eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Trypanosomiasis: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Antonio Muñiz, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Texas Medical School at Houston; Medical Director of the Pediatric Emergency Department, Children's Memorial Hermann Hospital
Contributor Information and Disclosures

Updated: Jan 27, 2009

Follow-up

Further Inpatient Care

  • The clinical condition of the patient with trypanosomiasis dictates further inpatient care.

Further Outpatient Care

  • Observe infants born to seropositive mothers for at least 1 year.

Transfer

  • Transfer to another facility is appropriate when required specialists and services are unavailable locally.

Deterrence/Prevention

  • Educate people in areas with endemic disease about how trypanosomiasis is spread and methods of prevention.
  • Inspect homes for presence of vectors and for measures that prevent vectors from entrance.
    • If reduviid or triatomine insects are found, a thorough disinfection with synthetic pyrethroid insecticides can help keep the home vector free for about 2 years.
    • Screens on windows and doors exclude the vectors. Improving the home by covering crevices and cracks significantly reduces triatomid insect infestation.
  • Screen blood donors in areas of endemic disease with serologic tests.
  • Blood recipients in areas of endemic disease can be protected by treating donated blood with gentian violet.
    • Gentian violet (250 mg/L blood, dilution of 1:4000 for 24 h at 4°C), an amphophilic cationic agent that acts photodynamically, has been used to kill the parasite in blood. Photoradiation of blood that contains gentian violet and ascorbate generates ascorbyl radicals and superoxide anions, which are potent trypanocides.
    • Other agents that can be added to the blood to treat the infection include mepacrine, an antimalarial agent, and maprotiline, an antidepressant.
  • Regular insecticide spraying with benzene hexachloride could decrease transmission of the infection.

Complications

  • Congestive heart failure
  • Myocarditis
  • Cardiomyopathy
  • Dysrhythmias
  • Sudden death
  • Meningoencephalitis
  • Megaesophagus: Esophagitis and esophageal cancer are the most common complications of megaesophagus.
  • Megacolon: Fecaloma and volvulus of redundant sigmoid complicate megacolon. Fecaloma-associated stercoral ulceration, overflow incontinence, and ischemic colitis have been described.
  • Embolic events (eg, cardioembolic stroke, small bowel infarction, splenic infarcts, kidney infarcts): Stroke has been found to be more frequent in patients with chagasic cardiomyopathy (15%) compared with other cardiomyopathies (6.3%).

Prognosis

  • The prognosis depends on the clinical stage and the complications that develop.
  • The acute phase is most serious in children younger than 2 years, and the disease is almost always fatal if heart failure or meningoencephalitis develops.
  • In chronic disease with pronounced cardiac manifestations, the prognosis is poor, and death usually occurs within 5 years as a result of heart failure or pulmonary embolism.
  • Right bundle branch block is an ominous sign in the acute phase.
  • The prognosis with the digestive form of the illness is generally good.

Patient Education

  • The use of proper preventive measures when one travels to endemic areas should be emphasized.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis in the appropriate clinical context
 


More on Trypanosomiasis

Overview: Trypanosomiasis
Differential Diagnoses & Workup: Trypanosomiasis
Treatment & Medication: Trypanosomiasis
Follow-up: Trypanosomiasis
References
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Further Reading

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Keywords

trypanosomiasis, American trypanosomiasis, Chagas disease, Chagas' disease, chagasic heart disease, chagasic megaesophagus, chagoma, chronic Chagas disease, chronic chagasic cardiopathy, contraction band necrosis, dyspepsia, focal myonecrosis, interstitial fibrosis, Kinetoplastida, lymphocytic infiltration, megacolon, megaduodenum, megaesophagus, parasitemia, parasitic disease, Romaña sign, Romaña's sign, Schizotrypanum, triatomid, Trypanosoma cruzi, T cruzi, Trypanosomatina

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Antonio Muñiz, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Texas Medical School at Houston; Medical Director of the Pediatric Emergency Department, Children's Memorial Hermann Hospital
Antonio Muñiz, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Medical Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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