eMedicine Specialties > Infectious Diseases > Parasitic Infections

Chagas Disease (American Trypanosomiasis): Follow-up

Author: Louis V Kirchhoff, MD, MPH, Professor, Departments of Internal Medicine (Infectious Diseases) and Epidemiology, Carver College of Medicine and College of Public Health, University of Iowa; Staff Physician, Medical Service, Iowa City Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Dec 17, 2009

Follow-up

Further Inpatient Care

  • The level of care depends on the clinical condition of the patient.

Further Outpatient Care

  • Monitor infants of mothers with T cruzi infection. Infants who are parasite-negative at birth should be tested serologically at ages 6 and 9 months, after maternal antibodies have disappeared. Treatment should be instituted when results are positive.
  • Persons with T cruzi infection should undergo electrocardiography every 6-12 months to look for dysrhythmias (see Other Tests).
  • Patients with clinically manifest cardiac or gastrointestinal Chagas disease should be managed by appropriate specialists (see Consultations).
  • Weekly WBC counts should be performed in patients being treated with benznidazole to evaluate for agranulocytosis.
  • Immunosuppressed persons with T cruzi infection who have unexplained febrile illnesses should be evaluated parasitologically for reactivation of the infection.

Deterrence/Prevention

  • Collective prophylaxis
    • No vaccination is available for T cruzi infection, and primary chemoprophylaxis in uninfected persons who plan to visit endemic regions is not recommended because of the extremely low risk of the infection, as evidenced by extreme rarity of infection in such circumstances (only 3 such cases have been reported51 ).
    • The proven effective approaches for eliminating vector-borne transmission of T cruzi to humans is through improvement of housing conditions, use of residual insecticides, and education of persons at risk for acquiring the infection.8
    • Transmission of T cruzi via transfusion of contaminated blood can be eliminated with serologic identification and permanent deferral of infected donors.
    • Although some risk factors for congenital transmission of T cruzi have been identified,88 no approaches for reducing this risk have been defined. The critical element in controlling congenital Chagas disease is the thorough parasitologic and serologic evaluation of babies born to mothers with T cruzi infection.
  • Personal prophylaxis
    • Secondary chemoprophylaxis to reduce the risk of reactivation of T cruzi infection in persons with concomitant HIV infection cannot be recommended.
    • Laboratory personnel who work with T cruzi or infected vectors should take protective measures appropriate for this risk group 2 organism.
    • Persons who travel to endemic areas should avoid sleeping in primitive buildings and should take general measures to protect themselves from insects.

Complications

  • Acute phase - Myocarditis, meningoencephalitis
  • Chronic chagasic cardiomyopathy - Congestive heart failure, apical aneurysm, thromboembolism, sudden death
  • Chronic chagasic megaesophagus - Esophagitis, esophageal cancer
  • Chronic chagasic megacolon - Fecaloma, volvulus of sigmoid colon

Prognosis

The overall prognosis among persons in the indeterminate phase of T cruzi infection is excellent, given that only 10-30% of infected persons ever develop signs and symptoms attributable to the disease, and those who do are generally asymptomatic for decades prior to developing cardiac or gastrointestinal problems.

Patient Education

Education of at-risk persons living in areas of active transmission is a key element in reducing the incidence of new infections. Data indicate that having dogs sleep outside the home can be an important factor in reducing transmission.10

Miscellaneous

Medicolegal Pitfalls

  • Patients in the indeterminate phase of infection should not be excluded from any work activities.
 


More on Chagas Disease (American Trypanosomiasis)

Overview: Chagas Disease (American Trypanosomiasis)
Differential Diagnoses & Workup: Chagas Disease (American Trypanosomiasis)
Treatment & Medication: Chagas Disease (American Trypanosomiasis)
Follow-up: Chagas Disease (American Trypanosomiasis)
Multimedia: Chagas Disease (American Trypanosomiasis)
References
Further Reading
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References

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Keywords

Chagas disease, American trypanosomiasis, Trypanosoma cruzi, T cruzi, Trypanosoma infection , T cruzi infection , Chagas cardiomyopathy, parasitic protozoan, triatomine, kissing bugs, Trypanosomatidae, Stercoraria, trypanosome, trypomastigote, epimastigote, amastigote, Triatominae, Triatoma, triatomine, autochthonous acute Chagas disease, Triatoma infestans, T infestans, Rhodnius prolixus, R prolixus, Triatoma dimidiata, T dimidiata, acute Chagas disease, Romaña sign, congenital Chagas disease, chronic Chagas heart disease, chronic Chagas gastrointestinal disease

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Contributor Information and Disclosures

Author

Louis V Kirchhoff, MD, MPH, Professor, Departments of Internal Medicine (Infectious Diseases) and Epidemiology, Carver College of Medicine and College of Public Health, University of Iowa; Staff Physician, Medical Service, Iowa City Veterans Affairs Medical Center
Louis V Kirchhoff, MD, MPH is a member of the following medical societies: American Association of Blood Banks and American Society of Tropical Medicine and Hygiene
Disclosure: Abbott Laboratories, Inc. Consulting fee Consulting; Quest Diagnostics Inc. Consulting fee Consulting; Goldfinch Diagnostics Inc. Salary Equity owner; Quest Diagnostics Inc. Royalty Licensed technology

Medical Editor

Mary Nettleman, MD, MS, Chair, Department of Medicine, Michigan State University
Mary Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

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Disclosure: eMedicine Salary Employment

Managing Editor

John W King, MD, Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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