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Section 2
Section 3
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Section 5
Appendices

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Section 3. Summaries of Infectious Diseases

American Trypanosomiasis

(Chagas Disease)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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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 when the portal of entry is the conjunctiva; it 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 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 or indeterminate 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 infection (chronic phase). Congenital disease may be characterized by low birth weight, hepatomegaly, and meningoencephalitis with seizures and tremors, but most infants infected in utero have no signs or symptoms of disease. Reactivation may occur, especially . . . [Go to Full Text]


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