Abstract
Chagas disease (American trypanosomiasis) is a potentially fatal zoonosis caused by the parasite Trypanosoma cruzi, transmitted by vectors found mainly in Latin American territory, although it has other less common transmission routes. The acute phase may be asymptomatic, present with nonspecific general symptoms or with complications such as myocarditis or meningoencephalitis; additionally there are chronic forms including cardiomegaly and its complications, gastrointestinal disease and peripheral neuropathy. Thromboembolic events are frequent, with cerebral infarction being the most common. Specific anti-trypanosomal treatment has a greater impact on the acute forms. Chronic forms should be treated according to their complications, except in selected cases. The pathophysiology, clinical manifestations, as well as the diagnosis and treatment, are according to the presentation of the disease.
References
Nguyen T, Waseem M. Chagas disease (American trypanosomiasis). En: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
Machado MP, Rocha AM, de Oliveira LF, de Cuba MB, e Oliveira Loss I, Castellano LR, et al. Autonomic nervous system modulation affects the inflammatory immune response in mice with acute Chagas disease. Exp Physiol. 2012;97(11):1186-202. doi: 10.1113/expphysiol.2012.066431.
Sánchez-Sancho F, Campillo NE, Páez JA. Chagas disease: progress and new perspectives. Curr Med Chem. 2010;17(5):423-52. doi: 10.2174/092986710790226101.
Carvalho AB, Goldenberg RCDS, Campos de Carvalho AC. Cell therapies for Chagas disease. Cytotherapy. 2017;19(11):1339-49. doi: 10.1016/j.jcyt.2017.07.014.
Lancet Neurology. Chagas disease: the forgotten American neuroinfection. Lancet Neurol. 2009;8(6):501. doi: 10.1016/S1474-4422(09)70113-9.
Pittella JE. Central nervous system involvement in Chagas disease: a hundred-year-old history. Trans R Soc Trop Med Hyg. 2009;103(10):973-8. doi: 10.1016/j.trstmh.2009.04.012.
Ministerio de Salud y Protección Social - Federación Médica Colombiana. Guía enfermedad de Chagas. 2012-2013. Disponible en:7. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/TH/Memorias_chagas.pdf
Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;17;375(9723):1388-402. doi: 10.1016/S0140-6736(10)60061-X.
De Bona E, Lidani KCF, Bavia L, Omidian Z, Gremski LH, Sandri TL, de Messias Reason IJ. Autoimmunity in chronic chagas disease: a road of multiple pathways to cardiomy-opathy? Front Immunol. 2018; 6;9:1842. doi: 10.3389/fim-mu.2018.01842.
Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018:6;391(10115):82-94. doi: 10.1016/S0140-6736(17)31612-4.
Román GC. The neurology of parasitic diseases and malaria. Continuum (Minneap Minn). 2011;17(1):113-33. doi: 10.1212/01.CON.0000394678.13115.ad.
Fernandes BFS, Caramelli P. Ischemic stroke and infectious diseases in low-income and middle-income countries. Curr Opin Neurol. 2019;32(1):43-48. doi: 10.1097/WCO.0000000000000641
de Paiva Bezerra R, de Miranda Alves MA, Conforto AB, Rodrigues DLG, Silva GS. Etiological classification of stroke in patients with chagas disease using TOAST, causative classification system TOAST, and ASCOD phenotyping. J Stroke Cerebrovasc Dis. 2017;26(12):2864-9. doi: 10.1016/j.jstroke-cerebrovasdis.2017.07.007.
Benck L, Kransdorf E, Patel J. Diagnosis and management of Chagas cardiomyopathy in the United States. Curr Cardiol Rep. 2018:11;20(12):131. doi: 10.1007/s11886-018-1077-5.
Nunes MC, Kreuser LJ, Ribeiro AL, Sousa GR, Costa HS, Botoni FA, et al. Prevalence and risk factors of embolic cere-brovascular events associated with Chagas heart disease. Glob Heart. 2015;10(3):151-7. doi: 10.1016/j.gheart.2015.07.006.
Berkowitz AL, Raibagkar P, Pritt BS, Mateen FJ. Neurologic manifestations of the neglected tropical diseases. J Neurol Sci. 2015:15;349(1-2):20-32. doi: 10.1016/j.jns.2015.01.001.
Monteiro JMC, San-Martin DL, Silva BCG, Jesus PAP, Oliveira Filho J. Anticoagulation in patients with cardiac manifestations of Chagas disease and cardioembolic ischemic stroke. Arq Neuropsiquiatr. 2018;76(1):22-25. doi: 10.1590/0004-282X20170180.
Mendes FSNS, Mediano MFF, Silva RS, Xavier SS, do Brasil PEAA, Saraiva RM, et al. Discussing the score of cardioembolic ischemic stroke in Chagas disease. Trop Med Infect Dis. 2020:26;5(2):82. doi: 10.3390/tropicalmed5020082.
Montanaro VVA, Hora TF, da Silva CM, de Viana Santos CV, Lima MIR, de Jesus Oliveira EM, de Freitas GR. Cerebral infarct topography of atrial fibrillation and Chagas disease. J Neurol Sci. 2019:15;400:10-14. doi: 10.1016/j.jns.2019.03.002.
Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR. Ischemic stroke classification and risk of embolism in patients with Chagas disease. J Neurol. 2016;263(12):2411-5. doi: 10.1007/s00415-016-8275-0.
Córdova E, Maiolo E, Corti M, Orduna T. Neurological manifestations of Chagas' disease. Neurol Res. 2010;32(3):238-44. doi: 10.1179/016164110X12644252260637.
Morillo CA, Marin-Neto JA, Avezum A, Sosa-Estani S, Rassi A Jr, Rosas F, et al; BENEFIT Investigators. Randomized trial of benznidazole for chronic Chagas' cardiomyopathy. N Engl J Med. 2015;373(14):1295-306. doi: 10.1056/NEJ-Moa1507574.
Abreu-Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR. Ischemic stroke classification and risk of embolism in patients with Chagas disease. J Neurol. 2016;263(12):2411-5. doi: 10.1007/s00415-016-8275-0.
Best JG, Bell R, Haque M, Chandratheva A, Werring DJ. Atrial fibrillation and stroke: a practical guide. Pract Neurol. 2019;19(3):208-24. doi: 10.1136/practneurol-2018-002089.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.