Chagas Disease

Chagas disease is caused by infection with the protozoan parasite Trypanosoma cruzi. It is endemic in many areas of Latin America, where it remains an important cause of morbidity and mortality. It is an important cause of heart disease and gastrointestinal (GI) dysfunction such as megacolon and megaesophagus. There has been increased immigration from endemic areas to North America and Europe, where Chagas disease is recognized with increased frequency as an imported infection. Chagas disease is also an opportunistic infection in immunocompromised individuals, including those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). The diagnosis of acute infection is based on finding trypomastigotes in the blood, and chronic Chagas disease is suggested by serologic testing. The antiparasitic drugs benznidazole and nifurtimox are used to treat acute infection, but antiparasitic treatment in the chronic phase is not uniformly recommended. The management of chronic chagasic cardiomyopathy is similar to that of cardiomyopathies from other causes. The management of the GI complications generally involves both medical and surgical interventions.