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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
American Trypanosomiasis
(Chagas Disease)Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Patients can have acute or chronic disease. The early phase of this disease commonly is asymptomatic. However, children are more likely to exhibit symptoms than are adults. In some patients, a red nodule known as a chagoma develops at the site of the original inoculation, usually on the face or arms. The surrounding skin becomes indurated and, later, hypopigmented. Unilateral firm edema of the eyelids, known as Romaña sign, is the earliest indication of the infection but is not always present. The edematous skin is violaceous and associated with conjunctivitis and enlargement of the ipsilateral preauricular lymph node. A few days after the appearance of Romaña sign, fever, generalized lymphadenopathy, and malaise can develop. Acute myocarditis, hepatosplenomegaly, edema, and meningoencephalitis can follow. In nearly all cases, acute Chagas disease resolves after 1 to 3 months, and an asymptomatic period follows. In 20% to 30% of cases, serious sequelae, consisting of cardiomyopathy and heart failure (the major cause of death), megaesophagus, and/or megacolon, develop many years after the initial
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