Chagas disease is a parasitic disease caused by an infection with Trypanosoma cruzi. It is mostly found in the area of Central and South America [26]. According to WHO, 8 million people are infected worldwide, whereas 10 000 infected patients die yearly [91]. Diagnosis is confirmed by serological prove of the parasite [92].
The parasite is transferred by biting insect from Reduviidae family [26]. Afterward, it infects primarily muscle cells (of the myocardium, smooth and skeletal muscles) and ganglionic cells [92], damaged by the parasite´s activity.
The active phase of the disease comes 1 to 2 weeks after the exposure to the transmitter. The course is mostly asymptomatic or mild manifesting with fever, Romanov syndrome (one-sided oedema in eye socket area at the seat of attachment of a transmitter) and lymphadenopathy [93]. The symptoms disappear spontaneously in up to 90 % of patients [92, 93]. The mortality rate in this disease stage is 5 to 10 % as a result of myocarditis or meningoencephalitis [26, 94]. In 30 to 40 % of infected people, the disease progresses in chronic phase what may happen even decades after the contact with the transmitter [26, 92]. In the rest of the patients, the disease progresses in the latent phase with normal cardiological finding [92].
In chronic phase, impairment of the cardiovascular system is the most frequent, but even GIT and urogenital systems may be affected [94]. In case of chronic cardiovascular impairment, the disease progresses in so-called Chagas cardiomyopathy when references describe extensive changes in heart structure and function – myocardial fibrosis, the direct damage of the heart electrical system, ventricular dilatation, production of thrombus and aneurysms of the left ventricular apex [26, 92, 94]. The clinical picture of patients is very variable. Besides above-mentioned changes, there are described even ECG changes like ventricular arrhythmias, AV block of the 1st degree, ventricular tachycardia, ST and PQ segment changes etc. [92, 93 ,94]. Bilateral heart failure with the predominance of the right-heart failure symptoms is an often complication and sudden cardiac death is also not an exception [92]. Therapy consists primarily of anti-parasitic treatment and therapy of heart failure (ACE inhibitors, beta blockers, diuretics, amiodaron, ICD etc.) and of thromboembolism, [92, 93]. Prognosis is variable and is based on the extent of cardiovascular damage, which is the main cause of mortality in infected patients [93, 95].
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References:
26) COOPER L. T., JR., KNOWLTON K. U. Chapter 67: Myocarditis. In.: D.P., ZIPES, MANN D.L., LIBBY P., BONOW R.O. a BRAUNWALD E. (eds.). Braunwald´s Heart Disease: A Textbook of Cardiovascular medic Tenth edition. Philadelphia: Elsevier Saunders, 2015. pp. 1589–1602. ISBN 978-1-4557-5133-4.
91) What is Chagas disease? WHO [online]. -: -, 2016 [cit. 2017-02-09].
92) JR., RASSI a et al. Chagas disease. Lancet. 2010, 375(-), 1388-1402.
93) H., MALIK a et al. The Epidemiology, Clinical Manifestations, and Management of Chagas Heart Disease. Clin. Cardiol. 2015, 38(9), 565-569.
94) BYSTRIANSKY. Kardiovaskulárne postihnutie pri Chagasovej chorobe. Očkování a cestovní medicína. 2015, 6(-), 35-38.
95) -X., LESCURE a et al. Chagas disease: changes in knowledge and management. Lancet Infect Dis. 2010, 10(-), 556-570.
