Chapter 8 : Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States

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In the United States it is important to keep in mind that imported cases among tourists returning from countries where acute Chagas' disease is endemic have not been reported and that autochthonous infections are extremely rare. Even though -infected triatomine insects are present in many parts of the western and southern United States, only four autochthonous cases of acute Chagas' disease have been reported. Importantly, none of the imported cases occurred in tourists returning to the United States, but two such instances have been reported in Europe. Although the number of imported and autochthonous cases of acute Chagas’ disease that go unrecognized may be several times the number described, the fact is that acute infection is rare in the United States, and there is no reason to expect that this situation will change. The courses of acute Chagas’ disease in the transfusion recipients were particularly severe because of immunosuppressive treatments that they were receiving, and no doubt this contributed to the specific diagnosis. Finally, an antifungal agent, bis-triazole (00807), was recently reported to cure acute infections in mice, but it is still in the early stages of development. Management of the occasional severely ill patient with chagasic meningoencephalitis or myocarditis is for the most part supportive. Cardiac transplantation is an option for patients with end-stage chagasic heart disease.

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 1

Life cycle of

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 2

Eggs, second instar nymph, and adult of a triatomine vector of

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 3

trypomastigote in human blood. Giemsa stain was used. Magnification, X625. Courtesy of Maria A. Shikanai Yasuda, Sao Paulo, Brazil.

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 4

Romaña's sign (unilateral painless periorbital edema) in a Brazilian patient with acute Chagas' disease. Courtesy of Mário Shiroma, Sāo Paulo, Brazil.

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 5

in the heart muscle of a child who died of acute Chagas' disease. The infected cardiomyocyte shown contains several dozen amastigotes. Arrows point to the kinetoplast (k) and nucleus (N) of one amastigote. The kinetoplast is characteristic of the order Kinetoplastida, to which belongs.

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 6

Barium esophagram in a Brazilian patient with dolicomegaesophagus caused by chronic Chagas′ disease. Contrast material is pooled in the distal esophagus, which is markedly enlarged. Courtesy of Franklin A. Neva. Reprinted from reference 89a with permission from The McGraw-Hill Companies.

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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Figure 7

Air contrast barium enema examination of a patient with megacolon associated with chronic infection. Increased diameters of the ascending, transverse, and sigmoid segments of the colon are marked with opposing arrows.

Citation: Kirchhoff L. 1999. Chagas'Disease (American Trypanosomiasis): a Tropical Disease Now Emerging in the United States, p 111-134. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch8
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