American Trypanosomiasis (Chagas' Disease)

Description

Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi. Chagas' disease is usually transmitted by contact with the feces of an infected triatomine ("cone nose" or "kissing") bug. Transmission can also occur through blood transfusion, organ transplantation, or transplacental infection.

Occurrence

Chagas' disease occurs in Mexico, Central America, and South America, as far south as Chile and Argentina.

Risk for Travelers

Triatomine bugs typically infest poor-quality buildings constructed of mud, adobe brick, or palm thatch, particularly those with cracks or crevices in the walls and roof. Avoiding overnight stays in such dwellings or camping or sleeping outdoors in endemic areas greatly reduces the risk of acquiring the infection, and reports of acute Chagas' disease in travelers are rare. In some regions, travelers should be aware that blood for transfusion might not be routinely tested or treated for T. cruzi.

Clinical Presentation

A local area of swelling may occur at the site of inoculation. Acute infection can be asymptomatic or accompanied by a febrile illness with meningoencephalitis or myocarditis, or both. Manifestations of chronic infection include cardiomyopathy and intestinal "mega" syndromes (e.g., megaesophagus and megacolon).

Prevention

No vaccine is available. Preventive measures include insecticide spraying of infested houses and the use of bed netting. The latter should be recommended for travelers who cannot avoid camping or sleeping outdoors in highly endemic areas.

Treatment

Anti-trypanosomal treatment exists for acute disease, and treatment can also be helpful for persons with longstanding infection. The drugs of choice are benznidazole or nifurtimox (under an investigational New Drug Protocol from the CDC Drug Service). Travelers should be advised to consult an infectious disease or tropical medicine specialist. Persons with chronic cardiac or megasyndromes may benefit from symptomatic therapy.

Health Information for International Travel 2003-2004