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What Is Chagas Disease and Why Don't More People Know About It?

Chagas disease is a life-threatening parasitic infection caused by the protozoan . It is endemic through much of the Americas, from the southern °®¶¹´«Ã½ States to Argentina and Chile. , a Brazilian bacteriologist, is credited with the modern discovery of Chagas disease in 1908. Today, there are an estimated , and more than 10,000 deaths per year can be attributed to this significant public health problem.

The geographic distribution of Chagas disease has changed substantially in recent decades. It was originally found primarily in rural areas of Latin America. However, due to global migrations, many people with the disease now live in large urban areas across the globe. It is estimated there are at least , many of whom are unaware they are infected. Both the , with the potential for local transmission. In Texas, for example, where Chagas disease is reportable, . Despite this, most people, including healthcare providers, are unaware that this disease even exists in the U.S.

There are significant barriers to an appropriate public health response to Chagas disease in the °®¶¹´«Ã½ States. Some of these factors include: 1) limited awareness by healthcare providers and the general public, 2) systemic problems with access to adequate healthcare in lower income populations, 3) diagnostic complications and 4) a lack of epidemiologic data and surveillance. However, simple seems to be the biggest barrier. was created to bring to light this neglected disease and spread awareness. Begun in 2017, it was adopted as an annual awareness day on April 14 by the World Health Organization as of 2020.

How Is Chagas Disease Transmitted?

Chagas disease is transmitted through various routes, but , also known as kissing bugs. The is found in the hindguts of a in North, Central and South America. These insects feed at night on the blood of animals, as well as humans, and have a relatively painless bite. If an infected , it can transmit the parasite through its feces. When the person or animal who has been bitten (usually still sleeping) scratches the bite or rubs the area, they may unintentionally introduce triatomine feces contaminated with T. cruzi into their bloodstream. The disease can also be transmitted several other ways, such as , from , blood transfusions and organ transplantations, laboratory accidents and sharing of syringes.

What Are the Symptoms of Chagas Disease?

Chagas disease is tricky to manage medically because it is mostly asymptomatic or mild until it is too late for treatment. The acute phase, which begins several days after infection, is usually asymptomatic or with mild flu-like symptoms and lasts about 8-10 weeks. After the acute phase, the person enters into the chronic phase of the disease. There are 2 possible chronic disease phases, the indeterminant (or asymptomatic) phase and the determinant (or symptomatic) phase. About 70-80% of people will remain asymptomatic for life and never develop Chagas-related symptoms. However, that are often fatal. The most common symptoms in this late symptomatic stage are .

Most people with Chagas disease are unaware they are infected, yet once noticeable chronic symptoms develop, it is most likely too late for treatment. The challenge is to identify people with the infection as early as possible so they may receive proper care. There has been some success with . However, because of the immunosuppression required for a transplant, reactivation of the T. cruzi parasites will most likely occur and should be monitored closely.

How Is Chagas Disease Diagnosed and Treated?

In the acute phase, Chagas disease can be diagnosed through . However, most people are tested during the chronic phase, which requires positive serology on at least 2 different tests to be confirmed as a positive diagnosis (a single test is not sensitive or specific enough to confirm a diagnosis). The most common tests include enzyme-linked immunosorbent assays (ELISA) and immunofluorescent antibody tests (IFA). There are to determine the best process for diagnosing their patients. The should always be consulted to confirm a positive diagnosis.

and are currently . Initially, they could only be obtained through the CDC, but and fully available in the U.S. either online or through a pharmacy. Both drugs are currently only approved for use in children, however should be based on a clinical diagnosis by a prescribing healthcare provider. Once a patient has received a confirmed diagnosis from the CDC, they should be .

Who Should Be Screened for Chagas Disease and How Can We Do a Better Job Saving Lives?

Proactive, provider-initiated testing and screening can make a significant difference in getting people treated for Chagas disease before it is too late. Currently, systematic screening for Chagas disease only happens for blood donations, and usually only for first-time blood donors. Screening via primary healthcare is likely the best way to address the current underdiagnosis of the disease in the U.S., since screening of blood donations likely underrepresents the socioeconomically vulnerable segment of the population with Chagas disease. Also, widespread screening of at-risk pregnant women could be implemented as part of obstetric care. There are to learn more about Chagas disease to better serve their patient population.

Not everyone is at . Currently, the Pan American Health Organization (PAHO) recommends screening , such as South America, Central America and Mexico. Also, anyone who was born to a mother who lived in highly endemic regions may be at risk from congenital transmission and may want to be tested. Those who do not fit into this category, but who have lived in the Southern °®¶¹´«Ã½ States and have spent a lot of time outdoors camping or hunting, or have lived in poorly constructed housing, may also consider testing. This is especially true if the person is able to readily identify kissing bugs as an insect they have seen before in or around their sleeping areas.

There is a , however, meeting the need will require more awareness by healthcare providers.