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
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
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
- healthcare occupations
- laboratory work occupations
- travel to endemic areas
- mother with Chagas disease
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 based on parasite lysate
- immunofluorescent antibody test
- indirect hemagglutination antibody test
- 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
Investigations 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
Emerging tests
- radioimmunoprecipitation assay
- immunofluorescent antibody test
- western blot
Treatment algorithm
accidental exposure and infection: nonpregnant without severe renal/hepatic insufficiency
accidental exposure and infection: pregnant or with severe renal/hepatic disease
acute infection
reactivated disease
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
Alberto Novaes Ramos Jr, MD, MPH, PhD

Senior Lecturer
Department of Community Health
School of Medicine
Federal University of Ceará
Fortaleza
Brazil
Disclosures
ANR Jr is an author of a number of references cited in this topic. ANR Jr declares that he has no other competing interests.
Jorg Heukelbach, MD, DTMPH, MScIH, PhD

Professor
Department of Community Health
School of Medicine
Federal University of Ceará
Fortaleza
Brazil
Disclosures
JH declares that he has no competing interests.
Andréa Silvestre de Sousa, MD, MMed, PhD

Adjunct Professor of Cardiology
Department of Internal Medicine
Federal University of Rio de Janeiro
Researcher
Evandro Chagas National Institute of Infectious Diseases
Oswaldo Cruz Foundation
Rio de Janeiro
Brazil
Disclosures
ASS declares that she has no competing interests.
Acknowledgements
Dr Alberto Novaes Ramos Jr, Dr Jorg Heukelbach, and Dr Andrea Silvestre de Sousa would like to gratefully acknowledge Dr Francisco Rogerlândio Martins-Melo, a previous contributor to this topic.
Disclosures
FRMM declares that he has 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.
Differentials
- CNS toxoplasmosis
- Non-Chagas-related cardiomyopathy
- Toxic megacolon
More DifferentialsGuidelines
- Chagas cardiomyopathy: an update of current clinical knowledge and management
- CDC health information for international travel (Yellow Book): American trypanosomiasis (Chagas Disease)
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