Chagas disease
Key points
Most common in Central and South America, Trinidad, and the southern United States
Parasite - trypanosoma cruzi
Transmitted through contact with contaminated faeces/urine of the reduviid bug, also known as the kissing bug or triatomine bug
The amastigote stage of the parasites is found inside pseudocysts located in muscle or nerve cells - myocardium or myenteric plexus - can destroy myenteric plexus
Can have vertical transmission
Phases
Acute phase: lasts 2 months following infection
Fever and lymphadenopathy
Conjunctivitis in single eye - Chagoma/Romana's sign
Hepatosplenomegaly
Cardiac and CNS involvement
Can be fatal
Indeterminate phase: Asymptomatic
Chronic phase: Can last years
Cardiac dysfunction
Achalasia
Constipation secondary to megacolon
Investigations
Blood MC+S
PCR
Contrast swallow + manometry for achalasia
Contrast enema for megacolon
Management
Nifurtimox and benznidazole, with more than 80% success during acute phase
Surgery for achalasia
Chagasic megacolon - Duhamel-Haddad operation; however, this procedure is usually used to treat idiopathic congenital megacolon (Basically Duhamel procedure)
References
Nguyen T, Waseem M. Chagas Disease. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459272/