused by Trypanosoma cruzi. LAMPIT is a nitrofuran antiprotozoal, indicated in pediatric patients (birth to less than 18 years of age and weighing at least 2.5 kg) for the treatment of Chagas disease (American Trypanosomiasis), caused by Trypanosoma cruzi.

Chagas disease is also known as American trypanosomiasis, and it is caused by the parasite Trypanosoma cruzi.

• The disease is treated with medications such as benznidazole and nifurtimox 2, 2, 3.
• Key points about Chagas disease include:
  • It is a parasitic infection
  • It is caused by Trypanosoma cruzi
  • It is also known as American trypanosomiasis

From the Research

Definition and Treatment of Chagas Disease

• Chagas disease is a potentially life-threatening neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi 4.
• The disease can persist and progress to a chronic, often debilitating, clinical form if left untreated 4.
• Current treatment options for Chagas disease include the nitroheterocyclic drugs nifurtimox and benznidazole, which have limitations such as long treatment courses and toxicity 5, 6.

Symptoms and Diagnosis

• People with Chagas disease may develop progressive and lethal heart conditions, and the disease can be diagnosed through blood tests and other methods 7.
• Symptoms of Chagas disease can include clinical, parasitological, and serological abnormalities, and treatment response can be evaluated through these methods 8.

Treatment Efficacy and Safety

• Nifurtimox has been shown to be highly effective for ChD treatment, with excellent treatment responses and fully resolved symptoms related to acute T. cruzi infection 8.
• Benznidazole has also been shown to be effective, but with a higher risk of adverse events, including cutaneous rash, gastrointestinal symptoms, and peripheral polyneuropathy 7.
• A new formulation of nifurtimox has been developed, which allows for more accurate body-weight-based and age-appropriate dosing and administration, and has been shown to be safe and effective in children with Chagas disease 4.

Combination Therapy

• Combination therapy with benznidazole and itraconazole has been shown to enhance anti-Trypanosoma cruzi activity in experimental Chagas disease, and may be a potential treatment option 5.
• However, more research is needed to fully understand the efficacy and safety of combination therapy for Chagas disease.