Chagas Disease (American Trypanosomiasis) Medication

  • Author: Louis V Kirchhoff, MD, MPH; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jun 3, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

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Antiprotozoal agents

Class Summary

These agents are used to treat infections caused by the protozoan T cruzi.

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Nifurtimox (Lampit, Bayer 2502)

 

Available only from the CDC. Well absorbed by digestive tract. Trypanocidal drug that acts on circulating trypomastigotes, as well as intracellular amastigotes. The mechanism of action may depend on the formation of nitro anion radicals, but precise details are not known. Efficacy can be assessed by monitoring disappearance of T cruzi –specific antibodies, although this may take several years in some patients. Repeated hemoculture or PCR-based assay can be used to look for treatment failure.

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Benznidazole (Rochagan, Radanil, Ragonil)

 

Available only from CDC. Well absorbed by digestive tract. Trypanocidal drug that acts on circulating trypomastigotes, as well as intracellular amastigotes. Little is known regarding mode of action. Efficacy can be assessed by monitoring disappearance of T cruzi –specific antibodies, although this may take several years in some patients. Repeated hemoculture or PCR-based assay can be used to look for treatment failure.

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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

Specialty Editor Board

Mary D Nettleman, MD, MS, MACP  Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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; MERCK None Other

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.

References

  1. Chagas C. Nova tripanozomiase humana. Estudos sobre a morfologia e o ciclo evolutivo do Schizotrypanum cruzi n. gen., n. sp., agente etiológico de nova entidade mórbida do homem. Mem Inst Oswaldo Cruz. 1909;1:159-218.

  2. Engel JC, Dvorak JA, Segura EL, et al. Trypanosoma cruzi: biological characterization of 19 clones derived from two chronic chagasic patients. I. Growth kinetics in liquid medium. J Protozool. Nov 1982;29(4):555-60. [Medline].

  3. Avila H, Goncalves AM, Nehme NS, et al. Schizodeme analysis of Trypanosoma cruzi stocks from South and Central America by analysis of PCR-amplified minicircle variable region sequences. Mol Biochem Parasitol. Sep-Oct 1990;42(2):175-87. [Medline].

  4. Tibayrenc M, Ayala FJ. [High correlation between isoenzyme classification and kinetoplast DNA variability in Trypanosoma cruzi]. C R Acad Sci III. 1987;304(4):89-92. [Medline].

  5. Gibson W, Stevens J. Genetic exchange in the trypanosomatidae. Adv Parasitol. 1999;43:1-46. [Medline].

  6. Zafra G, Mantilla JC, Valadares HM, et al. Evidence of Trypanosoma cruzi II infection in Colombian chagasic patients. Parasitol Res. Jun 4 2008;[Medline].

  7. Lent H, Wygodzinsky P. Revision of the Triatominae (Hemiptera, Reduviidae), and their significance as vectors of Chagas' disease. Bull Am Museum Natural History. 1979;163:123-520.

  8. Schofield CJ, Jannin J, Salvatella R. The future of Chagas disease control. Trends Parasitol. Dec 2006;22(12):583-8. [Medline].

  9. Bradley KK, Bergman DK, Woods JP, et al. Prevalence of American trypanosomiasis (Chagas disease) among dogs in Oklahoma. J Am Vet Med Assoc. Dec 15 2000;217(12):1853-7. [Medline].

  10. Cohen JE, Gürtler RE. Modeling household transmission of American trypanosomiasis. Science. Jul 27 2001;293(5530):694-8. [Medline].

  11. Schofield CJ, Dujardin JP. Chagas disease vector control in Central America. Parasitol Today. Apr 1997;13(4):141-4. [Medline].

  12. Schofield CJ, Dias JC. The Southern Cone Initiative against Chagas disease. Adv Parasitol. 1999;42:1-27. [Medline].

  13. Schmunis GA, Cruz JR. Safety of the blood supply in Latin America. Clin Microbiol Rev. Jan 2005;18(1):12-29. [Medline].

  14. Barcan L, Luna C, Lunao C, et al. Transmission of T. cruzi infection via liver transplantation to a nonreactive recipient for Chagas' disease. Liver Transpl. Sep 2005;11(9):1112-6. [Medline].

  15. Riarte A, Luna C, Sabatiello R, et al. Chagas' disease in patients with kidney transplants: 7 years of experience 1989-1996. Clin Infect Dis. Sep 1999;29(3):561-7. [Medline].

  16. Centers for Disease Control and Prevention. Chagas disease after organ transplantation--United States, 2001. MMWR Morb Mortal Wkly Rep. Mar 15 2002;51(10):210-2. [Medline].

  17. Centers for Disease Control and Prevention. Chagas disease after organ transplantation--Los Angeles, California, 2006. MMWR Morb Mortal Wkly Rep. Jul 28 2006;55(29):798-800. [Medline].

  18. Gürtler RE, Segura EL, Cohen JE. Congenital transmission of Trypanosoma cruzi infection in Argentina. Emerg Infect Dis. Jan 2003;9(1):29-32. [Medline].

  19. Schijman AG, Altcheh J, Burgos JM, et al. Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother. Sep 2003;52(3):441-9. [Medline].

  20. Santos FC, Amato N, V, Gakiya E, et al. Microwave treatment of human milk to prevent transmission of Chagas disease. Rev Inst Med Trop Sao Paulo. 2003;45:41-42.

  21. Di Primio, R. An outbreak of illness in Teutonia. Trop.Dis.Bull. Ref Type: Abstract. 1968;65(4):400-401.

  22. Shikanai-Yasuda MA, Marcondes CB, Guedes LA, et al. Possible oral transmission of acute Chagas' disease in Brazil. Rev Inst Med Trop Sao Paulo. Sep-Oct 1991;33(5):351-7. [Medline].

  23. Steindel M, Kramer Pacheco L, Scholl D, et al. Characterization of Trypanosoma cruzi isolated from humans, vectors, and animal reservoirs following an outbreak of acute human Chagas disease in Santa Catarina State, Brazil. Diagn Microbiol Infect Dis. Jan 2008;60(1):25-32. [Medline].

  24. Herwaldt BL. Protozoa and helminths. In: Fleming DO, Hunt DL, eds. Biological Safety: Principles and Practice. 4 ed. Washington, DC: American Society for Microbiology; 2006:115-61.

  25. Andrade ZA. Patologia da doença de Chagas [Portuguese]. In: Brener Z, Andrade ZA, Barral-Netto M, eds. Trypanosoma cruzi e Doença de Chagas. 2 ed. Rio de Janeiro: Guanabara Koogan; 2000:201-30.

  26. Ochs DE, Hnilica VS, Moser DR, et al. Postmortem diagnosis of autochthonous acute chagasic myocarditis by polymerase chain reaction amplification of a species-specific DNA sequence of Trypanosoma cruzi. Am J Trop Med Hyg. May 1996;54(5):526-9. [Medline].

  27. Parada H, Carrasco HA, Anez N, et al. Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological study. Int J Cardiol. Jun 27 1997;60(1):49-54. [Medline].

  28. Hoff R, Teixeira RS, Carvalho JS, et al. Trypanosoma cruzi in the cerebrospinal fluid during the acute stage of Chagas' disease. N Engl J Med. Mar 16 1978;298(11):604-6. [Medline].

  29. Jones EM, Colley DG, Tostes S, et al. Amplification of a Trypanosoma cruzi DNA sequence from inflammatory lesions in human chagasic cardiomyopathy. Am J Trop Med Hyg. Mar 1993;48(3):348-57. [Medline].

  30. Bellotti G, Bocchi EA, de Moraes AV, et al. In vivo detection of Trypanosoma cruzi antigens in hearts of patients with chronic Chagas' heart disease. Am Heart J. Feb 1996;131(2):301-7. [Medline].

  31. Zhang L, Tarleton RL. Parasite persistence correlates with disease severity and localization in chronic Chagas' disease. J Infect Dis. Aug 1999;180(2):480-6. [Medline].

  32. Basquiera AL, Sembaj A, Aguerri AM, et al. Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction. Heart. Oct 2003;89(10):1186-90. [Medline].

  33. Andrade ZA, Andrade SG, Oliveira GB, et al. Histopathology of the conducting tissue of the heart in Chagas' myocarditis. Am Heart J. Mar 1978;95(3):316-24. [Medline].

  34. Kirchhoff LV. American trypanosomiasis (Chagas' disease). Gastroenterol Clin North Am. Sep 1996;25(3):517-33. [Medline].

  35. Rezende JM, Moreira H. Forma digestiva da doença de Chagas [Portuguese]. In: Brener Z, Andrade ZA, Barral-Netto M, eds. Trypanosoma cruzi e Doença de Chagas. 2 ed. Rio de Janeiro: Guanabara Koogan; 2000:297-343.

  36. Tarleton RL. Chagas disease: a role for autoimmunity?. Trends Parasitol. Oct 2003;19(10):447-51. [Medline].

  37. Tarleton RL, Zhang L, Downs MO. "Autoimmune rejection" of neonatal heart transplants in experimental Chagas disease is a parasite-specific response to infected host tissue. Proc Natl Acad Sci U S A. Apr 15 1997;94(8):3932-7. [Medline].

  38. Hyland KV, Engman DM. Further thoughts on where we stand on the autoimmunity hypothesis of Chagas disease. Trends Parasitol. Mar 2006;22(3):101-2; author reply 103. [Medline].

  39. Añez N, Carrasco H, Parada H, et al. Myocardial parasite persistence in chronic chagasic patients. Am J Trop Med Hyg. May 1999;60(5):726-32. [Medline].

  40. Siriano Lda R, Luquetti AO, Avelar JB, Marra NL, de Castro AM. Chagas disease: increased parasitemia during pregnancy detected by hemoculture. Am J Trop Med Hyg. Apr 2011;84(4):569-74. [Medline]. [Full Text].

  41. Dorn PL, Perniciaro L, Yabsley MJ, et al. Autochthonous transmission of Trypanosoma cruzi, Louisiana. Emerg Infect Dis. Apr 2007;13(4):605-7. [Medline].

  42. Kirchhoff LV, Paredes P, Lomelí-Guerrero A, et al. Transfusion-associated Chagas disease (American trypanosomiasis) in Mexico: implications for transfusion medicine in the United States. Transfusion. Feb 2006;46(2):298-304. [Medline].

  43. Young C, Losikoff P, Chawla A, et al. Transfusion-acquired Trypanosoma cruzi infection. Transfusion. Mar 2007;47(3):540-4. [Medline].

  44. Trypanosoma cruzi (T. cruzi), Whole Cell Lysate Antigen, ORTHO® T. cruzi ELISA Test System (Package insert). Ortho-Clinical Diagnostics, Inc. 2006.

  45. Tobler LH, Contestable P, Pitina L, et al. Evaluation of a new enzyme-linked immunosorbent assay for detection of Chagas antibody in US blood donors. Transfusion. Jan 2007;47(1):90-6. [Medline].

  46. Gorlin J, Rossmann S, Robertson G, et al. Evaluation of a new Trypanosoma cruzi antibody assay for blood donor screening. Transfusion. Mar 2008;48(3):531-40. [Medline].

  47. Centers for Disease Control and Prevention. Blood donor screening for chagas disease--United States, 2006-2007. MMWR Morb Mortal Wkly Rep. Feb 23 2007;56(7):141-3. [Medline].

  48. Frank M, Hegenscheid B, Janitschke K, et al. Prevalence and epidemiological significance of Trypanosoma cruzi infection among Latin American immigrants in Berlin, Germany. Infection. Nov-Dec 1997;25(6):355-8. [Medline].

  49. Nishimura A, Ueno Y, Fujiwara S, et al. [An autopsy case of sudden death due to Chagas' disease]. Nihon Hoigaku Zasshi. Feb 1997;51(1):39-43. [Medline].

  50. Piron M, Verges M, Munoz J, et al. Seroprevalence of Trypanosoma cruzi infection in at-risk blood donors in Catalonia (Spain). Transfusion. Sep 2008;48(9):1862-8. [Medline].

  51. Schmunis GA. Epidemiology of Chagas disease in non-endemic countries: the role of international migration. Mem Inst Oswaldo Cruz. Oct 30 2007;102 Suppl 1:75-85. [Medline].

  52. Lescure FX, Canestri A, Melliez H, et al. Chagas disease, France. Emerg Infect Dis. Apr 2008;14(4):644-6. [Medline].

  53. Estimación cuantitativa de la enfermedad de Chagas en las Américas. Geneva, Organización Panamericana de Salud. Ref Type: Pamphlet. Department of Control of Neglected Tropical Diseases (NTD). 2006.

  54. Dias JC, Silveira AC, Schofield CJ. The impact of Chagas disease control in Latin America: a review. Mem Inst Oswaldo Cruz. Jul 2002;97(5):603-12. [Medline].

  55. Sabino EC, Goncalez TT, Salles NA, et al. Trends in the prevalence of Chagas' disease among first-time blood donors in São Paulo, Brazil. Transfusion. Jul 2003;43(7):853-6. [Medline].

  56. Segura EL, Cura EN, Estani SA, et al. Long-term effects of a nationwide control program on the seropositivity for Trypanosoma cruzi infection in young men from Argentina. Am J Trop Med Hyg. Mar 2000;62(3):353-62. [Medline].

  57. Becerril-Flores MA, Rangel-Flores E, Imbert-Palafox JL, et al. Human infection and risk of transmission of Chagas disease in Hidalgo State, Mexico. Am J Trop Med Hyg. Feb 2007;76(2):318-23. [Medline].

  58. Mukherjee S, Nagajyothi F, Mukhopadhyay A, et al. Alterations in myocardial gene expression associated with experimental Trypanosoma cruzi infection. Genomics. May 2008;91(5):423-32. [Medline].

  59. El-Sayed NM, Myler PJ, Bartholomeu DC, et al. The genome sequence of Trypanosoma cruzi, etiologic agent of Chagas disease. Science. Jul 15 2005;309(5733):409-15. [Medline].

  60. Fontanella GH, De Vusser K, Laroy W, et al. Immunization with an engineered mutant trans-sialidase highly protects mice from experimental Trypanosoma cruzi infection: a vaccine candidate. Vaccine. May 2 2008;26(19):2322-34. [Medline].

  61. Stuart K, Brun R, Croft S, et al. Kinetoplastids: related protozoan pathogens, different diseases. J Clin Invest. Apr 2008;118(4):1301-10. [Medline].

  62. Kirchhoff LV. Trypanosomiasis of the central nervous system. In: Scheld WM, Marra CM, Whitely RJ, eds. Infections of the Central Nervous System. 3 ed. 2004:777-89.

  63. Kirchhoff LV, Weiss LM, Wittner M, et al. Parasitic diseases of the heart. Front Biosci. Jan 1 2004;9:706-23. [Medline].

  64. Dias E, Laranja FS, Miranda A, et al. Chagas' disease; a clinical, epidemiologic, and pathologic study. Circulation. Dec 1956;14(6):1035-60. [Medline].

  65. Jorg ME, Freire RS, Orlando AS, et al. Disfunción cerebral mínima como secuela de meningoencefalitis aguda por Trypanosoma cruzi. Prensa Med Argentina. 1972;59:1658-69.

  66. Sartori AM, Ibrahim KY, Nunes Westphalen EV, et al. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Ann Trop Med Parasitol. Jan 2007;101(1):31-50. [Medline].

  67. Kirchhoff LV, Votava JR, Ochs DE, et al. Comparison of PCR and microscopic methods for detecting Trypanosoma cruzi. J Clin Microbiol. May 1996;34(5):1171-5. [Medline].

  68. Freilij H, Altcheh J. Congenital Chagas' disease: diagnostic and clinical aspects. Clin Infect Dis. Sep 1995;21(3):551-5. [Medline].

  69. Kirchhoff LV, Gam AA, Gusmao RA, et al. Increased specificity of serodiagnosis of Chagas' disease by detection of antibody to the 72- and 90-kilodalton glycoproteins of Trypanosoma cruzi. J Infect Dis. Mar 1987;155(3):561-4. [Medline].

  70. Virreira M, Torrico F, Truyens C, et al. Comparison of polymerase chain reaction methods for reliable and easy detection of congenital Trypanosoma cruzi infection. Am J Trop Med Hyg. May 2003;68(5):574-82. [Medline].

  71. Moser DR, Kirchhoff LV, Donelson JE. Detection of Trypanosoma cruzi by DNA amplification using the polymerase chain reaction. J Clin Microbiol. Jul 1989;27(7):1477-82. [Medline].

  72. Sturm NR, Degrave W, Morel C, et al. Sensitive detection and schizodeme classification of Trypanosoma cruzi cells by amplification of kinetoplast minicircle DNA sequences: use in diagnosis of Chagas' disease. Mol Biochem Parasitol. Mar 15 1989;33(3):205-14. [Medline].

  73. Shikanai-Yasuda MA, Ochs DE, Tolezano JE, et al. Use of the polymerase chain reaction for detecting Trypanosoma cruzi in triatomine vectors. Trans R Soc Trop Med Hyg. Nov-Dec 1996;90(6):649-51. [Medline].

  74. Mora MC, Sanchez Negrette O, Marco D, et al. Early diagnosis of congenital Trypanosoma cruzi infection using PCR, hemoculture, and capillary concentration, as compared with delayed serology. J Parasitol. Dec 2005;91(6):1468-73. [Medline].

  75. Diez CN, Manattini S, Zanuttini JC, et al. The value of molecular studies for the diagnosis of congenital Chagas disease in northeastern Argentina. Am J Trop Med Hyg. Apr 2008;78(4):624-7. [Medline].

  76. [Best Evidence] Bern C, Montgomery SP, Herwaldt BL, et al. Evaluation and treatment of chagas disease in the United States: a systematic review. JAMA. Nov 14 2007;298(18):2171-81. [Medline].

  77. Altcheh J, Biancardi M, Lapena A, et al. [Congenital Chagas disease: experience in the Hospital de Niños, Ricardo Gutiérrez, Buenos Aires, Argentina]. Rev Soc Bras Med Trop. 2005;38 Suppl 2:41-5. [Medline].

  78. Sosa-Estani S, Segura EL. Etiological treatment in patients infected by Trypanosoma cruzi: experiences in Argentina. Curr Opin Infect Dis. Dec 2006;19(6):583-7. [Medline].

  79. Braga MS, Lauria-Pires L, Arganaraz ER, et al. Persistent infections in chronic Chagas' disease patients treated with anti-Trypanosoma cruzi nitroderivatives. Rev Inst Med Trop Sao Paulo. May-Jun 2000;42(3):157-61. [Medline].

  80. Lauria-Pires L, Braga MS, Vexenat AC, et al. Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives. Am J Trop Med Hyg. Sep-Oct 2000;63(3-4):111-8. [Medline].

  81. Lauria-Pires L, Nitz N, Vexenat AC, et al. The treatment of Chagas disease patients with nitroderivative is unsatisfactory. Rev Inst Med Trop Sao Paulo. 2001;43:175-81.

  82. Fiorelli AI, Stolf NA, Honorato R, et al. Later evolution after cardiac transplantation in Chagas' disease. Transplant Proc. Jul-Aug 2005;37(6):2793-8. [Medline].

  83. Bocchi EA, Bellotti G, Mocelin AO, et al. Heart transplantation for chronic Chagas' heart disease. Ann Thorac Surg. Jun 1996;61(6):1727-33. [Medline].

  84. Campos SV, Strabelli TM, Amato Neto V, et al. Risk factors for Chagas' disease reactivation after heart transplantation. J Heart Lung Transplant. Jun 2008;27(6):597-602. [Medline].

  85. Haddad J, Raia A, Netto AC. [Colonic retro-rectal depression by perineal colostomy in the treatment of acquired megacolon. Modified Duhamel's operation]. Rev Assoc Med Bras. Mar 1965;11(3):83-8. [Medline].

  86. Teixeira AR, Silva R, Cunha Neto E, et al. Malignant, non-Hodgkin's lymphomas in Trypanosoma cruzi-infected rabbits treated with nitroarenes. J Comp Pathol. Jul 1990;103(1):37-48. [Medline].

  87. Teixeira AR, Cordoba JC, Souto Maior I, et al. Chagas' disease: lymphoma growth in rabbits treated with Benznidazole. Am J Trop Med Hyg. Aug 1990;43(2):146-58. [Medline].

  88. Bocchi EA, Higuchi ML, Vieira ML, et al. Higher incidence of malignant neoplasms after heart transplantation for treatment of chronic Chagas' heart disease. J Heart Lung Transplant. Apr 1998;17(4):399-405. [Medline].

  89. Carlier Y. [Congenital Chagas disease: from the laboratory to public health]. Bull Mem Acad R Med Belg. 2007;162(7-9):409-16; discussion 416-7. [Medline].

  90. Jackson Y, Myers C, Diana A, Marti HP, Wolff H, Chappuis F, et al. Congenital transmission of Chagas disease in Latin American immigrants in Switzerland. Emerg Infect Dis. Apr 2009;15(4):601-3. [Medline].

  91. Marin-Neto JA, Rassi A Jr, Morillo CA, Avezum A, Connolly SJ, Sosa-Estani S, et al. Rationale and design of a randomized placebo-controlled trial assessing the effects of etiologic treatment in Chagas' cardiomyopathy: the BENznidazole Evaluation For Interrupting Trypanosomiasis (BENEFIT). Am Heart J. Jul 2008;156(1):37-43. [Medline].

  92. Tanowitz HB, Machado FS, Jelicks LA, Shirani J, de Carvalho AC, Spray DC, et al. Perspectives on Trypanosoma cruzi-induced heart disease (Chagas disease). Prog Cardiovasc Dis. May-Jun 2009;51(6):524-39. [Medline].

  93. Yacoub S, Mocumbi AO, Yacoub MH. Neglected tropical cardiomyopathies: I. Chagas disease: myocardial disease. Heart. Feb 2008;94(2):244-8. [Medline].

 
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