Chagas Disease (American Trypanosomiasis) Follow-up

Updated: Sep 07, 2018
  • Author: Louis V Kirchhoff, MD, MPH; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Follow-up

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 white blood cell 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.

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Further Inpatient Care

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

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Deterrence/Prevention

Collective prophylaxis

No vaccination is available for T cruzi infection, and primary chemoprophylaxis in persons who plan to visit endemic regions is not recommended because of the extremely low risk of the infection in such circumstances (only 5 such cases have been reported [175, 176, 177] ).

It has been demonstrated in major portions of the endemic range that vector-borne transmission of T cruzi to humans can be achieved through improvement of housing conditions, use of residual insecticides, and education of persons at risk for acquiring the infection.

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, [40, 178] no approaches for reducing this risk have been defined. The critical element in controlling congenital Chagas disease, beyond reducing the prevalence of chronic T cruzi infection in women of childbearing age, 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 is not 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. 

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Complications

See the list below:

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

The overall prognosis among persons in the indeterminate phase of T cruzi infection is good, 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. 

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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 suggest that making dogs sleep outside the home can be an important factor in reducing transmission. [28]  

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