Last reviewed: December 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • irritability
  • prolonged fever
  • palpitations
  • syncope or presyncope
  • hepatosplenomegaly
  • enlarged lymph nodes
  • tachycardia
  • hypotension
  • cardiomegaly
  • dysphagia
  • regurgitation/aspiration
  • odynophagia
  • substernal discomfort
  • prolonged constipation
  • acute abdominal pain
  • abdominal distention
  • swelling around the site of inoculation
  • jaundice
  • abdominal rebound tenderness
  • clinical evidence of meningeal irritation
  • clinical signs of a cerebral mass lesion

Other diagnostic factors

  • anorexia or fatigue
  • vomiting or diarrhea
  • headache
  • myalgia
  • reduced exercise tolerance
  • dizziness
  • thromboembolic phenomena (e.g., stroke, PE)
  • dyspnea
  • cough
  • generalized edema
  • pericarditis
  • epigastric pain and/or hematemesis
  • melena or hematochezia
  • rash
  • seizures or tremors

Risk factors

  • exposure to Triatoma species
  • low socioeconomic status
  • consumption of contaminated food or drink
  • blood transfusion
  • organ transplantation
  • history of immunosuppression
  • climate change
  • deforestation
  • healthcare occupations
  • laboratory work occupations
  • travel to endemic areas
  • mother with Chagas disease
  • living in areas of risk in the US

Diagnostic investigations

1st investigations to order

  • CBC
  • LFTs
  • serum electrolytes, BUN, and creatinine
  • microscopy: fresh blood
  • microscopy: concentration methods applied to fresh blood
  • microscopy: thick blood smear
  • enzyme-linked immunosorbent assay (ELISA) based on parasite lysate
  • immunofluorescent antibody test
  • indirect hemagglutination antibody test
  • urinalysis
  • serum or urine beta-hCG
  • ECG with a 30-second lead II rhythm strip
  • chest x-ray
  • barium swallow
  • barium enema
Full details

Investigations to consider

  • culture (blood and CSF)
  • xenodiagnosis
  • CSF analysis
  • coagulation profile
  • ambulatory 24-hour ECG
  • exercise testing
  • echocardiography
  • esophageal manometry
  • upper GI endoscopy
  • cranial CT/MRI
Full details

Emerging tests

  • PCR
  • radioimmunoprecipitation assay (RIPA)
  • immunofluorescent antibody test (IgM)
  • western blot
Full details

Treatment algorithm


Authors VIEW ALL

Alberto Novaes Ramos Jr

Senior Lecturer

Department of Community Health

School of Medicine

Federal University of Ceará




ANR Jr is an author of a number of references cited in this monograph. ANR Jr declares that he has no other competing interests.

Jorg Heukelbach


Department of Community Health

School of Medicine

Federal University of Ceará




JH declares that he has no competing interests.

Dr Alberto Novaes Ramos Jr and Dr Jorg Heukelbach would like to gratefully acknowledge Dr Francisco Rogerlândio Martins-Melo, a previous contributor to this monograph. FRMM declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine




CH declares that he has no competing interests.


London School of Hygiene and Tropical Medicine




RR declares that he has no competing interests.

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