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Chagas disease

Last reviewed: 12 Nov 2024
Last updated: 28 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • 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
Full details

Other diagnostic factors

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

Risk factors

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

Diagnostic tests

1st tests 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 based on parasite lysate
  • immunofluorescent antibody test
  • indirect hemagglutination antibody test
  • chemiluminescence
  • radio-immunoprecipitation assay
  • western blot
  • polymerase chain reaction (PCR)
  • urinalysis
  • serum or urine beta-hCG
  • ECG with a 30-second lead II rhythm strip
  • chest x-ray
  • barium swallow
  • barium enema
Full details

Tests to consider

  • culture (blood and cerebrospinal fluid)
  • xenodiagnosis
  • cerebrospinal fluid analysis
  • coagulation profile
  • ambulatory 24-hour ECG
  • exercise testing
  • echocardiography
  • esophageal manometry
  • upper gastrointestinal endoscopy
  • cranial CT/MRI
  • cardiac MRI
  • nuclear medicine testing
  • cardiac catheterization and coronary angiography
Full details

Emerging tests

  • immunochromatography
  • commercial polymerase chain reaction (PCR) kits

Treatment algorithm

INITIAL

accidental exposure and infection: nonpregnant without severe renal/hepatic insufficiency

accidental exposure and infection: pregnant or with severe renal/hepatic disease

ACUTE

acute infection

reactivated disease

ONGOING

chronic infection: indeterminate disease or mild to moderate symptoms: children

chronic infection: indeterminate disease or mild to moderate symptoms: adults

chronic infection: advanced disease: children and adults

end-stage organ failure

Contributors

Authors

Alejandro Marcel Hasslocher-Moreno, MD, MBA, MSc, PhD

Infectious Diseases Physician

Evandro Chagas National Institute of Infectious Diseases

Oswaldo Cruz Foundation (Fiocruz)

Rio de Janeiro

Brazil

Disclosures

AMHM was reimbursed by Faculdade Unyleya in Rio de Janeiro, Brazil, for coordinating a course on Tropical Medicine. He is also the author of several articles cited in this topic.

Acknowledgements

Dr Alejandro Marcel Hasslocher-Moreno would like to gratefully acknowledge Dr Alberto Novaes Ramos Jr, Dr Jorg Heukelbach, Dr Andrea Silvestre de Sousa, and Dr Francisco Rogerlândio Martins-Melo, all previous contributors to this topic.

Disclosures

ANR Jr is an author of a number of references cited in this topic. JH, ASS, and FRMM declare that they have no competing interests.

Peer reviewers

Christopher Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

VT

Disclosures

CH declares that he has no competing interests.

Richard Reithinger, MD, PhD

Professor

London School of Hygiene and Tropical Medicine

London

UK

Disclosures

RR declares that he has no competing interests.

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