Medscape is available in 5 Language Editions – Choose your Edition here.


Chagas Disease (American Trypanosomiasis) Treatment & Management

  • Author: Louis V Kirchhoff, MD, MPH; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
Updated: Nov 10, 2014

Medical Care

The goals of therapy in persons with T cruzi infection are to eliminate the parasites with specific drug treatment and to manage the signs and symptoms that result from the largely irreversible lesions associated with the disease. Two drugs, benznidazole and nifurtimox (see Medication), are available through the CDC for specific treatment of T cruzi infection. As noted below, both benznidazole and nifurtimox are limited in their capacity to effect parasitologic cure, especially in chronically infected patients.[112, 113, 114] In fact, the usefulness of treating chronic infection has not been established in properly structured treatment trials; thus, the use of these drugs in such patients is controversial.[115]

Acute Chagas disease

All patients with acute Chagas disease, including those with congenital infection and those with reactivation of chronic infections due to immunosuppression, should be treated with either benznidazole or nifurtimox.

In general, the younger the patient and the closer to acquisition of the infection, the higher the probability of parasitologic cure. Babies with congenital Chagas disease have the greatest chance for cure. Data from Argentina show that the cure rate exceeds 90% if treatment is given within the first year of life.[116] Some sources have stated that the overall parasitologic cure rate in persons with acute Chagas disease is 70%, although the author is unaware of specific data that support this estimate.

The usefulness of corticosteroids or interferon-γ in patients with acute Chagasic myocarditis or meningoencephalitis has not been established.

Indeterminate-phase Chagas disease

All children and adolescents through age 18 years with chronic T cruzi infection should receive either benznidazole or nifurtimox. Good data indicate that a high proportion of these patients will be cured parasitologically.[117]

In contrast, the probability of parasitologic cure with full courses of either drug in adults with long-standing T cruzi infection, most of whom were infected while quite young, is less than 10%.[118, 119, 120] Although such treatment suppresses the infection and reduces the likelihood of isolation of parasites via xenodiagnosis or hemoculture after treatment, the overall effect of this transient suppression is unknown. No properly structured comparative trials have been completed to determine whether treatment imparts a long-term benefit in these patients. A detailed discussion of this issue that resulted from a 2-day meeting of a panel of Latin American and US Chagas experts late in 2006 has been published.[115]

A large, blinded, placebo-controlled trial of benznidazole therapy in persons with T cruzi infection is currently underway in Colombia, Argentina, and Brazil (the BENEFIT trial), but results will not be available until 2015.

Only one small study has been done supporting the concept that treatment of chronic infection in women prior to pregnancy reduces the probability of congenital transmission.[121] Likewise, no information is available on which to base guidance for prophylactic treatment of chronic infection in persons who will undergo immunosuppression (eg, pretransplant) or in persons who are already immunosuppressed (eg, those with HIV infection).

Chronic symptomatic Chagas disease

The consensus among experts is that persons who have already developed cardiac or gastrointestinal symptoms should not be given antiparasitic treatment.

General medical treatment

As with diagnostic procedures, the medical treatment of cardiac and gastrointestinal signs and symptoms attributable to Chagas disease is similar to that instituted for similar problems caused by other etiologies. Such patients should be referred to specialists for appropriate evaluation and management.


Surgical Care


Atrial and ventricular rhythm disturbances may require pacemaker placement. Ablation procedures for tachyarrhythmias, as well as implanted defibrillators, have been used in some patients with Chagas disease.

The usefulness of implantable cardioverter devices in patients with advanced Chagas heart disease is controversial, and randomized clinical trials are needed to resolve this issue.[122, 123, 124, 125] This issue is currently being studied in a randomized controlled trial.

The usefulness of resection of the left ventricular apical aneurysms that develop in some patients with Chagas cardiomyopathy has not been established.

Cardiac transplantation is an option for some patients with end-stage Chagas heart disease. More than 100 such procedures have been performed, mostly in Brazil, but also in the United States. Interestingly, the survival rate among patients with Chagas disease who have undergone cardiac transplantation is better than that in the general group of patients who have undergone cardiac transplantation for other reasons,[126, 127] probably because the pathogenic process that results in cardiomyopathy in Chagas disease is not systemic, as is the case in diabetes mellitus, for example. Reactivation of the underlying T cruzi infection was a severe problem when the first such transplantations were performed in the late 1980s in Brazil; however, this is less of a problem now with the reduced dosing of immunosuppressives.[128, 129, 130]


Patients with Chagasic megaesophagus in whom esophageal dilatation is inadequate often undergo wide esophagocardiomyectomy of the anterior gastroesophageal junction, combined with valvuloplasty to reduce reflux. Laparoscopic myotomy is being used increasingly to manage severe megaesophagus.

Partial esophageal resection with reconstruction with esophagogastroplasty has been used in extreme cases.


Patients with chagasic megacolon may benefit from the Duhamel-Haddad operation typically used in the treatment of idiopathic congenital megacolon.[131]

In some cases, patients with sigmoid volvulus awaiting the Duhamel-Haddad procedure have undergone anterior sigmoidostomy with an eventual resection of the necrosed segment.



Depending on the phase of T cruzi infection, the following consultations may be appropriate:

  • Infectious diseases specialist
  • Cardiologist and cardiac surgeon
  • Gastroenterologist and general surgeon


A diet appropriate for patients with congestive heart failure should be recommended as appropriate.

Ingestion of warm and pasty food, in small volumes with water, is recommended in patients with megaesophagus. Such patients should not eat in the hours before bedtime to reduce the likelihood of regurgitation and aspiration.

A high-fiber diet is recommended in patients with chagasic megacolon.



Activity should be as tolerated.

Contributor Information and Disclosures

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; Professor of Clinical Medicine, SUNY Upstate Medical Center (2012-2013)

Louis V Kirchhoff, MD, MPH is a member of the following medical societies: American Association of Blood Banks, American Society of Tropical Medicine and Hygiene

Disclosure: Received salary from Goldfinch Diagnostics Inc. for equity owner; Received royalty from Quest Diagnostics Inc. for licensed technology; Received royalty from Abbott Laboratories, Inc. for licensed technology.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

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

Mary D Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Society of General Internal Medicine

Disclosure: Nothing to disclose.

  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. Llewellyn MS, Rivett-Carnac JB, Fitzpatrick S, Lewis MD, Yeo M, Gaunt MW, et al. Extraordinary Trypanosoma cruzi diversity within single mammalian reservoir hosts implies a mechanism of diversifying selection. Int J Parasitol. 2011 May. 41(6):609-14. [Medline]. [Full Text].

  3. Yeo M, Mauricio IL, Messenger LA, Lewis MD, Llewellyn MS, Acosta N, et al. Multilocus sequence typing (MLST) for lineage assignment and high resolution diversity studies in Trypanosoma cruzi. PLoS Negl Trop Dis. 2011 Jun. 5(6):e1049. [Medline]. [Full Text].

  4. Diosque P, Tomasini N, Lauthier JJ, Messenger LA, Monje Rumi MM, Ragone PG, et al. Optimized multilocus sequence typing (MLST) scheme for Trypanosoma cruzi. PLoS Negl Trop Dis. 2014 Aug. 8(8):e3117. [Medline]. [Full Text].

  5. Fernández MD, Cecere MC, Lanati LA, Lauricella MA, Schijman AG, Gürtler RE, et al. Geographic variation of Trypanosoma cruzi discrete typing units from Triatoma infestans at different spatial scales. Acta Trop. 2014 Aug 1. 140C:10-18. [Medline].

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

  7. Miles MA, Llewellyn MS, Lewis MD, Yeo M, Baleela R, Fitzpatrick S, et al. The molecular epidemiology and phylogeography of Trypanosoma cruzi and parallel research on Leishmania: looking back and to the future. Parasitology. 2009 Oct. 136(12):1509-28. [Medline].

  8. Ramírez JD, Guhl F, Rendón LM, Rosas F, Marin-Neto JA, Morillo CA. Chagas cardiomyopathy manifestations and Trypanosoma cruzi genotypes circulating in chronic Chagasic patients. PLoS Negl Trop Dis. 2010 Nov 30. 4(11):e899. [Medline]. [Full Text].

  9. 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.

  10. Carbajal-de-la-Fuente AL, Yadón ZE. A scientometric evaluation of the Chagas disease implementation research programme of the PAHO and TDR. PLoS Negl Trop Dis. 2013 Nov. 7(11):e2445. [Medline]. [Full Text].

  11. Hashimoto K, Schofield CJ. Elimination of Rhodnius prolixus in Central America. Parasit Vectors. 2012 Feb 22. 5:45. [Medline]. [Full Text].

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

  13. Lizundia R, Picado A, Cordero M, Calderón A, Deborggraeve S, Montenegro VM, et al. Molecular and serological rapid tests as markers of Trypanosoma cruzi infection in dogs in Costa Rica. Trop Parasitol. 2014 Jul. 4(2):111-4. [Medline]. [Full Text].

  14. Tenney TD, Curtis-Robles R, Snowden KF, Hamer SA. Shelter dogs as sentinels for Trypanosoma cruzi transmission across Texas. Emerg Infect Dis. 2014 Aug. 20(8):1323-6. [Medline]. [Full Text].

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

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

  17. Moncayo A, Silveira AC. Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy. Mem Inst Oswaldo Cruz. 2009 Jul. 104 Suppl 1:17-30. [Medline].

  18. 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. 2005 Sep. 11(9):1112-6. [Medline].

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

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

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

  22. Congenital transmission of Chagas disease - Virginia, 2010. MMWR Morb Mortal Wkly Rep. 2012 Jul 6. 61(26):477-9. [Medline].

  23. Burgos JM, Altcheh J, Petrucelli N, Bisio M, Levin MJ, Freilij H, et al. Molecular diagnosis and treatment monitoring of congenital transmission of Trypanosoma cruzi to twins of a triplet delivery. Diagn Microbiol Infect Dis. 2009 Sep. 65(1):58-61. [Medline].

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

  25. 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. 2003 Sep. 52(3):441-9. [Medline].

  26. Bern C, Verastegui M, Gilman RH, Lafuente C, Galdos-Cardenas G, Calderon M, et al. Congenital Trypanosoma cruzi transmission in Santa Cruz, Bolivia. Clin Infect Dis. 2009 Dec 1. 49(11):1667-74. [Medline].

  27. 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.

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

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

  30. 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. 2008 Jan. 60(1):25-32. [Medline].

  31. Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz-Guevara R, Mauriello L, Zavala-Jaspe R, et al. Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis. 2010 May 1. 201(9):1308-15. [Medline].

  32. Díaz-Bello Z, Thomas MC, López MC, Zavala-Jaspe R, Noya O, DE Noya BA, et al. Trypanosoma cruzi genotyping supports a common source of infection in a school-related oral outbreak of acute Chagas disease in Venezuela. Epidemiol Infect. 2014 Jan. 142(1):156-62. [Medline].

  33. Xavier SC, Roque AL, Bilac D, de Araújo VA, Neto SF, Lorosa ES, et al. Distantiae transmission of Trypanosoma cruzi: a new epidemiological feature of acute Chagas disease in Brazil. PLoS Negl Trop Dis. 2014 May. 8(5):e2878. [Medline]. [Full Text].

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

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

  36. Bern C, Martin DL, Gilman RH. Acute and congenital Chagas disease. Adv Parasitol. 2011. 75:19-47. [Medline].

  37. 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. 1996 May. 54(5):526-9. [Medline].

  38. 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. 1997 Jun 27. 60(1):49-54. [Medline].

  39. 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. 1978 Mar 16. 298(11):604-6. [Medline].

  40. Marin-Neto JA, Cunha-Neto E, Maciel BC, Simões MV. Pathogenesis of chronic Chagas heart disease. Circulation. 2007 Mar 6. 115(9):1109-23. [Medline].

  41. 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. 1993 Mar. 48(3):348-57. [Medline].

  42. 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. 1996 Feb. 131(2):301-7. [Medline].

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

  44. 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. 2003 Oct. 89(10):1186-90. [Medline].

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

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

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

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

  49. 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. 1997 Apr 15. 94(8):3932-7. [Medline].

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

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

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

  53. Cantey PT, Stramer SL, Townsend RL, Kamel H, Ofafa K, Todd CW, et al. The United States Trypanosoma cruzi Infection Study: evidence for vector-borne transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion. 2012 Sep. 52(9):1922-30. [Medline].

  54. 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. 2006 Feb. 46(2):298-304. [Medline].

  55. Bern C, Kjos S, Yabsley MJ, Montgomery SP. Trypanosoma cruzi and Chagas' Disease in the United States. Clin Microbiol Rev. 2011 Oct. 24(4):655-81. [Medline]. [Full Text].

  56. Carabarin-Lima A, González-Vázquez MC, Rodríguez-Morales O, Baylón-Pacheco L, Rosales-Encina JL, Reyes-López PA, et al. Chagas disease (American trypanosomiasis) in Mexico: an update. Acta Trop. 2013 Aug. 127(2):126-35. [Medline].

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

  58. Bern C, Montgomery SP, Katz L, Caglioti S, Stramer SL. Chagas disease and the US blood supply. Curr Opin Infect Dis. 2008 Oct. 21(5):476-82. [Medline].

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

  60. Kessler DA, Shi PA, Avecilla ST, Shaz BH. Results of lookback for Chagas disease since the inception of donor screening at New York Blood Center. Transfusion. 2013 May. 53(5):1083-7. [Medline].

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

  62. 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. 2007 Jan. 47(1):90-6. [Medline].

  63. Chang CD, Cheng KY, Jiang LX, Salbilla VA, Haller AS, Yem AW, et al. Evaluation of a prototype Trypanosoma cruzi antibody assay with recombinant antigens on a fully automated chemiluminescence analyzer for blood donor screening. Transfusion. 2006 Oct. 46(10):1737-44. [Medline].

  64. 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. 1987 Mar. 155(3):561-4. [Medline].

  65. Cheng KY, Chang CD, Salbilla VA, Kirchhoff LV, Leiby DA, Schochetman G, et al. Immunoblot assay using recombinant antigens as a supplemental test to confirm the presence of antibodies to Trypanosoma cruzi. Clin Vaccine Immunol. 2007 Apr. 14(4):355-61. [Medline]. [Full Text].

  66. Shah DO, Chang CD, Cheng KY, Salbilla VA, Adya N, Marchlewicz BA, et al. Comparison of the analytic sensitivities of a recombinant immunoblot assay and the radioimmune precipitation assay for the detection of antibodies to Trypanosoma cruzi in patients with Chagas disease. Diagn Microbiol Infect Dis. 2010 Aug. 67(4):402-5. [Medline].

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

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

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

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

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

  72. 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.

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

  74. 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. 2003 Jul. 43(7):853-6. [Medline].

  75. 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. 2000 Mar. 62(3):353-62. [Medline].

  76. Dias JC. Elimination of Chagas disease transmission: perspectives. Mem Inst Oswaldo Cruz. 2009 Jul. 104 Suppl 1:41-5. [Medline].

  77. 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. 2007 Feb. 76(2):318-23. [Medline].

  78. Gamboa-León R, Ramirez-Gonzalez C, Pacheco-Tucuch FS, O'Shea M, Rosecrans K, Pippitt J, et al. Seroprevalence of Trypanosoma cruzi among mothers and children in rural Mayan communities and associated reproductive outcomes. Am J Trop Med Hyg. 2014 Aug. 91(2):348-53. [Medline]. [Full Text].

  79. Martínez-Tovar JG, Rebollar-Téllez EA, Fernández Salas I. Seroprevalence of T. cruzi infection in blood donors and Chagas cardiomyopathy in patients from the coal mining region of Coahuila, Mexico. Rev Inst Med Trop Sao Paulo. 2014 Mar-Apr. 56(2):169-74. [Medline]. [Full Text].

  80. Cunha-Neto E, Chevillard C. Chagas disease cardiomyopathy: immunopathology and genetics. Mediators Inflamm. 2014. 2014:683230. [Medline]. [Full Text].

  81. Nogueira LG, Santos RH, Fiorelli AI, Mairena EC, Benvenuti LA, Bocchi EA, et al. Myocardial gene expression of T-bet, GATA-3, Ror-?t, FoxP3, and hallmark cytokines in chronic Chagas disease cardiomyopathy: an essentially unopposed TH1-type response. Mediators Inflamm. 2014. 2014:914326. [Medline]. [Full Text].

  82. Tomasini N, Lauthier JJ, Llewellyn MS, Diosque P. MLSTest: novel software for multi-locus sequence data analysis in eukaryotic organisms. Infect Genet Evol. 2013 Dec. 20:188-96. [Medline].

  83. Farrow AL, Rachakonda G, Gu L, Krendelchtchikova V, Nde PN, Pratap S, et al. Immunization with Hexon modified adenoviral vectors integrated with gp83 epitope provides protection against Trypanosoma cruzi infection. PLoS Negl Trop Dis. 2014 Aug. 8(8):e3089. [Medline]. [Full Text].

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

  85. Maguire JH. Chagas' disease--can we stop the deaths?. N Engl J Med. 2006 Aug 24. 355(8):760-1. [Medline].

  86. Rassi A Jr, Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, et al. Development and validation of a risk score for predicting death in Chagas' heart disease. N Engl J Med. 2006 Aug 24. 355(8):799-808. [Medline].

  87. Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010 Apr 17. 375(9723):1388-402. [Medline].

  88. Machado FS, Jelicks LA, Kirchhoff LV, Shirani J, Nagajyothi F, Mukherjee S, et al. Chagas heart disease: report on recent developments. Cardiol Rev. 2012 Mar-Apr. 20(2):53-65. [Medline]. [Full Text].

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

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

  91. Mott KE, França JT, Barrett TV, Hoff R, de Oliveira TS, Sherlock IA. Cutaneous allergic reactions to Triatoma infestans after xenodiagnosis. Mem Inst Oswaldo Cruz. 1980 Jul-Dec. 75(3-4):3-10. [Medline].

  92. Klotz JH, Dorn PL, Logan JL, Stevens L, Pinnas JL, Schmidt JO, et al. "Kissing bugs": potential disease vectors and cause of anaphylaxis. Clin Infect Dis. 2010 Jun 15. 50(12):1629-34. [Medline].

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

  94. 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.

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

  96. Cordova E, Boschi A, Ambrosioni J, Cudos C, Corti M. Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992-2007. Int J Infect Dis. 2008 Nov. 12(6):587-92. [Medline].

  97. Bern C. Chagas disease in the immunosuppressed host. Curr Opin Infect Dis. 2012 Aug. 25(4):450-7. [Medline].

  98. Guiang KM, Cantey P, Montgomery SP, Ailawadhi S, Qvarnstrom Y, Price T, et al. Reactivation of Chagas disease in a bone marrow transplant patient: case report and review of screening and management. Transpl Infect Dis. 2013 Dec. 15(6):E264-7. [Medline].

  99. Pinazo MJ, Espinosa G, Cortes-Lletget C, Posada Ede J, Aldasoro E, Oliveira I, et al. Immunosuppression and Chagas disease: a management challenge. PLoS Negl Trop Dis. 2013. 7(1):e1965. [Medline]. [Full Text].

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

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

  102. Otani MM, Vinelli E, Kirchhoff LV, del Pozo A, Sands A, Vercauteren G, et al. WHO comparative evaluation of serologic assays for Chagas disease. Transfusion. 2009 Jun. 49(6):1076-82. [Medline].

  103. 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. 2003 May. 68(5):574-82. [Medline].

  104. Sabino EC, Lee TH, Montalvo L, Nguyen ML, Leiby DA, Carrick DM, et al. Antibody levels correlate with detection of Trypanosoma cruzi DNA by sensitive polymerase chain reaction assays in seropositive blood donors and possible resolution of infection over time. Transfusion. 2013 Jun. 53(6):1257-65. [Medline]. [Full Text].

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

  106. 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. 1989 Mar 15. 33(3):205-14. [Medline].

  107. Schijman AG, Bisio M, Orellana L, Sued M, Duffy T, Mejia Jaramillo AM, et al. International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. PLoS Negl Trop Dis. 2011 Jan 11. 5(1):e931. [Medline]. [Full Text].

  108. 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. 1996 Nov-Dec. 90(6):649-51. [Medline].

  109. 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. 2005 Dec. 91(6):1468-73. [Medline].

  110. 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. 2008 Apr. 78(4):624-7. [Medline].

  111. Russomando G, de Tomassone MM, de Guillen I, Acosta N, Vera N, Almiron M, et al. Treatment of congenital Chagas' disease diagnosed and followed up by the polymerase chain reaction. Am J Trop Med Hyg. 1998 Sep. 59(3):487-91. [Medline].

  112. Pinto AY, Valente Vda C, Coura JR, Valente SA, Junqueira AC, Santos LC, et al. Clinical follow-up of responses to treatment with benznidazol in Amazon: a cohort study of acute chagas disease. PLoS One. 2013. 8(5):e64450. [Medline]. [Full Text].

  113. Machado-de-Assis GF, Silva AR, Do Bem VA, Bahia MT, Martins-Filho OA, Dias JC, et al. Posttherapeutic cure criteria in Chagas' disease: conventional serology followed by supplementary serological, parasitological, and molecular tests. Clin Vaccine Immunol. 2012 Aug. 19(8):1283-91. [Medline]. [Full Text].

  114. Lana Md, Lopes LA, Martins HR, Bahia MT, Machado-de-Assis GF, Wendling AP, et al. Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais, Brazil, before and nine years after aetiological treatment. Mem Inst Oswaldo Cruz. 2009 Dec. 104(8):1139-47. [Medline].

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

  116. 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].

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

  118. 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. 2000 May-Jun. 42(3):157-61. [Medline].

  119. 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. 2000 Sep-Oct. 63(3-4):111-8. [Medline].

  120. 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.

  121. Sosa-Estani S, Cura E, Velazquez E, Yampotis C, Segura EL. Etiological treatment of young women infected with Trypanosoma cruzi, and prevention of congenital transmission. Rev Soc Bras Med Trop. 2009 Sep-Oct. 42(5):484-7. [Medline].

  122. Cardinalli-Neto A, Bestetti RB, Cordeiro JA, Rodrigues VC. Predictors of all-cause mortality for patients with chronic Chagas' heart disease receiving implantable cardioverter defibrillator therapy. J Cardiovasc Electrophysiol. 2007 Dec. 18(12):1236-40. [Medline].

  123. Barbosa MP, da Costa Rocha MO, de Oliveira AB, Lombardi F, Ribeiro AL. Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease. Europace. 2013 Jul. 15(7):957-62. [Medline].

  124. Rassi A Jr, Rassi A. Another disappointing result with implantable cardioverter-defibrillator therapy in patients with Chagas disease. Europace. 2013 Sep. 15(9):1383. [Medline].

  125. Gali WL, Sarabanda AV, Baggio JM, Ferreira LG, Gomes GG, Marin-Neto JA, et al. Implantable cardioverter-defibrillators for treatment of sustained ventricular arrhythmias in patients with Chagas' heart disease: comparison with a control group treated with amiodarone alone. Europace. 2014 May. 16(5):674-80. [Medline].

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

  127. Fiorelli AI, Santos RH, Oliveira JL Jr, Lourenço-Filho DD, Dias RR, Oliveira AS, et al. Heart transplantation in 107 cases of Chagas' disease. Transplant Proc. 2011 Jan-Feb. 43(1):220-4. [Medline].

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

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

  130. Bacal F, Silva CP, Pires PV, Mangini S, Fiorelli AI, Stolf NG, et al. Transplantation for Chagas' disease: an overview of immunosuppression and reactivation in the last two decades. Clin Transplant. 2010 Mar-Apr. 24(2):E29-34. [Medline].

  131. Di Martino C, Nesi G, Tonelli F. Surgical treatment of chagasic megacolon with Duhamel-Habr-Gama technique modulated by frozen-section examination. Surg Infect (Larchmt). 2014 Aug. 15(4):454-7. [Medline].

  132. 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. 1990 Jul. 103(1):37-48. [Medline].

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

  134. 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. 1998 Apr. 17(4):399-405. [Medline].

  135. Centers for Disease Control and Prevention. The Global Surveillance Network of the ISTM and CDC. The GeoSentinel Newsletter: Information for Action. Infrequent Diagnoses & Their Geographic Exposures. 2008.

  136. Carter YL, Juliano JJ, Montgomery SP, Qvarnstrom Y. Acute Chagas disease in a returning traveler. Am J Trop Med Hyg. 2012 Dec. 87(6):1038-40. [Medline]. [Full Text].

  137. Virreira M, Truyens C, Alonso-Vega C, Brutus L, Jijena J, Torrico F, et al. Comparison of Trypanosoma cruzi lineages and levels of parasitic DNA in infected mothers and their newborns. Am J Trop Med Hyg. 2007 Jul. 77(1):102-6. [Medline].

  138. 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. 1990 Sep-Oct. 42(2):175-87. [Medline].

  139. 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].

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

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

  142. 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. 1982 Nov. 29(4):555-60. [Medline].

  143. Fabbro D, Velazquez E, Bizai ML, Denner S, Olivera V, Arias E, et al. Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease. Rev Inst Med Trop Sao Paulo. 2013. 55(3):[Medline].

  144. 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. 2008 May 2. 26(19):2322-34. [Medline].

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

  146. 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. 1965 Mar. 11(3):83-8. [Medline].

  147. 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. 2009 Apr. 15(4):601-3. [Medline]. [Full Text].

  148. 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. 2008 Jul. 156(1):37-43. [Medline].

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

  150. Pereira Nunes MC, Donnes W, Morillo C, Encina JJ, Ribeiro AL. Chagas Disease: an Overview of Clinical and Epidemiological Aspects. J Am Coll Cardiol. 2013 Jun 12. [Medline].

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

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

  153. 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. 2011 Apr. 84(4):569-74. [Medline]. [Full Text].

  154. 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. 2009 May-Jun. 51(6):524-39. [Medline]. [Full Text].

  155. 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].

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

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

Chagas disease (American trypanosomiasis). The trypomastigote is the infective flagellated form of the parasite found in the blood of the mammalian hosts (blood trypomastigote) and in the hindgut of vectors (metacyclic trypomastigote). Image courtesy of Peter Darben, MD.
Chagas disease (American trypanosomiasis). The epimastigote form of Trypanosoma cruzi is the multiplying stage of the parasite that grows in the gut of the insect vector and also in cell-free culture medium as shown here. Image courtesy of Peter Darben, MD.
Chagas disease (American trypanosomiasis). Megacolon.
Life cycle of triatomines. Courtesy of the CDC.
Trypanosoma cruzi trypomastigotes in a mouse blood smear (Giemsa, x625). Courtesy of Dr. Herbert B Tanowitz, New York, NY.
Rhodnius prolixus, a common vector of Trypanosoma cruzi. Eggs, first- and second-stage nymphs, and adult.
Trypanosoma cruzi in heart muscle of a child who died of acute Chagas disease in Texas. (H&E, x900).
Chest radiograph of a Bolivian patient with chronic Trypanosoma cruzi infection, congestive heart failure, and rhythm disturbances. Pacemaker wires can be seen in the area of the left ventricle.
Barium swallow radiographic study of a Brazilian patient with chronic Trypanosoma cruzi infection and megaesophagus. The markedly increased diameter of the esophagus and its failure to empty are typical findings in patients with megaesophagus caused by Chagas disease. Courtesy of Dr. Franklin A. Neva, Bethesda, MD.
Air-contrast barium enema of a Bolivian patient with chronic Chagas disease and megacolon. The markedly incrased diameters of the ascending, transverse, and sigmoid segments of teh colon are readily apparent.
Natural course of American trypanosomiasis. Courtesy of Dr. Patricia Paredes, Guadalajara, Jal., Mexico.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.