Trypanosomiasis Follow-up

Updated: Mar 16, 2016
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
  • Print
Follow-up

Further Outpatient Care

See the list below:

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

Next:

Further Inpatient Care

See the list below:

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

Previous
Next:

Transfer

See the list below:

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

Previous
Next:

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.

A vaccine likely would prove cost-effective. [61]

Previous
Next:

Complications

See the list below:

  • Congestive heart failure

  • Myocarditis

  • Cardiomyopathy [62, 63]

  • 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%).

  • Pregnancy: In addition to risk of congenital infection, [64] pregnancy may exacerbate chronic infection, [65] during which circulating parasites increase in number.

Previous
Next:

Prognosis

See the list below:

  • 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. Death usually occurs within 5 years as a result of heart failure or pulmonary embolism.

  • Right bundle branch block (RBBB) is an ominous sign in the acute phase.

  • The prognosis with the GI symptoms of the illness is generally good.

Previous
Next:

Patient Education

See the list below:

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

Previous